 Namaste. Good morning everybody. I'm Lopamitra Goswami and I'm an Indian researcher currently doing my PhD at Griffith University in Australia. I've been doing research with Indian surrogate mothers since 2014 and I'll be talking to you about some of the perspectives from the surrogate mothers perspective. Also I'll be using the term surrogate mother because that's how Indian surrogates would like to be called. I didn't realize that that would be something of significance until I heard Erica yesterday who preferred not being called a surrogate mother. So I think it is important that I tell you why I'm referring to surrogate mothers in India surrogate mothers and we'll talk a little bit more about that in in a little while. Before I begin I'll have to acknowledge my mentor Dr. Karen Smith-Rutabi. She's in here today but it's only because I've heard that both these research have been possible and also the cover of the image that you see is the cover of a book by Karen and Nicole where I have a book chapter also talking about the perspectives of Indian surrogate mothers. Just to give you an idea about India because this is going to be quite significant when we talk about certain things. The population of India is 1.3 billion people and compared to the world population which is 7.53 billion. Also the number of people on the poverty line as of 2011-12 census is 269 million which is about 21.9 percent of the population. And when we talk about people living below the poverty line we're talking about about 308 British pounds per year for a household of people or roughly around 390 US dollars per year. Surrogacy in India. Now India has been the capital of international surrogacy, international gestational surrogacy until 2016 when we banned international gestational surrogacy and we legalized surrogacy back in 2002. Most of the academic papers about 90 percent of it comes from the Indian diaspora as well. With the current ban however you would question as to is this a real ban or how long will it stay around for keeping in mind the kind of investment that has gone into the surrogacy market in India. We don't know what is the exact number of surrogate birds due to the unregulated nature of the market there. Also we estimate about between 400 million to a billion US dollars per year that was generated by surrogacy due to surrogacy arrangements in India. Now it's quite interesting as to why did India become this hub for surrogacy and these are some of the reasons that we quickly go through. Lack of surrogate mothers in the intending parents or the commissioning parents country of origin. I was just talking to somebody here from Israel yesterday as well and you know we were talking about how probably you know we don't have as many surrogate mothers or women willing to be surrogate mothers in that country. Comparatively lower costs you just notice in the previous slide that yeah if you noted for the last bit it's only about a third of the amount that you pay in countries such as the US or such as the US. Legislative issues around the world as well and in India there's always a way where you can find a loophole and work around it so oftentimes people come and you know use that. Also India is pretty known for its cutting edge medical technology and you know it's no secret that some of the best doctors in the world are also from India so I think that's another reason why people come into India to you know commission surrogacy arrangements. Also India actually invested a lot in marketing itself as the surrogacy hot spot so with about 3,000 fertility clinics around the country and this is only the number of registered surrogacy clinics around the country. Also a lot of surrogate women a lot of women who have been surrogates in India actually have taken this as an accepted way of you know earning money as against anything else that they were doing like for example working a sweatshop and it gave them a bump of for example whatever money they would gather with a job as a factory worker or or a domestic helper it would take them 10 years to gather the amount of money that they would gain from you know nine months of investment in a surrogacy arrangement. Also a lot of there was a lot of western interest in Indian surrogates due to the cultural background in India Indian women are known or in those socioeconomic status known to not use alcohol or drugs so it sort of made them the perfect mother to raise surrogate babies and it reduced the risks by a large extent and also it made them a perfect mother worker while they would take care of the surrogate child also there was no legislation that helped them or or they couldn't afford to keep this child after it was born so it was almost like a perfect you know solution that they will raise the child perfectly and they'd also be sort of in a way you know they don't have any option but to give away the child as well. This is I'll give you a quick you know understanding of our first field visit which was in 2014. The basic idea that we went in was to understand there's a lot of sorry there was a lot of discussion and debate around whether Indian surrogates were being coerced or was there exploitation going on at this point in time so we went in and actually asked the surrogate mothers and tried to see what their understanding of exploitation was and if or not they felt exploited at all. I interviewed about 25 surrogates between the age group of 26 and 45 their monthly income was between 2000 to about 25 000 rupees both our partners put together you can see the dollar equivalent of that and the educational level of these women where anything from being illiterate to about second year of college marital status is two of them were widowed three of them were divorced and 20 of them were in marital situations. So one of the questions was why did you choose to become a surrogate and these were some of the reasons that they gave us to buy a house to provide food for the family they didn't have a job they were a single parent to provide better education to their children to pay rent to save up for their daughter's wedding pay pay off debt win-win and it was a gift of a child that they were giving to a childless couple so you can see the spectrum of responses here from being absolute financial where they really just needed the money to also altruistic where they actually wanted to give a child to a childless couple I'll expand a little bit in some of the about some of the responses here when you talk about providing food for the family one