Surrogacy Bill welcome, but implementation will be big task: Doctors

Bengaluru: While the passing of the Surrogacy (Regulation) Bill 2016 seems to be an accomplishment, it still appears to have a long way to go before actually accomplishing its purpose. The bill, passed in the Lok Sabha on Wednesday by a voice note, may have overlooked the issue of implementation, experts said. The bill aims to bring strict controls over surrogacy and intends to protect women from exploitation. But activists believe that the Bill’s analysis reveals that it has focused a bit more on the first aspect than the second.

Monitoring commercial surrogacy
The Bill proposes to put an end to the monetary aspect by banning commercial surrogacy and allowing only altruistic surrogacy. But monitoring it can be a challenge for the government. Usually, a surrogate rents her womb to a childless couple and earns anywhere between Rs 4 lakh and Rs 12 lakh, varying from clinic to clinic and depending on the city, an expert said. But there is no data on the exact amount charged. Some activists said that surrogates get only a small amount, while clinics and middlemen make most of the money. Over the years, it had turned into a business for many. Commercial surrogacy is defined any surrogacy arrangement where the surrogate mother is compensated for her services beyond reimbursement of medical expenses. Dr Sylvia Karpagam, a public health doctor and researcher, said, “Surrogacy has several medical, psychological, financial, ethical and legal implications. With the rampant commercialisation of private healthcare in India and the booming medical tourism (now fertility tourism), unethical surrogacy practices can go underground putting women at more risk. For instance, in spite of the Transplantation of the Human Organ Act, unethical practices continue and often come to light only when something goes wrong.” There is also the hindrance of tracking the frequency of surrogacy. Commenting on how one-time surrogacy can be regulated, Ms Sarojini N., founder of Sama Resource Group for Women and Health, said, “Implementation is always an issue in our country. There are laws and a board that will take care of it, but how they will they manage to implement bring it is the question.”

Does not cater to all
Activists claimed that the Surrogacy Bill fails to adequately address certain gaps. Ms Sarojini said that the bill allows only heterosexual, married couples to seek commercial surrogacy and only married women with the consent of their respective husbands to act as surrogates. “These conditions are highly discriminatory. It also denies surrogacy to single, queer and couples who are in live-in relationships and allows only altruistic surrogacy by a close 
relative. However, the Bill nowhere defines ‘the close relative’, which leaves many confused,” she said. She said that the Bill also doesn’t define the embryo count, which is the number of embryos to be implanted in or retrieved from a surrogate. If not done in the amount prescribed,  it can have serious  consequences on the health of the woman.

Patriarchal pressure
Ms Sarojini said that surrogacy has two major concerns to it – one, an opportunity to earn an income and another, the exploitation of women. The Bill was necessary as surrogacy arrangements are mainly in the private sector. However, proposing altruistic surrogacy as the only solution is not right as the close relative may also not have a choice in a patriarchal society or family, she said. Dr Karpagam said that the absence of a definition of what constitutes a “close relative” and how that could affect the genetic outcomes in the baby are not well addressed. “The Bill has to uphold a woman’s right to decide about her body without any form of social and economic coercion. The psychological and medical aspects of surrogacy have to be addressed. Earlier, even the death of the woman during pregnancy was not registered as a maternal death. Surrogacy is now a booming industry in the country and regulating it will require major financial, social and policy commitment. Otherwise, it will only be another piece of poorly implemented legislation,” she said. While Ms Sarojini stressed that it is important to look at the broader perspective than just remuneration for surrogacy, which includes a woman’s ability to make informed decisions about their reproductive autonomy, their right to health and control over their reproduction.