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Surrogacy in India

Gerry and Rhonda Wile have travelled halfway around the world to meet the stranger who could make them parents. They are just one of thousands of foreign couples who’ve turned to India’s booming surrogacy industry

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The petite woman in the tangerine-coloured sari confidently waves a hennaed hand at the couple entering a stuffy conference room in Mumbai’s World Trade Centre. “Mr. Gerry, come sit here,” Rekha Tayde commands in halting English, smiling broadly. “Come, come, Miss Rhonda.” Gerry and Rhonda Wile smile back, delighted. But they approach carefully, as if the woman is made of china, fragile and easily broken.

Gerry stands a solid six feet tall, with broad shoulders, tattooed, muscular arms and fingers as thick as cigars; Rhonda, with blond, wavy hair and a kewpie-doll face, is not much smaller. They dwarf Rekha, but she isn’t nervous. She wants to put Rhonda, a nurse from Niagara Falls, Ont., and Gerry, a veteran of the Canadian Armed Forces, at ease. This is their first meeting, and Rekha wants to assure them that they’ve done the right thing by choosing her to try to become pregnant with their child. A housewife and a mother of two, she is an old hand at the surrogacy business, having carried another couple’s baby to term in 2007, just one year ago.

“I’m strong,” she declares, pointing to her abdomen.
“I’m big,” Gerry shoots back.
“No worry,” she replies, serene.
He laughs and hugs her. “I hope you don’t mind, but I’m from Nova Scotia,” he says. “I hug everybody.”

For the couple, it has been a long journey to this place, on a plane from halfway around the world and then several hours by taxi through monsoon rains.

In this moment, as they meet the woman who is willing, literally, to carry all their hopes and dreams over nine long months – morning sickness and water retention included – all their doubts are erased. “We can’t tell you how happy we are that you’re doing this,” Rhonda says, a bit teary from emotion and the hormone shots she has been administering over the past two weeks to make her ovaries produce more eggs.

They carefully place children’s backpacks on the table and begin to pull out gifts. They knew what to bring, sort of, after watching a grainy video of Rekha sent to them by Surrogacy India, the company they have contracted to broker and manage the deal. They know she has a seventh-grade education and liked being a surrogate the last time, partly because her husband and children pampered her as if she was a queen. They know she is interested in children’s theatre and the ancient art of mehndi, in which intricate henna designs are painted on the body; that her 13-year-old son is a budding artist and her 10-year-old daughter is a fan of all things pop cultural. So the presents include a drawing manual, a set of coloured pencils, Hannah Montana paraphernalia and a picture book of Disney princess tales. Rekha is silent for a moment as she surveys the pile on the table. “My children will feel rich,” she finally says. “Much joy.”

Rhonda laughs through tears. “Oh Rekha, you bring us much joy, too,” she says.
Rhonda and Gerry are just one the thousands of foreign couples who travel to India each year for surrogacy services – a new and largely unregulated enterprise that adds about $500 million to the country’s economy. The women who work as surrogates are mostly poor and married, and they will earn up to $11,000 (US) for their services, depending on their level of education, which clinic they work for, and whether the pregnancy is successful. Some health and women’s rights activists decry the practice, saying it turns women’s wombs into little more than a marketable commodity, a corporeal outsourcing similar to the spread of computer call centres and high-tech firms that serve the West.

But for people like Rhonda, Gerry and Rekha, the situation is less complicated. Surrogacy is about their dreams and desires; about one couple’s yearning for a baby and one woman’s wish to improve the quality of her family’s life. Rather than dwell on the criticisms of surrogacy, they are all conscientiously positive, concentrating on what they are doing right here, right now, in this muggy, close room.

Modern-day commercial surrogacy agreements were pioneered in the U.S. in the 1970s, but the practice gained notoriety in 1987, during a bitter custody dispute in New Jersey over the infant known as “Baby M.” The surrogate, Mary Beth Whitehead – who had also donated the egg – reneged on the agreement she had signed, threatening suicide if she had to comply. (The judge eventually granted custody to the baby’s biological father and his wife, and gave Whitehead visitation rights.) These kinds of legal battles, coupled with ethical concerns about paying women for reproductive services, prompted Canada to outlaw surrogacy for pay in 2004. (It is still legal for a woman to voluntarily carry a fetus, and it’s assumed that some couples get around the law by offering “gifts” to surrogates instead of paying them a fee.) Other places, such as Hong Kong and Germany, have banned surrogacy altogether. And in the U.S., where it is legal, it is also, for many people, prohibitively expensive.

