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The Surrogacy Cycle

ISSUE:  Spring 2016
Promising an escape from poverty, transnational surrogacy has left many Indian women with little to show for their efforts. What went wrong?

Ulhasnagar, India, is in that part of the world where things are made. The city is known for making cheap knockoffs of American jeans, and babies are made here, too, by women who cannot read or write but can become pregnant and will do so for money, for clients they will meet once or twice, if at all. Until recently, these women bore children for foreigners who never saw this place.

Coming into the station from Mumbai, the train pulled up alongside a nullah—a broad, shallow, fouled river. On the shore, lines of cloth billowed in the hot, dry air. From the busy market in front of the station, we took a rickshaw to a street that was still being laid down and picked our way over the rubble. Sonali,* a widow of just six weeks when we met, in January 2014, stood in the doorway of her one-room house. She was slender, in a green kurta, and seemed watchful even as she smiled. Her mother-in-law was filling steel pots with the water that had just arrived, as it did every morning around eleven. “When I did the surrogacy, she did all the work,” Sonali said in Hindi. On the floor, her children played with the cat in a patch of sunlight.

Sonali showed us a photograph of herself and her husband, a young man with brilliantined hair and a maroon dress shirt that was too big for him. He had died on the railroad tracks—a rumored suicide—leaving the family with weighty home loans. Sonali had already borne a child—despite her husband’s reservations—for an Israeli couple, in December 2012, for which she had earned 2.5 lakhs, or about $4,600, which had not been enough to buy the house outright. To pay the loans, Sonali now planned to do a second surrogacy. She was also recruiting new surrogate mothers and egg donors for Padma, the neighbor who had recruited her in 2009. Padma in turn brought the women to a Mumbai surrogacy practitioner, Dr. Meenakshi Puranik, whom the women called “Madam,” as maids often call their mistresses.

Between 2010 and 2014, Padma says she recruited about twenty-five surrogate mothers who delivered babies, and “so many” egg donors, some of whom—like Sonali—donated eggs three or four times. 

For ten years, transnational surrogacy was a thriving business in India, enough so that the country became known in media outlets such as Slate as the “Rent-a-Womb Capital of the World.” India’s total assisted-reproduction sector has been reported as being worth $445 million or $2.3 billion, depending upon one’s information source. There is no reliable measure of commercial surrogacy’s distinct value; while legal in India since 2002, the industry has never been regulated. Since 2005, there have been repeated attempts to draft and pass comprehensive surrogacy legislation.

Then the Indian government effectively banned paid surrogacy for foreigners. In October 2015, the Indian government filed an affidavit in the Indian Supreme Court, arguing that commercial surrogacy on the part of foreigners invited the exploitation of poor women. Within days, the Indian Council of Medical Research (ICMR), a government regulatory body, ordered fertility doctors not to accept new foreign surrogacy clients. The Indian Home Ministry followed up by denying visas to foreigners seeking surrogacy. Swiftly, international surrogacy became not illegal, but virtually impossible. 

Arguably, the ban was inspired not just by concern for poor women, but by the unappealing narrative foreign surrogacy told about India—stories about stateless babies caught between countries and about women who had died during labor. Memorably, the Times of India reported that “deserted or dirt poor” women were delivering “vanilla-white babies from burnt-sienna wombs.” Jayshree Wad, the lawyer who filed the affidavit on behalf of the government, told the New York Times, “There is a common opinion about India which hurts very badly—that because there is poverty they sacrifice their womb by renting it for their family.” 

Critics say it is unlikely that banning foreign surrogacy clients will protect poor Indian women or end the practice. For one thing, surrogacy remains legal for straight, domestic Indian couples. For another, transnational surrogacy is notorious for its elaborate work-arounds. When the Indian Home Ministry abruptly banned gay foreign surrogacy clients in 2012, Indian fertility clinics shipped Indian surrogates across the border to Nepal. When Nepal also banned transnational surrogacy in 2015, as did Thailand, industry insiders told me they believed that Indian surrogates were being rerouted to African countries instead. They say that the ban will drive the practice underground. 

