Saturday, March 1, 2014

World of Surrogacy & The Daily Beast

The Rent-a-Womb Boom

Who really profits from India’s multimillion-dollar surrogacy industry?
Adrienne Vogt-- explores the uncertain future of the subcontinent’s baby business
They’ve been called “baby factories,” conjuring up images of poor, illiterate women packed into bunks and forced by their husbands to bear surrogate children for Westerners. And they make up a vital industry in India—since 2002, when surrogacy was legalized in the country, a U.N.-backed study estimates that the surrogacy business has raked in more than $400 million a year. 
More than 3,000 fertility clinics operate across India, and some can be quite flashy. Dr. Nanya Patel —who once appeared on Oprah and has been dubbed the country’s “mother of surrogacy”—says she plans to open a huge clinic that will house hundreds of Indian women, along with delivery rooms, an in-vitro fertilization department, even restaurants and a gift shop. With couples paying an average of $25,000 to $30,000 for the entire procedure, and Patel paying her surrogates around 400,000 rupees ($6,500), it’s safe to say that she’s earning a pretty penny. Since 2004, she has delivered more than 650 babies. She says she’s a feminist and her work involves “one woman helping another.”
Patel’s critics are not so sanguine when discussing the international surrogacy industry. While its promoters say it empowers women by giving them money to support their families and improve their lives—not to mention helping bring a life into another family—detractors call India’s surrogacy circuit a cruel, manipulative business that exploits powerless women in male-dominated societies.
Crystal Travis, of North Laurel, Maryland, had her three children—a five-year-old son and three-year-old twins—delivered by Patel. Since her kids were born, Travis has become deeply involved in international surrogacy and started the consulting service World of Surrogacy in 2010. She travels to India every few months to meet with doctors, and she also has around-the-clock advisers on the ground in India. She says she refuses to recommend clinics to a couple unless the doctors grant her full access to their facilities. “People don’t understand the underbelly unless you’re in the business,” she says. “You can get people who are dermatologists running an IVF clinic.”
Travis says that for many women, international surrogacy is a response to the difficulty of adopting. A product of the adoption and foster-care system herself, she notes that most people look into adoption first before turning to surrogacy, but find it uncertain and tedious. “People should have the option, if they can afford to pay for it, to have a child that’s genetically linked to them,” she says.
Prospective parents have plenty of options, all a few clicks away. A search for willing Indian surrogates on surrogacy websites yields hundreds of results. Sree, 25, from Bidhan Nagar, says, “I am housewife, want to help my husband… anything requirement i will do.” Babita, 23, from Delhi, is straightforward: “I need money. I belong to poor family.” And 23-year-old New Delhi native Bora’s answer to why she wants to be a surrogate mother? “Everything.” 
The number of children born via in-vitro fertilization is at an all-time high, according to a February 17 report. The Centers for Disease Control and Prevention estimates that 7.4 million women in the U.S. have undergone infertility treatments, likely the result of women waiting longer to have children than ever before.  
In the United States, surrogates are paid between $28,000 and $35,00, says Dr. Jeffrey Steinberg, medical director of The Fertility Institutes, a surrogacy services provider. Total surrogacy fees range from $75,000 to $120,000 , and can inch higher if complications arise.
“Surrogates [in India] are paid about one-fourth of what they would be paid here, but that’s enough to put a family of three kids through college [in India],” Steinberg says. “They see it as a real positive in Indian culture.”
Steinberg’s practice has offices in Los Angeles, New York, Guadalajara, and soon in India. He is set to open his first Mumbai center in March and has about 30 people waiting for surrogates right now. “It’s supply and demand. I’d far prefer to use American surrogates, but I just can’t get enough of them,” he says.
The screening standards for Indian surrogates are the same as for his Los Angeles practice: They have to pass medical, psychological, infectious disease, obstetrics history, and drug and alcohol tests.
Just last month, India agreed to allow frozen embryos  to be imported into the country, a decision that’s appealing to fertility doctors like Steinberg. It makes prospective parents more comfortable, because the entire medical process can be done in the U.S.; India only has to supply the surrogates, he says.
Steinberg says that he didn’t see any evidence of Indian women being exploited at clinics he’s visited. He didn’t sense any traces of stigma, either. The surrogates are able to live in apartments next to a Mumbai hospital with their families, and their children’s educational needs are taken care of, he says.
“People really have to be careful,” Travis says, “If they don’t understand the legalities of what’s going on in another country, it’s very easy to be fooled. A lot of these intended parents are willing to do almost anything to have a family.”

