Desperate mothers fuel India's "baby factories"

"Even grandmother can be mother" at unregulated clinics


STEPHANIE NOLEN

Source Globe and Mail

February 13, 2009


NEW DELHI — Anoop Gupta slumps in his swivel chair and surveys what the day has brought his Delhi fertility clinic: a rich housewife who wants to check on the pregnancy of her 21-year-old peasant surrogate; a rural farming couple, both past middle age and seeking an heir after their son was killed in an accident, who need an egg donor; a mother of a developmentally delayed teenager shepherding the surrogate carrying the quadruplets that will maximize her chance for a "normal boy;" a British IT consultant who needs a hormone injection as part of in-vitro fertilization that would cost five times more back home; a Montreal woman who wants profiles of egg donors; and a Toronto mother of two toddler girls who wants a male embryo implanted.

It's a regular day in his packed and humming clinic, where poor women in bright saris and tribal jewellery wait beside women whose vast Louis Vuitton handbags spill over the sides of their chairs.

When 60-year-old Ranjit Hayer gave birth to twins in Calgary two weeks ago - babies conceived with donor eggs collected, fertilized and implanted in India - the news caused an uproar in Canada.

A woman of Ms. Hayer's age would not be treated at a Canadian assisted-reproduction facility; she suffered potentially life-threatening pregnancy complications linked with her age, and her children were seven weeks premature.

But here in his thriving Delhi clinic, Dr. Gupta often sees 10 women like Ms. Hayer before lunch. His clinic literature boasts of 500 post-menopausal pregnancies; "even grandmother can be mother," it says.

Canadians may have been caught off guard by Ms. Hayer's imported embryos, but in the global community of infertility, India is the salvation destination, the country where an unregulated reproductive-technology sector makes anything possible. Mr. Gupta's practice is just one of an estimated 150 clinics across India offering assisted reproduction.

"Total madness is prevailing," said Imrana Qadeer, a professor of public health at Jawaharlal Nehru University and a campaigner for regulated assisted reproduction. "It is a totally unregulated thing ... in India the doctors get away with a lot of things because people trust them and also there is lot of ignorance about technologies. ... Women are vulnerable, they can be pressured, and it's spreading like wildfire."

The surrogacy business is worth an estimated $500-million a year. And while the private clinics in India do not provide any figures on the number of other procedures they perform or the income they generate, no one disputes that the baby-making business is enormously lucrative. Behind the counter at Dr. Gupta's Delhi IVF & Fertility Research Centre, a staff member sits counting huge bricks of rupees; the lineup to pay for drugs or scans or embryos snakes all the way down the staircase.

Dr. Gupta, a genial workaholic with a zealot's admiration for the possibilities of assisted reproduction, considers himself a sort of Santa Claus figure. He promises the endless stream of anxious women that his success rate is about 50 per cent, that they too will have babies. "I feel very happy, very satisfied - if you see so many happy patients who are blessed - they cannot forget you in a lifetime."

But with the babies come a passel of ethical questions. How old a mother is too old? Who looks out for the rights of surrogates, who are usually poor women, often unable to read the contracts they sign with a thumbprint? Where is the line between commissioning an embryo to avoid passing on hereditary disease, and eugenics?

Patients are drawn to Dr. Gupta's clinic, in an upscale quarter of the capital city, because they have heard he has the best success rates. But if he turns them away - too old, too poor - there are plenty of alternatives. Patients report hearing of other clinics where the doctor will inseminate a woman who is 65, will let a woman carry triplets, will find a surrogate they can afford.

Dr. Gupta said 10 per cent of his clients are foreign; most are like Ms. Hayer, people of Indian origin now living abroad. His clinic has policies, as all are supposed to, under a non-binding directive from the Medical Council of India: he said his cut-off age for women bearing children is 50.

But minutes later he happily reported on the case of a 59-year-old woman in whom he implanted embryos the day before; he made her walk 10 kilometres a day for a month to prove she was fit enough. "You could not say she is 59 from looking at her, her system is immaculate."

Does he have qualms about creating a mother that old - who may not even live to see her child into adulthood? "These days, children want to leave their parents by the time they are 15 anyway," he chirped.

"I considered turning that couple away but I thought it would be giving them stress rather than happiness, so that's why I did it."

Dr. Gupta, who works with his wife, Alka Gupta, the clinic's "chief embryologist," is particularly excited about the chance to offer donor egg embryos or surrogacy to women whose first-born children have some sort of congenital problem. "All these people with abnormal babies - thalassemia [a blood disorder], juvenile diabetes, a Mongol child [Down syndrome]," he enthused. "We can help them."

