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New Cannibal Markets

Jean-Daniel Rainhorn
Samira El Boudamoussi

Part 2. Wombs for Rent

For Motherhood and for Market: Commercial Surrogacy in India

Sarojini Nadimpally

Texte intégral

  • 1 Assisted reproductive technologies (ARTs) are a group of technologies that assist conception and p (...)

1The key features of globalization, such as the crossing of boundaries, convergences, transitional economies, commercial opportunities and the market forces are significant in the context of assisted reproductive technologies (ARTs).1 Originating in the West, in recent years these technologies have proliferated under neoliberal economic globalization, wherein the ideology of trade without borders is central (Gupta and Richters 2008). A transnationalized fertility market is created wherein reproductive materials like sperm, ova, and uteri are traded like any other commodity to make profit. This justifies that markets, being “indiscriminate [and] promiscuous... reduce everything, including human beings and their sexual and reproductive capacities, to the status of commodities, things [that] can be bought, sold, traded and stolen” (Soros 1998).

2Though, commodification of the body is definitely not something new (Sharp 2000), but recently there has been an unprecedented surge in markets for human organs, tissues, and reproductive body parts. Thus, under present condition, bodies have emerged as economic capital to be bought and sold to the highest bidder.

  • 2 In case of kidney donation, slums of Mumbai, Kolkata, and Chennai have been referred to as “organ (...)

3Reproductive materials in this market become commodities in the same way reproductive technologies are. On the one hand, through the process of objectification and commodification, these reproductive materials and organs assume an individual existence and become the sole identity of the person selling them. At the same time the physical, social, and cultural attributes of the donor also enhance the price of the reproductive material through a process of personification. The movement of reproductive material and processes2 also follows the “modern routes of capital” flow—from “South to North, from Third to First World, from poor to rich, from black and brown to white, and from female to male” (Scheper-Hughes 2000, 193; Nadimpally et al. 2011).

  • 3 One poor woman earned $750 for a kidney. The ultimate recipient, a Singaporean, paid $37,000 for i (...)

4This becomes crucial because although some couples who travel for in vitro fertilization use their own eggs and sperm, most couples and singles utilize the oocytes of women or surrogates of the host country. Hence this becomes murky, as this free flow of people, capital, goods, and services operate within global relations that are characterized by stark economic inequalities. The problems of access to these expensive technologies in home countries thus often have far-reaching implications on the lives of economically vulnerable women in the host countries who participate in ART programs. This unequal power relation is true, however, not only in case of foreign clients, but also when the recipient is from India itself. This scenario often echoes of the market that developed in India in relation to organ trade, where some areas came to be known as the “Kidney District” because of the high number of residents who sold organs.3

5The entire business of ARTs, whether as part of medical tourism or while providing service to its own clientele, operates in legal and ethical vacuum. The wider ethical question that arises here is: Given that poverty, hunger and lack of basic amenities are the lived reality of most women who offer these services, what are the chances of making an informed choice? Or is it a choice of compulsion, as in a capitalist world one can only choose from those options, which are available to them. This has led Storrow (2006) to claim that fertility tourism has acted in a way to transform public oppression in one country into private oppression in another. This movement of babies, reproductive body parts, and women’s caring and reproductive labor both as nannies, egg donors, and surrogates has led to the “globalization of motherhood” (Browner and Sargent 2007, 236), impacting women who mother and enable others to do so.

Indian context

6Over the past few years, the sharp growth in commercial surrogacy—the practice of gestating a child for another couple or individual through the use of ARTs in return for remuneration—in India has drawn much attention and raised several ethical concerns. Surrogacy has become an essential component of the larger fertility industry that one witnesses today. In the absence of any kind of regulatory and monitoring mechanism of ARTs in India (including a national registry), it is difficult to arrive at the exact figures with regard to the existing surrogacy industry. However, the steep rise in media reports and anecdotal evidence related to commercial surrogacy arrangements are a significant indicator for estimating the scale and spread of the commercial surrogacy market. An exponential growth in the industry is evident from the comparative figures over years. In the year 2008, the surrogacy business was reported to be worth $445 million in India (Indo-Asian News Service 2008), while in 2011, it is estimated to be over $20 billion. Considering the acquired status of India as the most favored destination for providing commercial surrogacy, these figures are perhaps not surprising. Surrogacy is boosted by both domestic and international demand, because of the comparatively lower costs in relation to many developed countries (for instance, Canada, the United Kingdom, and the United States), less waiting time, the possibility for commissioning parents to closely monitor surrogates, and the availability of a large pool of women willing to be surrogates (Sama 2010).