That’s why India, with its low fees and relaxed regulations, is so tempting. Rudy Rupak is the co-founder and president of a California-based medical travel agency called PlanetHospital, which books trips for clients undergoing procedures in foreign lands. He says that his surrogacy packages, which he has offered since 2007, are already among the most popular, up there with gastric bypasses and joint replacements. “We have clients from Los Angeles to Calgary to Montreal,” he says.

Rhonda and Gerry’s journey began on a blind date in 1998 in Belleville, Ont. Rhonda, now 39, was working several nursing jobs to make ends meet, and Gerry, now 43, from tiny New Germany, N.S., had just ended a 12-year stint with the Canadian Forces. They fell in love, got married two years later and prepared to live happily ever after. They had both been married before and they wanted to build a life together, have a nest egg and careers that brought in good incomes, before they started a family. To that end, they moved south, first to Florida and then to Mesa, a suburb of Phoenix, Arizona. Rhonda became a nursing supervisor, while Gerry qualified as a firefighter and joined the U.S. Air Force Reserves. In 2004, he was called to active duty, spending most of the year in Kuwait and Iraq.

When he returned, they tried to get pregnant but failed. Through a myriad of tests, Rhonda discovered she has two uteruses, each smaller than normal; while this didn’t preclude her carrying a child, in-vitro fertilization was out of the question because her condition put her at high risk for complications. Then, she got pregnant. For a few weeks, everything was right in the world, until it all went wrong again. When they discovered the fetus didn’t have a heartbeat.

Fertility treatments were unsuccessful. Rhonda and Gerry looked into adoption, but were quickly disheartened by long waiting lists. When their doctors suggested surrogacy, Gerry, who has two grown children from his previous marriage, rejected the notion outright. “It’s gross,” he protested at the time. “It’s not an option.” Rhonda, who’d dreamed of being a mom since she was a little girl, persisted until she convinced him. As far as she was concerned, surrogacy was their best bet, until she discovered the price for a standard arrangement in the United States: $50,000 to $80,000(US). That’s when the couple turned to India. “We figured the cost there would be between $20,000 and $25,000 [US], airfare and hotel included,” Rhonda says. “We thought, We can do that. For a baby, we can do that.”

They made their first attempt in April 2007, when they travelled to Mumbai, giddy and certain they were going to have a baby nine months down the road. When she learned their surrogate wasn’t pregnant, Rhonda was broken-hearted and reluctant to go through the roller-coaster ride of hormones and expectations again. Gerry convinced her to give it a second shot. “If we don’t,” he argued, “then we’ll always live our lives wondering, What if?”

About 30 minutes before Rhonda and Gerry’s arrival at the Mumbai World Trade Centre, Rekha, who turns 29 this year, and her husband, Prabhakar, a solemn, 32-year-old garment worker with his name tattooed on his left forearm, sit around a U-shaped conference table, along with three other potential surrogates. A lawyer’s aide explains the contracts they are about to sign with the intended parents. The women, all in their late twenties, have already been through a vetting process, passing medical and psychological exams to ensure their general fitness and ability to have children.

The aide videotapes her audience as she painstakingly reviews each clause, outlining each party’s responsibility and the payment schedule. The lawyer, Amit Karkhanis, who often works in conjunction with Surrogacy India, is in the conference room as the aide gives her spiel. He turns to me to explain: “We don’t want anyone to come back afterwards and say they didn’t understand.”

I ask the lawyer if he ever worries that the women are being exploited, or are doing this against their will. He shakes his head. “They do come from lower economic strata,” he tells me. “But if they didn’t have this option, many might go into prostitution or give up an organ, a kidney, in order to survive and help their families.”

However, some women’s health activists in India say that surrogacy is inherently exploitative. The country’s guidelines for surrogacy, issued by the Indian Council of Medical Research, are vague: One stipulates that surrogates should not be over 45 but gives no minimum age, for example. Another limits the number of embryos that can be implanted into a uterus to three, but allows for more in “exceptional circumstances.” (The Society of Obstetricians and Gynecologists of Canada and the board of the Canadian Fertility and Andrology Society recommend that no more than two embryos be implanted in women under 35, no more than three in women 35 to 39, and no more than four in those older than 39.) The result is that there is no ironclad protection for the rights and health of surrogate mothers.