Surrogate mothers themselves protested the ban, according to reports out of Gujarat, and spoke in favor of the work on a popular New Delhi talk show. But Indian surrogate mothers have never had much control over how their story is told. For one, they do not write academic papers and rarely speak English. In the media, they tend to appear as one-dimensional characters, in one-off interviews. Their experiences are often framed in a binary, in which the women are cast either as winners of a life-changing sum of money or as victims forced by their poverty into “renting their wombs.” Both narratives oversimplify and distort the reality. Sociologists like Amrita Pande argue that this binary deprives these women of their agency, and that paid surrogacy should instead be framed as a form of work, no matter how problematic.

Viewing surrogacy as “work that can be exploitive,” as Pande suggests, rather than inevitable exploitation, makes it possible to imagine reforming rather than banning the practice—and, appealingly, women claiming a voice in that reform. Between 2010 and 2014, I spoke with thirty-three surrogate mothers and egg donors in the outskirts of Mumbai. They described choosing the work, within their limited field of choices, but also having little power over a deal in which they had the most to lose. Their stories did not conform to a popular “win-win” narrative, which concealed surrogacy’s real conditions. Instead of sharing a meaningful connection, the foreign intended parents and surrogate mothers I met knew little more about one another than workers and customers on the far ends of any other global supply chain. The question is whether this divide, which hurt the women, could ever be bridged.

Kalpita bore three children in two surrogate pregnancies, but she has only one photograph to show for it. It hung on the wall of the narrow room she shared with her husband and three teenage daughters. In the photograph, taken in 2009, she stands between two handsome men with Mediterranean complexions, her head just reaching their broad shoulders. She told me the men were brothers. Likely, they were a gay couple; the women I interviewed never acknowledged that their clients might be gay. (Gay sex is illegal in India, and homosexuality is often not a visible part of community life.) 

For these men, Kalpita had carried twin boys, for which she was paid 2.75 lakhs, or about $5,700, in 2009. It wasn’t nearly enough money, she said, for such dangerous work, “delivering two babies, putting our life in risk.” She believed 4 lakhs would have been fairer compensation (women who delivered one child were paid 2 lakhs, or 2.5 lakhs with a cesarean section). But Puranik, who arranged the pregnancy, set a fixed rate, and the clients did not speak Hindi or Marathi, the languages Kalpita knows. They’d left no phone number. Kalpita didn’t know where they came from, or where they went. What the sentimental photograph failed to show was that Kalpita could not negotiate or speak for herself, even as her clients stood smiling by her side. “They did not ask us how much we have been given, or what happened,” said Kalpita. “They never asked.” 

Speaking to intended parents like Kalpita’s clients, I was often struck by how little they knew about the women who bore their children, or the details of their payment and care. These intended parents shared a powerful and reassuring assumption: that the surrogate mothers were earning a life-changing sum of money.

This narrative of Indian surrogacy as a “win-win” for surrogate and client began with Dr. Nayna Patel, a fertility doctor in the mercantile city of Anand, Gujarat. In 2004, her clinic began offering surrogacy services to Indian couples and then to a couple from Korea, making Patel the pioneer of transnational surrogacy in India. 

In her clinic, Patel implanted a local surrogate with a foreign client’s embryos. If a client couldn’t produce her own eggs, the surrogate carried an embryo created with donated eggs, but never her own. By separating eggs from womb, doctors hoped that the surrogate would not bond with the baby. By “unbundling these components of a child,” writes former Harvard economist Debora Spar in The Baby Business, gestational surrogacy doctors had created a new market in the mid-1980s, with the introduction of in vitro fertilization (IVF). Overseas clients came from countries where commercial surrogacy is illegal, like Australia and most of Europe, or expensive. In American states where commercial surrogacy is legal, the process cost between $75,000 and $120,000 in 2015, roughly three to four times what it cost in India. For many foreign couples, adoption was difficult or nearly impossible due to age, sexual orientation, or the availability of babies in their home countries.

From the beginning, Patel welcomed journalists, and her story was told on the Today show, Oprah,CNN, CBS, the Guardian, and ABC, among many other media outlets. By February 2010, when I followed the pilgrim’s trail to the Akanksha Clinic in the low-slung Kaival Hospital, it had already become a journalistic cliché to note the studio portraits of Oprah that hung on the walls like domestic goddesses. In her office, Patel wore her black, silver-threaded hair drawn up. Her bearing was aristocratic. Pleasantries were brief. “I wish you had sent me an e-mail outlining the scope of your research,” she said. She did not want to be interviewed in depth because she was already the subject of two upcoming books and a published hagiography, The Last Ray of Hope: Surrogate Mother—The Reality. On that trip and another, I learned little that was new about Patel, but did see the charisma that helped enshrine her story in media lore.