7The surrogacy industry is functioning through actors and collaborations at various levels, in an environment that lacks binding standards or regulation where these multiple stakeholders stand to profit enormously. ART clinics are not the only players in the business of promoting “reproductive tourism” in India. Other emerging players include a wide array of organizations catering to clientele both at the national and international levels. These range from ART consultants, medical tour operators, surrogacy agents, the hospitality industry, and tourism departments to other organizations specializing in medical tourism promotion.

8To create demand, ART providers argue that with infertility “rampant and rising steadily” today, ARTs have become the “need of the hour.” They cite higher rates of infections and ensuing complications, particularly in the absence of adequate gynecological and obstetric services, as factors that contribute to the high infertility in India. Providers thus claim that they are merely responding to the demand of women “desperate” to become mothers. There is an increasing medicalization and pathologization of the condition of infertility, with the industry pushing for early medical intervention (Sama 2010).

9The choice to be a surrogate, like all choices, is not free or absolute; rather, it is made in a context of economic necessity. The practice of commercial surrogacy reminds us that ethical, economic, and political questions are contained in issues commonly regarded as personal. Feminist critiques of surrogacy have highlighted that the ART industry lies at the intersection of patriarchy and market, wherein these technologies meet rather than question the pressure on women to be mothers. The commodification of the body in surrogacy is clear; the child becomes a “product” of the arrangement while the woman’s body becomes a “resource.” Combined with the availability of women’s cheap labor in an unorganized sector that is characteristic of the globalizing Third World economy, the “surrogacy industry” constructs the discourse of a win-win scenario for infertile couples and women struggling with poverty.

10Surrogacy lies at the “peculiar intersection of a high reproductive technology and a low-tech work force.” Greater commercialization of women’s labor and body parts is taking place under globalization today, with women finding themselves pushed into more informalized jobs such as export zones and the service sector, where there is a demand for their cheap, “docile,” even sexualized labor. India’s economic policy has shifted away from centralized industries, and towards new industries that operate with minimum controls, including for labor. As the unorganized sector grows, temporary and contractual jobs for underskilled labor are on the rise (Shah 2009). In the Indian subcontinent today, women who are in professions such as garment work, sex work, migrant domestic work, and surrogacy are engaging in contemporary and commercial forms of sexualized and reproductive labor—an extension of their “care work,” which was generally, traditionally considered economically non-productive, apart from being seen as dignified only if domesticated. These jobs are usually inattentive to women’s rights and health, but are some of the only “real” options available in a context that is destroying indigenous livelihoods, while rolling back state investments in social sectors. Commercial surrogacy may be best understood as “a new kind of labor—gendered, exploitative and stigmatized labor, but labor nonetheless” (Pande 2010).

11However, it is also important to understand that this subversion is located within an industry that is operating in the context of the increasingly liberalizing economic policies of the Indian state, of an established and flourishing privatized health sector, and of the availability of cheap female labor—on one level the subversive potential lies in the fact that child-bearing is considered as a commercial act, for which women are being remunerated. Ketchum (1989) argues that “contract motherhood” is to be seen as selling bodies and babies, the commodification of which is objectionable for three reasons: it turns people into means rather than ends, the consequences for women and children who are bought and sold, and concerns about protecting the mother-child relationship from the potential coerciveness of commercial transactions (Sama 2012).

12However, Malm (1989) argues that the payment should be seen as compensation for the surrogate’s use of her own body and not for the use of her body in the sense that the customers may acquire a space over which they then have control. In choosing to enter into arrangements to use their bodies in ways that benefit others they reaffirm their status as agents.

