[wvns] Surrogate Mothers: Womb for Rent

Customer service, tech support...these days we outsource everything to
India. So why not pregnancy? Here is a report on the growing number of
Indian women willing to carry an American child.

Surrogate Mothers: Womb for Rent
By Abigail Haworth
http://lifestyle.msn.com/mindbodyandsoul/womenintheworld/articlemc.aspx?cp-documentid=5835633&page=1

The midday sun is ferociously hot outside the Akanksha Infertility
Clinic, a scuffed concrete building in the small Indian city of Anand.
Crammed into a single patch of shade by the gate, a stray cow and a
family of beggars — caked so uniformly in dung-colored dust they
resemble clay models — wait out the noontime heat. Inside, the lobby
is jammed with barefoot female patients in circus-bright saris. Nurses
in white Indian tunics scuttle among them, hollering out names and
brandishing medical files. The air smells faintly of sweat and damp
cement. On the walls, blurry photos of babies and newspaper clippings
celebrate the clinic's raison d'être: "The Cradle of the World"
declares one headline.

In this case, the metaphor is also literal. The Akanksha clinic is at
the forefront of India's booming trade in so-called reproductive
tourism — foreigners coming to the country for infertility treatments
such as in vitro fertilization. The clinic's main draw, however, is
its success using local women to have foreigners' babies. Surrogacy
costs about $12,000 in India, including all medical expenses and the
surrogate's fee. In the U.S., the same procedure can cost up to $70,000.

How surrogacy came to be so popular in the choking backwater of Anand,
a dairy community with a population of 150,000 in India's western
state of Gujarat, is a long story. The short answer is Dr. Nayna
Patel, 47, the clinic's director. A charismatic woman with flowing
hair and a toothpaste-commercial smile, Patel single-handedly put
Anand on the map when, in 2003, she orchestrated the surrogacy of a
local woman who wanted to "lend" her womb to her U.K.-based daughter.
The woman gave birth to test-tube twins — her own genetic
grandchildren — and the event made headlines worldwide. Afterward,
Patel was inundated with requests for surrogacy. She now has 45
surrogate mothers on her books, mostly impoverished women from nearby
villages. Twenty-seven of them are currently pregnant, and each will
be paid between $5000 and $7000 — the equivalent to upwards of 10
years' salary for rural Indians. More than 50 babies have been born at
the clinic in the past three years, half to Westerners or Indians
living overseas.

Another example of third-world exploitation? Globalization gone mad?
The system certainly lends itself to the criticism that foreign women
unwilling or unable to pay high Western fees happily exploit poor
women at a 10th of the price it would cost back home. The system also
avoids the legal red tape and ill-defined surrogacy laws women face in
the U.S. (Not to mention that India, unlike some developing countries,
has a fairly advanced medical system and doctors who speak English.)
Or is it a mutually beneficial relationship? By some estimates, Indian
surrogacy is already a $445-million-a-year business.

Jessica Ordenes is a petite yoga-school proprietor from New Jersey.
Hot, disoriented, jet-lagged, and alone — her husband, David, will
join her in a week's time — she is sitting in an empty doctor's office
at the Akanksha clinic, sipping fresh coconut juice and waiting for
her daily hormone injection. A girlishly pretty woman with dark hair
pulled back in a ponytail, Ordenes wears a crisp green shirt and a
liberal slick of lip gloss ("to stop my lips from shriveling up in
this heat," she explains after numerous reapplications). She has come
to Anand because she felt, at age 40, that she was nearly out of time.

Unable to get pregnant but still ovulating, she spent years
unsuccessfully trying to arrange for a surrogate in the States to
carry her biological child. "I was running out of eggs, running out of
hope, and running out of patience with being treated like a number in
the U.S. system," she says. "I read about this clinic online — I felt
India was my last chance."

Ordenes arrived a few days ago, checked in to the only hotel in town
with air conditioning, and arrived within hours at the clinic, where
she began having hormone treatments to stimulate her ovaries. In about
10 days, the eggs she produces will be extracted and fertilized with
her husband's sperm. Two days after that, if all goes according to
plan, some of the resulting embryos will be implanted into local
surrogate Najima Vohra, a 30-year-old mother of two. Ordenes knows
very little about the woman she hopes will carry her baby. She has met
her only once, during a short session with Patel on the first day.

Ordenes is not childless. She had a daughter at age 20 with her first
husband, but her uterus became infected after a C-section, and she had
to have it removed. Her marriage ended soon after. Three years later,
she met David, a pharmaceutical executive and the love of her life.
Not being able to have a baby with him tormented her. "I come from a
huge family, and I always wanted a house full of kids," she says.
Ordenes hoped for at least one child with David "to make our union
complete."

The couple, who live in a sprawling house in the suburbs, started to
think seriously about surrogacy seven years ago. Ordenes tried local
agencies but learned that willing candidates were scarce because New
Jersey state law decrees that surrogates cannot receive payment. She
found herself languishing on waiting lists and frustrated by potential
surrogates who backed out. "It was the most demoralizing experience of
my life," she says.

