The surrogate mothers of India’s Akanksha Clinic eagerly await their 600th delivery. But is there an ethical price to pay?
By Tom Rowley
Michael and Veronica have spent months preparing a nursery for their firstborn twins. Piles of baby clothes lie across three beds – two for the babies and one for Veronica, who will lie awake with them each night. Feeding and nappy stations stand against the wall, which is covered in Winnie-the-Pooh paper. Yet their babies are being born to another woman, 7,000 miles away.
They are among an increasing number of couples seeking “wombs for hire” abroad. Frustrated by strict Western guidelines on surrogate births, Britons who cannot fall pregnant naturally or via IVF treatment are choosing to pay an Indian woman to have their children.
Michael, a 62-year-old GP, emigrated to Canada from Salisbury in the 1980s, and thought he would never be a father after he married his first wife, who already had a family. But after their divorce, he met Veronica, 33, at a medical conference five years ago and fell in love again. They married four years ago. At last, he thought, he could have children of his own.
Veronica, who is from a large family in Russia, also wanted a family but could not fall pregnant because she had been born with an abnormally small uterus. The couple tried IVF four times, but each attempt failed.
“She shed so many tears,” says Michael, who wishes to keep secret his full name to protect his children’s identity. “Because I am a doctor, I could see her result on the computer so I was the one who always had to break it to her. If she saw me turn up with flowers and a bottle of wine, she knew the results were not good.”
The couple finally resigned themselves to living without children – until last summer when they heard of the Akanksha Infertility Clinic, where up to 100 Indian women at any time carry the children of Western clients. Michael and Veronica quickly signed up.
More childless couples are making the same decision. Since surrogacy was first regulated in Britain in 1985, only about 50 couples a year have chosen to ask another woman to carry their child. But the rate has quadrupled in the past six years, as a growing number of older couples opt for surrogacies and new legislation permits gay men and lesbians to do so, too. Although only 203 surrogate babies were recorded in Britain last year, social workers say this understates the true figure as many couples do not apply for the parental order that grants them official status as parents.
Britain bans commercial surrogacy to prevent exploitation, meaning that surrogate mothers can only be paid expenses, such as for maternity clothes. Typically, surrogates are friends or family, or altruistic strangers kept on registers with long waiting lists.
But more than a quarter of British couples are now bypassing the law to find surrogate mothers overseas, where they pay up to £50,000 per baby. India is the most popular country, largely because its clinics charge less than half the rate demanded in America.
At the centre of this £620 million industry is the Akanksha Infertility Clinic, set on a dusty backstreet in Anand, a small city in rural India, some 600 miles from Delhi. It is run by Nayna Patel, a fertility specialist who made headlines a decade ago when she helped a British woman give birth to her own grandchildren as a surrogate for her daughter.
Dr Patel admits to running a “baby-making factory”, charging clients from 34 countries around $28,000 (£17,000) to match them with one of dozens of local surrogate mothers, for whom she provides a healthy diet and accommodation during their pregnancies.
Business is rapid, and Dr Patel has thrived in the nine years since she established the clinic. She lives with her family under armed guard in a large house in the suburbs and is driven around in the back of an Audi. She expects to deliver her 600th baby next year, when she hopes to open a new 100,000 sq ft hospital, large enough to house 100 surrogates and 40 clients, who will be offered apartments when they come to visit.
The trade in babies is nothing if not highly controversial. “I don’t think any of us has a right to be a parent,” says Marilyn Crawshaw, a leading academic with a special interest in assisted reproduction. “There are people who say this is a win-win situation, and you can find Indian women who have acted as surrogates who say they have earned more money in nine months than they would in 10 years. But these women wouldn’t be doing this if poverty wasn’t a driver.”
She also worries that surrogate children may be unable to discover their heritage. “They need to have a choice,” she explains. “If the child is curious, they will want to know about the surrogate. [But] if the parents see the surrogate as immaterial to their family, they won’t be able to tell their child about her, how it was for her during the pregnancy and how her other children are doing now.”