Oprah Winfrey’s 2007 segment effectively advertised Patel’s clinic and transnational surrogacy in India. In it, reporter Lisa Ling follows a childless American couple, Jennifer and Kendall West, as they visit Patel’s clinic to hire a woman to bear their child. Ling reported that Patel chargedthe couple $12,000 (compared to $80,000 in the United States), of which $5,000 went to the surrogate mother—equaling ten years of her ordinary income—enough to buy a house or fund a child’s education. To top it off, Patel put the money in bank accounts she created in the women’s names to keep it in their control. This was the “win-win” story: two lives changed for the better, and for a bargain. “We were able to come together,” Jennifer West said,“and give each other a life that neither of us could achieve on our own. And I just don’t see what’s wrong with that.”

Of course, Patel’s story invited scrutiny and got it.The New York Times columnist Judith Warner, looking at photographs of pregnant surrogates lined up for medical exams, saw “industrial outsourcing pushed to a nightmarish extreme.” Certain details rankled, like the default cesarean sections, implantation of multiple embryos, and the “surrogacy house” where, for Mother Jones, investigative journalistScott Carney interviewed women who lived in a shared dormitory room, closely monitored and removed from their families for the duration of their pregnancies. In critical stories, the house was called a “baby factory.”

But for those committed to surrogacy, Patel’s story had undeniable appeal. Not only had she devised an unimaginable new way to make children, but she had packaged it into a free-market fairy tale. She took a business deal between wildly unequal parties, made possible through fertility biotechnology, and made it sound not only fair but altruistic. Patel once wrote, “At one end of this world, there is one woman who desperately needs a baby and cannot have her own child. And at the other end, there is a woman who badly wants to help her own family. If these two women want to help each other, why not allow that?”

This story was particularly important for foreign parents because they had very little contact with the woman (or women) they’d hired to create their children. When transnational surrogacy was in operation in India, from 2005 to 2015, foreign surrogacy clients usually flew to India just twice—once to drop off a sperm sample or to create embryos and once to retrieve their child. ICMR guidelines ensured that Indian egg donors remained anonymous at the time of the deal. (By these guidelines, children can learn the identity of egg donors when they reach the age of eighteen.) A couple might have met their surrogate once or twice—briefly in a hospital room or consulate. Conversation took place through a translator. For clients, the “win-win” story not only justified the ordeal of a paid pregnancy, but made it into an act of charity. 

Edward and Paul, a New York couple who have three daughters—twins and a singleton born eight days apart from two surrogate mothers in Delhi—told me they chose surrogacy in India in part to help poor women: “In the United States, $25,000 is not going to change the life of the surrogate,” Edward explained. “But an Indian surrogate, you are fundamentally changing the trajectory of her life.”

As the practice of transnational surrogacy spread to India’s major cities, where new practices opened, Patel’s story of the good and fair exchange spread with it, and helped it to spread. By October 2015, her clinic announced the 1,001st baby born to a surrogate mother.

Patel’s work paved the way for a number of surrogacy entrepreneurs, including Doron Mamet, a project manager at a software company, and subject of the Emmy Award-winning documentary Google Baby, which follows Mamet as he launches his medical-tourism business bringing surrogacy clients from Israel to India. Apparently inspired by a gay friend who could not afford surrogacy in the United States (commercial surrogacy is illegal for gay men in Israel), Mamet traveled to India to explore “outsourcing” paid pregnancies. Although Mamet met with Patel, they did not ultimately work together because she did not accept gay clients. Instead, Mamet brought his business south to Mumbai, to the posh Lilivati Hospital, where he worked with IVF specialist Dr. Hrishikesh Pai. At one point in the film, Mamet offers a client the option of having two surrogate mothers impregnated for the price of one—a common strategy for increasing success rates in Indian surrogacy, as is implanting multiple embryos and “reducing” to twins. At a screening of Google Baby in New York, Mamet replied to critical questions with a claim that underlies his business: that everyone has a right to be a parent.

