This guest post has been sent by IMRANA QADEER and MARY E. JOHN
Surrogacy is suddenly front-page news. First there was the uncertain future of baby Manji, following the divorce of her Japanese commissioning parents; then the happy pictures of an Israeli gay couple with their son born to a Bombay-based surrogate mother. India is becoming a cheap location for foreigners wanting to use ‘assisted reproductive technologies’ (ART) and local clinics are promoting surrogacy arrangements because they are seen as lucrative ventures. While there is hardly any public debate on the ethical, social, epidemiological and medical questions around infertility and surrogacy, the extremely problematic ART Regulatory Bill (2008) is being hurried through. It barely addresses important concerns and ignores national health and population norms. It permits, for instance, three surrogate pregnancies to a woman.
To understand surrogacy in the Indian context, one must begin with the fact that while the Transplantation of Human Organ Act, 1994 banned sale of human organs, organ loaning – equally difficult and risky – is being promoted through paid surrogacy. This is due to a medical industry that welcomes all profitable ventures like ‘reproductive tourism’, even when infertility constitutes a small segment of local priorities. Total infertility is estimated at about eight to 10 per cent, and for the vast majority of Indian women it is preventable as it is caused by poor health, nutrition, maternity services and high levels of infections. Only about two per cent of the cases are because of ‘primary’ infertility amenable to ART alone.
Because ART amplifies deep-seated notions of “blood”, now bolstered by genetics, it tends to overshadow safer, cheaper and more progressive options like adoption. ART clinics do not provide reliable information about low rates of success, the probability of multiple pregnancies and the high possibility of foetal abnormalities.
The starting point for tackling the question of surrogacy is in recognising that this new technology splits up older notions of natural reproduction into three parts – ‘social’ parents, a gestational mother, and the genetic matter that links the first two. The ‘stakeholders’ thus created often have conflicting interests – the “commissioning” parents; the surrogate mother; her family, if any; the new baby; and the commercial sperm banks and ART clinics.
Ethical practice must take its cue from the experiences of surrogate mothers, who – motivated primarily by a shortage of personal income – often endure the social stigma associated with surrogacy. They may leave their homes, lie about the parentage and claim the death of the baby after it has been handed over.
Given this situation, the State must strive to help create an environment free of secrecy and anonymity. As equality and volunteerism may be rare in surrogacy agreements, arrangements to ensure informed consent, proper counselling and legal assistance for drawing up contracts for safe procedures, as well as total health care insurance and compensation, must be ensured through the state regulatory institutions proposed in the Bill. A surrogate mother should not only have the right to abortion but also to keep the baby if she cannot part with it. Her name should be on the baby’s birth certificate and parentage legally transferred to the new parents later. Her family should be aware of the contracting parents and be included in health care arrangements.
Today, ART markets as well as the State emphasise relationships of blood and the genetic basis of paternity, marginalising the essential social and biological contribution of nurturing children in an enabling environment. Is it ethical to use prevailing social constraints that prevent open surrogacy arrangements, to promote the business of surrogacy and ART? The amount of compensation given to the surrogate mother is another particularly difficult aspect when what is involved is the creation of life – a baby no less. It is telling that in the West up to 50 per cent of the total cost goes to the surrogate mother while in India most of the money is appropriated by sperm banks, ART clinics and lawyers.
There is also an in-built bias against the newborn baby as the surrogate mother is constrained to underplay her bond with the growing baby from the beginning. Early separation is at the cost of the baby’s immunological and psychological health. The baby is denied the right to breastfeeding even for three months. This aspect is completely ignored with the burden of surrogacy being shifted to one who cannot protest. Every child born through ART, whether disabled or one of a multiple pregnancy must have the same rights of survival and care as any other child. The proposed right of social parents to ask for “pregnancy reduction” goes against this.
The social parents, too, must not simply be commissioning agents, but participants in the custody and nurturing of the baby. There is the opportunity here of involving both parents equally and early – whether heterosexual, gay or lesbian – and, therefore, of challenging patriarchal and biologistic notions of mothering. Same sex couples and single parents in India must be beneficiaries of surrogacy. Adoption laws need to be improved or amended, so that all religious groups can promote adoption.
ART is widely canvassed for its scientific potential – stem cell research and cloning. The proposed Bill, too, defines surrogacy as “a pregnancy achieved in furtherance of ART” and, therefore, does not address unethical practices and exploitation sufficiently. The State and the public must debate the issue: How are the interests of the baby to be best protected? What are the rights of the surrogate mother? What should the role of the adopting parents be? All these three actors should converge within an ethical framework.
In an age of science and globalisation, surrogacy should be seen as an opportunity to question patriarchal conceptions of the family and social perceptions of infertility, not deepen ties of blood and inequality.