Surrogacy for foreign parents attracts the most attention in India; the practice was pioneered by a Gujarat doctor named Nayna Patel in 2003. Her clinic in the small town of Anand has an adjacent hostel where dozens of village women, many seeking a way to pay to educate their own children, wait out their pregnancies, hot and bored, before they deliver babies for North Americans and Europeans. The total cost is about $10,000, compared with $50,000 to $70,000 in the United States. (Commercial surrogacy is illegal in Canada).

"These surrogate mothers are just being kept there like baby factories," said Nandita Rao, a lawyer pushing for regulation of the fertility industry. "The women are just sitting there producing that child with no rights on that child and no rights on their health - the contract says if you don't produce the child, you don't get the money - so they go on with a pregnancy no matter what [the risk] and there is no maximum number on the times they can do this. In India, which is so fiercely patriarchal, many families are using their daughters-in-law as baby-churning factories."

Many of the best-known Indian fertility clinics offer a roster of surrogate profiles from which to choose. Better educated women command a higher price - perhaps a $7,000 fee, compared to $3,000 for a village woman in Gujarat. The buyer also pays medical and living costs.

One of Dr. Gupta's clients, Anita, a Delhi private-school teacher who didn't want her surname published, found her surrogate through an ad in a women's magazine. At 38, she had failed at IVF herself and sought a young woman to carry a baby made with donor eggs and her husband's sperm. The ad was placed by the surrogate's husband; the woman, Puja, 21, said quietly that she didn't like the idea and it took her three months to agree, that she gave in because her father-in-law has left the family with debts that they must pay. She has two small children of her own. Anita comes to hover over her ultrasounds; asked how Puja felt about carrying the twins developing in her womb, Anita replied blithely, "Oh, we haven't told her yet."

A year ago, Anita had another surrogate pregnancy under way with a woman she brought to stay at her home, but six months in, Anita began to suspect the surrogate was stealing. "We lost confidence in her, so we terminated that pregnancy," she said calmly.

It is part of the standard Gupta clinic surrogacy contract that a surrogate must terminate a pregnancy if the doctor directs her to do so. "We were more careful choosing someone this time," Anita added.

Yet if surrogacy is getting the most attention, much more of the other forms of assisted reproduction are going on here - for example, egg donation has shot up with the economic downturn, Dr. Gupta said.

Dr. Gupta won't allow clients to select the gender of their babies, but there are few other requests he will turn down. "Everyone can afford surrogacy," he said; many of his clients are rural farmers or the urban poor, people who have borrowed money or sold land to pursue IVF. "They feel they are nothing without a child," he said. "I ask, 'Can you sell [an acre]?' Invariably the reply is yes. 'Then you can get a baby.' "

The Satyanarayans had no qualms. They are seeking a son to replace their teenage boy who died last year. "We have land and we want someone to have it when we go," Satyabati Satyanarayan said a few minutes after Dr. Gupta assessed her readiness for the donor eggs they will pay $6,500 to have fertilized and implanted.

While a Canadian IVF clinic will not implant more than two embryos in a woman under 37 for fear of creating a multiple-gestation pregnancy, Dr. Gupta's policy is less strict. "You can get a 40-50 per cent success by implanting three or four, and if they are multiple, we reduce the number - if more than two is [not desired]," he said. "Except with Muslims - they make a fuss [about aborting some of the embryos]."

He said that while he has created only four sets of triplets, his clients have given birth to more than 1,000 sets of twins. "It's a two-for-one bonus," he said with a grin.

Dr. Gupta sees 100 patients each day; counselling for assisted reproduction consists of a few minutes of chat with women about their options to maximize the chances of pregnancy. Upstairs, his wife merges the eggs he harvests in the early morning with sperm collected from sheepish men emerging from a room with a selection of DVDs. In her spotless lab, the only quiet place in the teeming three-storey clinic, dozens of embryos grow each day. Downstairs, her husband decides who will get them. "There is no regulation, so you do the most ethical thing you can," he said.

*****

Clinic procedures

Assisted reproduction includes a host of procedures and techniques, some common and some still experimental. These are among those offered in Indian clinics.

IN VITRO FERTILIZATION

This is one of the most commonly used procedures. A woman's eggs are combined with a man's sperm in a dish in a laboratory. Once fertilization has occurred, the resulting embryos develop for 3 to 5 days before being placed in a woman's uterus.

