Sunday, February 29, 2004

Manufactured motherhood
Aruti Nayar

Illustration: Kuldip Dhiman

WHEN 46-year-old Radha Patel gave birth to her own grandchildren, last month, not only did it trigger a debate about the ethics of surrogate motherhood but also led to a discussion on the checks and balances needed when man decides to intervene and control the process of reproduction. She had been implanted with embryos created from her daughter's eggs at a private IVF clinic. Her daughter had Rokitansky syndrome, a rare genetic condition in which the ovaries are healthy but the womb is undeveloped.

While the U.K-based young couple had tried for four years for a surrogate mother, they found the 50,000- pound cost prohibitive. They saw nothing unethical in their decision and felt they had every right to use science to produce their own children. Even the mother, who had been initially horrified, could overcome her fear of social disapproval and cultural conditioning to lend her womb to make her daughter happy. Radha Patel was not the first one. In 1991, Edith Jones was the first British woman at 51 to give birth to her grandchild. However, it was a South African who became the first woman, in 1987, to give birth to her grandchildren after IVF treatment.

Code of conduct for ART

  • The ART clinic is not a commercial party in donor programme or surrogacy.

  • No ART procedure can be done without the spouse’s consent.

  • The sperm donor and surrogate should not be a relative or a friend of the couple.

  • Sex selection is not permitted. There should be pre-implantation diagnosis-testing of parents for genetic abnormalities.

  • The consent of couples for the use of embryos is a must.

  • Biological parents must adopt a child born through surrogacy.

  • The sale or transfer of human embryos outside the country is prohibited.

  • Donors should be screened for HIV and hepati tis B/C infections.

  • ART clinic has to get approval from the appro priate accreditation authority.

  • The records have to be maintained and regu larly checked to guard against tampering.

The pattern of procreation might have been picked and the genetic and gestational mother might have been delinked but the joy in babies' arrival was primordial and the urge to have children universal. Said the woman who made medical history: "These babies are a miracle and have brought so much joy to our families. I knew it was the best thing I had ever done."

One can not help wondering how the fertility revolution has redefined the concept of family and identity. Continuing research and advancement of technology has given hope to many who are devastated when they cannot have children but in the triumph of science one is likely to forget that procreation is not merely a cut and dried scientific experiment to be conducted in controlled laboratory-like conditions. After all, flesh-and blood human beings are involved.

Assisted reproductive techniques or ART continue to be much sought after by all those who want to have children. Unlike the West, where it is a commercial practice and legal codes have been framed and implemented, in India there is no law on issues related to ART. It is only now that ICMR—the Indian Council for Medical Research—(see box for code) has framed national guidelines. A draft of the bill shall be given to the Ministry of Health for being passed in the next session of Parliament. There is a felt need for bringing out formal legislation to regulate a process which has deep and widespread social, legal, psychological as well as cultural implications.

Basic instinct

The overwhelming desire to have a child is the product of a deep-seated, instinctive and evolutionary urge to perpetuate the species and pass on the genetic material to another. It is this archetypal desire, embedded in our collective unconscious, which often spurs human beings to have children at any cost, come what may. "It is this irrepressible drive that propels man to go to any extent to propagate his genes," says Nirja Chawla, a gynaecologist, adding, "motherhood is important for completion of self." To this biological drive add the socially conditioned expectations of the role and function of a woman and you know why so many people flock to fertility clinics in the region. And it is a blatant exploitation of this desire to have children that makes millionaires out of gynaecologists in the business who laugh all the way to the bank.

Booming business

A proponent of the dire need to set up a specialised, appropriate authority to monitor ART is Ludhiana-based, Austria-trained Iqbal Ahuja. A pioneer of infertility treatment in the region, he is of the view that genuine practitioners have been marginalised in the race to notch up profits, often at the expense of vulnerable patients. Widespread and no-expenses-spared advertising and the projections of an inflated success rate that is even more than the internationally acceptable standards, help net many customers who come quietly. There is an element of social embarrassment that prevents patients from discussing the choice of doctors openly.

"I do not know much science, neither do I understand other complicated details. All I know is that in order to hold my child in my arms, I am willing to put up with any amount of pain and spend as much as is needed", says Sukhjit. Incidentally, Sukhjit is not an illiterate villager but an engineer who is so desperate to have a baby that nothing else seems to matter. Others like Veena feel that her husband will stray if she does not produce a child. The reasons vary from the fear of losing one's husband to facing the wrath and disapproval of the mother-in-law.

While social attitudes largely remain unchanged, the mother-in-law remains the most persistent when it comes to seeking treatment at any cost, says Ahuja. He is of the view that while some cannot spend even Rs. 5,000 on ads, while others can spend up to crores . Not only is the success rate exaggerated to woo customers, even the cost of treatment (which is only Rs 2,000 for the first cycle of tests) is inflated. IVF may be required only in 10 to 15 per cent of the cases and not in all cases and cost up to Rs 65,000. Patients often have to shell up to Rs one to two lakh and even when IVF is not required, they might be told that it is. Not only this, people are also hired to pose for stage-managed photographs proclaiming the efficacy of the treatment.

G.K. Bedi, another infertility specialist who trained with B.N. Chakravarti, "the pioneer of infertility treatment in India", feels it is important to ensure the secrecy of donor insemination and maintenance of all relevant records pertaining to IVF and surrogacy, followed by legal adoption of the child. An ART centre has to possess a licence, be monitored and be constantly upgraded just as a surrogate has to register and sign an agreement. Infertility treatment is a highly specialised field and only being a gynaecologist is not sufficient. The treatment has to be individual-specific. It is said that even though the success rate the world over is 35 to 40 per cent it is 80 to 85 per cent being projected here by those keen to cash in on what is an emotive issue that can be exploited. Since it is for the first time that rules have to be framed, in the absence of precedence, suggestions of legal experts along with biologists, members of various medical bodies and sociologists and those running ART clinics were invited and considered by the ICMR