13Commercialization is seen as an engaging concern, because profitmaking and promotional interests often lead the providers to either present the incumbent health risks and complications as minimal, or justify them in terms of a cost/risk-benefit analysis. As Nadimpally and Das (2010) assert, “Cost-benefit analysis is invalid for health issues, because the inputs and outputs cannot be quantified. As a result, financial constraints determine public health priorities rather than epidemiological resources. This assumes that technology available is necessary, effective and safe.”

14Thus, commercial surrogacy as a practice exists precisely because of the existing political economy, and the transitions that the practice makes from the prescribed dichotomy of family to market are to be seen as intersections of multiple systems of power and institutions. It has become clear by now how and why ARTs have proliferated so quickly in the Indian context, becoming a booming market. It is this private medical market that is the focus of our systematic enquiry, situated as it is within this wider framework.

The study

  • 4 Sama Resource Group for Women and Health is a Delhi-based organization that has been working on th (...)

15For over the past nine years Sama,4 a Delhi-based resource group for women and health, has been engaging with ARTs, at levels ranging from community to policy—raising and addressing concerns around gender and health rights that result from their unchecked proliferation from a pro-regulation standpoint.

16This paper relates a part of the research conducted by Sama during the period from October 2011 to December 2012. This research aimed to document the experience of surrogates, to theorize their subject location and situate this within current debates in feminist theory, and to examine the processes followed and use the above evidence to advocate for a comprehensive legal framework to regulate the ART industry, including surrogacy, in India. The study was conducted in two states, Delhi and Punjab, in northern India. Twelve surrogates were interviewed, six from each site. Given the qualitative nature of the research, the focus was on conducting in-depth interviews, with a small sample size. The research team however faced many constraints in accessing respondents, given the general atmosphere of secrecy that surrounds the practice and reluctance of doctors and agents to provide access to surrogates.

Key findings


  • 5 Currency conversion done on February 2, 2015,

17The socio-economic background of the surrogates who entered into surrogacy arrangements had a direct bearing upon their choice to enter as well as the terms of the arrangement. The women came from a similar economic working class background: they have a low education level (apart from two who were graduates, the rest were below class ten or had not received any formal education), employed in low-paying, informal, casual work such as piece garment stitching work, domestic work, cooking, or as housewives. Their household monthly income ranged INR3,000 to INR15,000 (from $49 to $245).5 Similarly, their husbands’ occupation in all cases was characterized by informal, low-paying and unstable options such as garment work, cooking, auto-driving, taxi driving, masonry, factory work, and patient care. In two cases where the husbands were employed in service and hotel management, the surrogates were not earning themselves and had the highest monthly income in the sample. All the surrogates in Delhi, barring one, resided away from their homes, in accommodation arranged by agents/agency for the period of surrogacy. In contrast, all the surrogates interviewed in Punjab resided at their own homes during the surrogate pregnancy.


18Doctors, agents and commissioning parents placed certain restrictions on women chosen as surrogates. The first selection criterion was “proven” fertility, such that women who had borne children could qualify as surrogates. This qualification was also extended to mean that only married women could enter this work, accepting the prevalent notions of women bearing children once married. This preference was also voiced out of concern for a successful and safe pregnancy by avoiding possibilities of conflict related to questions raised by a pregnancy in case of a single/separated/widowed woman. Further, women were tested for various diseases and medical conditions to ascertain their “fitness” for the pregnancy. When diagnosed with such a condition, they were either treated or asked to seek treatment and then come again once “healthy.”

19Doctors and agents confirmed that commissioning parents set other criteria related to caste or religion, often depending on the identity of the commissioning parents. Preference was also expressed on lines of surrogates’ appearance as healthy, fair, beautiful, and hygienic. The agents came from similar socio-economic backgrounds as the surrogates. They had formal links with the hospitals, being nurses, procuring referrals, or lab technicians. They were also employed for their social skills and having good network in their community.

