Friday, 10 August 2012
Surrogacy in India
BY ADRIANA JANOVICH
DELHI — After two miscarriages and six unsuccessful rounds of fertility treatments, Adela Ramirez Fryhover would do anything to have a baby, including hiring someone else to carry it for her.
"I want to become a mother so bad," says Fryhover, an American who moved from Miami to Delhi for her husband’s job with Nokia, the phone company. "The ultimate goal (in life) is to have a child, to experience motherhood."
The desire consumes her. Fryhover says she thinks about it all the time: "This is what you wake up to, and this is what you go to sleep with."
She’s hoping Wyzax Surrogacy Consultants, part of a relatively new but booming commercial surrogacy industry in India, will help.
Surrogacy is a reproductive technique in which a woman agrees to carry a pregnancy for someone else after being implanted with an embryo. The practice was legalized in India in 2002 and, in the last three years, has been the subject of at least two documentary films: 2009’s "Google Baby" and 2010’s "Made in India." This spring, Adrienne Arieff, a public relations executive from San Francisco, published "The Sacred Thread: A True Story of Becoming a Mother and Finding a Family — Half a World Away," documenting her journey to motherhood via India’s commercial surrogacy industry.
Among the changes in the industry during the past decade are rising costs. But commercial surrogacy remains cheaper in India than in most countries, including the United States. India began implementing free-market policies in 1991. Commercial surrogacy was legalized 11 years later, part of a long-term campaign to boost medical tourism. Patients began arriving from around the world — Europe, Australia, the United States and Middle East, particularly Israel.
The practice remains unregulated. In fact, in India, it’s easier for foreign clients to have a baby via surrogacy than adoption, an option Fryhover also explored but backed away from because of all the strings attached.
A year and a half ago, after losing a baby in the third month of pregnancy, Fryhover, a 39-year-old yoga instructor, and her husband Rex, 35, took a break from trying to conceive. A fertility specialist referred her to Wyzax, and that’s where she found herself in mid-March, three weeks before she and her husband were slated to move to Dubai, a three-hour plane ride from Delhi.
Wyzax, located on the sixth floor of Vishwadeep Tower, a beige, concrete block of a building in West Delhi, bills itself as a "one-stop shop" for "the entire surrogacy process."
A tiny pair of metallic feet — resembling those of a newborn or the popular mark often seen on steamed glass inside a car window with the side of a fist and finger-tip stamps for toes — is affixed to the floor outside the entrance. They represent Lakshmi, the Hindu goddess of courage, fortune and fertility."You put them in front of the door as a sign for her to bring you prosperity and wealth," Fryhover explains.
Surrogacy in India is rapidly growing, particularly among non-resident Indians and foreign clients, like Fryhover. According to industry experts, that growth is expected to continue.
"It’s a new area, with a lot of clients coming from abroad, all over the world," says Sunil Agrawal, a Delhi-based lawyer who’s worked on surrogacy cases for the last four years. "There is a lot of potential in this business."
The medical tourism industry in India, including surrogacy, is projected to bring in $2.3 billion this year. Commercial surrogacy alone is valued at an estimated $450 million.
However, because of the lack of regulation, many argue the potential for exploitation, extortion and corruption is also growing.
The most vulnerable people in the process sit on each end: the poor, low-caste women who want to better the lives of the children they already have by carrying one or more for another, and the women and men who desperately want to parent a child. Both sides face the commercialization of their needs and bodies. Meantime, those in the middle — clinics and agencies, doctors and lawyers, bookended by vulnerable populations — stand to make a lot of money.
Fryhover says she’s aware of the risks. She’s done research online. That’s why — after meeting privately with Wyzax director Jagatjeet Singh for about 20 minutes to review her medical records and talk about options — she wants to see where and how the surrogates live. She wants to meet the women and decide whether they seem happy. And she has mixed emotions: "I’m excited. I have anxiety. I’m very emotional."
She and her husband celebrated their fourth wedding anniversary in June. They have been trying to conceive for five years, a year longer than they have been married. In all, Fryhover says, they have also spent about $10,000 on fertility treatments. She still doesn’t know what’s wrong.
"I don’t have diabetes. I don’t have high blood pressure," she says, adding she doesn’t smoke or drink and abstains from caffeine — "no Coke or coffee." But, she says, "I got married late."
Now, she’s on the verge of "one of the most important decisions that my husband and I have to make in our lives. You’re talking about a human being. If we find a good, healthy surrogate, we will be forever grateful to her."
Prices for commercial surrogacy in India have been going up, from about $15,000 to $20,000 as little as two years ago to more than $25,000 now. But that compares to as much as $70,000 to $100,000 or more in America, where surrogacy laws vary state to state. Some expressly forbid it. Many side heavily with the surrogate.
At Wyzax, the basic surrogacy package costs about $26,500, paid in five installments. Surrogates, Singh says, are paid 3.5 lakhs, or about $7,000. They come from different religious backgrounds — mostly Hindu and Muslim — as well as different parts of India. Most learn of surrogacy through word-of mouth. And they’re not interested in it for altruistic reasons.
"The money is the only driving force," Singh says. "All of them or most of them are poor, low-caste women."
A Catholic, Fryhover says she sees them as "blessings."
Unlike most intended parents from India, Fryhover isn’t concerned about the surrogates’ religion or caste: "I don’t believe in caste. I don’t like to differentiate people. To me, people are people."