incident one of the interviews that struck me was when she said I used to beat up my kids every night so that they would get tired and go to sleep because I didn't have food to provide at the table so this is the level of poverty we're talking about when you say there's no food to provide also so this research was conducted in Gujarat in India and getting your daughter married is a big dowry is still prevalent there for example so you almost start saving up as soon as you have a female child born into the family and in a lot of cases there's also a lot of female infanticide and things like that which is decreasing let me tell you about that so but yeah so you see when I say why are they becoming a surrogate so it's not just you know for money for money to buy myself jewelry or whatever but it's actually to put food on the table and one of them also said I mean we are all aware of this already where surrogacy is very often also compared to sex work and as soon as I went in oftentimes you would hear them saying like at least I'm I'm not selling my body I'm doing this where there is no sex involved and you know I'm doing this for my family also when you talk about win-win this was very interesting when they said I need the I need the money and they need a child and this is you know this works perfectly so they're giving me what I need and I'm giving them what they need right another question we asked was how did you feel when you handed over the baby now this was a mixed bag because while some of them well very few of them said I didn't feel anything my interest was only with the money but sometimes of course I think of them and hence those commissioning parents can still call me I asked for their photographs and they agree right now this is a very rare situation whereas most often they said something like I would feel happy but also I remember those kids or I miss them or I wish that the commissioning parents they keep in touch with me or I wish I had photographs from them right some of them also said I cried I cried for days you know I remember the child for a very long time and the situations vary between some commissioning parents keeping in touch with these fair with the surrogate mother whereas some who had a clear cut off from them as well um this was what was the main in goal of our research do you feel like you were taken advantage of or used unfairly in your in your surrogacy experience these are some of the quotes um no I'm looking at the green one no uh why will they take advantage they haven't asked me to become a surrogate it was my situation which pushed me into becoming a surrogate I went there by myself I thought if someone else benefits only then I will benefit uh they have no advantage here it's good work as someone got a child and our poverty also got erased I'll quickly look at the blue one top right no nothing like that we came here at our own will no one pulls us here we also have some problems so we come here on our own no one is taking any advantage we go out on our own to the hospital tell madam who's the doctor that we want to be a surrogate and if she feels that we can be taken in only then she will agree we have to be uh married should have our own kids have to show their pictures etc and only then she will take us in if there is any problem she will then she then refuses right next we went in for a second time in 2016 and this time we went in right after the ban was introduced and we went in to talk to women who lived in that same community but had not been surrogate mothers and when we went in with this perspective we were basically trying to figure out why it whilst living in the same community uh have these mothers not engaged in surrogacy and if there was some information that they knew of that the surrogate mothers themselves were not telling us for example something like um uh you know mortality rates where there are a lot of surrogate mothers who are um you know dying during childhood uh you know and then we weren't being informed about this by the surrogate mothers so we just tried to get a taste of that again i interviewed about 25 non surrogate mothers and um uh this was in december whereas the ban was introduced in um in august these are some of the profiles so just give you an idea the women range from the age group of between 22 to 45 and again their education levels were between being illiterate to having a master's degree as well um these were some of the points of significance uh we were trying to figure out what was their reason uh if they uh you know uh why have they chosen not to be a surrogate and if they wanted to be a surrogate why would they under what circumstances would they be a surrogate um and uh we also uh looked at what was their opinion on the current ban that was introduced which is what i'll talk to you about um in a bit um to just give you an idea of why they hadn't been surrogates what they responded was that uh they didn't need the money uh some of them also talked about it being a taboo in their community and so they didn't want to engage in this unless they really needed to uh they also spoke about um um uh if they would if possibly in the future they needed that kind of money and uh also uh i think a few of them spoke of they didn't know what they would say to their child when they grew up as to what they were doing with this pregnancy and why were they giving away the child um to somebody else so uh what is their opinion on the current ban now i mean just to give you an idea the whole point of my presentation is to present to you what these women are wanting to tell us instead of what we want to speak for them so it's basically to have an idea of what they really want for themselves and to give them the agency and hear their voice uh what these women spoke off about the current ban was that it's really good for us people as in surrogacy is really good for us poor people surrogacy is really good i don't understand why they have banned this we can't earn as much in a year otherwise for uh which is five to six lakhs um in indian rupee uh it should continue for for a poor person they get a place of shelter and everything it is good for them it shouldn't have happened they're not able to become surrogates this is bad surrogacy has to be there for outsiders too because majority of these parties are good they pay the surrogates well and more people come from there and this is why it should be there so the current situation in india is that we have banned international surrogacy and the only