Mamet and his partner had a warm relationship with their surrogate mother in the United States, with whom they once strolled in Central Park. But it seems that kind of intimacy wasn’t possible for his clients in India, from what Mamet told me. “In India, the cultural gap is too big to create a relationship with the surrogate,” he said. Mamet relied on Dr. Meenakshi Puranik to recruit and work with the women, whom he described as shy and uncommunicative.

Puranik, a flat-faced woman with an incurious expression, organized surrogacy care from her clinic in the Mumbai suburb Mulund. Puranik said her role was to solve a surrogate’s problems: “She should be mentally happy during the pregnancy.” Puranik also handled payments. Mamet’s clients paid from $30,000 to $50,000 for surrogacy in India, depending on whether they required an egg donor: “We paid Dr. Puranik 12K,” he wrote in an e-mail, “which was supposed to cover the surrogate compensation as well as all other pregnancy related costs (delivery is excluded).” As to how much surrogate mothers were paid, “I never knew for sure,” Mamet told me, “but I think it was $5,000 or $6,000.”

In 2011, the surrogacy agent Padma showed me a printed list of Puranik’s “surrogate payment mode”—the one in operation when Mamet’s business was in Mumbai. The base rate was 2 lakhs, or a little more than $4,000 then. If you had a cesarean section—and almost every surrogate mother I interviewed did—you were paid an extra 50,000 rupees, or approximately $1,000. If you had a cesarean section andtwins, you received an extra 75,000 rupees. So, in 2011, Puranik paid surrogates at most 2.75 lakhs, or approximately $5,600. But if you stayed in the hospital for a month or more, 3,000 rupees would be docked from your pay and, if you delivered prematurely, another 10,000 rupees. And 50,000 rupees were deducted for the cost of the surrogate’s monthly food and housing, even though these women spent much of their pregnancies at home. This meant that Puranik retained more than half of Mamet’s clients’ “surrogate compensation” fee for supervising surrogate mothers’ recruitment and monitoring—services she partially outsourced to agents like Padma.

“She ate my lot of money,” Kalpita told me of Puranik. “She ate everyone’s money.” Did Kalpita and Sonali, who bore a child for a gay Israeli couple, work for Mamet’s clients? It’s impossible to say for sure, as the women did not get to keep copies of the contracts they signed. Despite the fact that neither Mamet nor his clients could say precisely what surrogate mothers were paid, the text on the company website read: “This process allows them to guarantee the future of their families and children.” The fine print on premature delivery fees went unread, tucked away with other troubling details out of sight.

When Sonali, the young widow in Ulhasnagar, decided to become a surrogate mother, she traveled two hours by train to Lilivati Hospital for sonography, the first stage in assessing a surrogate mother. (She tells the story of what happened next simply, without the names of drugs or procedures, which reflects her limited knowledge about the involved medical process.) At the time, Sonali was still breastfeeding her son, who was one-and-a-half or two years old, and she was told she could not become pregnant while breastfeeding. The doctors gave her some type of medicine to stop her milk. When it stopped, her agent, Padma, took Sonali to Puranik’s clinic for the embryo transfer, in which embryos are placed in the uterus.

At nearly two months, sonography showed that the fetus had no heartbeat, and Puranik told Sonali she would need an operation in a nearby clinic. It was painful. When the procedure was done, Sonali was shown the embryo, which had been placed in a plastic jar. “It was all cut into pieces,” Sonali said. “And they handed it over to me, and seeing that, I got more scared. And the nurse said, ‘Go, take this to Meenakshi Madam,’” as she called Puranik.

The sample had to be shown to the clients. Sonali’s husband, who had accompanied her, carried the jar, and they walked together, terrified, to the clinic. At that point, Sonali had been paid 10,000 rupees, or about $200, the standard fee for an embryo transfer. She felt she deserved 5,000 rupees more, the monthly fee received by surrogates. But Sonali told us that Puranik refused, as was her policy: Women only got the monthly fee when the sonogram showed a heartbeat. 

Sonali did not want to try for surrogacy again. But the family needed money, and so she donated her eggs three times that year—for 15,000, then 20,000, then 25,000 rupees, a total of roughly $1,200. Two months later, she agreed to another surrogacy. Until five months in, Sonali worried that the fetus would not survive, but this pregnancy was a success. 