20Hospitals had links with agencies or independent agents. Medical tourism agencies sometimes used independent agents to arrange for surrogates. Agents increasingly depended on word of mouth, often depending on surrogates and egg donors to locate and bring women as potential donors/surrogates to the agents, for which the women are offered a commission. This trend was increasing rapidly. Egg donors were also considered as potential surrogates. Women also heard about surrogacy through local cable TV programs about IVF technology and clinics, or through media reports about IVF/surrogate births at the particular clinics.

Reasons for entry

21Surrogates described conditions of unemployment or nature of work available to them as insufficiently paying, casual work, and the struggle to run a household. Some women came from families that faced immediate needs and, along with their husband, they bore the responsibility of paying off debts or buying a house. The appeal lay also in the fact that no other work option would enable them to earn such a large sum of money in a short span of time, and this was the only way for realizing their aspirations regarding securing their children’s future and affording them education or some financial security by creating savings. After finding out about surrogacy, many women had to convince their husbands, who expressed initial reluctance, before entering the arrangement. Some surrogates also considered surrogacy as a better option than the domestic work or factory work available to them. In a couple of cases the surrogates also stated the continued persistence of couples and agents as a factor encouraging them agreeing to take up surrogacy.

Informed consent

22Commonly there was no process of informed consent regarding any procedures. Surrogates were given scanty, if any, information about the several tests conducted, procedures, technology, etc. Surrogates were generally excluded from communication that occurred between the commissioning parents, doctors, and agents. The surrogates expressed discomfort and feeling intimidated in the hospital environment, which further weakened their position to ask for information or bargain over the terms of the arrangement.

Medicalization and health risks

23It was questionable whether the procedures employed were necessary, whether there was any real “medical indication,” given that many technologies were chosen out of concern to secure a healthy birth and smooth relinquishment to accommodate the wishes of the commissioning parents. This was often placed above the possible consequences and concerns for the surrogate’s health. Given the low success rate of the technology, multiple embryo transfer was the standard practice, which could in turn lead to fetal reduction depending on the possible number of safe births or based on the preference of the commissioning parents. Selection of “healthy” embryos at the time of transfer was also practiced, leading to concerns about sex-selection as well, even though the doctors denied such a practice. Similarly, caesarean delivery was chosen as a standard to prevent any risk to the child during delivery. In some cases the time of the delivery and labor were also controlled to accommodate the commissioning parents’ presence, as requested by them. The surrogates were given medication to prevent them from lactating; surrogacy arrangements did not allow surrogates to breastfeed the child. This was understood by providers as necessary to prevent building of any bond between the surrogate and the child.

24The surrogates were often told that there would be no health risks, and the pregnancy would be just like their previous ones. In the course of the pregnancy and thereafter, the surrogates reported discomfort in having to follow an unanticipated aggressive routine of medication and injections, which they found extremely painful and often causing lumps. They also reported varied effects such as nausea, lack of appetite, swelling in legs, weakness, reduced mobility, weight gain after delivery, or persistent pain related to the caesarean operation. Consequently they had to slow down their pace of work in and outside the house.

25There was no responsibility borne by the doctors or the commissioning parents for the health of the surrogates after delivery. Any instance to have medical expenses covered or care offered was contingent on the individual opinions or wishes of the commissioning parents.

Regulation of the lifestyle

26Attempts were made to regulate the lifestyle of the surrogates during pregnancy. The surrogates were asked to abstain from having sexual relations with their husbands at least for the first three months and preferably throughout the pregnancy and to control their sexual behavior. Doctors also prescribed a specific diet, sometimes on the behest of the commissioning parents, and the women were asked to eat only home-cooked food. Instructions are also given to keep their physical activity to a minimum and to discontinue work outside and within home. Surrogates expressed that such demands could be contrary to their needs in daily life and could be difficult for them to follow.

Monitoring and surveillance

27Agents were seen to be particularly useful in exercising some form of surveillance. Ways of monitoring and ensuring compliance included surprise visits, phone calls and encouraging commissioning parents to check up on the surrogates. The surrogate’s husband or children were asked to ensure she does not exert herself and the husband was asked to give up his job and be available at home to take care of her. More recently, agents or agencies arranged accommodation in hostels or separate rooms.


