The world we live in today runs on the energy of one word, 'Yes.' Yes to instant gratification bubbling like coffee up to the rim of life. Yes to space tourism. Yes to cloning of cherished pets. Yes to pleasure in all its forms and fulfilment at every level. Yes to borrowed eggs, frozen sperm to hired wombs, to children nature had denied to some of us.
India till now considered by the West to be a bit of an odd conglomeration of outsourced spirituality and IT talent, timeless tourist spots like slums and palaces, oceans and deserts now has another face. That of a large, sprawling womb store from where fertility can be outsourced cheaply, safely and legally. A surrogacy process would cost over $50,000 or thereabouts in the US while it amounts to only around $ 10,000 in India. Shopping for a cost-effective baby here is like cocking a snook at fate, pumping the air and saying aloud 'Yes.' With the constant inflow of womb shoppers, surrogacy, legal in India since 2002, has become highly commercial and profitable.
Surrogate motherhood is a lucrative idea for many desperate for money. Young women in urban and rural areas and the volumes of surrogate mothers, egg donors (some of whom may even be young college girls looking to buy something expensive in lieu of an egg or two harvested from their bodies) is increasing in response to the demand for both.
Things go well most of the times except ofcourse when unseen complications arise as in the case of Dr Ikufumi Yamada, 45, a Tokyo surgeon who went through a divorce with wife Yuki, 41, a month before their surrogate baby Manji was born in India. The fate of the baby consequently hung in balance since Indian law does not allow the adoption of a girl by a single father.
Is this case indicative of some of the reasons why the idea of surrogacy should be reevaluated? Would it not be existentially confusing for children like Manji to not have a clear idea of who they are and who they belong to?
Should we not worry that the surrogacy industry in India is largely unregulated? And do these qualms mean anything at all in a country where 40 per cent of more than a billion people live under the poverty line and bring children into a dangerous, deprived, unstable world of lacks? While worrying about what will happen to babies like Manji, do we spare even a thought to the children whose numbers swell everyday on our streets? Atleast surrogate babies are needed by someone in some part of the world. What about the children naturally born to parents who bring them into the world without having the means to protect and nourish them?
Let us also remember that sex-based foeticide continues to thrive unchecked in some parts of our country, even affecting the ratio between the sexes. So really, how low can fertility tourism be rated on a moral scale?
Yes, it is strange that children are now commodities and wombs are on sale. It is stranger still that "superovulated" young woman are advertised on virtual billboards "exclusively" for cash rich, hungry for parenthood people. Were not atleast some aspects of life, supposed to be beyond human manipulation?
But everything can be tweaked for human convenience today, even laws of nature. So a single woman in her late 30s can get a few cheap embryos (that may or may not have anything to do with her genetically. The egg and sperm may belong to donors who may not even know each other) planted in her womb in an Indian clinic. The seed of life can be bought online these days from sperm banks from a distant part of the world and a prospective mother can pick the donor she wants depending on (among other things) whether he is a tall sportsperson or a mid-sized architect.
The 'contents' can then be shipped in heat proof containers to an Indian clinic where fresh eggs bought from another donor can be fertilised with the long-travelling sperm. The baby who emerges from this 'union' may have an Australian father she will never see, and an Indian, biological mother she will never know either. She will only know the mother who gives birth to her.
Another couple may rent a womb for their genetic child. Or buy embroys from another donor couple. How this conundrum is resolved by the people involved in the situation is a conundrum too. More than any moral and ethical questions, surrogacy has far reaching human implications on relationships between a surrogate womb and the child in it and the 'parents' and the baby they have prayed and paid for. How these relationships pan out depends solely on the people in it.
But the business thrives on in India because unlike in developed countries, here women donors are aplenty, the bills do not break the bank and the number of embroys a doctor can plant in a woman's womb is not strictly monitored unlike say in the UK. And all this can be paid for, online with your credit card. The baby shoppers love India also because the doctors here, among their other skills, can converse with them in English and soothe their fears and clear their doubts.