KAFILA - COLLECTIVE EXPLORATIONS SINCE 2006 
I worked on an early draft of the ART Bill that eventually developed into the bill that’s been presented before Parliament.
Critiques of the Bill are important and certainly necessary, but I feel that this response conflates a critique of the Bill with a critique of ARTs in general.
At the time that the ICMR commissioned a draft Bill to regulate ART procedures, the semi-regulated ART industry already moved revenue in the neighbourhood of 15,000 crores. Its correct that “ART clinics do not provide reliable information” or guarantee informed consent: these two regulatory deficits are the main focus of the draft law.
I can’t help but feel that the writers are playing fast and loose with the ethical complexity of surrogacy when they say, “A surrogate mother should … have the right to … keep the baby if she cannot part with it.” This may seem to restore to the surrogate mother, in her implicitly class-disadvantaged position, her reproductive rights. But the gamete-donors (the biological parents) have reproductive rights too. So there is an ethical debate here.
But I don’t think it is wise to prioritize the proprietary implications of “donating” the genetic material versus providing the gestational environment: both readings are facile. This is why the Bill upholds the initial, contractual understanding about parental rights. It also cuts out the problem of the gamete-donors being recompensed for the money they spent on the pregnancy, as well as their emotional distress at being denied the child.
There is a valuable corollary to this arrangement, in Clause 11 of the Surrogacy section. If the child is born with what the act terms “abnormalities,” it is still legally incumbent on the genetic parents to accept custody. In the more diffuse, delayed custody arrangement that Drs Qadeer and John are proposing, it would be far too easy for them to abandon the disabled child with the surrogate mother.
Other points of confusion: the bill does require medical insurance for the surrogate mother. The Bill does not “permit” three surrogate pregnancies to a woman: it says that no woman shall act as a surrogate for more than three successful live births in her life. Are Drs Qadeer & John suggesting this is too many, or too few?
Further: the identity of the surrogate mother is not eradicated after the birth; by Clause 17 she will be provided a certificate by the receiving parents “stating unambiguously” that she has acted as a surrogate for them.
The writers propose that “Every child born through ART, whether disabled or one of a multiple pregnancy must have the same rights of survival and care as any other child. The proposed right of social parents to ask for “pregnancy reduction” goes against this.”
How so? “Pregnancy reduction” does not pertain to children, it pertains to late-stage embryos; I assume that progressive commentators take care to maintain that distinction. To clarify, in situations where an ART procedure leads to a multiple pregnancy, the Bill provides the parents the right to terminate some. Embryo reduction is only advised if more than two embryos have implanted, and only because multiple pregnancies reportedly increase the chances of miscarriage.
In a conventional pregnancy, of course, the parents have the right to abort a foetus for the first twenty weeks. A foetal reduction would have to occur immediately after a multiple pregnancy was detected, that is, much earlier than twenty weeks.
There is something invidious about the writers’ use of “social parents” to refer to the people who make the decision to raise a child, who provide the genetic and somatic material of the fertilized ovum, who arrange for the surrogacy and support and compensate the surrogate mother. It should be obvious that “social parents” is a misnomer; they begin by placing it in quotes, but then dispense with the quotes. “Commissioning agents” is, of course, worse.
The principal aim of the ART Bill was to improve the position of genetic parents and surrogates vis a vis ART clinical providers, which have so far had — and continue to have — almost no controls on manipulating their clients (and other crimes, such as offering sex-selected implantations).
It is easy to say, “All three actors should converge within an ethical framework,” which means precisely nothing. There was in fact a extended debate about the rights and roles of participants in assisted reproduction. The original guidelines that emerged from the ICMR’s expert committee were remarkably progressive: for instance, they advocated explicitly for the rights of same-sex couples and transgenders/transsexuals to use ART. A countervailing conservative opinion within the ICMR bureaucracy reversed this, even going so far as to compromise the rights of single women to access ART. We opposed that effort, and the Bill now includes a guarantee to single persons, married couples and unmarried couples.
The Bill of 2008 was the product of this kind of contention; so it is far from a perfect instrument to regulate an industry as technically, ethically and emotionally complex, and as swiftly changing, as assisted reproduction. But I do feel chagrined when it is damned by a critique that is this incomplete, unspecific and misread.
It is true that the Bill fails to build conditions of comprehensive protection and equality between ART participants (the possible manipulation of economically disadvantaged participants was always a concern). But I don’t think it was ever possible for a legislation to do so. Yet if its implementation follows the letter of this law, everybody involved in assisted reproduction will be on an incomparably safer, fairer footing. That includes surrogate parents.
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To write the comment above, I used the version of the Bill available on the ICMR website here:
http://icmr.nic.in/art/draft_art.htm
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The post, the comments with the link were very informative. Thank you all.
