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for its research and innovation. But how the process
works and how surrogates are treated and compen-
sated varies widely from clinic to clinic.
At Akanksha, some women directly approach the
clinic, but Patel also has a network of about 20 “care-
takers,” women in different areas of Gujarat who help
find potential surrogates. After becoming a surrogate
herself for the first time in 2019, Vasava has since
joined the caretaker ranks. Married off at 16, she
eventually divorced her husband and moved back
to her mother’s home with her three children. While
cleaning a woman’s home in a town nearby, Vasava
spoke of her plight, and her employer showed her a
video of Patel on YouTube. Vasava soon signed up
to be a surrogate at Akanksha. “Sometimes we slept
with an empty stomach,” she says of her life before
she went to the clinic. She used the money from her
surrogacy to build a small store, which stocks milk,
chips, chocolate, lentils and rice. “After the surro-
gacy, there is at least always something to eat.”
Vasava still has a picture on her cell phone of the
infant she delivered and looks at it every day. “He
would be 2 years old now,” she says, recalling her
sadness when she handed him over to his intended
parents after her cesarean section. Akanksha staff
encouraged her to recommend surrogacy to other
women she knew, and promised her a fee of $269 for
every woman who becomes pregnant at the clinic.
Most clinics in India use agents (who coordinate
everything from finding potential surrogates to ar-
ranging their housing and medical checkups) or
middle men (sometimes employed by agents to just
find the surrogates). However, the methods used
by middlemen and agents can vary greatly, as can
the fees they charge facilities and the amount they
pay surrogates. “There is [no] regulation of agen-
cies or even clinics right now; there are only guide-
lines,” says Karkhanis, the lawyer. “All these agents
do whatever they want to do in their own manner.”
Patel is careful to distinguish the fees she pays
to the women who recruit surrogates for her from
those paid to middlemen. She prefers to call the fee
a “caretaker charge,” saying that the women she
hires are responsible not only for vouching for the
surrogate’s character and background, but also for
acting as liaisons between the hospital and the sur-
rogate until the delivery date, checking in on the
surrogate’s family and conveying messages from
doctors. “She’s the bridge. You can’t rely on anyone
who walks in and says, ‘I want to be a surrogate.’
We don’t have any background checks,” says Patel,
who created the system in 2007 after having a bad
experience with several surrogates.
When Vasava is working for Akanksha, she ap-
proaches women in her neighborhood and tells them
about the opportunity and her own experience being
a surrogate. She has made $538 through this system
so far, and will be paid $269 more for a third refer-
ral who has just become pregnant. “Earlier they were
thinking it is a kind of prostitution, but I explained it
to them,” says Vasava. “I told them that they should
go there for the future of their children. I have gone
there myself, and it is very good.”
Her neighborhood is mostly home to people on
the lowest rung of India’s caste system, many of
whom belong to the Vasava community. (The women
in this story and the accompanying photos who share
the Vasava surname are not related.) They subsist
on daily wagework at construction sites or cleaning
homes, and live in shanties that flood with every
monsoon. Six women from the neighborhood have
signed up to be surrogates, and some have built solid
concrete homes with the money they have earned.Despite the opportunities that commercial
surrogacy offers some women, the industry has
been embroiled in controversy for years. Since
2012, news reports of women confined to hostels,From left: posters
of babies born
through surrogacy
decorate the walls of
Akanksha Hospital;
Kajal Vasava,
seven months
pregnant as a
first-time surrogate,
undergoes a
checkup; nurses
with a patient after
an IVF procedure