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paid insufficiently and not given adequate informa-
tion about the health risks of procedures carried out
on them have highlighted the need for reforms, par-
ticularly as India has become a top destination for
foreigners looking for surrogates.
In 2013, concerned about the lack of binding legal
standards for how surrogates were being treated,
Dr. Ranjana Kumari, the director of the Centre for
Social Research, a nonprofit organization based in
New Delhi, set out to study the field in order to push
for reforms. She visited clinics across the country,
including in Anand, and found the treatment of sur-
rogates was highly inconsistent—and in some cases,
the women had no rights at all. A 2014 report from
her organization highlighted several issues: surro-
gates rarely received a copy of the contract they had
signed with the intended parents; most contracts
failed to protect the health of the surrogate; and
some surrogates underwent up to two dozen IVF
sessions. (There is little data on exactly how many
IVF cycles are safe over the course of a few years, but
each round poses some health risks.) The study also
found a huge range in compensation among clin-
ics, and there was often a discrepancy between the
amount clinics claimed to be paying and what sur-
rogates said they were receiving. Some women inter-
viewed for the study said that clinic staff were rude
to them and “treated [them] like objects.”
Things came to a head in 2014, when an Austra-
lian couple was found to have abandoned one of their
twin babies born to an Indian surrogate. The follow-
ing year, the Indian Parliament passed new restric-
tions on surrogacy, making it available only to Indian
citizens and putting an end to foreign couples com-
ing to India to find surrogates. Surrogates gathered
outside Akanksha Hospital in protest.
“I’ve seen the industry grow. I’ve seen it come
down,” Karkhanis says. In the industry’s boom
years, he facilitated nearly 200 agreements each
year, meeting 15 new foreign clients each week.
These days, he does about 20 agreements annually.
Still, surrogacy has continued to flourish, espe-
cially among upper-class, educated Indian women
who are looking to have children later in life. Bolly-
wood celebrities like Shah Rukh Khan speaking out
about using surrogacy has led to greater acceptance
within urban India, but a stigma remains, for both
intended parents and surrogates. Macwan told her
relatives and neighbors that she was going away for
work because she worried that being pregnant while
divorced could subject her to malicious rumors. “If I
tell anyone, they think that I am going to give away
my own child,” she says. “They don’t understand that
I am simply giving my womb on rent.”
Prime Minister Modi’s right-wing government
doesn’t see it that way, and has pushed for further
restrictions, telling the Supreme Court in a 2015
affidavit that it did not support commercial surro-
gacy. In 2019, the government revived a 2016 bill
banning commercial surrogacy that had been lan-
guishing in the lower house of Parliament. The only
surrogacy option would be for what is known as “al-
truistic surrogacy”—where the only compensation is
for medical expenses and insurance—and that would
be limited to childless Indian hetero sexual couples
who had been married for at least five years, had a
doctor’s certificate proving their infertility, and were
in the age groups of 23 to 50 for women and 26 to 55
for men. Under this proposal, only a close relative be-
tween the ages of 25 and 35 could act as a surrogate.
Passed by the lower house in August 2019, the
Surrogacy (Regulation) Bill was broadly criticized
as too restrictive and failed to clear the upper house.
A committee of 23 members of Parliament was di-
rected to examine the surrogacy industry, and recom-
mend amendments to the legislation. In the course of
their research, committee members met with Patel
and Karkhanis, both of whom voiced opposition to