“As a matter of fact, I think the surrogates there may get better attention and care than the surrogates here [in the U.S.],” he says. “I was almost expecting to see them being exploited, but I just didn’t find it.”
New Delhi’s Centre for Social Research paints a less rosy picture, though. Surrogates don’t have a uniform payment structure, aren’t provided with written contracts, and some are even subject to forced impregnations and abortions without their knowledge, according to a study released last year.
So do surrogates think they are fairly treated? Most people would assume that surrogates feel a natural connection to the babies they carry for nine months. Seita Thapa, a surrogate at one New Delhi clinic, says her clinic conducted courses that “prepare us mentally for the fact it’s not our baby.” Another woman at the same clinic, Mamta Sharma, says she was able to buy a house after her surrogacy payment. “Everything has changed in my life with the money I got,” she says. Even though her extended family considers surrogacy to be shameful, Manisha Parmar became a surrogate mother at Dr. Patel’s clinic in Gujarat. She summed up the arrangement to the San Francisco Chronicle: “They need their child. I need the money.” 
If the situation sounds rather impersonal and complicated, that’s because it can be. Maulik Modi, a father to two children born via IVF, says the Indian system “is literally like a machine factory, for lack of a better word.” He says it’s nearly impossible to connect with the surrogate: “You’ve been shut out from the emotional aspect of it all. It’s probably one of my biggest regrets in life that I have my two IVF children and I never met the surrogate or the donor.”
But Modi’s story also shows how confusing international surrogacy can be. Modi, a computer programmer and self-described IVF activist, currently lives with his 4-year-old daughter in Vadodora, which is located in the country’s surrogacy hub state of Gujarat.  However, his 9-year-old son lives in Houston, Texas, with Modi’s ex-wife. Due to a myriad of immigration laws, his son and daughter are landlocked in separate countries and have never met each other. As Modi puts it, they’re “stuck in IVF purgatory.”
That’s because to bring a child into the United States, the parent must be a U.S. citizen or U.S. green-card mother. And for a child to attain U.S. citizenship, one parent must be a U.S. citizen at the time of birth and have a genetic link to the parent. Someone like Modi—who came to the U.S. from India in 1989 as an international exchange student, and received his U.S. citizenship in June 2010, a year after his daughter was born—doesn’t meet those requirements.
“Because of U.S. immigration laws, as an IVF father, I cannot bring her to the U.S. If I were a green-card mother, then I could have, but a green-card father cannot,” Modi explains. He and his then-wife had encountered five failed IVF attempts with two donors and two surrogates before conceiving their second child via IVF in January 2009. But after his wife filed for divorce that July, months before the child was born, Modi had to decide whether to stay in the U.S. where his son was living, or go to India to raise his daughter. He decided on the latter.
Both children are essentially landlocked: a court order prevents Modi from taking his son (of whom he has joint custody) outside the U.S., and the U.S. government won’t grant his daughter a passport. He’s pleaded with embassy officials, the FBI, and immigration officials for more than four years, but has been deadlocked because laws haven’t kept up with IVF technology, he says.
“My daughter has been killed. She has been made legally invisible, just like abandoned IVF children at an orphanage. They have no rights,” he says. “Why are you forcing me, as a parent, to discriminate against my own two children, who were born exactly the same way?”
As technology changes, international surrogacy laws may be forced to adapt—and there’s a faint glimmer of hope they will. Travis, the surrogacy adviser, and one of her company’s attorneys and clients met with Rep. Ted Poe, R-Texas, in early February about the need for updated laws. He seems receptive that both sides of the aisle can implement guidelines addressing IVF issues and immigration, she says.
But over in India, regulatory laws are still in flux, and they may hinder international surrogate-seekers, especially gay or lesbian couples and single parents-to-be. In July, the Indian government updated visa regulations: It now requires a special surrogate visa and a valid marriage certificate showing that parents are married for at least two years before leaving with their baby, says Steinberg, the fertility doctor. The new regulation effectively eliminated the entire ga.y community from surrogacy in India, which accounted for 60-70 percent of the total volume, Steinberg says. And officials seem steadfastly opposed to budging on the marriage certificate requirement
This year, Indian Parliament is expected to reintroduce the Assisted Reproductive Technologies Bill , or ART, which was drafted to regulate surrogacy in the country. But Travis is skeptical about the timeline — she’s heard the update may take years.
“A lot of people want [surrogacy] shut down to foreigners in general because they feel it’s too problematic,” Travis says. “They highly encourage doctors not to help singles and gays; however, many still do. If the law does get passed to shut it down for singles and gays, then that industry will cease in India.” Travis says that many are instead turning to Thailand and Nepal, but she thinks some of the surrogacy industry as a whole will move back to the United States. Every state has its own rules, but some, like New York outright ban commercialized surrogacy. Travis is currently looking into avenues that may open up affordable surrogacy in Texas or Puerto Rico.
“People really have to be careful,” Travis says, “If they don’t understand the legalities of what’s going on in another country, it’s very easy to be fooled. A lot of these intended parents are willing to do almost anything to have a family.”