28Lawyers hired by the commissioning parents or doctor drew up the contract, without any negotiation or discussion with the surrogates, while some surrogates expressed their inability to afford any legal aid. The surrogate or her husband did not read the document, which was in English in all cases; nor was it read out to them, and they were told only verbally what it states. The surrogate’s husband’s signature was a mandatory requirement.

29Surrogates and their spouses were informed that the contract states that they agree to give up the child after birth. In one case, there was mention of payment, though the surrogate was unaware of the exact details. The contract was used as a tool to minimize any conflict or contestation against the commissioning parents’ rights to the child, leaving out a whole gambit of crucial issues that should have been negotiated and settled as the terms of the arrangement. It served as security for the commissioning parents, while the surrogates had none, with no control or say in the matter.

Counseling services

30None of the centers offered counseling services. “Counseling” was limited to the informal interaction that the surrogates had with doctors and agents. They received information and explanations from a standpoint of ensuring that they would comply with the instructions given and would be ready to give up the child. The object of these interactions was not to provide information or cater to their concerns or their psychological health; it was largely reduced to one-time information giving. “Counseling” for the husbands was carried out to “convince” them and procure their consent for the surrogacy arrangements.


31Attempts were made to create a “distance” between the child and the surrogate, to ensure relinquishment. The preference of using IVF technology and not using the surrogate’s egg were motivated by the concern to establish that she not have a biological link with the child. The fact that the husband did not participate in the child’s conception was also stated to impress upon them that they could not keep the child. Similarly, surrogates were denied breastfeeding and were not permitted to see the child for any length of time after the birth.

32After delivery, contact between the surrogates and commissioning parents decreased over time, and in some cases, there was no contact after birth. The commissioning parents alone decided the duration of contact. Surrogates generally expressed the desire to have some contact and keep communication with the commissioning parents through the pregnancy and after birth, though some were skeptical of the possibility given the commissioning parents’ preference of keeping the surrogacy a secret from the child in future. Two of the surrogates expressed the desire to keep one of the twins they were carrying, although the agent and the commissioning parents refused. Surrogates had no right to choose the terms of the baby’s relinquishment; the clinics decided whether the baby was handed over to the intended parents immediately or soon after birth.


  • 6 One lakh equals 100,000 rupees. Currency exchange calculated on February 2, 2015,

33In most cases, the commissioning parents or agents decided the surrogate’s remuneration, which ranged from 1 to 4 lakh Indian rupees ($1,633 to $6,532),6 the average being higher in Delhi. In addition, the payment could include gifts after the birth, or promises to secure employment for one of the surrogate’s children (in one case). In some cases, the surrogates were not aware of the exact amount promised by the couple, with the agent/agency paying on their behalf. In Punjab, an agent reported that for surrogates of “high” caste, the commissioning parents paid up to 1 lakh Indian rupees ($1,633) more than the usual amount.

34Payment was usually made in installments, but there was variation in the frequency and amount disbursed, while the bulk leftover of the promised amount was paid after birth. In some cases the expenditure on travel for appointments at the clinic was included in the monthly expenditure, while in some the reimbursement was additional. Where agents had arranged for accommodation, they bore the expenses for travel or arranged for conveyance. There was also variation in the allowance provided for hiring domestic help or diet consumption across cases.

35Surrogates were unaware of the amount agents and doctors charged, but some reported having observed that the doctors were paid significantly more. The agents reported that they had a fixed commission rate. In Delhi, the agent deducted the commission fee from the surrogate fee as well; the rate increased consistently over the years. In Punjab, the agent reported she claimed a flexible percentage, depending on how much the commissioning parents could afford to pay. In one case, a surrogate reported that the agent had taken gifts the commissioning parents had given to the surrogate.


36Surrogates were apprehensive about how others perceived this work is and how it would/could affect them. They surmised that they would encounter responses that would equate surrogacy to sex work or baby selling. Due to lack of information, there were prevalent misconceptions that becoming a surrogate required having sexual relations and that a child was given in exchange of money, both ideas sources of stigma.