Eight days before she was to deliver the baby, the clients visited her in the marble-floored Hiranandani Hospital. “Both were men,” said Sonali. “They were not husband and wife.” She didn’t know what to say to them. They asked her how she was feeling and told the doctor to give her a normal birth, if she could. The doctors treated her well, but in the end, Sonali had a cesarean section that left her trembling with cold. The incision swelled horribly. She never should have done it, her husband would later tell her—so much pain, and what was the use?

Sonali met the clients just once more, in court, where she had gone to give her signature. It was then that she finally met the baby, who was just like them, she said—their hair, nose, and blue eyes. She felt an impulse to keep the baby, even though she had “kept her mind ready” all along to give the baby up. The clients thanked her profusely, then gave her a 7,000 rupee tip. They were immensely happy. Sonali thought, Whoever those people are, at least I have helped somebody. 

Sonali couldn’t say what her clients paid for her surrogacy, adding that she and her husband had been given no time to read the contract. (A rare English-speaking surrogate mother, who also worked with Puranik, described a nurse who would not even let her hold the contract.) In the end, Sonali received a check for 2 lakhs. (She had already been paid 50,000 rupees for “monthly maintenance”—her food and housing.) But you cannot buy a house for 2 lakhs in Ulhasnagar. So she and her husband took out a loan of 3 lakhs and, along with most of her payment, bought the house in Ulhasnagar, with its dim kitchen and sunny room, where the whole family slept. A money plant twined in the window. 

Within months, her husband was dead. Sonali now sold Tide door-to-door, for which she made 5,500 rupees in a good month. With a loan payment of 100,000 rupees due, Sonali asked to borrow money from Padma, hoping to repay her after a second surrogacy.

Padma, a solid woman with a calm, steady bearing, had also worked as a surrogate mother for Puranik. She’d learned about the work from her sister-in-law, a brash widow, the first of at least five women in their family to try paid pregnancies. When, one night after dinner, Padma proposed that she do a surrogacy, too, her husband warned her: “Those people are cheap. Do not follow them.” Meaning that if his sister was doing the work, there must be something wrong with it. Many people believed that, to become pregnant, a woman had to have sex with a strange man. Hence, surrogate mothers often kept their work secret. But Padma persuaded her husband otherwise, explaining “test-tube babies” and reminding him of their children’s future. 

At the time, Padma and her husband were desperate for money. His work trucking bitumen to new road sites was irregular, and Padma had trouble making ends meet by cleaning houses. They had to pay rent and tuition for a pricey English-language school, as Padma considered the free state-run Marathi schools so useless that she once kept her children home for a year rather than send them there. Four years earlier, when her husband was out of work, the family had gone hungry. Padma refused to let that happen again. She also wanted to finally buy a house.

And so, working with Puranik, Padma bore a son for a couple from Bihar. Giving up the baby, she felt sad: “You have kept the child inside of you and given it the same kind of care as your own child.” She tried calling the family on the child’s first birthday, but they had changed their number. For the work, Padma was paid 1.25 lakhs, or about $2,900. “It was not enough money,” she told me. 

Still, Padma had learned a useful new English vocabulary: endoscopy, sonography, embryo transfer, egg pickup, ultrasound, patient, client, donor, surrogate. She said that the agent who was supposed to guide her through her pregnancy deserted her, and so she taught herself the business. In 2010, Padma’s husband’s friend referred his wife to her, and then Padma recruited her younger sister as a surrogate.

Padma found a niche as an agent, one that was desperately needed in the byzantine geography of surrogacy. Unlike the practice in Anand, under Nayna Patel’s supervision, the surrogacy practices in Mumbai are diffuse, with each station representing a stage of reproduction. Farthest out from the city center are the fringe cities like Ulhasnagar, home to the women who make a living selling their eggs and renting their wombs. Closer in is Mulund, where agents lead egg donors and surrogates to Puranik’s office for medicine, checkups, and payments. At Grant Road, in the city center, and Bandra, a posh, traffic-choked suburb, IVF doctors like Pai do in vitro fertilization, coaxing eggs from follicles and planting embryos in surrogates’ wombs. In Powai, a gleaming planned suburb as unnatural as Oz, an obstetrician named Dr. Anita Soni delivers babies. 

