Millennium Post

Pregnant with questions

What is this flesh I purchased 
with my pains,
This fallen star my milk sustains,
This love that makes my heart’s 
blood stop
Or strikes a sudden chill into my bones
And bids my hair stand up? – WB Yeats

These famous lines from Irish master of Modernism in The Mother Of God are certainly not enough to describe the experience of motherhood and definitely not the sense of fulfilment a woman achieves and enjoys through a phase that can undoubtedly be described as the most rewarding part of her life.

However, there are many women who can enjoy this on their own. But science has come up with some extremely important developments to redefine reproductive determinism. Hence, for some, continuation of the species involves an ‘anything is possible’ outlook whereas for a much larger section of the society, pregnancy remains what pregnancy always has been: a risky, unpredictable, and a deeply personal experience.

Embryos can be created in laboratories but human beings take shape – where? In wombs? In mothers? In families? Such distinctions matter but it takes more than scientific progress and legal reform to make them clear.

Pregnancy creates something from one’s own flesh, with lasting physical aftermath, yet one does not own it. A baby is not one’s own self. Yet in the 21st century, we have started to behave as though something so complex can be traded on a market whose very foundations rest on global inequality and the unpaid labour of women.

The development of reproductive technologies and the associated commoditisation of pregnancy since the 1980s are inseparable more so, in a country like India where people suffer from abject poverty and impoverishment.

In a recent turn of events, the Cabinet approved the Surrogacy (Regulation) Bill, 2016, which will soon be introduced in Parliament. Assisted Reproductive Technologies (ART) have impacted lives for some time now. However, due to a regulatory exhaustion and conflicting laws, the rights and interests of adults and children in ART are in shambles.

ART, as the name suggests, incorporates a range of technologies that helps persons become parents (“commissioning parents”). Surrogacy is only one such process. In surrogacy, the commissioning parents may seek donors for sperms or ova or both, which are fertilised in ART clinics. Either the commissioning mother or a surrogate mother carries the resulting embryo in her body till delivery.

A conventional commercial surrogacy would involve an agreement in which a woman, in exchange for money, agrees to carry a child for another person to whom she will surrender the child when it is born. The woman can either be the child’s genetic mother – which is the most traditional form of surrogacy – or, alternatively, if implanted with an embryo, she could merely be a gestational carrier owning no genetic connection to the child whatsoever.

Since 2002, when the Indian Council for Medical Research issued a set of non-binding regulations that envisaged transactional surrogacy, these forms of arrangements have flourished in India. According to some reports, the assisted-reproduction sector may now be worth as high as $2 billion, with more than 25,000 surrogate children being born every year in the country.

Apart from surrogacy, there are other ways too to have a baby. In vitro fertilisation, called IVF or “host” surrogacy, involves taking fertility medications to stimulate the ovaries, then undergoing an egg retrieval, where eggs are removed from the follicles in the ovary and fertilised in the IVF lab. Several days later, embryos are placed back into the uterus where they implant and emerge as infants nine months later.

Both infertile women and men benefit from IVF because fertility medications help women who don’t normally ovulate to produce eggs. The IVF lab can fertilise eggs by injecting a single sperm right into an egg, a process called ICSI, which helps with men who have poor sperm. The best-looking sperm in the sample are used for ICSI; they should be shaped right and swim well; these are generally the healthiest sperm and the ones most likely to succeed at fertilisation.

In some cases, couples going through IVF produce more embryos than they can actually use. They may choose to donate these already made embryos to an infertile woman. In this case, if the woman has a partner, neither of them is the genetic parent of the child she gives birth to. Embryo adoption involves taking medications to thicken the uterine lining so it’s a good place for the embryo to implant. Some IVF centres do not get involved with matching embryos with couples but transfer the embryos once a couple is matched.

Another widely practised method that couples adopt is the test tube baby. But with surrogacy, this process seems to have taken a backseat. However, there are several untold facets of this process, a history that we as Indians will cherish till the time we live. And the hero of this unsung saga – Dr Subhas Mukherjee – who discovered the easiest and most successful way of producing a test tube baby.

In fact, he was the first Asian to discover such a process but never got his recognition during his lifetime. In 2002, 21 years after his death, ICMR (Indian Council of Medical Research) recognised his achievement for the first time and his works on methods of IVF using innovative techniques was presented to the world.

Dr Mukherjee was the first physician in India (and second in the world after British physicians Patrick Steptoe and Robert Edwards) to perform the IVF resulting in a test tube baby “Durga” (Kanupriya Agarwal) on October 3, 1978. Both Dr Mukherjee and the British scientists began work at the same time. The Indian baby was born on October 3, 1978, just 67 days after Marie Louise Brown was born.

In another perspective, understanding the difference between a surrogate mother and a test tube baby is important, especially when a couple is having trouble conceiving. Both of these procedures are options that are available when there is no opportunity for a natural birth. While these are both options for this type of situation, they are completely different processes.

A test tube baby is created through IVF. During this process, eggs will be gathered from the woman and sperm from the partner. Donor eggs and sperm are also options that can be used. An embryo is then created in a lab and inserted directly into the woman’s uterus. At this time, the embryo will attempt to attach to the uterus so that the woman will become pregnant.

With surrogacy, another woman actually carries the baby in her womb. This can be arranged through a couple of different methods. In one instance, sperm can be gathered from the father and an artificial insemination take place.

However, many parents are looking to have a genetic relation to their children. In this case, it is possible to gather both eggs and sperm from the parents and use them to create the embryo that will be placed inside the surrogate mother. After the baby is born, the child will belong to the parents of the child rather than the woman who gave birth to it.

That surrogacy can bring enormous happiness to those who could not otherwise have children who are genetically their own is not in question, nor is the fact that the children themselves lead happy lives. For us, it is pertinent to understand the issue of how we place their stories alongside the broader narrative of women’s reproductive rights and destinies.

Delhi has almost 65 ART clinics which deal with cases of surrogacy. These clinics and the doctors who run them are worried about the road ahead in the wake of the Centre’s Surrogacy (Regulation) Bill.

In a recent report, Dr Alka Kriplani, Professor and Head of Department, Obstetrics and Gynecology, AIIMS says, “There cannot be a total ban on commercial surrogacy”, but the process is needed to be regulated “judiciously” by the medical board concerned.

She further explains: “There are so many women who cannot conceive. In the majority of the cases, surrogacy is not by choice but by compulsion… Commercial surrogacy will have its own place in any society because motherhood is the right of the woman. There should be a medical board to certify the genuineness of the case… We cannot totally ban it. Instead, we should use it judiciously.”

Rather than broadening the ambit of debate, it is now essential to focus not only on the regulations that may be brought about with the Centre’s measure but to address a situation where commercial surrogacy has become an industry and has commodified motherhood to an extent that it borders on human trafficking.

Though commercial surrogacy has been banned in many countries; in India, the deliberation rages on between commerce and emotions. Hence, India’s booming baby industry that has more than 2,000 assisted reproductive technology clinics continues to widen.

Given the systematic inequalities in India, the ideological baggage overrules questions of implementation. And just like motherhood where a physical process takes place in a women’s body, not to be separated from the idea of herself, such is surrogacy where fair payment for an essential service entrenches exploitation and is a psychological shame. With or without legislation!
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