A few questions that bother me; but first let us get this out of the picture; 1) I am a mother -understand pregnancy, childbirth and its impact on my life. 2) I also have friends who are dealing with infertility issues, and hence am aware of that trauma too. 3) My profession is in the sciences, hence believe technology should help humanity.
Now, my concerns or rather I seek clarifications that did not come through to me from the above discussion – they are all about surrogate mothers;
[if married, she has to sign saying that she has her husband’s consent ]
If unmarried, she requires no consent from anybody?
How do surrogate mothers become available? if it is not volunteerism, if it is a unknown person, does she respond to the advertisement from the sperm banks and turns up at the bank? How visible are these ads? on TV? I do not watch TV, but am trying to understand, who comes forward, someone who can read and understand by herself ? The unlettered or not involved in this is what I presume from the information given, yes? no?
If yes, is there a bias towards choosing only a lettered woman as surrogate? If the whole business is a money transaction for the mother, why not the uneducated otherwise healthy woman?
If no, please let us know the exact mechanism of how an uneducated woman came to be a surrogate. Start from, who tells her of the proposition, how do they convince her to take this up, then when she agrees what counseling happens? there is plenty written about tests etc, nothing about the emotional and psychological preparation that she would require to take up this unnatural endeavor. Are there visits to her home by some agency? how long does the counseling happen?
[At several points it is made categorically clear that she will hand the baby over after delivery, in the report]
Childbirth is not a something that finishes abruptly. How is postpartum depression dealt with, is it recognized?
If the woman is married with other children, whereby she cannot just disappear for the period, how are the other children brought into this scenario, are they just told that the baby died, or are they informed about the surrogacy? I picture older children running to school announcing that they have new brother or sister coming. How does the mother handle those questions, will money be allotted for this kind of emotional toll?
How are the histories of surrogate mothers charted after this? we do want some record of how this whole process effects her long term biology. We do want to know if the marriage survived this massive intrusion?
There is so much more that i want to ask, but will stop for now.
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Thanks for the two responses (from Raghu Karnad and Anu) to our piece, which was precisely meant to lead to a debate on the issue of surrogacy. In response to Raghu Karnad, I am happy to acknowledge my confusion over the implications of surrogacy, do not claim to have many answers and am definitely guilty of “incomplete” knowledge on the subject. Have Imrana Qadeer and myself “misread” the draft ART Bill and Rules? Quite possibly, especially when one actually tries to go through it carefully and notices many discrepancies and problems – there is not even a preamble to help place it in a larger perspective of health and reproductive care.
Let me begin by noting that it is a great pity that people like Karnad did not use their privileged access to the drafting of the Bill to encourage a more democratic process – representatives of women’s organisations, consumer groups, public sector service providers, experts on ethics, child development and so on, were conspicuous by their absence. (If this was not so, I am happy to be corrected.) Why has there been no forum for publicly debating the Bill till women’s organisations demanded this, organized a national consultation in November 2008, and ensured that the draft was placed on the ICMR website for suggestions and feedback?
Our piece was definitely just “the tip of the ice-berg” prepared for newspapers and open forum readers. More detailed critiques have been undertaken by Sama women’s health collective (sama.womenshealth@gmail.com) (which, by the way, are even more damning) and in ongoing research elsewhere.
As for the rights of the surrogate mother, the list of problems is unfortunately a very long one. The Bill is not even clear about her compensation (is it from semen banks or the future parents?) and there are absolutely no safeguards regarding the amount that she is to receive – what would be her bargaining power in such a context? What independent authority is going to ensure her legal aid, counseling and so on and cover all the expenses involved? Regarding the number of pregnancies – there are at least two issues here. We all know that the same Ministry has been pushing a two child norm to the point of imposing penalties on families with more than two children. Not only can a surrogate mother now go in for up to three live surrogacy births (quite apart from her own “normal” ones), but as I discovered – she is permitted up to three cycles of attempted pregnancy per couple, which add up to a possible total of nine pregnancies! What confusion could there be here, when you consider the physiological and emotional complexity and risk that attends these procedures already?
Regarding the future parents and our unfortunate terminology. We certainly do not wish to downplay the enormity of their own emotional and financial investment – even though it is well known that India is chosen precisely for its relative cheapness and lack of regulation. The Draft Rules do not prevent intermediaries and actively promote the appointment of a local “guardian” by foreign parents-to-be, who will monitor the surrogate mother during her pregnancy. How is this acceptable and what language should we use for such arrangements where these parents have no contact whatsoever with the surrogate? One of the more confusing aspects of terminology is the very concept of genetic parenthood, which may well be a misnomer. It is perfectly possible that both gametes (sperm and oocyte) come from donors other than the future parents if they are unable to provide them. Why, then, does the draft explicitly forbid the surrogate mother from using her own eggs even in such cases? Indeed, there is much in our language and in the amplification of genetics that sorely needs to be questioned.