Tuesday, December 10, 2013

The New Republic Magazine & Crystal Travis


These Two Americans Want Babies Through Indian Surrogates. It's Not Been Easy.

In separate photos, the twins are wrinkled and pale. Both boys lie on a blue-green hospital sheet—one with limbs outstretched, the other curled up—and their faces are scrunched; perhaps they’re crying. The twins’ father, Trevor1 flips back and forth between the two photos on his cellphone. At 53, he is married and has two daughters, 15 and 8, but he has the restless energy of a first-time father. “Just looking at the pictures every night, I pray for them. I tell them good night. I kiss them, and I say, ‘This looks like it’s real.’”
The photos are how Trevor knows his sons exist. At this point, he hasn’t met them yet because they were born to a surrogate mother in New Delhi, India, thousands of miles away from his home in Philadelphia, Pennsylvania. When they were born on October 16, at 37 weeks, he hadn’t booked his plane ticket. “It still hasn’t felt real,” Trevor said. “Not until I touch those babies, until I start hugging those babies.”
Trevor’s strange limbo isn’t unusual for those who pursue surrogacy abroad, one kind of fertility tourism that's on the rise as singles and couples, both gay and straight, seek ways to overcome the limits—biological, financial, legal, technological—of having children. For U.S. residents in particular, surrogacy costs are cheaper overseas—by tens of thousands of dollars. But there are trade-offs. The child is born in another country, a distance that's more than physical; it spans language and culture. And parents need paperwork and embassy appointments and an international flight to bring their baby home.
That’s partly what brought Trevor to this booth in a Cosi in Philadelphia. Next to him sits Crystal Travis, founder of World of Surrogacy, which helps parents with surrogacy abroad, primarily in India. Trevor is one of her clients. This is their last meeting before he leaves for India, where she'll later meet up with him and help him fly home with the boys. Travis has arranged as much as possible beforehand, and now she pulls out a stack of white letter envelopes, laying them in front of Trevor like she’s dealing cards. They're thick with papers—applications for the twins’ passports, copies of embassy appointments. “This is all the stuff that you’re going to have to do there,” she tells him.
Travis has been through this process herself. She's married with three kids—a five-year-old son, and three-year-old twins—all born through surrogacy in India. She is open and empathetic but direct about the difficulties, and potential disappointments, of Trevor's decision. Surrogacy in India is “never the first option,” Travis says. “It’s people who’ve expended a lot of effort, money, energy trying to get [children] in other ways.”