INTRACYTOPLASMIC

SPERM INJECTION

A man's sperm is placed into a woman's egg with a microscopic needle, rather than many sperm positioned close to the outside of the egg, as in IVF, in a dish in a lab. Once fertilization occurs, the resulting embryo is placed in a woman's uterus.

DONOR EGG OR EMBRYO

An egg donated by one woman is mixed with a man's sperm and the resulting embryo is implanted in another woman's uterus. This procedure also can be done with a donated embryo.

SURROGACY

One woman agrees to carry an embryo to term and give the baby to another woman after birth.

ASSISTED HATCHING

In a lab, one of the outer layers of an early embryo is perforated by chemical, mechanical, or laser-assisted methods to assist in implantation of the embryo in the uterus.

IN VITRO MATURATION

A process that matures a woman's eggs in the lab, rather than naturally in the ovaries.


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Transcript of Obama's CBC interview
Official White House transcript of 11-minute interview with CBC's Peter Mansbridge and U.S. President Barack Obama



Source: Globe and Mail

February 17, 2009


Q Mr. President, thank you for doing this — Canadians are very excited about your trip.

THE PRESIDENT: Thank you.

Q When they watch you today sign your recovery bill into law, how concerned should they be that the Buy America clause is still there, even though you've given assurances international trade agreements will be respected — how concerned should they be?

THE PRESIDENT: I don't think they should be too concerned. You know, I think that if you look at history one of the most important things during a worldwide recession of the sort that we're seeing now is that each country does not resort to "beggar thy neighbor" policies, protectionist policies, they can end up further contracting world trade. And my administration is committed to making sure that even as we take steps to strengthen the U.S. economy that we are doing so in a way that actually over time will enhance the ability of trading partners, like Canada, to work within our boundaries.

And my expectation is, is that where you have strong U.S. competitors who can sell products and services, that a lot of governors and mayors are going to want to try to find U.S. equipment or services, but that we are going to abide by our World Trade Organization and NAFTA obligations just as we always have.

Q You mentioned NAFTA. A year ago you were pretty critical of NAFTA; in fact, you even suggested at one point that the U.S. opt out if it couldn't renegotiate. Do you think that's the time now to be making that case, or is it something that's set aside now?

THE PRESIDENT: I think there are a lot of sensitivities right now because of the huge decline in world trade. As I've said before, NAFTA, the basic framework of the agreement has environmental and labour protections as side agreements — my argument has always been that we might as well incorporate them into the full agreement so that they're fully enforceable.

But what I've also said is that Canada is one of our most important trading partners, we rely on them heavily, there's $1.5-billion worth of trade going back and forth every day between the two countries and that it is not in anybody's interest to see that trade diminish.

Q Especially now.

THE PRESIDENT: Absolutely.

Q Part of that trade involves the energy sector, a lot of oil and gas comes to the United States from Canada, and even more in the future with oil sands development. Now there are some in your Canada — and Canada, as well — who feel the oil sands is dirty oil because of the extraction process. What do you think; is it dirty oil?

THE PRESIDENT: What we know is that oil sands creates a big carbon footprint. So the dilemma that Canada faces, the United States faces, and China and the entire world faces is how do we obtain the energy that we need to grow our economies in a way that is not rapidly accelerating climate change. That's one of the reasons why the stimulus bill that I'll be signing today contains billions of dollars towards clean energy development.

I think to the extent that Canada and the United States can collaborate on ways that we can sequester carbon, capture greenhouse gases before they're emitted into the atmosphere, that's going to be good for everybody. Because if we don't, then we're going to have a ceiling at some point in terms of our ability to expand our economies and maintain the standard of living that's so important, particularly when you've got countries like China and India that are obviously interested in catching up.

Q So are you drawing a link, then, in terms of the future of tar sands oil coming into the U.S. contingent on a sense of a continental environment policy on cap and trade?

THE PRESIDENT: Well, I think what I'm suggesting is, is that no country in isolation is going to be able to solve this problem. So Canada, the United States, China, India, the European Union, all of us are going to have to work together in an effective way to figure out how do we balance the imperatives of economic growth with very real concerns about the effect we're having on our planet. And ultimately I think this can be solved by technology.

I think that it is possible for us to create a set of clean energy mechanisms that allow us to use things not just like oil sands, but also coal. The United States is the Saudi Arabia of coal, but we have our own homegrown problems in terms of dealing with a cheap energy source that creates a big carbon footprint.

And so we're not going to be able to deal with any of these issues in isolation. The more that we can develop technologies that tap alternative sources of energy but also contain the environmental damage of fossil fuels, the better off we're going to be.

