A fertile ground for exploitation of women, says study

Growing demand for male

children, same-caste surrogates
Aarti Dhar
NEW DELHI: Unregulated fer-

tility clinics indulge in medical malpractices, including

physical and economical exploitation of women, a study
has shown.
Shockingly, preference
for male children and demand for same caste surrogates are prevalent in India.
Some couples, say about
5 per cent, who come to my
clinic demand surrogates
from their own caste, says
Nayna Patel, of the Akanksha Fertility Clinic in
Anand, Gujarat that has
come up as a major centre
for surrogacy in India.
There is a couple from
Tamil Nadu who want a surrogate from the same caste.
They have been waiting for
the past three years and can

continue to wait. I do not

entertain such requests or
ones that require sex determination, says Ms. Patel.
Ground reports from Bihar suggest that people do
make queries on whether it
is possible to have eggs or
sperms from a person of the
same caste.
The Sama report brought
out last year suggested that
there is lack of standardisation in treatment, including
the number of births, gaps
between births, cost of drugs
and procedures. This variation was found not only
across Uttar Pradesh, Tamil
Nadu and Orissa, where the
study was done, but also
among clinics in the same
State.
Construction Conceptions: The Mapping of Assisted
Reproductive

Technologies in India, by
Sama, a Delhi-based resource group working on
gender, health and rights,
conducted the study from
2008 to 2010 and is one of
the rst of its kind, highlighting unethical medical
practices and making a case
for the regulation of the ART
industry. As part of the research, 43 ART providers
and 86 women users, who
were undergoing Intra Uterine Insemination (IUI), In
Vitro Fertilisation (IVF), or
Intracytoplasmic Sperm Injection (ICSI), were interviewed.
Along
with
exploring issues of access
and regulation, a key objective of this research is to investigate
the
industry
aspects of ARTs in India;
this included the interlinkages between ART clinics
in metropolitan cities and
those in smaller cities and
towns.
The study found that side

There is lack of standardisation in treatment:

report
Side effects of certain procedures are underrepresented to users
effects of certain procedures, such as ectopic pregnancies, and the potentially
fatal Ovarian Hyper Stimulation Syndrome (OHSS)
were under-represented to
users.
Multiple
births,
which carry serious risks to
the health of the mother and
the children, were celebrated by clinics as an achievement,
and
widely
advertised.
When a woman is made
to ovulate repeatedly, she is
given a heavy dose of hormones which can have an
adverse affect on her health.
There is a risk to her life at
all stages whether it is ovulation or surrogacy. It is
like blood and organ dona-

tion. We cannot do it repeatedly and needs to be

regulated, says Amar Jesani, a medical practitioner
and an expert on medical
ethics. He calls for a nationwide debate on whether
commercial
surrogacy
should be allowed at all.

Question of consent
The survey report says the
process of obtaining informed consent was treated
as a mere formality, with little attention being paid to
the content of the consent
form. In several instances,
no form had been signed, or
forms had been signed without being read, or by proxy,
the study says. There was no

the countrys growing medical tourism industry, which

experienced 30 per cent
growth in 2000 and 15 per
cent growth between 2005
and 2010. A study by the
Confederation of Indian Industry states that Indias potential in this eld is so
lucrative that it can become
a $2.3 billion business by
2012. According to one estimate (of Research Professor
Rupa Chanda, Indian Institute of Management, Bangalore), medical tourism is
expected to fetch an impressive $4 trillion on a worldwide scale. As an integral
part of the growing medical
tourism industry, the fertility industry is slated to bring
in additional revenue of $1
billion to $2 billion by 2012.
India is also turning into the
surrogacy outsourcing capital of the world; commercial
Medical tourism
surrogacy and egg donor
The fertility industry in programmes are fast becomIndia is an integral part of ing signicant services promandatory insurance for
women
who
became
surrogates.
Practices like sex selection, multiple embryo implantation and even the
inducement of pregnancy in
postmenopausal women, are
common. Given the present
climate for son preference,
ARTs have the (unchecked)
potential to encourage pronatalist eugenics and attitudes to design ones own
child (preferably male).
Though the Preconception
and Prenatal Diagnostic
Techniques (Prohibition of
Sex Selection) Act (1994)
2003 prohibits sex selection
before and after conception,
and regulates the use of new
reproductive technologies,
evidence of the use of ARTs
for sex selection was found
in the research.

vided by the fertility

industry, the Sama report
says.
While there is no official
data available about the
number of fertility clinics,
the Indian Council of Medical Research has identied
886 such clinics across the
country. However, unconrmed reports from various
sources suggest that at least
50 such clinics are added every year. The ART clinics are
not the only players in the
business of promoting reproductive tourism in India.
Other emerging players include a wide array of organisations
catering
for
clientele, both at the national and international level.
These range from ART consultants, medical tour operators, surrogacy agents, the
hospitality industry, and
tourism departments to other organisations specialising
in
medical
tourism
promotion.