Dr Nayna Patel - Medical Director, Akanksha Infertility Clinic, India HARDtalk

have hit Indiana, Illinois and Kentucky. Search and rescue teams

are looking for people said to be trapped inside buildings. Time for

hardtalkmacro. `` `` In India, producing surrogate babies is a

booming business. Reproductive technology allows childless, wealthy

couples to hire impoverished Indian women as surrogate mothers `

pregnancy and childbirth have become commercial transactions. We speak to

Dr Nayna Patel, a pioneer in the field. Her clinic has been

recruiting surrogates and delivering babies to order for a decade. Is

this 21st`century way of making babies irresponsible and

exploitative or a positive public service? Welcome to HARDtalk. Thank

you. You are a doctor that has long specialised in reproduction and

fertility. Just explain to me how you got into the business of

surrogacy. I never did surrogacy for five years after starting my IVF

practice. It was in 2003 that a couple from the UK, an Indian

couple, needed a surrogate. For three months, we tried to find a

surrogate and we were not able to find it. To be clear, that is a

woman who would carry their baby. That is correct. The woman was born

without a womb. We could not find anyone in India or the UK. And so we

had her grandmother carried the babies and she delivered the twins

in 2004. That was the first surrogacy case I ever did. When we

saw the end result was very happy for the story get mother, the

grandmother, why not do it for those unfortunate females who might not

have a mother or a friend carry their baby? And that is how we

started. We got the idea to do surrogacy and we started the

surrogacy arrangements. Obviously, you thought early on that you could

turn it into a business. In effect, you've turned pregnancy and

childbirth into a commercial transaction. I would say there is a

give and take of money but no amount of compensation can ever compensate

a surrogate for what she is doing. The word business is to... Too crude

for this practice. Surely it isn't too crude because you're not trying

to tell me, are you, that the women you recruit as surrogates are doing

it for any other reason than the money? Money is there but they also

get joy and happiness for helping a couple who is childless. In India,

childlessness is a stigma. Feelings when they know that this couple is

not able to have a baby, when they know that she does not have a womb,

women will go to any extent to help her have a baby. I'm sure people

across the world would like to know the details of the money before we

get into the complicated ethical issues that surround this. In terms

of the money, and my right in thinking that a couple who comes,

let's say from a western third country, they are childless and

desperate to have a baby, they pay you about $28,000 for the service

you offer? Approximately. 20 7000, 20 $8,000 US. How much of that goes

to the woman who acts as this are get, who you take on this nine

months of "work". They get about $10,000 US. If it's twins, it could

be 13,000 US dollars. Otherwise, they get 10,000 to 12,000. Well over

half, two thirds of the money, goes to you and your business. The

remaining goes to be are in`house web based day. But that's your

business. You pay for that. You cannot have free food for the

surrogates. You have to pay for that. The breakfast, the lunch, the

medicine, the antenatal checkups, the bloodwork, the ultrasound is,

the referral to a surgeon if required. All of this is being

done. And there are various people who do this and they get paid for

that. Yes and they are all your staff because it's your business.