This system is difficult for surrogates to navigate, which is one reason why these practices need agents like Padma—called “caretakers” by the doctors—who shepherd women to their appointments, jotting down the particulars of their care in a mustard-yellow notebook and injecting them with hormones. Other former surrogate mothers, like Sonali, tried recruiting egg donors and surrogates, but not as successfully. 

When we met in January 2011, Padma lived in a dingy one-room apartment off a narrow lane. By March of that year, she had moved her family to an airy one-room apartment with a balcony and pink walls, for twice the rent. When I visited Padma and her family in 2014, they were living in a two-room house with a kitchen. That very month, she said, she’d earned 50,000 rupees—roughly ten times Sonali’s monthly salary selling Tide—through her work as an agent. Her daughter, nineteen, was in college and her English was fluent. Padma had bought her a laptop on installment. In addition to her classes, Padma’s daughter was doing some agenting work of her own, sending egg donors to a practice in Kerala. 

Padma’s surrogacy did indeed transform her life and the life of her family, but only through her work as an agent. Now, when the women came to see her, they bowed and touched her feet. 

Dr. Sukhpreet Patel, an IVF doctor in Mumbai who spoke with obvious passion about her surrogacy practice, said she was troubled by the number of women returning to her clinic for second surrogacies. She considered these repeat pregnancies medically dangerous and, moreover, evidence of the clinic’s failure to transform surrogates’ lives. For that reason, she said she wanted to teach surrogates such skills as embroidery or even financial planning. “I think they come with that hope that we can make their lives better,” she said, “and then I think that becomes our responsibility.”

One reason surrogate mothers had difficulty transforming their lives through this work was that their income was not all their own. In her book Discounted Life: The Price of Global Surrogacy in India, sociologist Sharmila Rudrappa interviewed seventy surrogate mothers and discovered that surrogacy payments evaporated quickly through the extended network of friends and family. “It becomes very difficult for you to say no,” Rudrappa told me, pointing out that this was only natural. “Why would you deny them an operation?”

Absent that elusive, life-changing sum of money, surrogate mothers like Sonali stayed in the business—donating eggs, performing surrogacies. Critics claim they’re coerced into this work, but in Sonali’s case, as in so many others, the question of choice and agency is complicated. Like many women, Sonali describes pursuing surrogacy despite the reluctance of her husband. But after that initial choice, Sonali seems oddly silent in the scenes she described with clients and doctors. Surrogate mothers, often illiterate, move in a deeply entrenched class and social hierarchy. It’s hard to know if Sonali could have protested medical procedures she considered unfair, or if she could freely ask for medical information.

“Every surrogate pregnancy is a high-risk pregnancy,” said Soni, the obstetrician, who also recruited surrogates for six or seven practices in Mumbai’s Hiranandani Hospital. When we last spoke, after the ban on foreign clients, she told me about a textbook chapter she’d coauthored based on 900 surrogate deliveries. The risks were typical, she said, of poor women who had undergone multiple pregnancies, and included hypertension and anemia. With the implantation of multiple embryos, permitted by ICMR guidelines, 42 percent of the surrogates had multiple births, which carry an increased risk of premature labor. Sixty-eight to 70 percent had cesarean sections, which are more dangerous than natural deliveries. And, Soni added, international couples tended to produce babies that were bigger than the women’s own—a claim echoed by the surrogate mothers themselves. Did the risks mean foreign surrogacy should be banned? Not at all, Soni said. To her, it simply meant that surrogate mothers required expert care. 

Another surrogate mother agented by Padma, who’d delivered twin girls in Delhi to clients she guessed were from Australia, described her labor as traumatic (afterward, she required a blood transfusion). And yet what she wanted to discuss most was how her clients had disappeared: “I wanted to see the children,” she told me. “But as soon as they were born, those people took them and went away. They should have come to see me—the one who has given them two children.”

In Hiranandani Hospital, Soni kept surrogates and “the biologicals” on separate floors, and whisked babies out of sight after delivery: “You don’t want a bonding of any sort,” she said, explaining that surrogate mothers were at risk of becoming too emotionally attached to the babies they carried. For that reason, the 2010 draft of the surrogacy regulatory bill recommended that the baby be removed from the surrogate directly after the birth. But the surrogate mothers portrayed this separation as harmful. 