India is one of a few countries, though perhaps the most popularized, where commercial surrogacy is legal. The country emerged as a “hotspot” in part because of lower costs and laws passed in 2002 allowing commercial surrogacy. In the U.S., surrogacy can cost between $80,000 and $150,000, while in India it ranges from $20,000 to $60,000, depending on the types of services and the clinic. That amount rarely includes unforeseen expenses like surrogate hospitalizations, or the basic travel costs such as flight and hotel stay. Yet those “savings can be the difference between being a parent and not being a parent for a lot of people,” says Kathryn Kaycoff Manos, founder of Global IVF, a resource for fertility tourists.
Exact numbers of U.S. citizens going to India—or anywhere else—for surrogacy are hard to pin down, but are a fraction of those seeking surrogacy within the U.S.. A recent report by the American Society for Reproductive Technology estimated that 4 percent of surrogacy deliveries in the U.S. are to foreigners, and that, conversely, the "incidence of U.S. patients traveling abroad for care is estimated to be far lower than the rate of patients coming into the United States." Even that is just a rough estimate; there is no international registry to track where patients are from, or where they’re traveling for reproductive care.
Where surrogacy is legal around the world
Surrogacy in India is largely unregulated, though the Indian Council of Medical Research is moving toward greater control, including the registration of clinics, says Hari Ramasubramanian, a lawyer who founded the Indian Surrogacy Law Centre. An estimated 2,000 foreign babies are born to Indian surrogates each year, according to research in the forthcoming book Patients With Passports: Medical Tourism, Ethics, and Law, by Harvard law professor I. Glenn Cohen. A recent study by Sama, a resource group for women and health in India, concluded about 3,000 clinics offer surrogacy services to foreigners, generating more than $400 million per year for the economy; the Confederation of Indian Industry analyzed data that put India’s commercial surrogacy even higher, at more than $2 billion.
But tighter restrictions may alter the scope of India’s surrogacy tourism. In July 2012, the Indian Ministry of Home Affairs ruled that foreigners needed medical, not tourist, visas to pursue surrogacy. The ministry limited those visas to straight couples who've been married at least two years, and who come from countries that also permit surrogacy. The rule change amounted to a bar on singles, gay, and unmarried couples, and on those circumventing their home laws to have children. Though the ministry relaxed regulations so foreigners who had already begun surrogacy in India could complete the process, the Indian government began enforcing the new rules this fall, Ramasubramanian says.
Enter Thailand and the Mexican state of Tabasco, two places where surrogacy clinics now cater to international singles and couples—particularly same-sex couples. Thailand has been a popular surrogacy choice for Australians, but has become more appealing to Americans because of the new restrictions in India, says Kim Hendrix, a Dallas-based facilitator who owns Complete Surrogacy Solutions and works with clinics in India and Thailand. Hendrix—who travelled to Bangkok last month to meet with doctors, visit clinics, and to find out the entry and exit processes for new parents—says they’re still trying to get a better sense of the landscape in Thailand, where surrogacy is de facto legal; there are no laws against it, but that also means few protections in place for surrogates, doctors, and expectant parents (though Thai officials have considered regulations).
As for Tabasco, many people I talked to say they have outstanding questions. “It’s still new,” says Lauri Berger de Brito, co-founder of Global IVF with Kaycoff Manos. “So everybody’s starting to flock there and flock to Thailand. The stories will soon start coming out, the good stories and the bad stories.”

No matter the destination, real risks exist. Clinics sometimes make false promises about results, or inflate success rates. Would-be parents can spend tens of thousands without ever having a baby. There is little, if any, legal recourse for foreigners who fall victim to scams.
Citizenship laws also haven’t kept pace with reproductive technology, or global access to it. Children born to surrogate mothers in India are not considered Indian citizens. But the U.S. grants citizenship to children born to surrogates only if they have a genetic link to at least one parent. Yet DNA mismatches—because of lab error, or when eggs or sperm are deliberately substituted to increase the chances of a fertilized embryo—have left babies "stateless," unable to and Indian or U.S. passport. “If you don’t have a passport, you can’t get on an airplane and come home,” says Catherine Tucker, an attorney who specializes in family and reproductive law. Though cases of stranded children are rare, Tucker has heard of parents going to extreme lengths: “Smuggling, physically smuggling, to get their children out of India."
But the surrogates also face risks. Because these women are paid, on average, $6,000 to $7,000, many see surrogacy as a pathway out of poverty. “It raises the status of them in their whole community. It is a positive thing,” says Kaycoff Manos. But women can miscarry, or develop health problems during and after pregnancy. Clinics don't always provide follow-up medical care or compensation for families if something goes wrong. Surrogates often come from the poorest households, and though many sign up willingly, they do so because they lack other options. Dr. Ranjana Kumari, a woman’s rights advocate and leading critic of Indian commercial surrogacy, told CBS News in April that “the vulnerability of poverty has been exploited in this whole system.”
Surrogacy supporters believe regulation—guarding the rights, health, and just compensation of surrogates—is crucial. Groups such as the Indian Society for Third Party Reproduction want to establish minimum compensation and treatment standards. Ramasubramanian’s Law Centre is trying to recruit both surrogates and parents willing to make agreements independent of the clinics or hospitals, which he says will protect surrogates’ rights. Clinics, not the surrogate, are the connection with foreign parents, which puts many surrogates in a vulnerable spot because they can’t change doctors, or pick which hospital they deliver in. “That part has to change,” he says.

