MOTHER JONES, Inside India’s Rent-a-Womb Business
By Scott Carney
March/April 2010
Gestational dormitories. Routine C-sections. Quintuple embryo implants. Brave New World? Nope, surrogacy tourism.
FROM ITS POCKMARKED EXTERIOR WALLS and stark interior, you’d never guess that the pink three-story building tucked in a narrow alley a few blocks from the train station in the fast-growing city of Anand houses India’s most successful surrogate childbirth business. But this is the place they raved about on Oprah. Nowadays, thanks to the endorsement of daytime TV’s leading lady, the Akanksha Infertility Clinic fertilizes eggs, implants and incubates embryos, and finally delivers contract babies at a rate of nearly one a week.
Doctor Nayna Patel, Akanksha’s founder, has just finished washing up after delivering twins by cesarean section. A team of nurses ushers me into her office from an adjoining one where I’ve had a chance to peruse a stack of press clippings lauding her accomplishments and contributions to international fertility. For the last three to four years, Patel has been the subject of dozens of gushing articles in addition to that game-changing 2007 Oprah segment, which all but heralded Patel as a savior of childless middle-class couples and helped open the floodgates for the outsourcing of American pregnancies. Patel took the publicity to the bank—autographed photos of Ms. Winfrey are displayed prominently throughout the clinic, which claims a waiting list hundreds deep and receives at least a dozen new inquiries from potential surrogacy customers each week.
The doctor, clad in a bright red-and-orange sari, sits at a large desk that covers about a third of the room. Heavy diamond jewelry dangles from her neck, ears, and wrists. Her wide grin projects a mixture of politeness and caution as she beckons me to sit in a rolling office chair. I showed up here without an appointment, fearing Patel would refuse to see me if I phoned in advance: Despite all the laudatory press, in the weeks prior to my visit a spate of critical articles had appeared, focusing on the clinic’s controversial practice of cloistering its hired surrogate mothers in dormitories. Among the claims: Akanksha is little more than a baby factory. “The world will point a finger at me,” Patel responds when I ask about the criticism. “She will point, he will point. I don’t have to keep answering people for that.”
As if to prove it, she politely evades my questions for 20 minutes, and then escorts me out. I had hoped to get her take on the residency units, but it’s not a topic she cares to discuss.
ON A QUIET STREET about a mile from the clinic, a government ration shop issues subsidized rice to an endless stream of impoverished clients. Across the road is a squat concrete bungalow enclosed by concrete walls, barbed wire, and an iron gate. Police once used the site as a storehouse for bootleg liquor captured in Eliot Ness-style raids. (Like the rest of India’s Gujarat state, Anand is a dry city.) The security measures were intended to keep away bootleggers who might be tempted to reclaim the evidence. Now the building functions as one of two residential units for Akanksha’s surrogates.
Akanksha surrogates spend their entire pregnancies within guarded residential facilities. The clinic claims they live better here than at home.
The women—all married and with at least one previous child—have traded the comforts of home to enroll as laborers in India’s burgeoning medical tourism industry. Most will spend their entire pregnancies living in this building. In exchange for the inconvenience and physical discomforts, they stand to receive a sum that’s quite substantial by their meager standards, but which the clinic’s customers understand is a steal. The customers are mostly foreigners—three of the city’s boardinghouses are constantly booked with American, British, French, Japanese, and Israeli surrogacy tourists.
After a few minutes of recon, I cross the street to the bungalow, where a friendly smile gets me past the gatekeeper. In the hostel’s main living quarters, some 20 nightgown-clad women in various stages of pregnancy lie about, conversing in a hurried mix of Gujarati, Hindi, and a bit of English. A lazy ceiling fan stirs the stagnant air, and a TV in the corner—the only visible source of entertainment—broadcasts Gujarati soaps. The classroom-size space is dominated by a maze of iron cots that spills out into a hallway and additional rooms upstairs. It is remarkably uncluttered given the number of people living here—each surrogate has only a few personal belongings, perhaps enough to fill a child’s knapsack. In a well-stocked kitchen down the hall, an attendant who doubles as the house nurse prepares a midday meal of curried vegetables and flatbread.
The women are pleasantly surprised to see me. It’s rare, one tells me, for a white person to show up here. The clinic discourages personal relationships between clients and surrogates, which according to several people I talked with makes things easier when it comes time to hand over the baby.
Through an interpreter, I tell the women that I’m here to learn more about how they live. Diksha, a bright, enthusiastic woman in her first trimester, elects herself spokeswoman, explaining that she used to be a nurse at the clinic. She left her home in neighboring Nepal to find work in Anand, leaving her two school-age children behind. She’ll use the money she makes to fund their education. “We miss our families, but we also realize that by being here we give a family to a woman who wants one,” Diksha says.
She and her dormmates are paid $50 a month, she says, plus $500 at the end of each trimester, and the balance upon delivery. All told, a successful Akanksha surrogate makes between $5,000 and $6,000—a bit more if she bears twins. If a woman miscarries, she keeps what she’s been paid up to that point. But should she choose to abort—an option the contract allows—she must reimburse the clinic and the client for all expenses. No clinic I spoke with could recall a surrogate going that route.
Diksha is the only Akanksha surrogate I meet who has an education to speak of. Most of the women hail from rural areas; for some, the English tutor Patel sends to the dormitories several times a week is their first exposure to anything resembling schooling. But they’re not here to learn English. Most heard about the clinic via local newspaper ads promising straight cash for pregnancy. (Kristen Jordan, a 26-year-old California housewife I met later, told me she opted for a Delhi clinic that recruits educated surrogates and doesn’t cloister them after she learned that some clinics hire “basically the very, very poor, strictly doing it for the money.”)
Among the justifications for cloistering the surrogates—Akanksha isn’t the only clinic doing it—is to facilitate medical monitoring and provide the women better living conditions than they might have back home. For their part, the women tell me their condition would almost certainly make them the subject of village gossip.
Even so, those who have been on the ward longer than Diksha don’t seem terribly thrilled with the whole setup. I sit down next to Bhavna, far along and bulging in her pink nightgown, with a gold locket around her neck. She looks older than the rest—tired. It’s her second surrogacy here, she tells me. Apart from occasional medical checkups, she hasn’t left this building in nearly three months, nor had any visitors. But $5,000 is more than she would make in years of ordinary labor. Mostly she just looks forward to collecting her check and being done with it.
I ask for her view of the overall experience. “If we have a miscarriage we don’t get paid the full amount; I don’t like that,” she says. But she’s thankful to be here and not at the clinic’s other hostel, a few towns away in Nadiad, which isn’t as nice. When I ask what happens after she hands over the baby, she replies that the cesarean section will take its toll. “I will stay here another month recovering before I am well enough to go home,” Bhavna says. (Not a single surrogate I interviewed expected a vaginal birth, even though C-sections are considered riskier for the baby under normal circumstances and double to triple the woman’s risk of death during childbirth. They are, however, far faster than vaginal labor—and some clinics charge clients extra for them.)
We’re joined by a second woman, who has dark brown eyes and wears a muumuu embroidered with pink flowers. I ask them whether they think they’ll have trouble handing over their newborns. “Maybe it will be easier to give up the baby,” says the second woman, “when I see it and it doesn’t look like me.”