Researching surrogate motherhood in Israel, medical anthropologist Elly Teman also found that being thanked for their “gift” was crucial for surrogate mothers, who formed more profound bonds with the hiring couples than the babies. According to Teman’s research, when surrogates weren’t thanked, they grieved. 

Why did intended parents often have so little contact with surrogate mothers? The couples I met spoke of not wanting to intrude on women’s privacy or of worrying how they’d be seen as gay fathers. Some couples believed that too much communication with a surrogate mother could be dangerous—a surprisingly common idea. 

Sukhpreet Patel depicted clients as vulnerable to surrogates’ demands, which is why she discouraged them from meeting surrogates during the pregnancy. “Who’s to say that she won’t blackmail them for something that she wants,” said Patel. She said the surrogate mother knew she was carrying something important for wealthy foreigners, while she herself only made 5,000 rupees a month. For that reason, Patel encouraged couples to meet the surrogate mother only after the delivery, when it was safe to do so. A client at Rotunda, another popular clinic, told me a policy was in place that prevented couples from meeting surrogates due to a case of blackmail. Medical anthropologist Daisy Deomampo, who wrote an ethnography of surrogate mothers in Mumbai, argues that this image of the “deceitful surrogate” helped doctors and parents conceal the power imbalance that made foreign surrogacy possible. For Deomampo, “Transnational surrogacy thrived in India in part because it relied on the fact that surrogate mothers and intended parents rarely, if ever, met face-to-face.”

The surrogate mothers, too, passed along rumors about women who blackmailed foreign clients for more money before giving up their babies. In one rumor, a woman sold the baby she carried herself. There were also rumors that you could get more money in this or that practice—8 lakhs in Bangalore!—and of which doctors were “eating” their money. That the stories could not be shown to be true is perhaps less significant than what they appeared to be for the women: a way to claim some power in a transaction structured to deny them control. 

After the babies were released from the hospital, they generally went to a hotel with their intended parents. A lengthy bureaucratic procedure followed, in which parents went to their country’s consulate for a cheek swab to confirm a genetic relationship to the baby, a necessary step for the baby to gain citizenship in the home country. From there, parents waited for the Foreigner Regional Registrational Offices to issue an exit visa, a process of up to eight weeks, after which parents brought their babies home—to Australia, Israel, the United Kingdom, Japan, the United States: homes the women I met in Ulhasnagar would be hard-pressed to imagine, unless they saw them in the movies.  

Surrogates, meanwhile, were left with photographs of the babies, if they were lucky, or thank-you notes written in English on hotel stationery, which they could not necessarily read. 

In June 2014, I went to visit Edward and Paul in their house in New York, driving up the Palisades Interstate Parkway in glimmering sunlight. After the exit, the road narrowed and tunneled through the lush woods. I drove up a steep private drive, which curved around to an open lawn, a white colonnaded house. In the garden: a bronze fountain of three girls dancing, hands linked, an invisible wind tousling their hair and dresses, circling around an altar made of lotus leaves.

Edward led me down into the playroom, where their three daughters, then three years old, were playing with an assortment of plastic toys. One hid behind a miniature kitchen; another teetered in a pair of purple glitter heels, which her fathers said she insisted on wearing. “We can’t stop her,” Paul said later. When the girls were small, their fathers dressed them up in silk kurtas for church: It was important, they felt, for the girls to have access to their Indian heritage. 

Later, as we sat on the porch, Edward showed us a YouTube video of Paul’s recent visit to Delhi, where he had been able to visit with the surrogate mothers in their doctor’s clinic. On the video, the women smile, holding boxes that contain saris and checks for $1,000 each, and peer at photos of the girls. 

Edward later told me that the trip had eased his and Paul’s minds because they were able to directly give a gift of money to the women, and show them the girls. He wanted them to know they were grateful. He would, he added, send them money every year if he could, but they likely had no bank accounts, and so there was no way to do so “without corruption.” 

Edward also seemed reassured by the fact that both women did second surrogate pregnancies, saying, “I have to assume if they did it again, it wasn’t an awful experience.” 

In December 2015, Tabasco, the one Mexican state where commercial surrogacy is legal, banned foreign and gay clients—following in the footsteps of Nepal, Thailand, and India. But the bans did not resolve the ethical questions at the heart of transnational surrogacy or dispel its near gravitational allure. 