A bill has been drafted to better regulate the surrogacy industry, but it has come under fire from women’s rights groups, and its merits have yet to be debated in the Indian Parliament.

In other countries, the issue is no less controversial. John Lantos, a bioethicist at The University of Chicago and The Center for Practical Bioethics, says he can’t stress enough that the rules need to protect both sides in an agreement and encompass every eventuality. “This includes what would happen if a baby was born with some sort of genetic anomaly and the contracting parents said, ‘Oh, that’s not what we contracted for. We’re out of here.’ As best I’m aware of, that issue has not yet been litigated,” he tells me.

Last November, the reporter Alex Kuczynski wrote a story for The New York Times Magazine entitled, “Her body, my baby.” In it, Kuczynski, who is married to a wealthy financier, detailed her experience of hiring a surrogate who was putting her own children through college. No less than 404 people responded to the story on the Times’ website. Among their comments: “This is the kind of thing people do when they have more money than brains,” and, “I am trying, very hard, to be happy for the writer and her new baby – how wonderful after all the years of heartache! – but all I have in my head right now are images of how our country is so … socially divided.”

Closer to home, Margaret Somerville, the founding director of McGill University’s Centre for Medicine, Ethics and Law, says of surrogacy: “The wealthy will buy it and the poor will supply it. But it’s not like other kinds of employment. Surrogacy is not like cleaning a house. Frankly, it shouldn’t be a service at all.”

Rekha, who wed Prabhakar in an arranged marriage when she was a teenager, is not bothered by questions about ethics. She says she wants to make enough money to buy a real house, one larger than the one-room house her family currently occupies. “I dream of a big mansion, but if it has just one bedroom, that is okay,” she says. “We need 300,000 more rupees. I will get 200,000 rupees (about $5,000 Cdn.) for this, as long as everything works out. And one day, we will have that house we can call our own.”

For her, carrying other people’s children is a business venture, one that is more lucrative than her old job preparing medications in a pharmaceutical lab. The only thing about surrogacy that has ever given her pause was the hormones doctors injected through her abdomen to prepare her uterus for multiple embryos. “The first time, my stomach turned black and blue,” she says. “But it turned out okay, so this time, I am not scared. My family takes care of me. Because of their age, the children have some understanding of what I’m doing, while my husband actually cooks and cleans. The last time, he made lots of chicken.”

“I’m good at chicken,” Prabhakar says, grinning.

Later that day, I accompany Rhonda, Gerry and Yashodhara Mhatre, or “Dr. Yash,” a fertility specialist who is a partner in Surrogacy India, to an ultrasound clinic to determine how many follicles (the fluid-filled structures that contain eggs), Rhonda’s hormone-ridden ovaries have produced. The couple bet each other. “We’ll have 20 eggs,” predicts Rhonda.

“No, we’ll have 25,” Gerry replies.

We all crowd into the curtained-off area behind the ultrasound specialist’s desk. Tall and gentle, he makes small talk about soccer as he waits for Rhonda to arrange herself on the ultrasound table. But the room falls silent as he applies gel to her abdomen and begins to pass the wand over it. Then, the ultrasound doctor murmurs something to Dr. Yash.
“What, what is it?” Gerry asks. The doctor continues to pass the wand. “I see seven follicles in the right ovary,” he says. “I can’t make out the left ovary. We’re going to have to go with the right one.”

Not 25 eggs. Not even 20 or 10. Without exchanging a word, Rhonda and Gerry know what this means: With few viable eggs to choose from, there will be even less to implant into Rekha’s womb. On the long ride back to the hotel through Mumbai’s rush hour, the mood is as sombre as the stormy weather. Gerry keeps his face turned to the window, furtively wiping his eyes with the back of his hand. Rhonda sits up straight and stiff, saying little for fear she will start to cry and be unable to stop. That night, they tell each other that science can be imprecise. That maybe there are more follicles hidden in a place the ultrasound missed. That in the end, all it takes is one egg. And that becomes their mantra.

“They are my babies until you get here.” So declares Anita Soni, a gynecologist who delivers surrogates’ babies at Mumbai’s Dr L H Hiranandani Hospital, a relatively new facility in the northeast sector of the city. We are on a tour at Rhonda and Gerry’s request – along with another couple and a woman from Europe, whose husband will arrive later – because they did this last time and found it helped to have a picture in their minds of where the happy event would take place.