Q I know you're looking at it as a global situation, in terms of global partners, but there are some who do argue that this is the time; if there was ever going to be a continental energy policy and a continental environmental policy, this would be it. Would you agree with that thinking?

THE PRESIDENT: Well, you know, I think one of the — one of the promising areas for not just for bilateral but also trilateral cooperation is around this issue. I met with President Calderón here in the United States, and Mexico actually has taken some of the boldest steps around the issues of alternative energy and carbon reductions of any country out there. And it's very rare for a country that's still involved in developing and trying to raise its standard of living to stay as focused on this issue as President Calderón's administration has.

What I think that offers is the possibility of a template that we can create between Canada, the United States and Mexico that is moving forcefully around these issues. But as I said, it's going to be important for us to make sure that countries like China and India, with enormous populations and huge energy needs, that they are brought into this process, as well.

Q Afghanistan. As you know, Canada has been there from the beginning, since the fall of 2001, and has suffered extreme casualties in its combat missions there. And the Canadian parliament has decided, out of combat by the year 2011. When you get to Ottawa, will you have any suggestions to Canada that it should reconsider what its role in Afghanistan is?

THE PRESIDENT: Well, first of all, I think the Canadian contribution has been extraordinary, and for all the families who have borne the burden in Canada, I think we all have a heartfelt thanks.

I'm in the process of a strategic review of our approach in Afghanistan. Very soon we will be releasing some initial plans in terms of how we are going to approach the military side of the equation in Afghanistan. But I am absolutely convinced that you cannot solve the problem of Afghanistan, the Taliban, the spread of extremism in that region solely through military means. We're going to have to use diplomacy, we're going to have to use development, and my hope is that in conversations that I have with Prime Minister Harper, that he and I end up seeing the importance of a comprehensive strategy, and one that ultimately the people of Canada can support, as well as the people of the United States can support, because obviously, here as well, there are a lot of concerns about a conflict that has lasted quite a long time now and actually appears to be deteriorating at this point.

Q But are you saying that you will or you won't ask Canada to remain in a combat role?

THE PRESIDENT: Well, I think, you know, we've got until 2011, according to the Canadian legislature, and I think it's important for the Canadian legislature and the people of Canada to get a sense that what they're doing is productive. So what I will be communicating is the approach that we intend to take. Obviously I'm going to be continuing to ask other countries to help think through how do we approach this very difficult problem. But I don't have a specific "ask" in my pocket that I intend to bring out in our meetings.

Q Is Afghanistan still one of them?

THE PRESIDENT: Well, I think Afghanistan is still winnable, in the sense of our ability to ensure that it is not a launching pad for attacks against North America. I think it's still possible for us to stamp out al Qaeda to make sure that extremism is not expanding but rather is contracting. I think all those goals are still possible, but I think that as a consequence to the war on Iraq, we took our eye off the ball. We have not been as focused as we need to be on all the various steps that are needed in order to deal with Afghanistan.

If you've got narco-trafficking that is funding the Taliban, if there is a perception that there's no rule of law in Afghanistan, if we don't solve the issue of the border between Afghanistan and Pakistan, then we're probably not going to solve the problem.

Q I'm down to my last minute. A couple of quickies on Canada — your sense of the country. I mean, I think — as you may know, you carry Canada on your belt. (Laughter.) That Blackberry is a Canadian invention.

THE PRESIDENT: Absolutely.

Q You've been to Canada once. What's your sense of the country?

THE PRESIDENT: Well, yes, I've been to Canada a couple of times. Most recently it was to visit my brother-in-law's family who was from Burlington right outside of Toronto. Look, I think that Canada is one of the most impressive countries in the world, the way it has managed a diverse population, a migrant economy. You know, the natural beauty of Canada is extraordinary. Obviously there is enormous kinship between the United States and Canada, and the ties that bind our two countries together are things that are very important to us.

And, you know, one of the things that I think has been striking about Canada is that in the midst of this enormous economic crisis, I think Canada has shown itself to be a pretty good manager of the financial system in the economy in ways that we haven't always been here in the United States. And I think that's important for us to take note of, that it's possible for us to have a vibrant banking sector, for example, without taking some of the wild risks that have resulted in so much trouble on Wall Street.

Q Appreciate this very much. You still haven't seen your first hockey game.

THE PRESIDENT: I'm looking forward to making it happen at some point.

Q Mr. President, thank you very much.

THE PRESIDENT: Thank you so much. Appreciate it.