Turning now to Anu’s comments and queries. I share many of them myself – and in a situation of secrecy and anonymity, with clinics and sperm banks playing a major role in obtaining surrogate mothers, we are all quite ignorant. The Draft Rules seem to be assuming that a surrogate mother is already married, but leaves the matter open. Should a married woman require the consent of her husband? Shouldn’t the whole process be more open and transparent?
The new draft rules now seek to prevent the ART clinics, who are the most powerful players, from procuring surrogates in order to lessen their control. But there are various intermediary agencies advertising their services, and they are increasing in a rapidly evolving situation. Advertisements can also be found in women’s magazines like Sarita and Woman’s Era, some of which sound like matrimonial advertisements in the details that are provided! And yet, we know from scattered reports that prospective surrogate mothers come from relatively disadvantaged backgrounds in terms of class and caste – hence their extreme vulnerability in this situation, in which issues of literacy or education would be but one aspect.
In our view there is simply too little concern in the Bill for providing and ensuring that the surrogate mother receives necessary legal aid and health insurance, turning most of her transactions into a private undertaking with the future parents but with no safeguards built in. Counselling would indeed be a vital aspect of her needs – this is equally true for ART treatment as such, where counselors who are not employed by ART clinics need to be available. The surrogate mother’s rights must also be expressly communicated to the future parents. Her family finds no place anywhere, which is why we have suggested that they be brought into the picture as well.
A severe shortcoming here is the lack of a reliable data base, whether of ART treatment more generally, or for surrogacy in particular. The Draft Bill proposes a centralized database to be maintained by the ICMR, which if properly implemented would be a corrective to the inflated and even false information put out by clinics. But, as you say, more than medical data is required. We need politically engaged and sensitive research into the experiences and consequences of ART treatment for women and for surrogate mothers in particular. We also need to demystify the so-called “natural” urge for one’s own off-spring – be it through openly making adoption more acceptable, as well as through the possibility of being child free.
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Mary,
I’m certainly not here to defend the attitude of the ICMR or the Ministry toward public consultation. I personally experienced the arrogance and conservatism of ICMR officials as they attempted to reorient the more progressive provisions of the guidelines.
As with the majority of legislation conceived by government agencies, it may have been hustled through in near-secrecy in the hopes of avoiding public scrutiny. However, groups like Saheli were reportedly sending inputs on the draft guidelines as early as 2002. I can’t comment on the transparency of the consultative process.
I only want to talk about the Bill itself, and the misunderstandings about its provisions.
For instance, you say: “Not only can a surrogate mother now go in for up to three live surrogacy births, but … she is permitted up to three cycles of attempted pregnancy per couple, which add up to a possible total of nine pregnancies!”
What you call three cycles of attempted pregnancy, and the Bill calls “undergoing embryo transfer three times,” does not constitute three pregnancies. With all respect, this is a glaring error. When an embryo (fertilized in vitro) is transferred to the surrogate mother’s uterus, it frequently fails to implant. As with in-vitro fertilizations where the gestational carrier is the genetic mother herself, multiple attempts are often necessary.
It is true, and not a trivial issue, that preparing for an embryo transfer involves a hormone therapy for the surrogate mother. But to describe an attempted embryo transfer as a pregnancy is a misrepresentation; it is usually more similar to a menstrual cycle than a pregnancy. I’m not trying to minimize the burden, but this is my understanding of the physiology.
In any case, I am surprised to hear demands for any state restrictions on women’s reproduction. I see the arguments for it, but it is surprising nonetheless. One of the more useful and progressive tenets of ART regulation worldwide is that ART should be seen as an infertility remedy, and the difference between artificially-aided reproduction and ‘natural’ reproduction should be minimized. This is obviously most complicated when it comes to surrogacy, but I would not like to see the State restrict how many pregnancies a woman can have herself, or on someone else’s behalf.
Secondly, you say the Bill is unclear about whether the compensation comes from the gamete donors or the semen clinic. Actually, 34(3) is explicit about “monetary compensation from the couple or individual.” You’re correct that there are no safeguards about the amount of compensation. Quantitative safeguards are difficult to write into a law; they quickly become meaningless. How would you formulate an appropriate amount? That is a sincere question, the answer eludes me completely.
Additionally, this law governs all surrogacy arrangements, including those made voluntarily within a family, where compensation is not desired. Unfortunately, no research exists to help us evaluate how often this sort of surrogacy occurs, as opposed to more impersonal (and perhaps exploitative) arrangements. But the Bill needs to set out provisions that accommodate both sorts.
