Outsourcing Maternity

If you thought the modern world couldn’t get any more messed-up in its understanding of reproduction and the family, you need turn no further than the WSJ weekend section, and a feature article on people hiring surrogate mothers from India to bring their children to term.

According to Hrishikesh Pai, a Mumbai-based in-vitro fertilization specialist and vice-president of the Indian Society for Assisted Reproduction, India now has about 350 facilities that offer surrogacy as a part of a broader array of infertility-treatment services, triple the number in 2005. Last year, Dr. Pai says, about 1,000 pregnancy attempts using surrogates were made at these clinics. This year, he estimates the figure will jump to 1,500, with about a third of those made on behalf of parents from outside India who hired surrogates.

Rudy Rupak, president of PlanetHospital, a California-based medical-tourism company, says that in the first eight months of this year he sent 600 couples or single parents overseas for surrogacy, nearly three times the number in 2008 and up from just 33 in 2007. All of the clients this year went to India except seven who chose Panama. Most were from the U.S.; the rest came from Europe, the Middle East and Asia, mostly Japan, Vietnam, Singapore and Taiwan.

Mr. Rupak says that because of growing demand from his clients for eggs from Caucasian women, he’s started to fly donors to India from the former Soviet republic of Georgia, where he has connections with clinics. The first woman arrived last month. A PlanetHospital package that includes an Indian egg donor costs $32,500, excluding transportation and hotel expenses for the intended parent or parents to travel to India. A package with eggs from a Georgian donor costs an extra $5,000.

For the Indian surrogates themselves, it’s an experience often fraught with emotional conflict. In most cases, the egg comes either from the woman who wants to become a mother but can’t carry a child, or from an egg donor. The egg is then fertilized with sperm from the intended father, or a sperm donor, and implanted in the womb of a surrogate who bears the child. Sometimes, no money changes hands, particularly when a friend or relative acts as the surrogate. Alternatively, it’s a commercial transaction, which is almost always the case in India for would-be parents from overseas.

Still, it’s a way to raise money in sometimes desperate circumstances. Take Sudha, a 25-year-old mother of two who now works as a maid in Chennai earning $20 a month. She owes moneylenders about $2,700, borrowed to pay bribes to secure a government job as a streetsweeper, which never materialized. A neighbor told her she could earn about $2,000 at a local clinic by bearing a child for an infertile couple. She gave birth in July 2008 — and is haunted by the memory. “Whenever I have free time and I lie down, I think about the child. I pray that the child is safe and happy and is taken care of well.”

Sudha, who like other surrogates asked that only her first name be used, has reduced her debt to about $600, but the family still struggles to eat. One solution, her husband Umat says, is for Sudha to act as a surrogate again. But he adds that he “won’t force her if she says no.”

For other women, like 29-year-old Lakshmi, a pregnant surrogate in Chennai who already has an 11-year-old daughter, a 12-year-old son, an alcoholic husband and a $4,000 debt, having someone else’s child sounded like a better option than her other plan: selling a kidney. A doctor advised her that with a single kidney left, “I might live for a shorter time. I have a daughter. I have to get her married…I prefer” to be a surrogate, she says.

Some middle-class Indian women, too, are becoming surrogates. In Bangalore, a cash-strapped high-school-educated wife, who earns about $20 a month selling Oriflame brand cosmetics, waits for a call from a local clinic that she has been chosen as a surrogate. Her husband, an office manager, owes more than $30,000, borrowed to start a company that faltered, and the couple can’t repay the loan.
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As human beings, we’re meant to reproduce via sex — and children are meant to be raised by their parents. Our instincts continue to reflect that, even if culture and money convince individuals to act some other way. So it’s hardly surprising that the women in India who are pushed into offering themselves as surrogates feel like they’ve lost a child, and suffer accordingly. The problem is that the people in America and elsewhere in the developed world who are seeking to “have a child” this way don’t seem to recognize that trying to pursue their wishes this way is hurting the birth mother of “their” child — and arguably the child as well in the long run.

Why do people seek these services?

Michael Bergen and Michael Aki, a gay American couple who got married in 2004 and work as graphic designers in Massachusetts, decided to try surrogacy in India after they waited unsucessfully for three years to adopt a child in the U.S. To hire a surrogate, “we looked at Panama and the Ukraine,” recalls 39-year-old Mr. Bergen. “But India had better infrastructure, more high-tech facilities and the healthier lifestyle. (Most women) don’t smoke, they don’t drink and they don’t do drugs.”

