Tuesday, February 05, 2008

Let’s ban surrogacy !

I recently participated in an NDTV program on Surrogacy. In a covert operation using a hidden camera, an NDTV reporter filmed the operations of an IVF clinic in Anand which offers surrogacy. This was an extremely negative story, which was slanted to show that poor women were being exploited by foreigners and doctors and were being used as “wombs on hire”. They called it the “baby outsourcing industry “ and claimed that the surrogacy industry was worth $ 20 billion dollars ! They stated that hundreds of women were lining up to be surrogates and were being exploited by greedy doctors.

I wonder where they get their “facts” from ! The figures are ridiculous and a simple “back of the envelope “ calculation will show how inflated they are ! In the entire country, about 300 IVF clinics perform a total of about 30000 IVF cycles every year. As a rule of thumb ( which can be corroborated by looking at the US figures from the ASRM), only about 1% of IVF cycles need surrogacy. (Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus. This comes to a grand total of about 300 surrogacy cycles every year in India ! This is worth about US $ 3000000 – does this make it an industry ? Unfortunately, no one wants to listen to reason. In order to get their 15 minutes of fame, activists deliberately fabricate figures and play on emotions , thus creating a storm in a teacup !

What is it about surrogacy which attracts so much media attention ? Why does everyone want to meddle and interfere in women’s reproductive rights under the garb of trying to “protect” them ?

If you approve of altruistic surrogacy, where a sister or family member agrees to be a surrogate out of love, then what’s wrong with commercial surrogacy ? Just because it is a commercial transaction does not make it wrong !

Is it unethical ? No ! There are 3 pillars on which medical ethics stands – Autonomy ( allowing people to decide for themselves) ; Beneficence ( do good); and Non-maleficence ( do no harm) ! Surrogacy allows us to respect all these, when done properly !

Does it make sense for activists to take the moral high ground ? If we cannot feed the poor women who volunteer to be surrogates to feed their starving children, is it ethical on the part of activists to ask for it to be banned ? Is it ethical to let the children of these poor women starve ?

The presenter asked – “ How does the poor woman feel about having to give up her baby after 9
months ? “ The answer is simple - Just like an unmarried woman feels when she has to give up her baby for adoption ! Most surrogates do not have an emotional attachment to the baby . They are doing it to help her own children who are already born and are hungry and need to be fed. They understand it’s not her child – she’s just carrying it for 9 months to help someone who cannot have a baby !

The other popular tack is to compare surrogacy to prostitution , because women are “selling their wombs” just like prostitutes “sell their bodies” ! This is unfair and ridiculous ! The goal seems to be to get quotable sound bites - not to get a dispassionate viewpoint or start an informed debate. Indian journalism seems to be following US industry standards and going downhill very quickly !

Unfortunately, doctors are no longer regarded as respected professionals. They are painted to be unethical money-hungry monsters, who are out to make a quick buck. I think doctors are to blame for this. Our profession has done a bad job with protecting its image, and has allowed it to be tarnished beyond repair. We have abdicated our responsibility towards our colleagues and our patients. Many doctors are so jealous of the successful ones, that they are happy to pull each other down, causing serious harm to the profession’s image.

Bureaucrats and lawyers sit in their ivory towers . They have never seen the pain which an infertile woman who cannot have a baby because she does not have a uterus goes through; or experienced the heart break a mother endures when her child cries because of hunger pangs . Magnificently blissful of ground reality, they are happy to interfere in women’s personal lives and pass laws which hurt the rights of the individual to decide for themselves. They are heartless and have no empathy.

I agree the present situation in India needs to be rectified. Surrogacy is overused and misused – and often done for women who do not need it by doctors who are out to make a quick buck. At present, there is no legal protection for surrogacy in India, which means there is no secure mechanism by which patients can take their baby after birth. I have written more about this at www.drmalpani.com/surrogacy-in-india.html

At present we are operating in a legal vacuum . While doing the treatment is not illegal, there is no safe mechanism by which the infertile couple can claim the baby after birth. This means that at present the birth certificate is forged or fabricated ( by putting the infertile couple’s name on the certificate, rather than the birth mother’s). While doctors may do this with good intentions, the fact still remains that this is blatantly illegal. It also means that good doctors often refuse to offer surrogacy treatment ( because of the uncertainty in which it is shrouded), as a result of which quacks have a field day. This means that the good doctors ( who would protect the patient as well as the surrogate) are being elbowed out by unethical doctors , leading to corruption and malpractice , and giving the entire treatment an undeserved bad reputation.

In fact, we could easily use the adoption model to help regulate surrogacy. Social workers would be responsible for counseling the surrogates – and only surrogates who have been certified by these agencies would be eligible to act as surrogates !

We can learn from Iran which legalized kidney donation – or from California, which has an elaborate legal mechanism to protect all parties concerned – thus creating a win-win situation which benefits everyone !

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