Latest job outsourced to India: giving birth

ANAND, India — Every night in this quiet western Indian city, 15 pregnant women prepare for sleep in the spacious house they share, ascending the stairs in a procession of ballooned bellies, to bedrooms that become a landscape of soft hills.

A team of maids, cooks and doctors looks after the women. The young mothers of Anand, a place famous for its milk, are pregnant with the children of infertile couples from around the world.

The small clinic at Kaival Hospital matches infertile couples with local women, cares for the women during pregnancy and delivery, and counsels them afterward. Anand's surrogate mothers, pioneers in the growing field of outsourced pregnancies, have given birth to roughly 40 babies.

More than 50 women in this city are now pregnant with the children of couples from the United States, Taiwan, Britain and beyond. The women earn more than many would make in 15 years. But the program raises a host of uncomfortable questions that touch on morals and modern science, exploitation and globalization, and that most natural of desires: to have a family.

Experts say commercial surrogacy — or what has been called "wombs for rent" — is growing in India. While no reliable numbers track such pregnancies nationwide, doctors work with surrogates in virtually every major city. The women are impregnated in-vitro with the egg and sperm of couples unable to conceive on their own.

Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment.

Critics say the couples are exploiting poor women in India — a country with an alarmingly high maternal death rate — by hiring them at a cut-rate cost to undergo the hardship, pain and risks of labor.

"It raises the factor of baby farms in developing countries," said Dr. John Lantos of the Center for Practical Bioethics in Kansas City, Mo.

Kaivel Hospital's surrogates are aware of the risks because they've watched others go through them. Many of the mothers know one another, or are even related. Three sisters have all borne strangers' children, and their sister-in-law is pregnant with a second surrogate baby. Nearly half the babies have been born to foreign couples, while the rest have gone to Indians.

Ritu Sodhi, a furniture importer from Los Angeles who was born in India, spent $200,000 trying to get pregnant through in-vitro fertilization, and was considering spending another $80,000 to hire a surrogate mother in the United States.

"We were so desperate," she said. "It was emotionally and financially exhausting."

Then, on the Internet, Sodhi found Dr. Nayna Patel's clinic.

After spending about $20,000 — more than many couples because it took the surrogate mother several cycles to conceive — Sodhi and her husband are back home with their 4-month-old baby, Neel. They plan to return to Anand for a second child.

Patel's center is believed to be unique in offering one-stop service. Other clinics may request that the couple bring in their own surrogate, often a family member or friend, and some place classified ads. But in Anand the couple just provides the egg and sperm and the clinic does the rest, drawing from a waiting list of tested and ready surrogates.

Young women are flocking to the clinic to sign up for the list.

Suman Dodia, 26, said she will buy a house with the $4,500 she receives from the British couple whose child she's carrying. It would have taken her 15 years to earn that on her $25 monthly salary as a maid.

Dodia's own three children were delivered at home, and she said she never visited a doctor during those pregnancies.

"It's very different with medicine," Dodia said. "I'm being more careful now than I was with my own pregnancy."

Patel said she carefully chooses which couples to help and which surrogates to hire. She accepts only couples with serious fertility issues, such as survivors of uterine cancer. The surrogate mothers have to be between 18 and 45, have at least one child of their own, and be in good medical shape.

Like a fertility reality show, a rotating cast of surrogate mothers live together in a home rented by the clinic and overseen by a former surrogate mother. They receive their children and husbands as visitors during the day, when they're not busy with English or computer classes.

"They feel like my family," said Rubina Mandul, 32, the surrogate house's den mother. "The first 10 days are hard, but then they don't want to go home."

The surrogate mothers and the parents sign a contract that promises the couple will cover all medical expenses in addition to the woman's payment, and the surrogate mother will hand over the baby after birth. Most couples end up paying the clinic less than $10,000 for the entire procedure, including fertilization, the fee to the mother and medical expenses.

Counseling is a major part of the process, and Patel tells the women to think of the pregnancy as "someone's child comes to stay at your place for nine months."

Health experts expect to see more Indian commercial surrogacy programs in coming years. "People are accepting it," said Dr. Indira Hinduja, a prominent fertility specialist who was behind India's first "test-tube" baby two decades ago. "Earlier they used to be ashamed, but now they are becoming more broad-minded."

The industry is not regulated by the government. Health officials have issued nonbinding ethical guidelines and called for legislation to protect the surrogates and the children.