In a cramped bylane off Station Road in Anand, men camp beneath the banyan tree, or perch on a bench waiting for their women to complete their business at an adjacent clinic. Foreigners and Indians, all couples, are dropped off by taxis at the entrance, husbands holding wives by the hand. India's cooperative milk capital has also turned into its surrogacy hub: The Sat Kaival Hospital and Akanksha Infertility Clinic run by Dr Nayana Patel, 55, and her husband Hitesh, 57, churns out 30 babies on average every month.
Surrogate No. 500, a 28-year-old single mother of two, delivered a baby girl here on August 5, an inadvertent milestone in the now routine comings and goings of cooperative commerce. Four days later, she sees the baby for the first time at the behest of the sponsoring parents, who are from Lucknow. She does not recognise the newborn from a series of photographs. "If it's a girl, it must be mine," she says, blankly.
Every turn on a road in Anand bears jagged signifiers of a township straining towards modernity. A chariot vendor is down the road from a gun store. Past the Subway franchise is the mandatory Amul outlet, selling shrikhand and the local mithai kaju katri from the 6.5 million kg-a-day cooperative milk union movement launched here in 1946 by Verghese Kurien.
While the world knows Anand, a town of 1.8 million, for the White Revolution, many other revolutions have since jostled for space here. There are 66 higher education institutes and two universities. The town is also an industrial engineering and emerging ship-building hub booming with the opening of the Khambhat port nearby. But it is hospitals, the Shankara Eye Hospital, the spanking new Zydus multi-speciality facility on the city outskirts and the multitude of medical agencies pharmacies, private nursing homes and clinics that drive its medical tourism. You won't find it mentioned in the 'Vibrant Gujarat' roadmap for Anand district but as far as cooperative movements go, the town offers up the mother of them all: Surrogacy.
The landmark Jan Balaz vs Union of India case, also involving Dr Patel's clinic, saw Indian citizenship being conferred on the twin babies and the due process of adoption followed. These pioneering cases conferred the surrogacy capital status on Anand.
The number of babies delivered at Dr Patel's clinic is 680 and counting. But a new draft bill in the making could remove surrogates from direct employment with the fertility clinic and put them under the influence of a surrogate agency.
Key features of the bill include:
- Surrogates must be in the age bracket 21-35.
- No surrogate should undergo implantation cycles more than three times for a couple.
- If married, a surrogate should receive consent of her spouse.
- Only Indian citizens can be considered for surrogacy.
- Surrogate mother must relinquish all filial rights over child.
- Parents must accept the child born of the surrogacy.
- IVF will be separated from surrogacy requirements, which will be outsourced to specialised agents.
Dr Patel wishes the Government engaged more with surrogates and doctors at the local level. "The Government is saying it will trust an agent, who may or may not be educated or humane towards surrogates, but not doctors. Why?" she asks. "I wonder sometimes, if there were two children, a girl and a boy, and they didn't want the boy, could I take him home?" says Suman, 32, six months pregnant and carrying twins. She was impregnated with quadruplets and two were terminated. She hasn't been home in five months though her three daughters, Niddhi, 7, Nisha, 9, and Nirali, 11, visit her often. Suman is carrying plastic dolls she bought for them from the market today.
The Eid festive air is accentuated at Mehrau village, 11 km from Anand, as villagers come out to wave, cheer and ask Suman how her pregnancy is going. Only one home in the village, that of a lawyer couple, refuses to participate. "Are the people who talk going to put food on my plate? I have not done anything wrong, so what is there to hide?" Suman asks as her children clamber all over her. She needs the money. Her husband earns Rs.100 a day as a labourer in the nearby fields.
Dr Patel has fought varying levels of social opposition since 2005, when she began her surrogacy programme. A third of the children born here have gone to Indian couples, another third to NRIs and the others to foreigners from over 34 different countries. All surrogates in the clinic are below 35 and mothers to at least one child of their own. They are required to meet minimum health requirements or are otherwise "nutritionally fortified". The husband's consent is mandatory in case of couples.
