“Fortunately, we had no major problem during the lockdown,” said Dr Samit Shekar, owner of Kiran Infertility Centre in Bengaluru. “Some of our babies did have to wait for their parents to come from different towns to pick them up. But it was not a big issue. They were safe with us until the intending parents or the guardian appointed by them came and took charge.”
Dr Shekar owns busy infertility clinics in Bengaluru, Hyderabad and Chennai. He also has some tie-ups abroad. Some years ago, when fertility treatment in India was available to people from all over the world, his clinics, like most other reputed infertility centres, were full of couples from abroad. But fortunately, when the pandemic hit, the ban on foreign couples seeking fertility treatment in India was in place and there were no babies waiting for parents from abroad to come and pick them up.
Dr Samit Shekar
Similarly, Dr Nayana Patel’s upmarket Akanksha IVF and Fertility clinic in Anand, Gujarat is always buzzing with activity. But now there are no international clients. Dr Patel said that during the lockdown, 28 babies were delivered in the hospital. They all belonged to Indian parents. “They had separate nannies and caretakers,” she said. “Video calling to their parents was done every afternoon between 2 and 3 pm. Alternate nurses were available for babies in the Neonatal Intensive Care Unit (NICU). All the parents came and picked up their babies according to their convenience. Right now, all the babies are with their parents.”
While discussing the lockdown and surrogacy, Dr Patel said that becoming a surrogate would help women who had lost their jobs during the pandemic. It could become an economy booster, she said, and suggested that instead of banning compensated surrogacy, India should open it up once more to everyone including OCIs (Overseas Citizens of India).
Dr Nayana Patel
Dr Shekar pointed out that the profile of surrogates and egg donors was changing. Many educated women who were working in various professions like the hospitality or travel industry had lost their jobs. They were now coming forward to donate eggs or become surrogates.
Dr Nirmal Bhasin’s Jannee Fertility Centre in Chandigarh is as busy as usual. She had to put in vitro fertilisation (IVF) cases on hold for two months in the beginning. “People were actually waiting for us to restart,” she said. “Now the regular cases have started coming in again, including surrogacy. Since we didn’t have any NRI patients during that time no one suffered. I heard babies were stranded in Ukraine and some other countries as well.”
The Ukraine surrogacy story could very well unfold in India if the fertility industry is pushed underground or if unregulated fertility tourism is allowed again. It highlights all that can go wrong when a surrogacy programme gets cancelled due to unforeseen calamities. If it was the pandemic that created the problem in Ukraine, in Nepal it was a major earthquake a couple of years ago. When calamity strikes, the babies and the surrogates become collateral damage.
Ukraine has a flourishing fertility industry built around the availability of a large pool of poor women who are ready to rent out their wombs and sell their eggs as a means of livelihood. While the laws in Ukraine are fairly liberal, they prohibit surrogacy for same sex couples. To circumvent this, surrogates carrying babies for same sex couples travel to neighbouring countries or splinter states like Northern Cyprus or Abkhazia and even parts of Russia where the laws on surrogacy are either lax or don’t exist. They get impregnated there and return to Ukraine where they stay till they come to term. Then they go back again to deliver their babies and hand them over to the intending parents.
In Northern Cyprus, Ukrainian mothers do not have a legal surrogacy contract. They are obliged to renounce custody of the child after birth and the intending parents have to adopt the children. This is a rather lengthy legal process. When the travel bans kicked in because of the pandemic outbreak, some Ukrainian surrogates who were afraid of getting stranded fled from Cyprus without handing over the babies to their future legal guardians. Since the legal guardians also could not travel, the babies were left in a limbo. Some of the surrogates who ran away spoke to the press about the miserable conditions in which they were kept and about the babies they were forced to leave behind because they had no means to support them. A public fight broke out between the agents who had arranged these cross-country surrogacies and the surrogates who fled. This in turn blew the lid off an illegal industry that had managed to operate underground for quite a while.
According to some estimates, last year alone 3,000 surrogates had travelled out of Ukraine to give birth and another 30,000 had gone to donate eggs. A surrogate’s remuneration in Ukraine is about US $15,000, paid after delivery. Egg donors get about 350 Euros per time.
Meanwhile in Ukraine itself, authorities said that in May at least 100 babies commissioned by foreign parents could not be picked up. They expected that as many as 1,000 babies may be born before Ukraine’s travel ban was lifted. The 15 odd agencies in Ukraine that offered these IVF packages were literally left holding the babies.
The ban in India on providing fertility treatment and surrogacy services to international clients meant a loss of revenue for the infertility clinics here. But under the given circumstances, in a way it proved to be a boon. When I was researching for my book Baby Makers a couple of years ago, these same clinics were full of foreign clients. Fertility tourism was booming in India then. American, European, Australian, Asian, African couples from all over the world came to India for fertility treatment. When it came to an abrupt halt, clinics catering exclusively to foreign clients closed and many would-be parents were left in the lurch.
An NRI doctor from Bengaluru, who spoke to me on condition of anonymity, told me about his checkered and expensive search for a surrogate to carry his child. When he started off, the ban on foreign passport holders had not yet come into force in India and so he was in talks with a fertility clinic in Mumbai. Since he is single, his plan was to have a baby through a surrogate and leave it in the care of his family in Bengaluru for a while until it was old enough to travel with him. But before he could finalise his project, the ban was imposed and it became impossible for him to legally avail of the surrogacy services in India. One agency suggested he could fly out an Indian surrogate to a country where the laws were grey, get the fertility treatment done and fly her back. He could use donor eggs from another country where egg donation was legal. But there was a hitch. For the purpose of adopting the child after it was born in India, he would have to declare that he was legally married to the surrogate.
He then spoke to agents in Ukraine, but as a single man he could not legally avail of their fertility services and he was unwilling to go the illegal way. Finally, he settled on getting it legally done in the US as he was an American citizen. But he ran into one more final glitch. The surrogate he hired had an abortion and he lost the only two viable embryos he had created with great care.
Bengaluru which has a couple of reputed infertility clinics was at one time a favourite destination for NRI couples. Today the clinics continue to provide fertility treatment, but only to people from within India and NRIs with Indian passports.
Meanwhile, fertility clinics all over the country continue to do booming business. According to a new report published by Allied Market Research in 2020, the India IVF services market size was valued at $478.2 million in 2018 and is estimated to reach $1,453 million by 2026, registering a compounded annual growth rate of 14.7% during the analysis period. Which also indicates that while the ban on foreigners might have chipped away at the revenue of IVF clinics, the fact remains that the bulk of those going in for fertility treatment come from within the country.
Gita Aravamudan is a journalist and the author of Baby Makers: The Story of Indian Surrogacy.
Views expressed are the author’s own.