She gets to meet five surrogates, dressed in colorful salwar kameez — turquoise, red, green, gold and orange. They share a three-room apartment in West Delhi, a 10-minute drive through a maze of thoroughfares and narrow dirt roads from the agency’s headquarters. Inderpreet Kaur, manager of corporate affairs for Wyzax, guides Fryhover and her driver to the location, then acts as an interpreter. She tells Fryhover two surrogates are pregnant.
The uncluttered, second-floor apartment where they live is made up of a main room and two bedrooms. When Fryhover arrives, the surrogates gather, sitting on two of the three beds in one of the rooms or standing in the doorway. None speak English. Kaur translates, providing only surrogates’ first names.
Right away, Fryhover expresses concern about their beds, which appear to consist of plywood boards, covered with a thin layer of bedding. She asks if she can bring a softer mattress.
"I’m thinking these are brick beds," she says. "I would feel better if I knew they were comfortable."
Through Kaur, the youngest surrogate in the house, 23-year-old Rajima, one of the two who are pregnant, says, "I’m happy here."
Rajima lives in the apartment with her 2-year-old daughter. According to Kaur, she is from North Delhi, and her husband "sells old things." She’s three months pregnant with twins for a European couple.
Fryhover — wearing black yoga pants and a gray, hooded knit top with sunglasses atop her head — is trying to understand their world and somehow bridge the gap between them, the women at both ends of a business that commercializes their deepest desires and bodies.
She has more questions: How’s her pregnancy going? (Well.) Does she have morning sickness? (No.) How long will she stay here? (About nine and a half months.) How often does she get to see her husband? (Weekends, usually.) Why is she doing this?
"I’m poor," Rajima says through Kaur, adding she wants to provide for her own daughter.
That’s why they are all doing it, Kaur says.
Fryhover has more questions: What foods do the surrogates eat? (Mostly vegetarian.) Are they vegetarians? (Not strictly, but some don’t eat beef or pork, for religious reasons.) Is there anything they need?
The surrogates seem to have few personal belongings.
"She’s saying, ‘We don’t require anything. We won’t ask anything,’" Kaur says, translating for 26-year-old Sadhna, a surrogate who has two boys of her own, ages 10 and 3, and is one month pregnant.
Fryhover takes notes, writing down the names and ages of the surrogates, how many children each has, how old they are.
Nazma, 28, has three children, ages 9, 6 and 3½. Her husband is unemployed. She is not pregnant. Through Kaur, she tells Fryhover she would like to carry her child. She also says, "If I had the money, obviously I wouldn’t do it."
Kaur says all the surrogates agree. She also says, "All would do it again."
Translating for Nazma, Kaur says: "She’s saying surrogacy is not a bad thing: I’m getting money, and the other person is getting a child. She says I’m doing it for your happiness. I’m doing it for money, but I want to see happiness on your face."
Clinics and agencies like Wyzax have financial reasons to safeguard the viability of a fetus. But there are no legal mandates for surrogates’ follow-up care or protocols should something go wrong. There are only guidelines.
"Right now, we are trying to take care of it by putting the names of nominees in the contract," says Agrawal, the lawyer, adding he wants to see the proposed legislation passed. Once surrogacy is regulated, "My thinking is more people will come to India for surrogacy. It’s cheaper here."
Numbers of surrogate births in India are on the rise, according to industry experts. The exact figure, however, is difficult to pin down. Reporting those statistics remains voluntary. There are no official numbers.
"It’s a very closed circuit kind of system," Singh says. "No one in the specific (surrogacy) centers reveals their exact numbers."
Started as a pharmaceutical company about 10 years ago, Wyzax shifted its focus to surrogacy in 2010. Since then, Singh says, the company has facilitated 22 successful surrogate births.
"We really feel proud of what we are doing," says Singh, who — like Agrawal — is in favor of the proposed legislation. He also says his agency adheres to the guidelines.
"We want to be as transparent as possible," Singh says. "We want to organize the system. There are lots of loopholes."
Wyzax requires surrogates to live in residential surrogacy homes for "better monitoring." Often, he says, the facilities are nicer than surrogates’ own homes.
Wyzax maintains a database of 60 to 80 surrogates. All are married and have at least one child of their own, Singh says. Young children are permitted to live with their mothers in the surrogacy home. Husbands are allowed to visit.
"We are really wanting to make it work, especially for the surrogate mothers who are presenting themselves and their bodies for this cause," Singh says.
Most foreign clients visit at least twice, three times if they are able to come in the middle of the pregnancy to "see the baby bump," Singh says. Most — some 65 percent — use egg donors, many of whom come from former Soviet bloc countries of Ukraine, Uzbekistan, Kazakhstan and Belarus.
When Fryhover eventually settles on a surrogate, through a different agency in Mumbai, she will use her own, previously frozen eggs and her husband’s sperm.
As she leaves the surrogates’ apartment, several of the women join her, waiting in the dirt road until Fryhover’s driver arrives. Rajima and Nazma ask to pose in a photo with her. As they stand together, Fryhover asks Rajima if she can feel her baby bump.
With her hand on Rajima’s stomach, in a language the surrogate doesn’t understand, Fryhover whispers three words to the young pregnant woman: "You’re so lucky."