Neha Goel and Dr Mrinal Bhasin

Infertility is at the heart of the problem.  According to research conducted by Inito, a Bengaluru-based medical technology company, around 27.5 million couples who want to conceive, currently suffer from infertility. The World Population Prospects: The 2017 Revision report estimated that the fertility rate of Indians (measured as the number of children born to a woman), had plummeted by more than half in the short span of 40 years—from 4.97 per cent during 1975-80 to 2.3 per cent in 2015-20. By 2025-30, the report projects that the rate would have nosedived further to 2.1. A fertility rate of about 2.2 is generally considered the replacement level—the rate at which the population would hold steady. When the fertility rate dips below this number, the population is expected to decline. 

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With lowering fertility, adoption and surrogacy seem to be the next best options for couples. But recent protocol and laws have complicated the state of affairs. 

Surrogates seen at Dr Nayna Patel’s infertility centre in the Anand district of Gujarat. The new Surrogacy (Regulation) Act only allows altruistic surrogacy, in which no money or remuneration, except medical expenses, are provided for the surrogate mother by the couple. Pic/Getty Images

According to CARA’s CARINGS data base, and its analysis released by voluntary organisation, Families of Joy,  at present, only 1,936 children are legally available for adoption with CARA, while 36,000 couples are in queue. This means that the current waiting period of two to three  years could stretch further. 

Surrogacy—a booming business in India and pegged at $2.3 billion, with around 6,000 clinics, mostly illegal, running across the country—has also taken a big hit, with the Parliament passing the Surrogacy (Regulation) Bill 2021. The new Act prohibits commercial surrogacy, while only allowing altruistic surrogacy, in which no money or remuneration, except medical expenses are provided for the surrogate mother by the couple. 

Bharati and VirinderMohan had twins through surrogacy after failed IVF attempts

The new law coupled with red tape may soon fuel black market adoptions, fear experts. Dr Paresh Desai at the paediatrics and neonatology department of Bhatia Hospital describes the current state of affairs as a “complete mess”. “The main problem is the long waiting period. So, people are either adopting a relative’s baby, or reaching out to those who are willingly giving up their children. This is bound to affect the child’s mental health at a later stage. Yes, the adoption process is long and complicated, but that’s to protect the child. Either go through that, or don’t have one.”
 
Chef Reetu Uday Kugaji and her husband Uday, residents of Mumbai, registered for adoption, when she was 37-years-old. This was nine years ago. “We went to the adoption centre in Nerul, and found the staff abrasive. They told me that I would have no choice in this [concerned with gender and/or how the child looks]. We filled all the forms, and followed due diligence; but, it’s been nine years, and no one has called us yet. I got another offer to take someone’s baby but I would have had to pay for the mother and elder sibling as well. I didn’t do it. I am 46 now, and think I am too old to run after a child.” 

Dr Nayana Patel, infertility expert and Dr Paresh Desai, Bhatia Hospital

For Powai-based Bharati Jha, it was only after multiple rounds of IVF that she and her husband Virinder registered for adoption in 2019. “We realised that some parents had been waiting for as long as three years.” Meanwhile, their IVF clinic suggested they try surrogacy. “We wanted to do it before the [surrogacy] Bill was passed by the government. I dealt with the surrogate directly, but there was a lot of legal documentation. The whole process, including hospital charges, cost us around Rs 15 lakh. I see people running down surrogacy, but they don’t get it. The decision to approach a surrogate is a very hard one to make and requires emotional healing. When you have tried for years for a baby, you are eternally grateful to someone who does it for you, irrespective of their reasons to do it. My surrogate was very clear that she was doing this for the money, she already had two children,” says Mohan, who is now mother to one-year-old twins Abir and Zara.

Dr Nirmal Bhasin, who has a 25-year-old career behind her, and has been working with legal surrogacy for 11 years, says that the intense need to have a child has driven many couples to the edge. “Now that you can’t compensate the surrogate, this will lead to even more problems. Who will come forward legally and be a surrogate free of cost? Even at CARA, it’s getting impossible almost to find a new born baby,” says Bhasin, who cites stress, sexually incompatible partners, damaged uterus, erratic lifestyle choices and multiple sex partners as reasons for infertility rising among couples. “It has risen almost 30 times in women younger than 40 in the past five years. It is leading to an increase in couples getting babies by illegal means. Many have come to me, and I have made it clear, I can’t get involved,” she adds. 

Chef Reetu and her husband Uday Kugaji registered themselves for adoption when she was 37. She is now 46. She says the attitude of the staff at the Neral adoption centre they visited was far from amiable

Dr Nayana Patel runs Akanksha Hospital and Research Institute in Anand, Gujarat, which is also called the “surrogacy capital of India”. Patel, who has been delivering 100 babies annually since 2010, has welcomed the new surrogacy law, as she feels it provides protection to the couples. She, however, feels that the government should look into the compensation factor. “Not giving compensation will lead to exploitation of the mother. The penalties are also very harsh. They should consider why a couple wants the baby—excuses like, ‘I don’t want to ruin my body’ or ‘I don’t have the time to conceive’ shouldn’t be entertained. Genuine couples should have the option, or else they will have to go to America, where the cost of surrogacy runs into millions. If that doesn’t work out, they may go the illegal route.” 

Not everyone thinks that the current adoption and surrogacy laws are restrictive. Adoption activist Neha Goel, who is a member of a non-profit working to spread Adoption Awareness doesn’t believe that adoption is difficult in India. “Even in the conventional ways of conceiving a baby, it takes at least two years, which involves getting pregnant, and nine months of carrying the baby to term. Why then do couples want adoption to work like two-minute Maggi? After the process has gone digital, it has become easier for many to adopt,” says Goel, who believes that delays are inevitable if we wish to ensure a watertight adoption.

Surrogate mothers stage a peaceful protest in the campus of Dr Nayana Patel’s hospital in Anand, 90 km from Ahmedabad, in 2015, after the Indian government said it would ban foreigners from using surrogate mothers in the country. Pic/Sam Panthaky/AFP via Getty Images

As a professional working in the sector, Goel says that she often gets mistaken for an agent. “Some days ago, I received a call from someone who wanted to give off their girl child for Rs 1.5 lakh. I was livid. I report such cases on a regular basis. Even the elite and educated go and adopt children from religious ashrams, which is obviously a trafficking scam.” Goel says that most people don’t know that they can surrender their child to the nearest adoption agency if they can’t afford to raise them. “The child then goes into the adoption system directly. Unfortunately, many parents abandon their children at stations, in parks, churches, and hospitals. There are almost 30 million abandoned children in India, and only around 2,000 valid for adoption,” says Goel, who has an adopted daughter as well. Goel finds surrogacy risky, as there were no proper laws governing it, until recently. “I think this business of having your own blood is such a cliché. Every child deserves a home so adoption needs to increase in India.”

Rs 15L
End-to-end cost of getting a surrogate to help a couple with pregnancy prior to new bill

1,936
Babies legally available for adoption, acc to CARA against 36,000 couples in queue

26.5M
Number of people in India who want to conceive and suffer from infertility according to research done by Bengaluru-based Inito