As she sits in the empty doctor's office, a young Indian man wearing a
red T-shirt and stonewashed jeans enters the room. Without a word, he
proceeds to stick a needle in Ordenes's arm and fill a syringe with
her blood. She looks up at him quizzically — she has no idea who he
is. After he leaves, she examines the livid red dot left behind on her
skin for a second, then shrugs. "So anyway, the years disappeared, and
now, as you can see, here I am in India."

The temperature at 9 a.m. the following morning is pushing a
brain-melting 107 degrees. Najima Vohra, immaculately dressed in an
electric-blue tunic-and-pants set, arrives at the clinic an hour early
for her meeting with Ordenes so they can bond a bit more before the
procedure begins. It's not the most intimate venue, but Vohra is
uncomfortable being seen anywhere else — like most women here, she
plans to keep her surrogacy a secret. Vohra is slim, and her long hair
is tied back with a plain rubber band. "I couldn't wait to get here,"
she says through a translator, sitting in a plastic chair in the
lobby. "I've been so excited since Dr. Patel chose me to be a
surrogate that I haven't been able to sleep."

Vohra says she's not ashamed of being a surrogate, but most locals are
very traditional and don't understand. "They think it's dirty — that
immoral acts take place to get pregnant," she whispers, explaining
their disbelief that she could conceive a child without having sex.
"They'd shun my family if they knew." Vohra comes from a village 20
miles outside Anand, but she has temporarily moved to the town with
her husband and two children, a 12-year-old daughter and a 7-year-old
son, to hide what she is doing. "We told our neighbors we were coming
here for work, which is not strictly a lie."

Vohra has no job but helps her husband in his scrap-metal business,
for which they earn 50 to 60 rupees ($1.20 to $1.45) a day. If her
pregnancy is successful, the $5500 she receives will, as she puts it,
"give my children a future."

Growing up, Vohra worked in the wheat fields; she had little
education. After her parents married her off at 16, she moved with her
husband into a one-room mud house that erodes every year during the
monsoon season. She plans to divide her surrogacy windfall three ways:
buying a brick house, investing in her husband's business, and paying
for her children's education. "My daughter wants to be a teacher," she
says. "I'll do anything to give her that opportunity.

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"I'm fit and strong, and I've already given birth twice," she
continues, scoffing at the idea of being nervous. And yes, she's
mentally prepared to hand over the baby. "It won't even have the same
skin color as me, so it won't be hard to think of it as Jessica's."
The clinic stipulates that all surrogates must already be mothers so
they understand what's involved physically and will be less likely to
become emotionally attached to the babies they bear.

Of course, it's impossible for Vohra to know how she will feel after
she gives birth — this is the wild card, the reason custody battles
sometimes ensue in the U.S. All surrogates at the clinic sign a
contract agreeing to hand over the baby — which reassures prospective
parents, but also supports arguments that the women, many of whom are
illiterate, are being taken advantage of. (In the U.S., only a handful
of states regard presigned contracts as legally binding. In others, a
surrogate has a small window of time after birth to stake her claim to
parental rights.)

Vohra sits in silence for a while and examines her cracked
fingernails. "If I do feel sad after the birth, I won't show it," she
says eventually. "I can understand how much Jessica wants this baby."
In India, she explains, infertility is considered a curse.

Ordenes arrives at exactly 10 a.m., having hired her own car and
driver to help navigate the belligerent scrum of auto rickshaws,
rusting buses, and camel carts in downtown Anand. She walks over and
hugs Vohra, ignoring the custom that discourages lower-caste Indian
women from interacting with those outside their group. Vohra smiles.

Ordenes has brought her own interpreter, a female student from the
local college recommended by the clinic, since Vohra doesn't speak
English. However, when they find an empty ward upstairs and sit on the
beds to talk, the women struggle for words. It's as though they both
realize the gap between their lives is so vast, there's simply no
sensible place to begin.

Ordenes feels her way with some questions about Vohra's kids, then
fills her in on her latest ovum count — a topic that consumes foreign
patients while they're here, since their sole contribution to the
pregnancy is healthy eggs. (Surrogates' own eggs are never used.)
Ordenes has produced six eggs so far, but two need extra time to
mature. She takes Vohra's hand and squeezes it and promises to look
after her during the pregnancy. "You're my angel, you're my angel,"
she coos and hugs her again. Then Ordenes gets out her camera to take
photos to send to her husband.

Patel's office is a gloomy, narrow room with a computer at one end and
an ultrasound machine behind a fraying living-room curtain at the
other. Her enormous desk sits in the center, piled high with papers.
The room is constantly packed with nurses, patients, and anyone else
who cares to wander in — nobody ever knocks before entering.

Making her rounds of the upstairs ward, where pregnant surrogates have
been admitted for monitoring, Patel says the business has taken off
beyond anything she imagined. She has about 150 foreign couples on her
waiting list, and every week three new women apply to be surrogates.
She works 14-hour days and insists she's only involved in surrogacy
because there's a genuine need. "I accept patients who have an
established infertility problem," she says. "I've had some women ask
to do surrogacy because they don't want to give up work for a
pregnancy, but I turned them down flat."

