Dr Shivani Sachdev Gour is founder and director of SCI (Surrogacy Centre India) Healthcare and Isis Hospital & Multispecialty Centre, New Delhi. Her centre is believed to have crossed 1000 babies born by surrogacy since the year 2010 and has reportedly helped IVF couples from over 55 countries to become parents.
Dr Sachdev Gour is a medical graduate (MBBS) from Seth G S Medical College and KEM Hospital, Mumbai and did MD (Obs/Gynae) from Grant Medical College and Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai. She spent four years in the UK as an IVF clinical research fellow at Hammersmith Hospital, London, and practised as a gynaecologist and obstetrician at Royal Infirmary of Edinburgh, Scotland. She gained membership of the Royal College of Obstetricians and Gynaecologists (UK) in 2005.
In 2007, Dr Sachdev Gour returned to India to consult as an IVF specialist with Delhi’s premier infertility treatment centres. She now leads the SCI Healthcare’s and Isis Hospital’s surrogacy and in vitro fertilization (IVF) programmes.
In an exclusive interview with India Medical Times, Dr Shivani Sachdev Gour talks about the surrogacy industry, its future outlook and interests of surrogate mothers and IVF-surrogacy clinics:
How big is the surrogacy industry in India? What’s the future outlook?
There are lots of media reports which keep saying that the surrogacy industry in India is booming but people are far away from the truth. In India, we are doing about 1.2 to 1.5 lakh IVF cycles in a year, out of which less than 10% are surrogacy cycles or may be less than 5%. In India, we are doing around 5,000 surrogacy cases in a year but definitely not more than that.
The future of surrogacy industry depends on what the new rules government brings in. In the year 2013, some new rules brought in by the ministry of home created a lot of visa problems for foreign patients who were coming for surrogacy in India. Because of these visa issues, at least 70% patients could not come to India. The policy makers objected to single parents, gay parents having baby which I think is a little backward thinking because nowadays you cannot say like that. Even if you see adoption, the Central Adoption Resource Authority (CARA) allows single parents to adopt but because of some reasons they are objecting the same in case of surrogacy. NGOs and agencies think that these parents are going to sell their baby, or may harm them. They may have these notions because of 1-2 bad cases but I don’t think so. I have treated hundreds of patient and I am in contact with them even today after so many years. They send me emails and pictures; I can see the babies are growing well; I know they are going to schools etc.
There are lots of married couples who abuse their children, how many paedophiles are there, but that does not mean you will stop married people from having children. Then why question surrogacy? The biggest sufferers in all these are childless couples. Whenever I do treatments I ask patients – ‘Are you coming to India first time?’ ‘Have you been here before?’ And 90% of the patients, whom I asked, had never been to India before. They only came here because — they had tried lots of treatments in their own country but things didn’t work and they had been told about India by some Indian doctor or someone who had been here before. By the time they leave India, they are celebrating Indian festivals like Diwali, Holi or having hawan in their own country.
But there is activism going on against surrogacy, which completely stopped 70% of these patients coming to India. What is happening right now is that there is a huge decline in the number of surrogacy which was happening in India. The activism is still going on; there are proposals to shut down the surrogacy industry completely.
I can only say that the future of surrogacy is uncertain right now and it totally depends on what policies the government brings in.
What makes India most favoured destination for most foreign couples seeking surrogacy?
First of all, they try it in their own country and if things don’t work out then they look for other countries. There are 6-7 countries that are offering surrogacy treatments with similar cost packages as India. But India’s reputation is higher because you won’t find a Ukrainian doctor or Georgian doctor there (from where the foreign patients are coming), but an Indian doctor. Reasons for the popularity may include:
i) The success rate is higher in India as compared to other countries.
ii) The word-of-mouth publicity – patients coming here hear it from someone who has a baby through surrogacy in India.
iii) Indian doctors are all foreign trained.
iv) They believe that Indian surrogate mothers have very healthy lifestyle; women in India are not very much into alcohol/drugs etc. They feel India can provide healthiest environment for their baby.
v) It is affordable; we provide very good facilities that are available at very reasonable cost.
What are the criteria for setting-up an IVF and surrogacy clinic in India?
There are guidelines for this. India has best guidelines in the world. The ICMR (Indian Council of Medical Research) guidelines are so extensive and each and everything they have written down in such a detail — what is the procedure, how do you register, and what kind of requirements there are for each and every room of the IVF centre, what kind of mechanism, medical equipments or administrative staff you need, what kind of training you need, what kind of reports, what kind of consent — everything is there in great detail. Chapter-3 of the guidelines mainly deals with the consent and chapter 1 and Chapter 2 deal with the technical aspects.
What are the major issues?
The new bill, which is coming, says that any clerical mistake made by any doctor in any form will be punished with three years of imprisonment. All the clerical errors are made as cognizable offence like it is a terrorism offence, which is outrageous. How many times we do error in writing something or many times cheques have come back from bank because of signature mismatch. Do we get jailed for that? But doctors are being put into jail. This is absolutely against the human rights. I feel this is too excessive and the clause has been pushed by NGOs. Somewhere the government has to say that this is ridiculous. There are agitations against this all over India but NGOs are so strong here that people are not having any say.
About 2-3 years back, I was in a surrogacy debate with a member of parliament of Australia which also included some social workers and parents, even there the activists were saying that surrogate mothers in India are exploited, they should do this and that and I was like “I am an Indian, sitting here and how can you — who is ‘thousands of miles away, has never visited my country, doesn’t know anything about it’ — make the rules and decide the things for us and our women here”.
