The Times article I had in mind and also below. Thankfully we live on a free planet and can travel to where we want to be to do what we want to do. I do think English law should allow this at home however.:
www.thetimes.co.uk/tto/magazine/article3477314.ece
Nayna Patel runs one of India?s best-known surrogacy clinics. In 2008, Adrienne Arieff paid her $30,000 for a 26-year-old cleaner to carry her child. Louise Carpenter meets them
To what lengths would you go to have a child? Adoption? IVF? Donor eggs or sperm? None of these things? Adrienne Arieff?s determination to be a mother saw her crossing continents on trains and planes, journeying 8,000 miles from San Francisco to the choking heat and dust of Gujarat, India. In deciding, four years ago, to pay a 26-year-old Hindu domestic cleaner, living in rural poverty, to carry her and her husband?s child, Arieff became one of a growing number of infertile women from all over the world, including the UK, spilling into India to enter surrogacy contracts with the ready supply of poor Indian women prepared to ?rent? out their wombs for a sum often equivalent to five years of a menial wage.
Today Adrienne Arieff is scrolling through her iPhone to find videos of her three-year-old twins, Emma and India, delivered by Caesarean section to Vaina (not her real name), Arieff?s surrogate, in an IVF/surrogacy clinic in the ramshackle town of Anand, the capital of India?s ?wombs for rent? industry. The girls were conceived from her own eggs and her husband?s sperm and placed inside Vaina. ?Oh, look at them!? Arieff says, showing me footage of two pale-skinned, pretty little girls. The twins tumble around on a bouncy castle, waving at the camera and singsong-ing, ?Hellooo, Mummy!?
?They are just so very sweet,? Arieff says, gazing at their pictures. ?The other day I found myself saying to somebody, quite by accident, ?When I gave birth to Emma and India?? ? She looks up and laughs. ?I completely forgot that I hadn?t.?
Since India legalised commercial surrogacy ten years ago as a way of promoting medical tourism, it has become the capital of outsourced pregnancies. There is no shortage of Indian women or foreign couples. The fee paid to a surrogate is a big draw for a poor Indian woman and can be life-changing; the surrogacy laws lack the complexity of those in other countries and are heavily loaded in favour of the biological parents; and medical costs for IVF procedures are comparatively low. The Confederation of Indian Industry estimates that being the ?womb of the world? is now a business worth $2.3 billion (£1.5 billion) a year.
There are something in the region of 1,000 clinics, but only 600 of them registered. Indian regulations, while currently in the process of being redrafted by the Indian Council of Medical Research, are not keeping up with foreign demand. Many of the less reputable clinics cut corners to compete for international business. There are stories of Indian women being treated purely as the ?vessels? that bring in the cash, certainly not of equal status to the foreigners paying the fees. Binding contracts may be signed but not fully understood by an illiterate woman. Some surrogates, it has been reported, are not cared for properly and then receive little postnatal care. On top of this, there are cases of coercion by husbands, eager to push their wives into such agreements for the money.
Culturally, there are problems, too. Surrogates are considered to be on the same level as prostitutes. It may be a boom industry in India, but it is still a covert, fringe practice. Critics have questioned the double standards of a patriarchal society that deprives a woman of the right to choose a husband, yet allows her to bear another woman?s child. While legal, surrogacy does carry with it a social stigma, and in certain religions it is banned. So surrogates may have to leave their villages and their families for nine months (or the family leaves with them) to be housed with other women in a ?surrogacy camp? set up by the clinic ? only to return after the birth with a concocted story.
Adrienne Arieff, who got her master?s at Columbia University and runs a communications company with offices in New York and San Francisco, is, at 40, the perfect example of an educated, accomplished, hard-working, go-getting Western career woman.
A large antique diamond sits on her left finger and she wears a navy silk dress to the knee and high black boots. Her naturally wild hair is ironed straight so that it hangs like a waterfall around her shoulders; her brows are perfectly shaped. Her husband is a partner in a San Francisco law firm, her father is an eminent Californian doctor. She had everything going for her, apart from the ability to sustain a pregnancy. She lost her first daughter at 20 weeks due to fibroids, and then had two further miscarriages. Seven years ago, she got the news that she would never be able to carry her own child to term due to the further discovery that her womb was misshapen.