It's not my staff entirely. An expert would be a freelancer. I

intrigued by the degree to which India has become the global centre

for this surrogacy business. It seems that there are two broad

regions `` reasons. Indian law says that the birth mother, that is, the

surrogates mother, has no legal rights when she signs a contract

with you and with the couple who seek to have a baby. No rights at

all accrued to the birth mother. Also, perhaps more importantly for

India, there is a vast reservoir of desperately poor women who see no

alternative but to make money in this way. Is that why India has

cornered the market? I would say that a large numbers of surrogacy is

are also being done in the US. But there has never been a mention of

surrogacy done in the US. When a third, developing country is doing

surrogacy, it becomes big news. But when the US is doing surrogacy for

European couples, not only Americans, for so many European

couples and for so many years... It's three times more expensive in

the US. I understand but nobody mentions it. But because it's

cheaper in your clinic, it's so attract if to so many people around

the world. Would you accept on the legal front that in India, there are

no legal rights enjoyed by the surrogates mother once she signs a

contract? That is correct. That is one thing. The surrogates mother has

no rights. She also has no duty towards the baby once the baby is

born. The birth certificate will carry the name of the genetic

parents. That is the second advantage. Third, when the couple

comes from so far away, the surrogates will not be able to reach

the couple wants the baby is born. These things happen in a western

country, when a surrogates will come up after a few years to claim the

baby. That's not possible when they are 10,000 miles away. I used the

word work before. It struck me as surprising that you said when you

sign up they deal with a surrogates, and let's not forget they are very

poor women, when you sign a deal with them, they, you say, should

regard what they are doing as like a labourer or a maid. It is simply

nine months of work. Do you really regard pregnancy, childbirth, the

intensity of that human experience as being like a maid or a

construction worker? Well, I would say that it is a person 's personal

choice. Do you stand by that comparison? I would stand by that

comparison, yes. They are doing some work and they are being compensated

for it. OK? And if it is work they can do and get good compensation and

help a family change their life around 360 degrees, it is much

better work than a labourer, a construction worker or a maid. The

contract is very important. What proportion of the women you use as

surrogates are illiterate? Illiterate, 100%, I would say that

they do not know how to read or write. I would say only 10%. Let's

say illiterate to the extent that they do not know how to write, read

or understand a legal contract. I would say at least 30% would be like

that. 70% to understand. I have had surrogates who are graduates and

have done this to tide over the financial crisis of her family. I

just wonder how much they understand what they are signing up for. Let me

finish. It's important to lay out this deal. You require them when

they sign the contract and then when they become pregnant, you require

them to stay in your hostile. There is a guard on the gate of the

hostel. They require your permission or the permission of your staff to

leave the hostel. You control their lives. That is not exactly the

truth. They can walk out. They go out into the park. With permission.

With permission or without permission. They live like a

dormitory. It's a hostel. They are not like the bonded labourer.

Absolutely not. They go home for 15, 20 days as well. They go and they

come back after 20 days. We have a caretaker who just make sure that

they see the take the medicine properly. They can go out, go to

temples, see the festivals, anything like that. Can they go home if they

want? Of course, for 20 days if they want. Without permission? Of course

not. The director has to know that the student is at home for 20 days.

That is all they want to know. One lawyer working in surrogacy says

that the sort of rules imposed by you are unlawful confinement under

the Indian criminal code. Absolutely wrong. It's nothing like unlawful

confinement. The surrogates's husband, children, they stay with

them over the weekend. Every Sunday, the children come to visit. There

are so many surrogates. Most of them spend two months out of nine in

their own homes. Here are the words of one surrogates featured in a

recent documentary, which, of course, you call operated with and

offered access to. It was revealing. She didn't have a

negative experience but at the end of it, after giving birth to a child

who was immediately whisked off and taken to the client family, she said

not in my entire life would I want my own daughter to be a surrogates.

Yes. It's not a positive experience, is it? Is a positive experience for

her because she has helped. But what she dreams of is that my daughter

could become a dog, an engineer, that sort of thing, and not go

through this sort of fruit. `` become a doctor. So your opinion is

that no woman herself would ever want to be a surrogates. Your

statement that it is all free will is not really true. It's like a maid

servant saying I would never want my daughter to be a maid servant or a

labourer saying I would never want my son to be a labourer. He would

want him to be an office worker or some them. You talk about empowering

the poorest of the poor women in India. How is it that you know that

when you give them a substantial sum of money, $8,000, $10,000 for one

baby, how do you know that given the nature of power dynamics within

Indian families and the patriarchal society that we see in so many

traditional Indian villages, how do you know that they enjoy the fruits

of this work that you describe. We have a team for this when they come

to sign up as a surrogates, the first counselling session, they are

asked why they are doing this. Why do they need this money. Some say

they want to buy a house, educate their children, start a business

with their husband. And we see to it that this is being done. We have a

lawyer to see that the papers are genuine. 80% of the surrogates use

the money the way that they have dreamt of. And that is how we are

different from the others. You might like that to happen but there's no

way you can enforce that. There's no way we can enforce it but for nine

months, they can cancel them. They see the positive experience of the

other surrogates. `` they can counsel them. Are you aware that

there are so many critics that look at the positive spin you put on this

and simply do not buy it? Margaret Somerville, a respected researcher,

she says that what you are doing is totally commercialising and

dehumanising the most intimate of human relationships, that between

parents and children. What I would say is that this is not her child in

any case. It is a genetic baby of some other couple. She has done this

knowing that she has her own children to take care of. I don't

want one extra mouth to feed, OK? But by giving... The surrogates

feels that she is not cheating anybody, she is not doing any

murder, but she is helping a couple bring a beautiful life on this earth

and in return bless that baby and bless that couple and bless her own

children. So, why do you criticise someone who was doing this?

