Examining the Impact of the Ban on International Surrogacy on the Livelihood of Surrogate Mothers in India

Background: Over the past two decades, the international surrogacy industry of India has grown into a thriving enterprise, as medical tourists seek out the low costs, modernized medical infrastructure, lax regulations, and abundance of surrogate mothers. Yet, after almost 15 years since India first legalized commercial surrogacy, the Indian Ministry of Health passed the Assisted Reproductive Technology (Regulation) Bill of 2014, making it illegal for women to become surrogate mothers for international couples. While this legislation will impact the medical tourism industry of India, it is unknown how this ban will impact women. The aims of this qualitative study were to understand how surrogates perceive the ban and how the ban impacts surrogates, financially and socially.

Method: Twenty-five semi-structured, in-depth interviews were conducted in June 2016 with former and/or current surrogates of international couples. The study took place at a rural fertility clinic located in the state of Gujarat, India. We used purposive theoretical sampling to identify women from an existing database of previous commercial surrogates with assistance from our partnering fertility clinic. Interviews were recorded, transcribed verbatim, translated, coded and analyzed for categories and themes. Analysis was guided by the narrative analysis approach with the goal of assessing women’s perceptions and meanings of phenomena through the way in which they discuss their lived experiences.

 

Results: On average, women had been surrogates about 1 to 3 times, ranged in age from 26 to 45 years, and were married. Women had about 1 to 2 biological children, and most were currently unemployed or homemakers. Three major themes emerged from analysis. First, surrogate mother’s perceptions of the ban were overwhelmingly negative. Most perceived tremendous financial gains and opportunities for poor women from the work. Second, the ban presented negative consequences for not only surrogate mothers, but also international couples and fertility clinics. Women expressed distress for fertility clinics that would lose business and for couples who would not have the chance to have a child. Third, the long-term economic gains of surrogacy were negligible, although most women had become dependent upon the work.

 

Conclusions and Implications: Women depend upon surrogacy for financial benefits and better livelihoods. However, surrogacy is complicated by inconsistent medical and ethical standards and care for surrogate mothers. Surrogate women come from disadvantaged socioeconomic backgrounds, and consequently, are not given many opportunities to have their voices and experiences heard. This research provides a first person account of surrogate mothers’ perceptions regarding the ban and allows women’s stories to be shared with the larger public and academic audience. Findings highlight the need for comprehensive social services for surrogates to address long term social and economic issues. Social workers are uniquely adept to provide international social services to surrogates and, consequently, should be engaged in international surrogacy issues.