Unwilling to give up, Arieff and her husband began looking at every option: domestic adoption; domestic surrogacy; foreign adoption; foreign surrogacy. She maintains that they weren?t concerned about the need to have a blood relationship with a child, but had already been told by her US doctor that surrogacy would be a good option, because the business of actually getting pregnant was relatively easy for her: ?We were thinking of everything and I was willing to give anything a go.?
Then her husband read an article in The New York Times about the Akshanka clinic in Anand, run by Dr Nayna Patel, the doctor who has become the face of Indian surrogacy, and who, in 2007, appeared on The Oprah Winfrey Show. Oprah gave Patel and her clinic her personal seal of approval, which helped fuel Patel?s word-of-mouth reputation. Patel?s clinic now attracts clients from, among others, Israel, Dubai, South Korea, Australia, New Zealand and the UK. Last month she announced the birth of her 500th surrogate baby: 253 boys, 247 girls, born to couples from 29 countries. The first birth in 2004 was twins, a boy and a girl, to parents from the UK.
Arieff did her homework, her ?due diligence?. Patel had trained in London; the clinic checked out on medical grounds (Arieff got more than ten references and put her doctor father on the case, too); the IVF and surrogacy fees were a third of the price of those in America ? $25,000-$35,000 (£16,000-£22,500) including flights, with $15,000 (£9,500) going to the surrogate; the surrogate women were counselled and interviewed beforehand to weed out cases of coercion; they had to have had children already; they were looked after in a clean surrogate ?house? prenatally, fed good food, urged to rest and taught various ?skills? during the nine months. Postnatally, surrogates were given free medical care and the money went into a bank account set up in their name, a gesture intended to encourage financial independence and self-betterment. Also important for Arieff?s lawyer husband was the fact that, in India, the ?genetic? parents hold all the legal cards. As Arieff herself puts it, ?With the level of medical care Dr Patel offers, why would anyone not go to India for IVF??
Still, what of the morality of taking a very poor woman away from her family, putting her through a potentially dangerous pregnancy and birth and asking her to risk being shunned by her community in the process?
Arieff admits that ?the exploitation and the bioethics? attached to her decision initially terrified her. When she told one of her closest friends that she was contemplating going to India, she exploded: ?You can?t rent a womb from some poor woman in an underdeveloped nation! It?s completely and utterly unethical. How could you ever live with yourself??
Throughout the process, Arieff kept a journal, recently published as a book, The Sacred Thread. In it, she writes of this argument: ?For [my friend], it was right versus wrong. Was she wrong? Was I? I was surprised at the passion of her conviction? In that moment, I realised how I truly felt? This was a win-win situation, allowing the surrogate to have a brighter future and the couple to have a child. If my money was going to benefit an Indian woman financially for a service she willingly provided, I preferred that to be a poor woman because the money would be, to be blunt, life-changing.?
?She?d never experienced infertility,? Arieff says now of the incident. ?What right did she have to judge me? It just made me realise that I had to follow my own instincts.?
As she sips a latte in a London hotel on a business trip, I ask Arieff what she makes of the latest research published by the New Delhi-based Centre for Social Research, commissioned by the National Commission for Women. It concluded that, in the absence of a stringent legal framework, poor and ill- educated Indian women are being exploited both physically and emotionally.
Manasi Mishra, the lead author of the report (based on interviews with 100 surrogate mothers), tells me, ?The women have been so brainwashed by the so-called ?social workers?, ?agents? and ?counsellors? appointed by the doctors and clinics that they are lured into this in the name of gaining some money, which is insufficient either to buy a one-room [home] or set up any business for her husband. The women often do not understand the repercussions associated with this, and by the time they come to know a little about the health hazards, a woman [can be] pregnant with twin children? There are instances of high blood pressure [BP] and gestational diabetes which prove fatal, as was the case recently in Ahemedabad, where a surrogate mother died due to high BP. Many times, either the doctor or clinic or the commissioning parents continue with the pregnancy even when there are warning signs, irrespective of the health conditions of the surrogate mother. It is the child that is precious, not the mother.?
Mishra is unequivocal about the bioethics: ?I don?t think there is a case to be made that surrogacy could benefit the women of India, even if properly handled. Instead, we should have more employment opportunities available to people as well as equal educational opportunities. It?s an unequal arrangement.?
A somewhat battle-weary Arieff responds, ?I?m not here to try to change anybody?s mind. Really, I just wanted to write about what I did to show that there were alternative routes available. I am not comfortable with what is happening in India within this industry, but having said that, I?m not happy about how a lot of industries treat their workers? It?s easy to have a kneejerk reaction, but these issues aren?t just a simple yes or no, good or bad.