Recently, your centre helped a single male become a father. Please share the details.
Yes, there was a single father who did treatment with us in India. Although, the foreigners are getting passports for babies, in India, it is still a new concept that a passport has only a single parent’s name. But the passport office did give it because as I told you even in adoption guidelines, single parents are allowed to adopt. You can’t infringe on their rights because that is the right guaranteed to them. This was something very forward and one of the empowering steps.
How strong surrogacy laws are in India?
The surrogacy bill has not yet been passed in the parliament but there are a lot of guidelines which cover each and every aspect. One difference between India and USA is – in USA you are able to do traditional surrogacy which means you are able to use surrogate mother’s egg and just put sperm inside and she carries the baby but in India it is not allowed. Surrogate mother can only get pregnant by IVF and not by putting sperm. And in IVF also the egg and sperm should not be related to her. But in other countries self-insemination is also allowed. In India, you need to register with the ART (Assisted Reproductive Technology) agency – the agency will get surrogate mother to the clinic and then we will do the IVF or surrogacy treatment.
Sometimes media reports that there is exploitation of surrogate mothers; that they are not paid what promised. It may be happening in some remote area but I am not sure where this is happening in a city like Delhi. Because if there is anything wrong the committee will not sit quite — they will file a complaint with the authority or police.
What is the amount paid to the surrogate mother? How much fertility clinics charge from their clients?
The payment to a surrogate mother may range between Rs 3-4 lakh, which is the standard payment limit. NGOs are criticizing that other charges are too much. But whatever the normal charges of the lawyers or hospitals are – those are. These are some of the things which come up in the news in terms of negative things that we read in media. In India, unless the surrogate mother signs a NOC (no objection certificate) that she has been paid all the dues and the FRRO (Foreigner Regional Registration Office) stamps the passport, the intended parent of the child can’t leave the country. Whereas in countries like US, the NOC is not required – as soon as the baby is born, the baby gets the passport and the parents can go. In other countries, there have been many cases where surrogate mothers are left with bills to pay.
Many media reports say that surrogate mothers in India are unaware of the risks involved in the process. How true is this?
Why don’t they speak with surrogate mothers themselves and find out if it is true or not. We have interviewed hundreds of surrogate mothers and there is nothing like that. If somebody is not educated that doesn’t mean that they are stupid. You have to differentiate between a dumb person and a person who is uneducated. How many MLAs in UP are educated? Seventy percent of them have not even completed their schooling but they are ruling us, making rules for us. The opportunity of education, which these surrogate mothers have missed, they are providing to their children now.
A few years back, some foreign researchers interviewed few surrogate mothers but the researchers were not able to communicate properly with the surrogate mothers due to language barriers. If anyone asks these surrogate mothers what did the researchers asked them or what was their aim/objective, the surrogate mothers won’t be able to tell because they could not understand the researchers’ language.
I have proofs to contradict these research reports but how will I? There is no platform or complain system. We write to the universities and they don’t even acknowledge our emails.
What are the major risks involved?
The surrogate mother undergoing the medical procedure has all the risk of any normal pregnancy – it is not like she is in a risk because it’s a surrogacy procedure. Some of the major risks involved are – high/low blood pressure, diabetes, bleeding, twin pregnancy (25% of our patients have twin pregnancy) or in a rare case it may lead to the loss of the uterus.
What safety measures are taken during the process?
The ART agency and the hospital both take full responsibility of surrogate mothers. Intended parents have to pay all the bills incurred during the whole procedure. The accommodation is given for one year — 9 months for pregnancy and 3 months for post pregnancy care. It is their choice whether they want to stay or not. Post pregnancy, some surrogate mothers come for follow up, some don’t. Generally, we call them to see us in a week for check-up. Some come even after 2-3 years just to stay in touch; some parents also come here and visit the surrogate mothers. Some of the surrogate mothers support others for this and join our committee for surrogates.
Is there any kind of counselling session for surrogate mothers to understand the process or risk involved?
Yes, there are multiple levels of counselling. First counselling is from agencies – these are people who explain the procedure/contract in a very simple language. Second is a physiological counselling where a physiologist professionally assesses the patient – is she mentally well, does she understand surrogacy, etc. Then there is a gynaecological counselling session where surrogate mothers are told that they need to keep themselves clean, eat health, wear loose cloths etc.
Many times the counselling session includes previous surrogate mothers and patients too ask questions and counsel each other.
Are you satisfied with the surrogacy laws in India? What changes you would suggest?
People are saying that to protect the surrogate mothers, some new guidelines were taken out. But I feel that the actual voices of surrogate mothers are not being heard. They are not even consulted for any decision made for them. I would strongly advise that there has to be a representative from their side too who can be a part of the decision makers. They are the actual people who are involved in the process; they know what their issues or problems are. If a surrogate mother writes to you saying that she wants to meet and discuss things then her voices should be heard.
As an IVF clinic, we are also not allowed to put in our views in front of the authorities. Any decision in democracy has to involve the stakeholders. Foreign funded NGOs are only giving their point of view and our voices go unheard.
Any message you would like to give?
Surrogacy is a boon and childless couples are genuinely helped. It’s heart breaking to read in media about exploitation of surrogate mothers because our international patients have framed pictures of the surrogate mothers on walls at their homes; they are making Taj Mahal replicas in their garden; they are celebrating our Indian festivals. They even come back and meet these surrogate mothers. They learn to respect our country so much and then we get to read stuff like these which make us feel bad. I feel the actual picture is not being put out in the media and only negative stories are published.
by Rajni Pandey