All the same, Patel admits there are dangers if the surrogacy business
continues to grow in India. "There is little regulation by the Indian
Medical Council, the body that oversees such practices," she says.
"Rules need to be tighter to ensure women are not exploited."

As a guest speaker at many international infertility conferences,
Patel isn't fazed by the foreigners who beat a path to her door —
including clients from Taiwan, Japan, the U.S., Europe, and Australia.
But she refuses to treat gay couples, revealing her deeply
conservative cultural roots. "I get e-mails from gays and lesbians,"
she says, "some of them very well written — but I don't feel right
about helping them." The people she does feel good about helping are
the local women — the surrogates — so long as they're not being
coerced by their husbands or in-laws eager for a paycheck. "I must be
certain it's a woman's own decision," she explains. "If there's any
sign of tension or unwillingness, I spot it straightaway." Patel also
helps to ensure each woman keeps control over her fee. "For example,
if she wants to buy a house, we'll hold her money for her until she's
ready. Or if she wants to put it in an account for her children, we'll
go with her to the bank to set up the account in her name." The money
gives many women their first taste of empowerment.

Achieving that financial freedom is hard work. In one of the wards,
Sofia Vohra (no relation to Najima), 35, is lying in a room with three
beds, an ancient ceiling fan, and wall paint that has bubbled in the
heat like a nasty rash. She is about to give birth for the sixth time,
to a baby she's carrying for a couple living in the U.S. She has five
children of her own, a husband who's a lazy drunk, and a job crushing
glass that's used in making (of all things) fortified kite string, for
which she earns $25 a month. She became a surrogate for no other
reason than to pay for her two daughters' dowries, an illegal — but
still widely practiced — Indian marriage ritual.

"I'll be glad when this is over," she says, as Patel places a
stethoscope on her ballooning brown stomach. "It's exhausting being
pregnant again." Then, in case her complaints are misunderstood, she
quickly adds, "This is not exploitation. Crushing glass for 15 hours a
day is exploitation. The baby's parents have given me a chance to make
good marriages for my daughters. That's a big weight off my mind."

It's lunchtime on Thursday, and the clinic's surrogate mothers crowd
into a small room where the staff is throwing a party. Among them is
30-year-old Rubina Mondal, a former bank clerk with long, straight
black hair, dressed in a red sari fringed with gold. In February, she
gave birth to a healthy boy for a couple from California.

Mondal heard about Patel's clinic on a TV show, and traveled to Anand
from her home in the eastern city of Kolkata. Her reason was purely
economic: Her 8-year-old son, Raj, has a hole in his heart, and
working as a surrogate was the only likely solution to covering his
expensive medical care. Patel matched Mondal with Karen, a 33-year-old
who works for a mortgage lending company in Los Angeles.

Karen and her husband, Thomas, wanted children, but she had been
diagnosed with a uterine tumor at age 16 and knew someone else would
eventually have to carry the baby. Mondal conceived on the first try.
Over the next eight months, Karen called every week from the States to
hear news of her growing child. On top of the surrogacy fee, Karen
paid for a spacious two-bedroom apartment in Anand for Mondal's
family, hired a cleaner, and sent care packages containing cotton
pajamas and panties for Mondal and toys for her two sons.

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Five weeks before the baby was due, Karen flew to India and moved in
with Mondal so they could go through the final weeks together. "Karen
became like my sister," says Mondal. Patel delivered the baby boy,
Brady, at the clinic.

Like Ordenes, Karen had tried to find a surrogate in the States. "Some
of the women were nice, but we just didn't click," she explains. As a
Buddhist, Karen thought she'd have an affinity with India's shared
beliefs in fate and karma. She also connected with the warmth of
Mondal and the clinic. "The people were honest and real," Karen says.

She bristles at those who suggest that she chose India because it was
hassle-free. "Some people made it out like we went grocery shopping
and came back with a baby," she says. "But being in India was tough —
the heat, the mosquitoes, worrying about Rubina and the baby's health.
You have to want a baby real bad to deal with this kind of arrangement."

Karen e-mails Mondal photos of Brady every week, and she plans to
bring her to the U.S. for her son's first birthday next year. "I want
Brady to have a relationship with the woman who carried him for me,"
she says. Meanwhile, she has embarked on a second surrogacy. Najima
Vohra's sister, Razia, is 10 weeks pregnant with a sibling for Brady.

Karen's story gives hope to Ordenes. Ten days after her arrival, she
learns that the latest ultrasound has revealed eight healthy eggs —
good news, seeing as more eggs mean a greater chance of producing
viable embryos to implant in Vohra. Still, the odds are iffy: For a
younger couple, the chances of a surrogate conceiving are 30 to 40
percent, but that drops to 15 to 20 percent for someone Ordenes's age.

As excited as she is about the prospect of Vohra's pregnancy, Ordenes
isn't sure she can stick around for the embryo transfer — Patel has
scheduled it for the following week. "I really want to stay to be with
Najima," she says, "but I need to get home because I've arranged to
have my basement renovated." She quickly realizes how that sounds and
adds a qualifier. "Well, you know, good workmen are very hard to find.
And the renovations are for the baby."

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