Celia Burrell, a consultant obstetrician at Barking, Havering and Redbridge University Hospital, has called for tougher guidelines. “How can we monitor a surrogate in India?” she asks. “Does she get the medical and emotional help and support that she needs? How do we know she is not being forced into it?”
Michael admits that such questions originally troubled him. “We obviously considered the fact that there may be some unfortunate poor woman who is doing it out of desperation. But other infertility clinics don’t care for the surrogates in the same way that Dr Patel does. With the knowledge we have, we are reassured that what the clinic said originally is true: the surrogates are taken good care of, they do it voluntarily, their families are involved in the decision and the outcome is an improved lifestyle for their children because they don’t have to struggle so much to survive.”
Dr Patel pays each of the women about £5,000. She encourages them to spend it on a house with their sole name on the title deeds, and employs embroidery teachers so the surrogates leave with a better chance of finding work. She also encourages clients to inquire about the well-being of their surrogates, and regrets taking on those who do not. “A couple of sentences is all it takes,” she insists.
“This woman is an absolute saint,” says Michael. “If the surrogates have abusive relationships, she makes sure the husband doesn’t take the money. I never got the feeling she was in it for profit. Every day, women lined up for the free gynaecological clinic she runs for the local community.”
Michael heard about the clinic on the radio last summer and told Veronica. After reading a book about Dr Patel and researching other options online, they sent her an email the following day.
There were also legal advantages to choosing India. In Canada, as in Britain, a surrogate is named as mother on a birth certificate and can decide to keep the child once she has given birth. “We might have gone through all this stress, had a beautiful baby born with both of our genes, and then had a surrogate say, ‘I want your baby’. In India, if you write a strong contract, it is enforceable in court.”
The couple flew out in March and – though Michael admits the clinic was “not built to Western standards” – he was impressed by the hygiene and medical procedures. The embryologist harvested Veronica’s eggs and collected a specimen of Michael’s semen, and a few days later showed them five blastocysts – the early stages in the development of an embryo – under a microscope. They chose to have two implanted into the surrogate’s womb to increase the chance of at least one successful conception, and will pay around $33,000 (£21,000) for the twins.
The couple have met their surrogate mother – Kokilla, 28, who has three children of her own – many times, and Dr Patel sends them email updates on her condition, so Veronica can look at the scans on her iPhone.
“Her husband is a policeman,” says Michael, “which is considered a very good job in India. They are climbing into the middle class. I have been told she is having a house built. She told Veronica it is wonderful that her own children are now going to have a great education. They can be enrolled in a private school [with the money]. Education in India is the lifeline for every family – it gets you out of the pits you are in.”
The couple were made to sign an agreement promising to collect their children even if they are born with a disability, but Michael says they would be grateful for any life, after living without children for so long. Nor would they have terminated the pregnancy if disabilities were spotted early on. “They would be loved and brought up just the same.” The pregnancy has gone smoothly so far, however, and the twins are due to be born on November 21.
The couple will stay in a nearby hotel once their children are born. They are not allowed to return home until Canadian authorities have taken DNA samples to establish that they are the genetic parents.
Even though she has not carried their babies, Veronica has bonded with the ultrasound pictures and is certain she will feel an immediate connection to them. She has already made a list of baby names. “They are my Alexander and my Katarina,” she says. “It is sentimental but I have had their names for two years, always saying I would one day have these two.”
Michael is also looking forward to teaching them to play sport. “They don’t play cricket here, but my kids are going to play. Hopefully, some Indian heritage has got into them for that.”
They have told only three close friends about the surrogacy, fearing playground bullying if too many know – but they will tell the children once they are teenagers. In fact, they are so happy with the process that they are already considering using the remaining three blastocysts. “You’ve read my wife’s mind. She is already planning it.”
For now, though, the couple must await news of the birth. “Veronica has suffered a lot. The greatest joy anybody could have is seeing the faces of those little ones that are part of you. I know I will be very emotional.”
Next week Veronica will fly out to stay near the hospital, carrying a case laden with gifts for Kokilla, with whom she wants to keep in touch after the birth. “We will forever be grateful to her because of what she has done,” says Michael. “This woman is a heroine to us.”