Jean,2 another of Travis's clients at the Cosi get-together, thought when she was younger she'd have the husband, the kids, the white picket fence. “But it didn’t happen that way,” she says. She survived a bad, and childless, first marriage. Then twelve years ago she met her husband, her junior by about ten years. She calls him Mr. Bear, and she talks about him like a schoolgirl with a crush. But still there's something missing: children. Jean has spent thousands on failed attempts to build a family. She looked into adoption. She found an egg donor and surrogate in the U.S., but the surrogate fell through. Now, at 67, she will attempt surrogacy in India in late December.
But even if she and her husband can finally bring a baby home, her struggle won't necessarily be over once she's back in the United States. As Trevor explains about seeking surrogacy in India, "It’s not everyone you can tell.” Some of his immediate family, even his wife for a time, opposed his decision. “You gotta pick who you want to tell. Some people will agree, some people will not agree. Some people will support you, some people will not.”
Crystal Travis says she didn’t expect to be questioned about her decision. She’s been asked how much her children cost, where she adopted them from, whether she was really their mother. “I don’t think there’s acceptance of it,” she says. “It’s a very personal and private type of thing."
But it's also something to bond over. Travis meets up with old clients, now friends, often. They decided they’ll celebrate the Hindu festival of Diwali together next year. Trevor and Jean and Travis are already are making their own plans. Spending time together is comfortable and easy, a play date free from judgment.
“The kids are going to have fun,” Trevor tells Jean. “Trust me.”
“Yes,” Jean answers, sounding both nervous and hopeful. “Yes I know.”
 “Your kids are going to go to Jamaica with us, and go to the beach and hang out with us. We’re going to have fun.”

Saturday, November 2, 2013

India Bound

It looks like I am headed to India within the next week.  Actually, the weather here on the East Coast is getting cold, so a little warm weather is welcomed.  It will be nice to get the temperature of what is happening in the surrogacy community from those on the land in India.  I will keep you all posted.

Sunday, October 13, 2013


Mark's Rocket Ship

For those of you who have followed our journey, Mark will be 5 on Tuesday and the twins will be 3 on December 20th.  Mark is a genius according to us, Elle runs our home and Alec has an A personality.  Well what does that say about us...for those of you who know fill in the blanks.

I decided to write this post for many reasons.  One a number of you always email me asking when will you post, and secondly due to the climate of surrogacy in India at this time.  I really want to give a shout out to Dr. Patel because she always holds the mantle that eludes many when surrogacy in India is discussed.  For those of us who have traveled this road I can say that we are tired of the voices that have never traveled our journey to talk about exploitation of surrogates yet have no idea how many intended parents or better known as IPs have been exploited.  We do not ask for any one's sympathies because we all embark on this journey desperate and wholeheartedly hoping for a connection with the best of humanity.

Often I wonder to myself, what role do intended parents play in this story.  Is it fair to ask the doctors to house the surrogates for 8-9 months?  Are we paying the surrogates what the market will bare?  Are the doctors truly exploiting the surrogates? I am concerned when people open business and facilitate and have never even had a surrogate anywhere in the world.  The answer to these questions are a mixed bag.

I have openly stated that our surrogate was not housed for the entire period of time in Gujarat, because she did not need to be.  We were fortunate enough to have had a surrogate who worked in the medical field in India.  I personally do not feel that all surrogates need to be  housed, although I do work with doctors who do feel that the should be housed.  The problem comes into play if a doctor tells their intended parents that their surrogates are housed, when they are not.  I have intended parents tell me that they have worked with doctors and did undercover work on their own only to find that their surrogate was not being housed, however they were charged for housing.  If you are concerned about your surrogate not getting the payment that you think is fair then it is incumbent upon you to if at all possible to hand the surrogate extra funds privately.

What I know for sure is that there are good doctors in India that value what they do and love their job.  I have cried with doctors who work tirelessly to do the best that they can because they will not tell a client that they have had yet another negative.  Are there bad doctors in India?  Yes just like anywhere else in the world, however it is more pronounced when it is not regulated.  I am not saying anything that I have not already said before, the truth is that now more voices are finally seconding  the realities of what I and others have been saying for years.

Thursday, August 8, 2013

Parliment and Surrogacy

Those of us in the surrogacy world have been emailing each other back and forth, wondering what will happen next in India.  Well I am being told, that the Parliament may vote on allowing gay and single people to either pursue or not pursue surrogacy within the next 48 hours.  As intended parents you still have options outside of your country.  World of Surrogacy will continue working with India, as long as they continue to allow surrogacy.  For our clients who are single and gay, if this option is cut off to you we are pursing surrogacy in Mexico and if need be Thailand as well.

Let's wait and see what the vote is!