37Surrogates very often chose not to tell people in their families, neighborhood, and workplace that they were part of such an arrangement. While some were more open than others, a number chose to move out of their own residence or cities to hide the pregnancy (Delhi). Surrogates who stayed in their own homes lied to their families and neighbors that it was their child, reporting a stillbirth after giving the child away, or that they were giving the child away to someone in the family (Punjab). Surrogates reported that commissioning parents also expressed concern or exerted pressure to hide the pregnancy, given the stigma attached to infertility, in addition to attempting to keep the records in their name or faking pregnancy.

38The surrogates in some cases reported feeling isolated, distanced from families and communities for months and having no one to talk to. The relationship with their husbands was impacted in varied ways, some reporting a greater closeness, or alternately less communication. Hostility from other members of family was also mentioned. One surrogate also chose to go to Delhi in the interest of keeping the arrangement hidden, even though she was offered a lesser amount than that in her hometown.

39In the face of stigma and social disapproval, or health risks and separation from family and a dissatisfactory experience of surrogacy, some women chose not to enter the arrangement again, although three surrogates decided on repeated surrogacies. One surrogate justified her choice as a means to achieve a respectable and equal status to others in society, escaping the suffering of a life ridden with insecurity; this choice became imperative for her despite the risks. Others justified it by referring to its altruistic dimension or that it was “not sex work”. In contemplating entering an arrangement again, however, surrogates expressed their wish to voice their demands the next time, wanting better pay, health insurance or communication with commissioning parents after relinquishing the child.


40There is enough anecdotal evidence to suggest that surrogates have limited autonomy over their contract pregnancies (Sama 2012; Nadimpally and Marwah 2013; Saravanan 2010). Surrogates are often chosen based on their submissiveness to the demands of doctors and intended parents. Processes such as recruitment, contracts and counseling create the perfect surrogate—cheap, docile, selfless, and nurturing (Pande 2010). These women are often poor and poorly educated, and once selected, have to submit to several rules. Some clinics make it mandatory for women to stay at surrogate homes, while others provide them with separate family accommodation away from their permanent residences. They have little or no say in decisions, including decisions about their own bodies.

41It is important to understand that this subversion is located within an industry that is operating in the context of the increasingly liberalizing economic policies of the Indian state, of an established and flourishing privatized health sector, and of the availability of cheap female labor. On one level, the subversive potential lies in the fact that childbearing is considered a commercial act, for which women are being remunerated.

42Currently, the terms “trafficking”, “donation,” and “trade” are used interchangeably, and it is not clear if what is being advocated is a ban/prohibition or regulation. There is an urgent need to revisit the issue of commercial surrogacy, with all its uncomfortable questions and contradictions. In India, even among feminists there are many discussions, and nothing definitive has been articulated regarding trafficking. There is no doubt that traffic in eggs and other human tissues without the knowledge and consent of women is unacceptable, but can we call all surrogacy arrangements trafficking?

43The question of commercial surrogacy, which has been the subject of much attention of late, especially in the media, is one directly related to reproductive rights and justice. While surrogacy arrangements that are motivated by altruism have been far less critiqued, commercial surrogacy arrangements, which are done for financial or material gain, have led to many polarized debates within feminist thought. This easy distinction between altruistic and commercial surrogacy is also problematic. Altruistic surrogacy is often represented as the more acceptable and less exploitative or coercive option. However, notwithstanding the impossible question of how the “altruistic” feeling in any relationship can be assessed, altruistic surrogacy is unlikely to be completely benevolent and without its own power dynamic. It may even render women more vulnerable, particularly in a patriarchal society like India, than commercial arrangements that carry the same health risks, as in India mainly gestational surrogacy is in practice.