With travel costs, Mr. Bergen estimates the couple spent about $60,000 in all, including compensation of $10,000 for each surrogate. That’s roughly half what he thinks the total cost would have been in the U.S.

For others, money is no object. Last year, a former U.S. investment banker in her early 40s, who asked that her name not be used, spent $128,000 to reach her goal. She approached a dozen fertility clinics in India for help. Despite her age, she and her husband wanted to try with her eggs. In the initial attempt, a doctor implanted several embryos in two separate surrogate mothers. That failed. In the second round, the doctor relied on three surrogates. Still no pregnancy. In the third round, he repeated the procedure with two additional surrogates. Bingo. The seventh surrogate gave birth to healthy twin girls.

It’s the kind of determination that Rhonda and Gerry Wile understand. She’s a 39-year-old blond registered nurse. He’s a hefty 43-year-old fireman. Originally from Canada, they married in 2000 and resettled in Mesa, Arizona, three years ago.

The couple started trying to conceive in mid-2005. After several months, Ms. Wile consulted a specialist who found a problem: She has two small wombs instead of a single one. Two months later, though, she was thrilled to find out she was pregnant. But she soon learned the fetus had no heartbeat, and she had to undergo a drug-induced abortion.

Next the couple tried artificial insemination. It failed. They started to consider other options. They ruled out adoption, discouraged by the red tape. A doctor, meanwhile, had recommended surrogacy, and Ms. Wile saw a TV program about surrogacy in India on “Oprah” in October 2007. The Wiles then trawled the Internet for information. In January 2008 they settled on Surrogacy India, a newly established private Mumbai clinic. They liked the quick response to their questions and the clinic’s policy of encouraging surrogates to move into designated quarters with their families during the pregnancy, rather than splitting them apart.

“It’s been hard for me, being a woman,” Ms. Wile said during a trip to India last April. “I’ve always believed that part of my job as a woman is to have a child.” For her, surrogacy seemed as close as she could get to creating a child. The price was also right. “We didn’t want to go broke” and “bring a child into the world bankrupt,” she added.

The Wiles figured it would cost them between $50,000 and $80,000 for each attempt if they had used a surrogate in the U.S. By comparison, they spent a total of about $50,000 on three attempts in India, including travel expenses for four round trips to India, $550 for the baby’s birth and a few days’ hospital stay and $5,625 paid to a woman they call “KT,” who carried their son.

In October, the Wiles selected an Indian egg donor over the Internet using the clinic’s Web site. Then they picked out a new surrogate, KT, a married woman with the Indian equivalent of a seventh-grade education who has two small boys of her own. In her profile, KT described herself as having a “supporting nature” and listed her motivation for becoming a surrogate as “financial, to educate (my) kids.”

A month or so before the birth, they finished the nursery in their Mesa home and held a baby shower. Mr. Wile bought the baby a set of golf clubs. Despite the ultrasound, they didn’t know whether they would be bringing home a boy or girl; to discourage the selective abortion of girls, Indian law prohibits disclosure of a fetus’s gender.

Mr. Wile says: “We’ve had a very good experience with surrogacy and we’re definitely going try it again.” They will have to find yet another surrogate, though. Mr. Wile says KT declined to carry a second baby for them.

Part of the problem here is people who want to have children in situations that don’t naturally result in children: Same sex couples. People who are too old to conceive and carry to term naturally.

Their pain at not being able to have their own children may be real, but this, “I should be able to have whatever I want,” attitude towards childbearing — turning children into a consumer commodity — only moves the pain to someone else, and makes it worse.

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  1. Indeed. And pity the “egg donor” mothers, who in addition to losing all contact with their children may pay with subsequent infertility and broken health.

  2. Why do people seek these services?

    Judging from the radio show I was listening to yesterday– about IVF and multiple births– it’s because they don’t see the children as real, or people.

    This guy– the normal announcer, not the woman being interviewed– calmly announced that he and his wife had been going to have triplets, and were going to “selectively reduce” them. For the good of the surviving children, of course. Later added that they were only going to have twins, now, apparently without “selective reduction.”

    Made me sick to my heart.

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