Most of the time "100 per cent success rate" is guaranteed even if the mother way beyond child bearing age is looking for an In Vitro Fertilisation process to get pregnant. There is not a single ethics committee or law to monitor this industry or to license clinics, though attempts are being made by the government to accredit fertility centres and make them subject to basic requirements and precautions. Still, so far, it is an open market sans red tape where everyone and anyone is welcome. No one is yet thinking about how assisted reproduction affects the child at the centre of it.
Or what will happen if she grows up and demands to know more about the anonymous donors who created her. No one knows either just who the donors of wombs and eggs are in India. Are they victims of their poverty or willing and well-paid participants in the creation of life? Are they short changed by the doctors swimming the dollar gravy or paid adequately? Are they counselled about the emotional and physical cost of their decision? Do they have rights, if any? No one is answering these questions because it is enough that dollars are flowing in, life is being stirred in sterlised jars and gurgling, inexpensive babies are being shipped out.
SHOPPING FOR GENES
At 43, Sanuthi Liyanage is a happy and content woman. She has everything a woman would ever aspire for — a loving husband, a caring family, riches, and, above all, a baby she can call her own. Well! If this sounds like a fairy tale to you, then you should listen to Sanuthi.
"I was a simple Sri Lankan woman who always craved for a baby. But when repeated attempts to have one failed, I was devastated. After 12 years of marriage, I had almost embraced the reality of my 41 years of living, that of being childless. I loved life and God. But felt let down by both," she writes.
Till one such day, when her family doctor advised the Liyanage couple to fly down to India to realise their dreams of having a child. The choice was between Chennai and Bangalore. The Liyanage couple chose Bangalore.
"This one suggestion meant so much to me. Very soon, everything fell in place and I am now a committed parent of one beautiful and loving daughter. I strive to stay in the spirit of gratitude for I realise this is no small gift from both life and God," she adds.
The Liyanage couple are one of the many fertility tourists who frequent India to avail of the affordable fertility services offered here. Though Delhi and Mumbai are high on the priority list of fertility tourists, our very own Bangalore is in no way lagging behind.
According to Dr Kamini Rao, a renowned fertility specialist and medical director, Bangalore Assisted Conception Centre, Bangalore, mostly draws fertility tourists from countries like Mauritius, Malaysia, Singapore, Bangladesh, Sri Lanka, Maldives and the Arab countries. "The fertility tourist traffic is definitely on the rise in Bangalore. Affordable fertility services and legal comfort levels prevalent in the City prove to be attractive to foreign nationals," says Dr Kamini Rao.
In her clinic alone, every month, about five-seven foreign nationals seek the expert's help in conceiving. "Though most such couples are NRIs, there are also couples of mixed races where either the husband or the wife is an Indian," she says.
However, there are also couples like the Liyanages who come to Bangalore, "Not because of the cost factor, but because of the reputation it enjoys as far as fertility clinics are concerned."
"The success rate in Bangalore is very high," says Sanuthi in an e-mail interview.
The change in approach also matters most, says Dr Rajalaxmi of Rajalaxmi Infertility Service, who emphasises on the natural method of conception. Most fertility tourists who frequent her clinic are from the Maldives, mostly those who have failed one or two IVF cycles back home and are seeking help closer home.
"Positive approach to pregnancy, counselling, reiki and pranayama — my treatment is all this and more, proving to be a big draw among Maldivian nationals," she says, adding that word-of-mouth publicity is what she relies on.
"Though increasing worldwide interconnectedness is a major factor in promoting fertility tourism in the State, it is the cost factor that brings most of them to Bangalore. And, of course, the easy availability of experts in the field," says Dr Kamini Rao.
"The fact that there is literally no waiting time and one is taken care of by highly qualified medical personnel who are fluent in English are added advantages. Also, many of the doctors in Bangalore are educated abroad and have practiced in many western countries, adding to the long list of advantages," writes Sanuthi, justifying her choice of Bangalore. "If some regulations are in place, the traffic of fertility tourists in Bangalore and subsequently in India can more than double in the next five-10 years," adds Dr Kamini Rao.