That same problem of conflation appears in describing genetic/social parents, who may be total strangers to the surrogate mother, living in another hemisphere, or may be close relatives living in the same house. Again, our empirical deficit means we don’t know which is more common, or more characteristic, of ART in India.
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Thank you Mary! This gets more and more disturbing. I spent sometime reading what is available about ART on the web (the science itself is overwhelmingly incomplete). ART + ICMR gave articles that lacked the requisite or rather complete lack of concern/s for surrogate mothers.
In these articles there seems to be a conflating of distinct reproductive instances; semen donation, egg donation and actual pregnancy-childbirth. All these gets addressed as one whole, explaining the rational for payment to donors of semen is somehow assumed to suffice as an explanation for the act of egg donation, pregnancy & childbirth.
Quoting from a 2005 Hindu article
” The practice of payment, Ms. Udgaonkar and others feel, can lead to the exploitation of the weaker sections of society. But more importantly, they fear that it can later be expanded to cover blood donations and other organ donations.
K. Vijayraghavan, Director, National Centre for Biological Sciences, said payment for semen donation was permissible if taken in the right context. “Are you going to ask people to come and donate the semen at their own cost? Is it wrong to pay for their travel and reimburse the money they would have lost by not going to work that day,” he asked.
http://www.hindu.com/2005/04/06/stories/2005040612751300.htm
Pregnancy and childbirth need I say, deserves the maximum input in terms of consideration while drafting such a bill.
A simple question to Raghu Karnad, of the 19 experts involved in drafting of the bill, could you please tell us how many were women? And how many of them are mothers?
This is purely for my curiosity of course, as I tend to wonder how an woman/mother -an educated one, would sleep through the implications of surrogate mothers while drafting such a bill.
The issue of why relatives are banned from donating seems more entrenched and i am keen to follow the discussions on those aspects too.
Mary, may I crosspost and circulate this post on some blogs that I read and write on, along with pushing this discussion through mailing lists. They are all educational/university mailing lists.
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Dear Raghu,
the purpose of our original piece was not simply to comment on the Draft Bill itself but rather to have a much needed discussion on the larger issues. which might then find their way into a legal document. Unfortunately we are in a situation where the Bill is taking precedence thus fundamentally narrowing and even distorting our questions.
On the issue of payment to the surrogate mother: At the level of the Bill itself, there is a contradiction because clause 26 (6) states that “A semen bank may advertise for gamete donors and surrogates, who may be compensated financially by the bank.” this contradicts clause 34 (2) that you cite.
But much more important is the larger question of compensation itself. In our article we had explicitly raised this as a particularly difficult question — how does one cost the making of a baby? Is there a fundamental problem here? On the other hand, couldn’t the very impossibility of placing a wage for this become a means for even greater levels of exploitation? Moreover, when everyone else in the business is charging fees why is this not addressed at all?
I believe that we ought to be particularly concerned about the commercial as distinct from a voluntary situation (after all this was the purpose of the Bill in the first place!). While it might well be impossible to lay down any exact amounts, surely one could come up with a list of costs that must be covered to begin with — health care and full health insurance, full legal aid, health care for the entire family, costs of travel for the surrogate mother for check ups, counselling and so on.
The question of compensation here may need to take a cue from other spheres where we use the term — in accidents for instance, in taking over property, in considerations of the opportunity costs in such situations and so on. Why not look at compensation payments in other countries like South Africa?
I am surprised by the bland statement that there should be no restrictions on women’s reproduction as though we were dealing with a regular situation. Of course I am completely opposed to the two child norm! (The point was to show up the inconsistencies of the Ministry itself.)
But here we are dealing with a highly risky set of procedures (which the Draft Bill appallingly calls “low risk”) whose costs to women’s health and well-being the clinics themselves have little idea about. Call the repeated cycles embryo transfers rather than pregnancies by all means — but they involve hormone treatments, and a whole psycho-social process — how can this possibly be likened to a menstrual cycle?
At a different level, why is it so difficult to imagine a different set of arrangements, with more rather than less interaction among those involved?
Anu, by all means do share these discussions with others.
It may also be important to keep in mind that there are many, feminists included, who would rather that commercial surrogacy if not all surrogacy arrangements be banned altogether, given all the problems involved. This is not my view. But then there is a responsibility to face up to the medical, social and ethical challenges and ask whether the Bill has gone far enough in its explicit aims. I don’t think it has.
