Stricter laws to regulate the misuse of surrogacy services and elimination of middlemen, who mint money out of someone else’s plight, is definitely a good move. But experts feel the Surrogacy (Regulation) Bill, 2016 has many clauses which need a relook. The joy of parenthood seems to have been snatched from many couples who exercise this option. Last week the bill was approved by Union Cabinet claiming it would prevent exploitation of poor women as substitute mothers. But many others will have to pay the price.
Forty-year-old Kalpana, who has had 16 abortions in twenty years, trying to experience motherhood, naturally is distraught at the idea of not being able to conceive. “We both (my husband and I) don't have any problem but still I cannot conceive,” she said.
“The government needs to understand the desperation of couples like us and we should not even be brought under the scanner of the legalities that need to be fulfilled,” adds Kalpana, who still hopes of being a mother through a surrogate.
“My dream of being a father has been thwarted, thanks to the new bill, which allows eligible couples to turn to close relatives. It will cause a lot of problems for couples like us, who would not even get a nod from a relative because of various reasons,” said Azhar (40), whose wife has been diagnosed with tuberculosis in the endometrium. This is a condition which reduces to zero her chances of conceiving.
Azhar has been married for only three years and so according to the bill he would have to wait for another two years. “I don't understand why I should wait for another two years when the clinical indications suggest that the window is really small,” he added.
These are just two examples, but there are many couples who are appalled by the new bill. At a time when they are coming out of their shells and looking towards commercial surrogacy as the last option, the bill is only making them go back into their shells.
Dr Harshita, Consultant at Manipal Ankur in Kalyan Nagar, who is also a consultant at Medikoe, shares her experience at CRAFT Hospital and Research Centre in Kerala. She was a consultant there earlier. She said that some nine surrogates are at the hospital at any given time of the year, where they are admitted after they conceive. They are taken care of till they deliver their babies.
“The issue of altruistic surrogacy is meaningless and in times when it is anyway becoming very difficult for commissioning parents to find surrogates, the passage of such Bills will only close that last option for them,” she added, who is currently helping a few such couples with other options as well.
“Certain cases should be allowed to go for commercial surrogacy and also a clinician's viewpoint should be invited when it comes to passing certain Bills,” Dr Harshita asserted. “The whole business of waiting for five years is unfair. What if the woman does not have a uterus? It will not grow back in five years. Such Bills need to involve medical professionals, so that they are more acceptable to society,” said Dr Kamini Rao, medical director, Milann, The Fertility Centre.
Dr Kamini raises another point. “No Surrogacy Bill can be passed without Assisted Reproductive Technologies (Regulation) Bill. Both need to be passed together. When there is already a 2014 draft Bill on ART, which has gone through debates, why can’t the government pass this Bill? As far as the Surrogacy Bill is concerned, it needs to be debated by the public,” she said. “The whole part about regulation is fine, because of misuse. I'm not against regulation of surrogacy, but it should be fair to all the sides,” she said.
“In the current format, it should not be passed as a law because it would be unfair to people who really merit the need. The ‘relative’ clause is definitely not needed and is flawed, as no relative would do it without money. That ‘relative’ clause should be removed. And, whoever is willing to come forward should be accepted,” she added.
Dr Manisha Singh, HOD, Infertility and reproductive medicine and surgery, Fortis hospital, Bannerghatta, who stresses the need for proper framework and guidelines for the ART Bill.
“The surrogacy and gamete donation Bill cannot come out in isolation and outside the framework of the ART Bill. We should have proper ART laws that need to be put in place and establish a proper framework for ART and then look at surrogacy,” she maintained.
As per the Surrogacy (Regulation) Bill passed by the Union Cabinet last week, only married (for at least five years) resident Indian couples who are infertile can opt for surrogacy as a means of extending their families. Only an immediate family member can be the surrogate in an ‘altruistic surrogacy’ (in which no money changes hands).
Further, the woman has to be between 23-50 years of age and the man should be 26-55 years old. It bans commercial surrogacy. The health ministry has proposed to amend the surrogacy laws in India because of increase in commercial surrogacy.
Altruistic surrogacy: Is it practical?
Altruistic surrogacy is when a surrogate gets no financial gain for carrying a child. This is another clause added to the Bill. Sadly, altruistic surrogacy would cause more social problems, said experts.
“Altruistic surrogacy would cause more social problems as the child grows, as the surrogate would be within the same family,” said Dr Harshita, Consultant, Manipal Ankur in Kalyan Nagar.
The doctor, who is also a consultant at Medikoe, added that the child would have issues being in the house where there is one woman who carried him for nine months and another who is raising him.
“Many of them don't want to be surrogates and they will be forced into surrogacy, which would not be a healthy thing, as it would pose bigger problems in the future. You cannot liberate one woman by suppressing another woman,” said Dr Kamini Rao. She raises another point. "What if you do not have a sister or a sister-in-law?”.
“Do you really think a relative would actually come forward willingly to be a surrogate without any kind of remuneration?” asks Manisha Singh, HOD infertility and reproductive medicine and surgery, Fortis hospital, Bannerghatta hospital.
Offering a solution, Dr Manisha highlights the need of the hour.
“Sadly, infertility in India is considered to be taboo, unlike in the West where issues such as this are discussed freely. Such couples should not be made to feel that infertility is a disability to be shy about. Such laws could harm them emotionally. And patients and patient support groups should come out and speak about their problems. They should reach out to the public and sensitize society as a whole.”
Let society be the judge: Dr H Sudarshan Ballal, Chairman, Manipal Hospitals
The recently introduced Surrogacy Bill has brought in the Debate on Altruism vs Commercial Medical Procedures involving paid donors. The bill brings in a lot of preconditions on surrogacy and essentially forbids paid surrogates. This is very similar to the Human Organ Transplant Act, which forbids commercial donation.
Surrogacy is a procedure where couples or individuals unable to have a child for various reasons have the embryo fertilized by the sperm of the partner and implant this in a surrogate, who then carries it in her womb for nine months. This is usually done by couples who are infertile for various reasons, single parents, those who wish to be single parents and same-sex couples.
Though there is an option of adoption in these cases, some opt for this method because of the joy and fulfillment of having one’s own child. In many cases in our country, in the absence of an altruistic surrogate, a paid surrogate is used.
In surrogacy the surrogate carries the baby in the womb for nine months and the childbirth may be natural or may need a caesarean section for delivery (the rates of which may vary between 20 and 40% depending on the clinical situation). It is also to be noted that many surrogates are older and might have had children of their own earlier, and this may increase the risk.
Though pregnancy is considered a safe physiological event, unfortunately there is a small risk of serious complications, including mortality, as evidenced by the death of versatile actresses Smita Patil in 1986 due to postpartum complications.
The risk of complications post-pregnancy (some minor and others major) may be in the range of 10 to 20% and the overall maternal mortality in our country is about 174 per lakh, depending on the risk factors and the need for Caesarean section.The risks are certainly higher for rural impoverished women in developing countries.
All in all, surrogacy is a very beneficial medical procedure, and can be a huge psychological boost for a childless couple. Unfortunately, surrogacy may happen for non-altruistic reasons; money may exchange hands, middlemen may be involved and exploitation of the impoverished does happen.
The million dollar question that we should seek an answer for is: Is renting a womb, even if it gives happiness to a childless couple (with somewhat low risk of serious complications to the surrogate), socially, medically and ethically justified?
Though all of us would condemn the exploitation of impoverished citizens by middlemen, civil society should debate, deliberate and come up with an answer to this question, which to me is certainly a burning issue right now.