Dr Patel is now building a 100,000 sq ft hospital on the outskirts of the city that will accommodate would-be parents, surrogates, IVF facilities and neonatal units next to a vocational institute. While that is slated for a March 2014 launch, for now she must flit between Surrogate House, the designated home for surrogate moms, multiple hospitals, standalone neonatal units, and her clinic. Since her first IVF case in 1999 that yielded baby Akanksha, after whom the clinic is named, Dr Patel has been a life-giving, family-saving benefactor. It is in her genes: Her late mother, a social worker and corporator in Rajkot in the 1950s, was herself a fierce advocate of women's rights.
At the clinic, a jet-lagged Portuguese-speaking couple from Angola, the second to arrive here from that country, nervously alights from a car. The woman, 34, lean, beautiful, her face strained with emotion, has just lost her baby and her uterus to complications. "Can we use more than one surrogate?" she asks, in halting English. At the door is Tajima, a 34-year-old Japanese woman who lost her uterus to nuclear radiation-linked cancer a few years ago. Her baby had just been born the previous day and is in neonatal ICU at Zydus hospital.
That evening, Dr Jagdish Prasad, the director general of health services, has circulated a Cabinet note on the Assisted Reproductive Technology (Regulation) Bill announcing a firm intention to disallow surrogacy for foreigners, on the back of the Ministry of Home Affairs already banning same-sex couples and single parents of foreign origin. At Akanksha clinic, prospective parents, with their heads bent over reports, medication and bills, ignore the news flashing on five LCD screens.
Surrogate House is a complex of two two-storied bungalows. It's Eid, August 9, and a baby shower is underway at 11 a.m. The 'parties' of Aarti, 31, Gita, 29, and Rukmini, 27, all seven months pregnant, have sent them saris, and shared the cost of the ceremony. The women don make-up and braid their hair as they slip into their new saris, stolen pleasures that bring home the reality of a pregnancy that is not quite theirs. Durga, 29, smiles. "It's our child, we call it our child." Rukmini has more reasons for joy. Her diamond-washer husband has just inaugurated his own store that morning. When she returns, she will open her own beauty parlour.
Housing for surrogates has often been criticised as glorified forced isolation but Dr Patel's stance is that it guarantees the health of both mother and child. Many surrogates say they prefer it. It allows them anonymity from prying neighbours or relatives. The controlled environment provides them with nutritional food and the chance to enrol in vocational classes, from chocolate-making to computers embroidery and hair and make-up.
Surrogate mothers say the base rate that accrues to them from bearing babies, be it for Indian parents or foreigners, is around one-fourth of the total cost of Rs.8-11 lakh that clinics charge. What differs though, is how they are treated. Indian parents rarely encourage an engagement with the surrogate after birth.
Inside a room on the ground floor of Surrogate House, Suresh, a 28-year-old autorickshaw driver from Ahmedabad, has cooked rice for his wife Seetal, 26, pregnant with her first surrogate child. Their own two children, aged 7 and 11, are in boarding school. They want to buy a house with the Rs.4 lakh from the surrogacy. He understands, he says, that the child is not his, but has trouble not feeling affection for it.
He caresses his wife's stomach affectionately. Local Methodist and Catholic churches, maulvis and priests have all preached against surrogacy to their respective congregations. In vain. "It used to be much harder when I started. Now I don't fight because I know no one who is talking is going to give these parents a child or save these surrogates from their poverty," says Dr Patel.
Surrogates keep coming back because the money counts. Kaushal, 37, has three children and works as a cook now, earning Rs.2,000 a month. Her small rebuilt home in Anand has a light and fan in the hall, and a television with a cable connection. But there are no bulbs in the inner room or the kitchen. Most of the money she earned through her two surrogacies since 2007 went into unsuccessfully treating her alcoholic husband's cirrhosis and heart condition complicated by diabetes.
A devout Catholic, her parish and the home she works in would both dismiss her if they found out what she had done, she fears. But thanks to the babies she carried, she doesn't need their approval to put a roof over her head. She can look God in the eye because she knows she hasn't done anything wrong. The rest, she says, she will manage.