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Anu, these were the members of the Expert Committee who came up with the ICMR guidelines:
Dr. Baidya N. Chakravorty
Institute of Reproductive Medicine
Dr. Pushpa M. Bhargava
Padma Bhushan
Former and Founder Director, CCMB,
Dr. Anand Kumar T C
Chairman, Hope Infertility Clinic
Dr. Sulochana Gunasheela
Ob-Gyn, Gunasheela Surgical and Maternity Hospital
Dr. Sudarsan Ghosh Dastidar
Director, Ghosh Dastidar Institute for Fertility Research
Dr. Mohinder Kochhar
Sr. Consultant Ob-Gyn, Sir Ganga Ram Hospital
Dr. Kamini Rao
Ob-Gyn, Bangalore Assisted Conception Centre
Dr. Mehroo D. Hansotia
Ob-Gyn, Fertility Clinic & IVF Centre, Mumbai
Dr. Sadhana K. Desai
Ob-Gyn, Fertility Clinic & IVF Centre, Mumbai
Dr. Chander P. Puri
Director, National Institute for Research in Reproductive Health
Dr. Firuza R. Parikh
Director, Dept. of Assisted Reproduction & Genetics
Jaslok Hospital & Research Centre
Shri Rajeev Dhavan
Senior Advocate, Supreme Court of India
Dr. Mira Shiva
Head of Public Policy, Voluntary Health Association of India (VHAI)
Dr. Lalrintluangi
Deputy Commissioner, Deptt. of Family Welfare,
Ministry of Health and Family Welfare
Dr. Vikram K. Behal
Deputy Commissioner, Deptt. of Family Welfare,
Ministry of Health and Family Welfare
Dr. Vasantha Muthuswamy
Sr. Deputy Director General, Division of Basic Medical Sciences, ICMR
Shri. Nirakar C. Saxena
Deputy Director General, Division of Reproductive Health and Nutrition, ICMR
Dr. Radhey S. Sharma
Deputy Director General, Division of Reproductive Health and Nutrition, ICMR
Dr. Nomita Chandhiok
Assistant Director General, Division of Reproductive Health and Nutrition, ICMR
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Thank you Raghu!
I didn’t think there would be names that I would recognize, but I can. I have nothing against senior scientists contributing to a bill that has such massive significance.
In fact, I am in complete awe, if these very senior scientists & Drs are able to keep up with burgeoning information, that a multidisciplinary subject like ART requires, assimilate it and are able to give valuable advice. I will with all due respect leave the future of my kind and our daughters in their hands. But if they are not on top of it all, and are sitting on these committees, it is very worrisome.
There is not day that passes by, where bright people much younger than those on this list, throw up their hands at not being to able handle all the information, even when they are working on very narrow fields of scientific research.
Anyway, thanks again.
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I see a lot of Sanctimonious judgement in this blog
about peoples reproductive choices.
Would anyone complain about “medical tourism” if a
foreign couple came to India for a life saving
surgery for their child because it was affordable
here? No. So what is wrong with any couple coming
here to use ART?
Carrying a baby does not require cutting out and
selling the uterus.Equating it to organ sale is
ridiculous.
There are many causes for infertility most of which
are not preventable.Please educate yourself on the
indications for ART.
ART patients are informed of their options and the
limitations of the technology and are required to
sign the consent form before the procedure.
We live in a free country where the government does
not decide how many children somebody can have or
even whether or not they choose to keep their
pregnancies or abort, or keep their children or give
them up for adoption.
Adoption is as an option for the fertile as much as
it is for the infertile.I wonder if you would
recommend that natural conception and the
narcissistic urge to pass on genes should be banned
by law till all children available for adoption have
been adopted.
The Surrogate is normally a fertile, healthy woman
who has already had children.She would enter into
the contract with eyes wide open to improve her
familys life. There is no question of her keeping
the child.That would defeat the purpose.Pregnancy
reduction is not done on a child,its done ,in rare
circumstances on a fetus, unless you are implying
that all abortions are murder.
As far as the right of a child to love and care,as
let me tell you that babies born after ART are loved
and cherished as much as any other.
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Are you completely satisfied with the provisions made in the draft for the parents/patients? As I see, this discussion is about the draft, various interest groups will have to air their concerns and work at improving them.
It would be useful to have an analysis of the parts of the draft which addresses the patients rights and point to lacunae there. I, for one don’t take any body’s health for granted, not the surrogates, parents or the child’s. And would like to be sure that the procedures and safeguards suggested in the draft, the hospitals standards, and databasing are the very best for all concerned.
I see this discussion as centered around the limitations in the draft.
No doubt, parts of the discussion here have centered around the inadequate safeguards for surrogate mothers in the draft regulation.
If groups spoke up for any one affected group, it only meant that other groups have not yet joined in the discussion in the spirit of improving the draft regulations. And not that one groups interest is somehow more important than the other.
