by Neeta Lal
The revolutionary in vitro fertilization (IVF) technique that has given the world about five million new people in the 34 years since the birth the world’s first test tube baby, Louise Brown, continues to court controversy in India.
Earlier this month, Bombay High Court chastised the Maharashtra state police for being lackadaisical in investigating the circumstances that led to the death of 17-year-old Sushma Pandey shortly after she donated her ovum at a suburban Mumbai fertility clinic two years ago.
The process of egg donation – or assisted reproduction – involves the donor providing eggs, ova or oocytes for fertilization in a laboratory after being injected with stimulating hormones. Apart from the blood group and physical fitness, height, weight, educational qualifications and professions are all recorded. According to the Indian Council of Medical Research (ICMR) guidelines, it is mandatory to maintain a gap of at least three months between donations.
Apparently in Sushma’s case, almost all the ICMR guidelines were blatantly violated. While an egg donor has to be between 21 and 35 years of age, Sushma was barely 17 she donated her eggs without her parents’ knowledge. And while she made donations thrice in 18 months an obligatory gap of three months between egg donations was ignored.
What rankles most, say activists, is that the girl was not remunerated by the fertility clinic, the salient reason why poor women agree to such highly invasive medical procedures. In other words, the clinic simply harvested Sushma’s eggs without compensating her and then went on to commercially profit from them. Reportedly, the teen was promised $ 550 for each donated ovum.
“If Sushma had donated the ovum thrice, she should have been paid 75,000 rupees [US$1,600]. But we have not received a paisa [cent] of the money she earned,” the girl’s mother told an Indian newspaper.
In the second such tragedy, Premila Vaghela, 30, who had rented out her womb to a US couple, died this May in the eighth month of a surrogate pregnancy reportedly due to negligence at a clinic in Ahmedabad in western Gujarat. Though Premila managed to deliver her surrogate child, her own two young children are now motherless.
Both episodes highlight the grey area in which “assisted reproductive clinics” (ART) continue operate in the country’s US$500 million fertility tourism industry. They also underscore the deficiency of laws to check malpractices.
Acknowledging this, ICMR said in a report last year that “Most of the new technologies aimed at taking care of infertility involve handling of the gamete – spermatozoa or the ooctye – outside the body … These technologies not only require expertise, but also open up many avenues for unethical practices that can affect adversely the recipient of the treatment, medically, socially and legally.”
The report added that “The last 20-odd years have seen an exponential growth of infertility clinics that use techniques. As of today, anyone can open infertility or ART clinic; no permission is required to do so. There has been, consequently, a mushrooming of such clinics around the country. In the public interest therefore, it has become important to regulate the functioning of such clinics to ensure that the services provided are ethical and that the medical, social and legal rights of all those concerned are protected.”
ICMR is setting up a national registry of assisted reproductive technology clinics. Until such a registry becomes operational, experts advocate that the Indian parliament clear a path-breaking ART Bill, 2010, which has been stuck in a legislative log jam. The proposed Bill seeks to put in place several important provisions to protect the rights of surrogates.
The pending legislation clearly states that a woman acting as surrogate mother in India cannot be less than 21 years or over 35 years and that she cannot give more than five live births, including her own children. There are safety nets that the Bill seeks to build for the surrogates – they should not undergo embryo transfer more than three times for the same couple and no ART bank or clinic can send an Indian citizen for surrogacy abroad. Strict confidentiality, according to the proposed bill, also needs to be maintained about the donor’s identity.
Most doctors concede the need for a legal framework for the industry, although some feel it is unfair to tarnish all fertility clinics with the same brush because good ones are indeed a boon to childless couples.
“Surrogacy is one of the well-accepted concepts of assisted reproduction,” said renowned IVF expert Dr Indira Hinduja, who gave the country its first test tube babies in the 80s, told this correspondent earlier. “It benefits patients who can’t conceive or carry a pregnancy to term. Such people can take the help of surrogates to carry their child in the uterus and then hand it over to the genetic parents post delivery.”
Demand from childless couples around the world for Indian surrogate mothers has turned “surrogacy tourism” into a fast-growing business. Driving the demand are India’s advantages are laws that are less restrictive than elsewhere, a lack of ART regulation, the easy availability of surrogate mothers and medical procedures that cost a fraction of what they do in the West.
According to the private Indian Society for Assisted Reproduction (ISAR), there are more than 600 IVF clinics in the country providing an estimated 60,000 assisted reproductive treatments a year. While the government legalized commercial surrogacy in 2002, the only code governing surrogacy transactions in the country is a 126-page document issued by ICMR in 2005, which lays down the National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India.
The guidelines are legally non-binding, as they have not yet been ratified by the Indian Parliament. Besides, the ICMR rules are ambiguous about vital issues like the rights of the surrogate, the minimum age of the surrogate, details about the contracts, informed consent and adoption requirements.
What also needs to be brought under the law’s ambit, say experts, is clarity on the issue of legal parentage. “Most childless couples spend whopping sums of money on airfare and surrogacy contracts only to be told at the last minute that they can’t take their baby out of the country till cumbersome paperwork is completed,” says Dr Anita Palwal, a Delhi-based gynecologist-obstetrician.
Palwal recounts the case of Manji Yamada, the daughter of a Japanese couple who was born in Anand through a surrogacy agreement in 2010. Manji’s parents were divorced midway through the surrogacy agreement and her Japan-based mother then refused to accompany the father to pick up the newborn from India. Indian laws wouldn’t allow the baby to leave the country unless accompanied by her mother. Finally, Manji’s paternal grandmother had to step in to take her back to Japan.
Another disconcerting area, say activists and bio-ethicists, are the rights of the infertile couple. “For instance,” said Vrinda Vassan, an activist volunteer for Bachpan, a pan-India children’s rights organization, “there must be a mechanism to assure that the donor’s unused harvested eggs or embryos are not sold by the fertility clinics to other couples for profit. The misuse of a surrogate child for purposes of terrorism, prostitution or unethical genetic engineering research also needs looking into.”
Increasingly, whimsies are also creeping into the business. A few fertility clinics in central Bihar’s capital Patna, for instance, are getting cases of local childless couples who nag the hospital staff about the caste of the sperm or egg donor before they sign on the dotted line. “This makes a mockery of the entire IVF process. The focus should always be on the “quality” of sperm and not the trivia,” said Dr Palwal.
Experts agree that while the proposed ART Bill won’t be a panacea for all the ills, it will at least sensitize the stakeholders about their rights while acting as a deterrent for unscrupulous merchants of the trade.
Neeta Lal is a widely published writer/commentator who contributes to many reputed national and international print and Internet publications.
source: http://www.atimes.com / Asia Times Online / Home> South Asia / By Neeta Lal / August 01st, 2012