Otherwise she has nothing to do. It's not criticism but teasing out

the ethical dilemmas raised by what you do and the commodification of

some in that most human beings regard as so personal, intense, so

intimate. One complexity I can see is that it's extraordinary how many

Caesarean sections are performed on your surrogates mothers. The Indian

national average is 8%. It's over 50% in your clinic. Is that because

it suits the client? Because they can schedule a visit? They know the

timing, when the baby will come out? It's so much more convenient for

them even though it's more dangerous for the birth mother? It's not like

that. The rate is much higher. That's not the Indian national

figure. Yes it is. For all IDF pregnancies. And when IVF was

started in London, people said it was an unnatural way of having a

baby and that's the what they're saying surrogacy now. But IVF is now

well accepted way of treating infertility. Similarly, there are

females who are unfortunate and need a surrogate. The second question you

asked is about the see section rates, it's not for the convenience

of the couple. It is because there are many multiple pregnancies,

twins, and there are high risks. You must have seen in the documentary

there was a natural birth. Yes, but that exception, not the rule. I want

to move on. What happens if there is a miscarriage? Does the surrogate

mother, because she is suffering something physically traumatic and

psychologically traumatic, but she get full recompense? Is she still

paid the full fee? After three months of pregnancy, it's around 300

US dollars. After five months it is 1200 US dollars. After birth,

whatever happens to the baby, whether it survives not, they get

the full payment. You were about this process and the most

businesslike coldhearted way. It is about taking care of the couple and

the surrogates and the baby. The baby is the most important person in

this. Really? You're telling me the surrogates more important even a

client who is paying you? So what happens if, I don't know this has

actually been experienced in your time, but what if a sorry at mother

dies in childbirth or sufferers serious long`term health

publications? Do you make an open`ended commitment to their

families that you will do what it takes to look after them? That goes

without saying, I would say. It has not happened. If something like this

does happen, the sorry it will definitely get a lot of

compensation. We have a trust. It would be around, considering Indian

rupee, we give some to the husband and there is a fixed deposit for the

children and the education of the children. Do you take a moral stand,

in a decade`long experience, have helped a single person go through

the surrogates process and acquire a baby? A gay couple? We have mostly

had heterosexual couples. We have had a handful of single parents. I

would say for single fathers. You think that's wise? One was an Indian

we knew, it was an interesting case whether father wanted the sums baby

because the father had an attack. What about gay couples? I would

respect their sexuality, but in India it is not currently allowed.

There are those you don't always seem to stick to, for example they

see a maximum of three embryos should be placed in one cycle,

whereas you sometimes use for, running a high risk of multiple

births and publications, so you don't always stick to the

guidelines. Four is only for those couples or this e`mail is more than

40 years old. 90% of the eggs are abnormal in that case, so the

chances are just higher. Sorry to corrupt but we are a little short on

time. What is the maximum age for a woman you'd agree to help? We go up

to 50 years, but not with her own eggs. I suggest a donation over the

age of 45. So you help couples who are 50, 60? 60 would be really

difficult. Even if there were prepared to pay you? No, we would

counsel them, what happens if the child if you are there any more. But

if she is 48, 49 and her husband is 60, we would do it. In some

countries there are clear laws against commercialised agency driven

surrogacy is. There is a danger, if they want to take the baby out of

India to their home country, but the contest is injured for the baby and

it is left in legal limbo. We had a problem with a German couple. But

now we know that these countries have legalised surrogacy is and we

do it. We asked the German couple, is it legal to take the baby? But

now it is made very simple by the Indians guidelines, they need to

produce a certificate that they will be able to take the baby. Are you a

religious person? Very special, very religious. You said that you believe

what you do is godlike. It's not godlike. I would characterise it

that I am doing something different, something controversial, but

ultimately it's what God wants, and that's where he has given this

arrangement to this world and he has made certain people involved in it.

But you are interfering with nature. Nature has dictated that some of us

human beings are infertile or incapable of having children. You

meddle with that reality. Do you ever think that that is perhaps

unwise? A young cancer patient, nobody asks, nature wanted to die of

cancer, why do you want treatment. But infertility isn't a disease. It

is a disease. The couple who are suffering from it, you should

experience one day of their life and you would no. They don't know what

they are doing without a baby, there are socially cut off. Finally, your

Indian surrogates have produced hundreds of babies are now live in

rich Western countries. You want to expand your business. You are

building a new $6 million clinic. How far can this surrogacy business

go? This can be a business in a big way, but that is for any new thing

that comes up. It is taken up as a business by everyone. But surrogacy

is much more than business. There are a lot of emotions involved in a

lot of humanity. We have turned them. Thank you very much. `` we

have to do and `` end there.