Infertility as a problem may not have affected me, but it might be an issue to my children right? and they might want to use ART, none here are shortsighted about the impact of the draft, both for present and future generations. So please be assured that we are earnest in listening and sharing concerns from all sides while studying the draft regulations.
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I should have specified @ARTpateint, in the last comment.
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pg 18 23(2)
(2) The number of oocytes or embryos that may be placed in a woman in any one cycle shall be according to the rules and regulations provided
under this Act.
This is ok as a guideline but the decision of how many embryos to transfer is taken at the time of such transfer and is dependant on a multitude of factors. Any attempt to arbitrarily limit the no. transferred for all patients by law must be resisted by patients and doctors.
Don’t understand why the option of oocyte donation by friend or relative has been removed??
Why the ten year limit on storage of Gametes???
Why the 5 year limit on embryo storage??
pg 51
2.4 Counsellor
Could help?? yet to have a consultation with one.
They should have up to date knowledge on all medical aspects of the treatment and also get sensitivity training on what to say and specially on what not to say to a couple going through infertility,ivf negatives,miscarriage,debating donor or surrogate options etc.Theres nothing more irritating than advice from someone who is not fully aware of the issues involved.
THE treating dr. normally tells us our options, and I sure don’t want to hear any “just adopt” speeches from them.All they are qualified to counsel us about are ART procedures and whether or not they can help.
“The counsellor must invariably apprise the couple of the advantages of adoption as against resorting to ART involving a donor” HUH??? why ? whos to say what would be better for the patient?
3.3 An examination room with privacy
A separate examination room with privacy for interviewing and examining male and female partners independently is essential.
Adequate measures must be taken to ensure that history taking and examination are carried out in strict privacy, maintaining the dignity of
the patients.
HA Privacy?? Now that would be nice for a change.
Another point regarding ART statistics.
ART clinics should be asked to report their statistics and success rates grouped by age/diagnosis etc for the last 4-5 years, like its done in the USA. This should be audited and printed in a proper format and displayed on a board at the clinic.It would be more useful than random thank you letters and photos of “successes”.
(Cases, if any, where the sole diagnosis was “stress” or “too busy for sex” should be mentioned seperately and not included in the overall success rate :) )
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Total infertility is estimated at about eight to 10 per cent, and for the vast majority of Indian women it is preventable as it is caused by poor health, nutrition, maternity services and high levels of infections. Only about two per cent of the cases are because of ‘primary’ infertility amenable to ART alone.
For Mary and Imrana:
May I know where you got these statistics and what exactly you are referring to as ‘primary’ infertility???
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http://pib.nic.in/release/release.asp?relid=35233
The following is the text of the Health Minister’s speech:
“Until the last decade the problem of infertility received little attention, as the main focus of health services has been on efforts to slow down population growth. Defining reproductive health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and its function. Infertility is deeply distressing with psychological trauma and pain, a disease worthy of investigation and treatment. In a society as ours where child bearing defines a woman’s identity and motherhood of great social significance, infertility leaves unhealed scars traumatizing the couple socially and emotionally.
Out of a population of 1000 million Indians, an estimated 25% (250 million individuals) are conservatively estimated to be attempting parenthood at any given time; by extrapolating the WHO estimate, approximately 13 to 19 million couples are likely to be infertile in the country at any given time. Prevention and appropriate treatment of infertility has been included in the ICPD (International Conference on Population and Development) Programme of Action; it follows that alleviation of infertility should be included as a component of the primary health care system. ”
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To quote from the who article
Click to access 5.pdf
“Evidence supports the conclusion that there is a
compelling need for infertility treatment beyond
prevention. In many instances, ART are the last hope or the only means to achieve a child for couples. There is a heightened need for ART in developing countries.
While developing countries have generally not
established adequate infertility programmes, mainly due to arguments based on overpopulation and cost,
some notable exceptions (2) raise hope of successful and just implementation of ART, perhaps through public–private partnerships. A failure to even consider examining low-cost models of ART will be to conceive of developing countries as perpetually developing, rather than developed, with respect to
public health.”
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Hey hello everyone,
THis is a really healthy discussion on Surrogacy. Its great to have these views on the ART bill and surrogacy in general as well.
I believe that everyone has their own perspective and it may differ. What maybe right for one may not be the same for the others.
I am myself a Lawyer, and being into Surrogacy agreements for about a year now. Though the agreements that we have drafted imbibe all aspects of ICMR guidelines & The ART bill, we also have put in a lot of clauses which make sure that none of the parties are exploited.
The most important aspect for the Surrogate is the finances.They think what better way to help themselves by helping others. I have till date not come across a case where the surrogate has gone into depression after her delivery.
Though there are a lot of views about their attachment with the baby in the womb, I never found it hard for the Surrogate to detach from the baby(Surrogates that I have come across). They are happy with the money they can use for their own good.