After I read about the ban in India, I contacted Padma, curious to know what she made of it. She was with her daughter Anu. “The government should remove that ban,” Anu translated for Padma. “The government is not giving any sort of loans to poor people—they are not helping with anything.” She added, “Surrogacy is the source from which these women are earning for the future. Maybe only a little bit, but something.” 

Padma’s argument evokes the ethical debate surrounding sweatshops that is so hard to parse, because somehow workers must be both free and protected. Fair-trade models propose a solution by making supply chains transparent—an idea that ought to have worked in a transaction that was as theoretically personal as bearing a child. Anu told me that she planned to create a surrogacy practice to serve Indian couples, where she would teach surrogates financial planning and cut out the middlemen.

When I discussed this “fair-trade surrogacy” idea with Rudrappa, who followed surrogate mothers in Bangalore, she smiled wearily. She told me of one group of women who wanted to start a surrogacy cooperative and deal directly with their clients. “I asked some of the intended parents I’ve gotten close with if they would use a co-op, and they answered no,” Rudrappa told me. “There’s just so much distrust.”

Sonali did not imagine any sweeping reform when it came to surrogacy—just a chance to visit with the intended parents monthly, even if they were foreign or male. “We will feel that they are our clients and they have care for their baby,” said Sonali. “And that they see us.” 


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Aylin Cook's picture
Aylin Cook · 8 years ago

Abby, this article was incredible -- thought-provoking and gut-wrenching. I'm at the age where my friends are having kids, and I'm always shocked at the amount of fear and judgment around motherhood (moms judging moms who don't use cloth diapers or send their kids to a Waldorf school, etc.). You provided a much-needed perspective shift -- that life, conditions, the physical and emotional toll of carrying a baby just to give it up, the low cost to these women who "rent" their wombs vs. Thank you for this piece and for opening my eyes/getting me into gratitude (and everyone I sent this article to reiterated that) before 10 am. 

Gupta  's picture
Gupta · 8 years ago

Abby, This  is  a very  thought  provoking  article and you have  written  this  very, covering different aspects of surrogacy. Thanks!

Crystal's picture
Crystal · 8 years ago

The article has many interesting points.  However as one who had 3 children born via surrogacy in India and a frequent flyer to India still, I have become disillusioned with most journalists writing on the subject of surrogacy. First off the majority of surrogates had a positive outcome econmically in India.  Many of us in the surrogacy community are finding that it's the women's rights group who do nothing to empower the women less healed, but continue to make judgments about their life and then they are on to the next subject.  Women want to get out of poverty and they are open to any other ideas in India, other than being the hired help for 6 days a week for meager wages.

Catherine's picture
Catherine · 8 years ago

What a fascinating and eye opening article. 

Franny's picture
Franny · 8 years ago

I have chronic glomerulonephritis. It was diagnosed 20 years ago, now I’m 37. I’ve got pregnant in 2007. My pregnancy resulted in severe preeclampsia, emergency caesarean and death of my child on the second week of resuscitation. Unfortunately I lost not only my daughter, but also my husband. I made a decision I should live and enjoy life no matter what. Of course I never forget my past and my eyes are filling with tears, when I recall that moments. Then I met my second husband. He supported me and gave me hope. We fell in love and got married in 2010. We decided we won’t conceive naturally, but use surrogacy program. Prices here are huge! So we started to look for clinics abroad. After long search we chose Ukrainian clinic BioTexCom. Their prices are much lower, medicine and services are on high level and the most important is they check each surrogate mother very carefully. We had surrogacy there in 2011 and 2015. Now we have 3 healthy and gorgeous kids, girl and two boys(twins). I’m happy wife and mother now and I’m glad I didn’t give up)

Clara Rooke's picture
Clara Rooke · 7 years ago

I cannot make anyone agree with me but this is my opinion


I think that there should be rather altruistic surrogacy or gestational and at the same time commercial surrogacy. as you see I feel like it is rather you have to deal with all of the legal parts or you the clinic, some facilitator that would be a helping hand for you in this process. and I think the second option is better. I feel like the clinic of my choice Biotexcom should have more agencies all over the world that would make the process even easier than it is now. but as for now, they deal with all of the questions considering SMs and as I am not familiar with their law system I have nothing to do with it except for being a second part.


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