The walls in Soni’s office are covered with crayon drawings by children she has delivered; stick figures of families in roughly etched homes, holding flowers and each other’s hands. Bespectacled and almost brash, her hair carelessly pinned back into a bun, the doctor monitors surrogate pregnancies after the first 13 weeks, with seven on the go right now. She assures everybody there is no chance the surrogates will bond with the newborns while waiting for the intended parents to arrive. “We don’t give them a chance to,” she says. “There is no place for emotions here. You have to be cutthroat.” Her words may be harsh but there is softness beneath the bluster, and she gets her point across: These prospective parents need not worry about a surrogate having second thoughts.

When I ask if any surrogates have wanted to keep their babies, she tells me, “No.”
We visit the birthing rooms and the suites, complete with comfy sofas, dishes, microwaves, wireless internet and TVs, which parents can book while waiting to take their babies home. Everyone coos over an infant in the neo-natal intensive-care unit. One woman suggests that the group meet next year with their babies for a reunion. Rhonda says nothing, but over breakfast a few days later, I ask how it feels when the others say such things. She takes her time to answer. “I guess this time, I’m a little bit more wary, but I understand their enthusiasm from our first time. I remember how we felt.”

Rhonda continues, talking about how close she is with her parents and siblings. “I was speaking to my mom last night and all of a sudden, she started to cry,” she says. “She told me they were happy tears, because she’d wished on a star that we could have a child and she kissed a bracelet we bought her that she never takes off.

“My mom’s my best friend,” she continues. “We’ve been through so much, so…” Her face crumples and she starts to sob.

The day of the embryo transfer has come. Four of Gerry and Rhonda’s embryos have been prepared. The couple is at the hospital by 8:30 a.m., passing through security just in time to watch a doctor complete an intricate procedure called laser-assisted hatching, which is supposed to help the embryos attach themselves to Rekha’s womb. They know this is it, that the embryos ready to be transferred represent everything they hope for. And they imagine that one day they will be able to tell their child they were there at the start.
When they see Rekha, they notice that she is wearing an orchid in her hair and a delicate necklace they gave her. “It’s a gift from my friends,” she tells people. It makes the couple feel there is a connection to her, no matter the distance between them. During the embryo transfer, Gerry holds Rekha’s hand. Afterwards, Rekha seems tired and picks at a samosa in the hospital’s cafeteria. Prabhakar, who has taken the morning off work, says: “No tension. Only smile. God will take care.”

The next day, Rhonda and Gerry board a plane for the long flight back to Arizona. They have been home for nearly two weeks, on tenterhooks, when they get the call. The result is negative. Again. In an email to me, Rhonda writes, “I am at a loss for words.”
After a few months of grieving, Rhonda and Gerry decide to give surrogacy another try, this time with Gerry’s frozen sperm, eggs donated by a third party and a different surrogate in India. In January, Rhonda sends another email. “Our surrogate is pregnant!” she writes. The baby is due September 16.

One dream fulfilled means another one dashed. Rekha did get paid partly for her efforts, for the time she spent having hormone injections, for signing the contract with Rhonda and Gerry, and for the embryo transfer. The couple’s happiness is tempered by the fact that it is not Rekha who is carrying their child, for they had visited her house, met her family and forged a relationship. Still, they know she will be a surrogate again, and they hope someday she’ll buy her dream home.

As long as there is a need, women like Rekha will continue to be surrogates. But unlike Rekha, many of them might be coerced into doing so, or be vulnerable to exploitation. And that is why activists are urging India’s central government to pass legislation that protects both surrogates and the intended parents. According to N.B. Sarojini, of New Delhi’s Sama-Resource Group for Women and Health, the guidelines are not enough, because they are vague and dependent on the goodwill and honesty of the people using them – or not. And that is not enough.

Though it’s easy to judge these surrogacy arrangements from a distance, there is a risk of arrogance in analyzing something that is so rooted in emotion, in parental longing and the need to nurture. There are real, complicated people behind the oversimplified roles of surrogate and parents. Rhonda’s tears are real, as is her yearning to have a child she can call her own. She will be a caring and devoted mom. Gerry is fiercely protective of his wife, but he was protective of Rekha, too. And Rekha is just as fierce in her desire to give her family something it can call its own. Here, in this teeming, smog-filled city of 14 million, already so full of children, the birth of one more can make all the difference for two deserving families.

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