There are many issues that the ART bill has cleared and it does make a good attempt to cover all bases.
One of my concern is that any couple opting for donated eggs and sperms also, may as well consider adoption. Maybe this needs to be addressed alongwith the issues that are raised in here.
I personally feel that everyone has the right to decide what is good for themselves, be it the Surrogate Mother or the future parents. All that needs to be done is try n safeguard the interests of all parties involved and avoid exploitation of either parties. To some extent the ART bill is successful. Its the right step in the right direction. lets hope it just gets better.
I also hope that problems like poverty,illiteracy, over population, security, corruption and many more important issues are discussed this same way by all of us.
Lets try and make our nation a better nation in all the aspects.
Take care everyone & have a great time
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Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!
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In Indian epics we find a lot of references for surrogacy
Duryodhana The product of surrogacy with faceless surrogate.
Balarama/brother of sri Krishna Product of embrio transfer into a known surrogate.
Kartikeya the one born to a surrogate who is living with the genetic parents
In surrogacy agreements we consider the emotional issues of surrogates and infertile woman only we should see from the point of male partner also. When man became naked ape his instinct became to protect and maintain the woman who conceives his baby. So man by instinct wants to know the well being of the surrogate.This induces stress if the surrogate is not allowed to be contacted then the baby gets undue previlages from the genetic parents just for their making it a genetic orphan, thus spoiling it, creation of Duryodhana.Genetic mother will be knowing that she has not given birth, her partner,surrogate will be knowing,baby will know by instinct then what is the point in distancing them by law leading to exploitation by the clinics
If the exploitation of both parties should be stopped they should be brought into contact by law then at least they can discuss financial matters post natal contact is also necessary in case the surrogate is not paid some ART clinics do it. If the Parents Want the Kartikeya Contact with the child with due respect to the surrogate is unavoidable.Otherwise they get only Duryodhana.Then the surrogacy becomes an arrangement to spoil at least four individuals for the benefit of ART center
To make the surrogacy as ethical as possible it is better if the Surrogate mothers are given access to the baby they have conceived.cause the bonding in the womb be Very strong and child will be Knowing (You may search the website son of a surrogate to know how the children born out of surrogacy feel)
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In Indian epics we find a lot of references for surrogacy
Duryodhana The product of surrogacy with faceless surrogate.
Balarama/brother of sri Krishna Product of embrio transfer into a known surrogate.
Kartikeya the one born to a surrogate who is living with the genetic parents
In surrogacy agreements we consider the emotional issues of surrogates and infertile woman only we should see from the point of male partner also. When man became naked ape his instinct became to protect and maintain the woman who conceives his baby. So man by instinct wants to know the well being of the surrogate.This induces stress if the surrogate is not allowed to be contacted then the baby gets undue previlages from the genetic parents just for their making it a genetic orphan, thus spoiling it, creation of Duryodhana.Genetic mother will be knowing that she has not given birth, her partner,surrogate will be knowing,baby will know by instinct then what is the point in distancing them by law leading to exploitation by the clinics
If the exploitation of both parties should be stopped they should be brought into contact by law then at least they can discuss financial matters post natal contact is also necessary in case the surrogate is not paid some ART clinics do it. If the Parents Want the Kartikeya Contact with the child with due respect to the surrogate is unavoidable.Otherwise they get only Duryodhana.Then the surrogacy becomes an arrangement to spoil at least four individuals for the benefit of ART center
To make the surrogacy as ethical as possible it is better if the Surrogate mothers are given access to the baby they have conceived.cause the bonding in the womb be Very strong and child will be Knowing (You may search the website son of a surrogate to know how the children born out of surrogacy feel) There is no stigma in Indian society about helping somebody else the stigma Perceived is because of giving up the child for money.If the arrangement becomes something altruistic with a long term friendship it is very much acceptable. For this we must see American laws where the surrogates must be known to the Genetic parent for at least 6 months before conception.It is not uncommon there for the surrogate children staying/ interacting with surrogate mother /Genetic parents having a long term friendship. In India the industry doesn’t want it just because if that is implemented the parties will come to know about the exploitation done by the clinics in terms of money.
Contrary to the belief IVF is a high tech/costly procedure it is simple ,A GP can do it then the cost will be much less so The ART centers want to avoid them.
There is no point in banning known /related donors for eggs/semen if they meet the minimum criteria, this clause helps only the commercialization increasing the cost for Intended parents
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In most of the countries a surrogacy is legal and surrogacy treatment is very helpful to the couple that those who are unable to conceive the baby. In ukraine surrogacy treatment is legal and surrogacy clinic will provide best facilities with well experienced doctors in affordable cost.
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