?I believe what I did helped another family, empowered the woman who was my surrogate and gave her the first taste of feeling like she was able to help her family financially. I am comfortable with how I handled the process. Is that enough? I question that frequently and that is something I live with and think about all the time.?
The Sacred Thread ? and by extension, Arieff?s decision ? has been heartily welcomed by the growing number of infertile women seeking alternative forms of parenthood. One mum wrote in response: ?I love this woman! She was infertile and she found a way to have her babies. Good for her! Why don?t you all leave her alone.?
?I wanted to phone that woman up and cry,? Arieff says. ?Reading that meant so much.?
Arieff is constantly asked to do book signing sessions by adoption agencies or groups of women with infertility issues, and is regularly approached by women contemplating surrogacy in India. But she has also rekindled the debate about outsourcing pregnancy to a poor country. One Indian woman responded to an extract of the book in The Huffington Post thus: ?You came here to get IVF? Really? No clinic in the US?? Another dubbed her ?Crazy Woman?; yet another dismissed her journey as ?white girls? problems?. The latter in particular cuts Arieff to the quick. ?Like I was doing it because I didn?t want to get fat or something! I?d been pregnant before ? I?d have done anything to be able to carry my own child.?
One woman wrote: ?Couples like this [who] insist on their own DNA when there are plenty of kids here in the States are selfish. What?s so special about them that adoption is not an option?? ?We would have adopted,? Arieff retorts. ?It?s just that this worked first.?
?A woman helping a woman ? I love it,? is how Oprah Winfrey put it when she met Patel, and it?s certainly how Patel sells her clinic today. She is the crucial piece of the jigsaw in Arieff?s story. Patel?s clinic boasts high ethical standards ? she only works, for example, with women who have fertility problems, not those who simply want to avoid a pregnancy.
So Arieff was surprised to encounter a couple there who were taking the surrogacy route at three clinics simultaneously. Three, is that allowed, Arieff wondered. ?Clinics have to compete for business,? she was told. Prospective parents who have flown across the world want results. But surrogacy arrangements such as Arieff?s ? in which IVF was used to create an embryo ? have the same odds as any regular IVF procedure: a 20 per cent chance of success at best.
Patel donates to the Anand Surrogate Trust, which was set up to work towards better education and healthcare for surrogates. But still, what about the broader picture? ?Are we justified in refusing to enrol a surrogate and let her live a life of struggles and pull the rug out from under her?? Patel responds when I contact her. ?No. The surrogate gets the blessings of the couple and financial support, the couple gets the baby ? a win-win situation for all.?
Patel sends me a package of information, including statistics and photographs: 117 of her surrogates bought new houses; 68 renovated their old homes; 10 educated their children; 6 started a business. She sends me before and after pictures, too ? Manjula in her shanty home and then beaming at the camera beside her new brick-built house, Shanta standing beside the new family rickshaw.
It?s persuasive stuff. But Manasi Mishra?s research raises a further key question. How is it possible to get an accurate picture of conditions even in one of the best clinics when semi-literate women undertaking surrogacy are no doubt terrified of any ?official? questioning? ?I?ve not met a single surrogate mother in Dr Patel?s shelter home,? says Mishra, ?who was in a happy state of mind. They all seem to be afraid and apprehensive. Why is it so if they are getting more than their expectations??
On this point, Arieff couldn?t be clearer. In the last stages of Vaina?s pregnancy, Arieff put her business on hold and spent two months living in a nearby hotel. She visited the ?surrogacy camp? every day, letting Vaina plait and oil her hair and holding her hands. ?It was like a sorority house in there,? Arieff says. ?They were happy and supportive of one another, with a kind of ?mother? looking after them.?
By way of proof, she gets out her iPhone again and shows me more video. ?Hello,? Arieff says to one woman as the camera zooms around the bare and clean room. ?Is this your first or second surrogacy?? Another woman smiles and nods at the camera. It?s a funny moment. ?She doesn?t understand a word I?m saying,? says Arieff to me. (Patel does, however, pay for the women to have English lessons as well as more vocational classes in sewing and beauty therapy.) The women on Arieff?s footage certainly do not look unhappy, especially not Vaina.
?All I wanted was to make sure she was happy and comfortable,? says Arieff. ?By the end, we felt an immense bond with one another which had nothing to do with words.?