44It is important to examine closely the nature of discomfort with trade in women’s reproductive parts and “labor,” especially at a time when women, particularly in low-resource settings, negotiate complex notions of the commoditized body as a “resource,” and deploy the gendered body for access in a patriarchal and heteronormative world, in ways that are both fluid and contextual. In fact, Sama’s interviews with surrogates illustrate that many women do opt for surrogacy arrangements voluntarily; the interviews also clearly illustrate that poverty and children’s education appear to be the two main driving forces behind transactions in reproductive body parts, including surrogacy. Yet it remains, as Jyotsna Agnihotri Gupta (2012) reminds us, that the decision to sell body parts or rent a uterus is seldom made on the basis of full information regarding health hazards, or in absolute freedom. It is made “in a context of limited possibilities for self-expression, rising unemployment, lack of financial resources and in circumstances not always self-created. As such, we should avoid framing this debate in binary terms; donation or trafficking, ethical or unethical, agent or victim etc.”

45The intersection of patriarchy and market should be explored further as there exists a hegemonic and violent systematization of motherhood under heteropatriarchy that is pushing women towards ARTs. The lure of big and fast money that comes with surrogacy may well be impossible to resist for economically marginalized women, coming as they do from positions that offer little or nothing by way of better alternatives. As such, the stage is set for a flourishing market based on capitalist principles of profiteering, deployed to cash in on patriarchal values. In the scenario of growing commercial interests and profit seeking in providing these techniques including surrogacy, the role of the state and regulatory bodies becomes important. Though regulation often provides a framework that enables the market to operate or to safeguard the interests of the industry, there is still a great need for a comprehensive regulatory mechanism, for legislation that safeguards the health, human-rights, and autonomy of women who act as surrogates and the children who are born through surrogacy.

46However, if women’s long-term interests are to be represented in determining the future direction of reproductive technology, women will need to participate collectively in shaping public policy. Un-fortunately, there has been too little discussion among women about either the fundamental values at stake or the social goals that would best promote women’s well-being. Our debates and efforts must bring the voices of the community into these discussions, and particularly those of the women we claim/seek to represent and protect.


47This article emerged from Sama’s work on the issue of ARTs and commercial surrogacy. For more information please visit The author acknowledges Tarang Mahajan and Vrinda Marwah, who coordinated the study on surrogacy described in this paper; and Deepa Venkachalam, Preeti Nayak, Anjali Shenoi, Aastha Sharma, Vrinda Marwah, Susheela, Manjeer Mukherjee, Dharashree Das, Beenu Rawat for their immense contribution to Sama’s research work on ARTs over the past nine years. Special thanks goes to Beenu for helping with references.



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1 Assisted reproductive technologies (ARTs) are a group of technologies that assist conception and pregnancy. These techniques are designed to increase the number of eggs and/or sperms, or bring them closer together, resulting in improved “probability” of conception/pregnancy not otherwise possible. These technologies used for assisting reproduction range from simple or “low-tech” methods like intrauterine insemination (IUI) to “high-tech” methods such as in vitro fertilization (IVF) in all its variations. Though surrogacy is an arrangement, it has been included in ARTs.

2 In case of kidney donation, slums of Mumbai, Kolkata, and Chennai have been referred to as “organ bazaars” (Chengappa 1990). The same can soon be said to be true of sale in reproductive substance and labor.

3 One poor woman earned $750 for a kidney. The ultimate recipient, a Singaporean, paid $37,000 for it, most of which went to a middleman. This reflects the vulnerability and irony of the trade in human organs (BBC 2002).

4 Sama Resource Group for Women and Health is a Delhi-based organization that has been working on the issue of ARTs for the past nine years through research and advocacy. Sama looks at issues of women and health through caste, gender, class and rights perspectives. More details can be found at; Blog:

5 Currency conversion done on February 2, 2015,

6 One lakh equals 100,000 rupees. Currency exchange calculated on February 2, 2015,


Women’s health and rights issues for over eighteen years and is one of the founder members of Sama–Resource Group for Women and Health. She was involved in the coordination of two national-level studies on assisted reproductive technologies and their implications on women. Nadimpally has co-coordinated “Reproductive Tourism in India: actors, agencies and contemporary transnational networks”, a joint project of Centre for Social Medicine and Community Health, Jawaharlal Nehru University, Sama and Kings’ College London. She has coordinated two multisite studies on participant’s perspectives in clinical trials in India, and has contributed several articles/papers to national as well as international journals. She was the Social Justice Practitioner-in-Residence in 2013 at University of Massachusetts.

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