A fact driven home as one enters the double storey-clinic-cum-chamber in a posh locality in New Delhi where anxious faces of patients from across the world stare at you. Dr Anoop Gupta, who is an IVF specialist since 1994, does around 800 IVF cases a year. He gets around 15 cases on an average in a month from couples coming from other countries. About 50 per cent of them are from the US and the remaining half from the UK, Middle East, Nigeria, Spain and Russia.
Ask him why do these couples come to India for IVF and pat comes the reply: expertise and cost.True, many of his patients from the US and the UK are NRIs and they prefer Indian doctors. But there are foreign couples, who prefer Indian doctors as, in the words of Dr Gupta, they have an "emotional bond with their patients."
"Infrastructure in Indian IVF clinics is 110 per cent better than the centres abroad and treatment in India is affordable too," Dr Gupta says. While in the US, an IVF would cost $20,000 per patient, in India it is $2,500 or between Rs 1.25-1.50 lakh. "If one gets same treatment at such a cheaper cost, why won't they come to India," asks Dr Gupta. Apart from the cost factor, there are certain restrictions in other countries like sperm or egg donation is banned in Muslim countries.
Dr Gupta does not see any thing unethical in surrogacy as long as the financial and medical concerns of the surrogate mothers are taken care of. "Again cost factor is there. It might take $100,000 to go for surrogacy in the US, but in India it is only about Rs 3-3.5 lakhs," he says.
Over the years, Mumbai and Pune have also emerged as top destinations for IVF treatment for foreigners. Among the casual international tourists taking strolls in South Mumbai, there is every chance at least some of them might have come here for infertility treatment. Take the example of Maria Halls (name changed), who is on her second trip from London to get pregnant. The 39-year old Maria says the IVF treatment in UK is much more expensive, and the doctors are not willing to provide treatment if they find even a slight problem, for fear of suing.
She has checked into the famous Malpani Clinic of Colaba, whose website lists a number of patients and their testimonials about treatment received in the hospital. Dr Aniruddha Malpani attributes the growing tribe of fertility tourists to the Internet.
There are around 35 infertility clinics in Mumbai, which are more than any other city in India. The famous Jaslok Hospital has treated women patients from 40 countries in the past 10 years. While the quality of the treatment and economics are chief reasons, Indian doctors are making it a point to give quick response to email queries from their prospective patients abroad.
Normally, a dozen emails are exchanged between a doctor and a prospective patient before she travels to Mumbai, said a doctor attached to Jaslok Hospital.
In the West, doctors will never take a patient who is too old or has a complicated medical history. The opposite is true in India, says Dr Hrishikesh Pai of Lilavati hospital, who gets an average dozen patients from abroad every month. His wife Dr Rishma Dhillon Pai, a consultant gynaecologist at Jaslok and Lilavati hospitals, has the distinction of having assisted a 60-year-old woman (one of the oldest patients in India) to deliver. Dr Rishma is the director of 'Everywoman Cliniqs' at Bandra and Kemps Corner and is also the director of the Pearl Centre Hospital at Dadar, which is one of the first and largest abortion and family planning centres in Mumbai.
Earlier this year, twin girls conceived by IVF in India were born in the Midlands to a British Indian couple with a combined age of 131. Their mother, thought to be 59, is one of the oldest women in Britain to give birth. Renowned gynaecologist Dr Sunita Tandulwadkar of Ruby Hall in Pune told Sunday Herald that the reasons behind the booming fertility tourism are simple: economica, international standards and very less waiting period. Age plays a very important role and more the waiting period, there are less chances of getting pregnant.
According to Alexandra (name changed), a patient from UK, "I came to Pune to get away from conditions back in Britain, particularly legal maze and ethical issues." She is impressed by the fact that India was the second country in the world after the UK to produce a 'test tube baby', just 67 days after the first British test tube baby in 1978.
Chethana Dinesh in Bangalore, Shruba Mukherjee in
New Delhi and Parag Rabade in Mumbai