?The practice of surrogacy should never be set aside in India,? Patel argues. ?Instead, it should be appreciated as the most viable option for a certain group of infertile couples? Is the world justified in saying ?outsourcing mums? about India when actually a good number of surrogacies are done in countries such as the US, the so-called superpower??
Surrogacy in the US is certainly a lot more mainstream than it is in the UK, helped, no doubt, by celebrity cases such as that of Sarah Jessica Parker. In terms of the law, it?s very complicated, with widely varying state legislation preventing any uniform legal framework. And unlike in the UK, where surrogates can only be paid expenses, those in America can earn between $50,000 and $100,000 per pregnancy (£32,000-£64,000). Why, ask Arieff and Patel, is it ethical to pay an American woman but not an Indian woman who probably needs the money more?
Adrienne Arieff has been back to Gujarat to visit Vaina three times since she returned home to San Francisco with her baby girls. This is not usual. She plans to return less frequently now, perhaps once every couple of years. When the twins are 10 or 11, she plans to take them over, too. She?s already bought some books to help explain to them their unusual beginning.
Reading The Sacred Thread, you are struck by Arieff?s need to befriend her surrogate; even now, she cannot let her go. Is she subconsciously trying to prove a point to herself, that she didn?t exploit her and that they are equals?
?I think it?s because she was so kind and gentle and carried my children for nine months,? Arieff says. ?She?ll always have that bit of them that I didn?t and, because of that, my connection with her remains strong.?
Nayna Patel maintains her surrogates feel nothing for the babies they carry. Arieff finds this difficult to believe, but admits that Vaina showed little interest in the twins. ?Her bond was much more with me. She said once, ?I am so happy to do this for you, because I want you to have what I have ? a happy, healthy family.? ?
Even now, Arieff does not know whether Vaina was under any family pressure to become a surrogate. The evidence certainly suggests she was. But as Arieff writes in The Sacred Thread, ?What does [doing it] of their own free will mean? Nearly all surrogates do so in order to benefit their own families.?
Arieff recalls telling moments when Vaina?s husband behaved as though Arieff and her husband were his ?golden ticket?. At one point, he asked for extra money ? Arieff obliged but limited it to $100 (£65), the same amount she?s given them on her subsequent visits since the birth. ?Some of the surrogates did amazing things like train to be nurses. I wanted that for her, too, but she just wasn?t that way inclined and, in the end, I realised that I was projecting my Western ideals onto her.?
And looking for proof for the world that you?d done her some good? ?Exactly,? says Arieff. ?But she just wasn?t like that.?
Throughout the course of the pregnancy, Arieff gave Vaina presents such as a diamond bracelet and a mobile phone, which she never saw again. Sold, presumably, by her husband. And when she went back to visit the second time, she learnt that Vaina?s husband had crashed the cab that had been bought with the fee. ?But they were happy,? Arieff says. ?Vaina seemed happy. Was it her choice to be my surrogate or her husband asking her to do it? I?ll never know for sure.
?In the end, I?m a Westerner and I don?t even know what?s going on in her head. But when I visited her, she seemed happy. I know I didn?t exploit her. I am 100 per cent confident about that. I always treated her with so much respect and I am for ever indebted to her. It is impossible for me to express what she did for us, and what she risked for us. I will never have the words to truly thank her nor will I ever forget it.
?You know,? she adds, ?if I?d followed my friend?s advice, I wouldn?t have my beautiful family. This decision was right for me.?
Adrienne Arieff?s The Sacred Thread: a True Story of Becoming a Mother and Finding a Family ? Half a World Away, published by Crown, is available from the Times Bookshop, priced £14.39 (RRP £15.99), free p&p, on 0845 2712134; thetimes.co.uk/bookshop
Surrogacy and UK law
? Commercial surrogacy is against the law, as is advertising for a surrogate. Surrogates may only receive basic expenses.
? A surrogacy arrangement is not enforceable in an English court: English law stipulates the surrogate is the mother. The legal situation of the intended father is complicated, too, particularly if he is not the genetic father. If the surrogate is married, her husband will, under most circumstances, be viewed as the legal father.
? Only about 100 babies are born to surrogates a year in the UK, which is why couples look to countries such as India and Ukraine, where intended parents can become ?legal? parents immediately. Once back in the UK, though, they must obtain a parental order under the 2008 Human Fertilisation and Embryology Act.
? The child?s citizenship is also an issue when a couple aren?t the ?legal? parents. Separate to a parental order, this involves the Home Office and immigration authorities.
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