Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India
- 1.7k Downloads
As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology (ART) Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded.
KeywordsReproductive ethics Surrogate mothers Informed consent Decision-making Embryo transfer Fetal reduction Delivery
Statement of Competing Interests
The authors have stated explicitly that there are no conflicts of interests in connection with this article.
- Beckmann, C.R.B., F.W. Ling, B.M. Barzansky, W.N.P. Herbert, D.W. Laube, and R.P. Smith. 2010. Obstetrics and gynecology, 6th ed. Baltimore and London: Wolters Kluwer and Lippincott Williams & Wilkins.Google Scholar
- Dodd, J.M., and C.A. Crowther. 2003. Reduction of the number of fetuses for women with triplet and higher order multiple pregnancies. Cochrane Database of Systematic Reviews, no. 2: CD003932.Google Scholar
- Indian Council of Medical Research (ICMR). 2005. National guidelines for accreditation, supervision and regulation of ART clinics in India. http://icmr.nic.in/art/art_clinics.htm. Accessed June 6, 2015.
- Ministry of Health and Family Welfare, Government of India, New Delhi. 2010. The assisted reproductive technologies (Regulation) Bill 2010 (ART Bill). http://icmr.nic.in/guide/ART%20REGULATION%20Draft%20Bill1.pdf. Accessed June 6, 2015.
- Minocha, A.A. 2010. The socio-cultural context of informed consent in medical practice. In Understanding Indian society: Past and present, edited by B.S. Baviskar and T. Patel, 231–253. New Delhi: Orient Blackswan.Google Scholar
- Nandraj, S. 1994. Beyond the law and the Lord: Quality of private health care. Economic and Political Weekly 29(27): 1680–1685.Google Scholar
- Prakash, G. 1999. Another reason: Science and the imagination of modern India. Princeton: Princeton University Press.Google Scholar
- Price, F. 1999. Beyond expectation: Clinical practices and clinical concerns. In Technologies of procreation: Kinship in the age of assisted conception, edited by J. Edwards, S. Franklin, E. Hirsch, F. Price, and M. Strathern, 29–59. London: Routledge.Google Scholar
- Reddy, S., and I. Qadeer. 2010. Medical tourism in India: Progress or predicament. Economic and Political Weekly 45(20): 69–75.Google Scholar
- Scheper-Hughes, N., and L. Wacquant. 2002. Commodifying bodies. London: Sage.Google Scholar
- Smerdon, U.R. 2008. Crossing bodies, crossing borders: International surrogacy between the United States and India. Cumberland Law Review 39(1): 15–86.Google Scholar
- Society of Obstetricians and Gynaecologists of Canada and the Canadian Fertility and Andrology Society (SOGC-CFAS). 2008. Guidelines for the number of embryos to transfer following in vitro fertilization: No. 182, September 2006. International Journal of Gynecology and Obstetrics 102(2): 203–216.CrossRefGoogle Scholar
- World Health Organization Division of Family Health. 1994. Indicators to monitor maternal health goals. Report of a Technical Working Group, November 8–12, 1993. Geneva: World Health Organization, publication no. WHO/FHE/MSM/94.14.Google Scholar