form of surrogacy that exists in india right now is domestic altruistic surrogacy but it also often brings us to question is this really going to be altruistic surrogacy i was having a discussion yesterday at dinner where i was telling them that her and i can be sisters or you know cousins in india you can establish that saying you know i she is my somebody somebody somebody somebody and that's how you know she can be or i can be a surrogate for her this is also seen in organ transplant in india in kidney donation for example and i have known somebody personally who has done this where they've changed documentation and then actually portrayed somebody to be a relative in order to be able to take their kidney in the past this was a discussion that came in yesterday about the feminist discourse as far as surrogacy is concerned it's very split even in amongst feminists some people talk about it being a basic abomination of all possible human rights whereas others talk about it giving agency to the woman and actually her being able to make the decisions for herself as well in the indian context though you have to be very careful because sometimes a lot of other things are going on you have to check whether she's been coerced whether she is doing it at her own on her own will so these are all different things that you really need to look into we have this particular medical practitioner i don't know if you've heard of her Dr. Naina Patel and she has developed a model in india in gujarat where it's it's very difficult for you to question that because she's under the limelight so she tries her best to keep it as transparent and as transparent as possible but but then again going back to the fact that there's a lot of unregulated clinics around and so you really don't know what they're doing for instance embryo reduction or informed consent oftentimes when i've spoken to sargit mothers who are not a part of Dr. Patel's clinic they're barely aware of what what is the procedure that they are really signing up for or if there's been a a fever reduction they go in and they say we did a procedure and we came back they really don't know what goes into the nitty gritties of it right this was something as well that caught my attention yesterday in the discussion is a shifting trend in terminologies i noticed that people from South Africa and also from India we used the terms commissioning parents and surrogate mother more commonly whereas you know people from the US and UK are potentially using the term intending parents and surrogate or carrier it just brings me to question are we trying to distance the surrogate mother from this procedure and be more how do i say that i'm losing the word but be more favorable towards the intending parents for example i mean it's just a question i'm putting out there and are there really cultural differences for example when i heard Erica yesterday it struck me and i think you know she's completely right in you know telling us that she does not want to be associated with the word mother in this context whereas in India it is quite different because the concept of blood is very important so in every interview that i've had with surrogate mothers they've almost always said that of course that is our child i mean i know it's not my child but i've shared blood with this child so i am also the mother whereas when susan was presenting also when santi was presenting it's very interesting that you know there's no confusion that the intending parents are the real parents whereas from the surrogate mother's perspective in a developing country like India they're actually thinking or even reporting something like i hope someday the child will come back and you know find me or you know i mean or they'll they'll want to know who i am right this brings me to yeah my current phd research after being in the field for this many years and talking to surrogate mothers i decided to go on the route of a phd and look at surrogate mothers and their mental health issues i'm currently trying to define whether it's mental health or psychosocial you know y'all can help me with that as well there is no provision for psychological screening or legal counseling for surrogates in india there is oftentimes i mean it's on it's there on paper of course however if she's physically capable she gets in there is no mental health assessment that is really conducted because there is no psychologist you know who is there assessing the person so it's the medical doctor who actually just by merely having a chat with her tries to get an understanding of her mental health status before engaging in a surrogacy arrangement this is just you know from literature there's a lot of demand you know on the part of the surrogate mother it requires a huge amount of maturity and also healthy adjustment women who there's you know evidence that women who relinquish a child are at a greater risk of postnatal depression including feelings of anger and guilt depression along with other psychological problems such as feelings of guilt regret and loss can emerge after giving birth surrogate mothers have indicated that they would keep the child in commissioning parents or doctors refuse to take care of the child this has been true in a few situations in india where surrogate babies have been born and parents of coming in from different parts of the world have not been able to get a passport for these kids to leave india so for example one of the surrogate mothers who had japanese twins was mentioning that she had them for three months in her house and she was dressing them up in indian attires and you know and she was also saying that oh they didn't even look japanese any longer but i think what she was trying to say is that you know but she was very happy to have them as well and obviously there monetary help from the parents you know to take care of these child and she wouldn't be able to take care of these two extra kids along with her other children as well but what i'm trying to say is that if nobody else will they will keep the child i mean at least as a situation in india surrogate mothers develop strong emotional ties with the child and separation leads to an overwhelming sense of loss and an emotionally stressful phase for the surrogate mother you know like you saw in some of the quotes that i put up they do miss their children and they would like to have some sort of connection with these children as well japan literature very little is known about the mental health impact of surrogacy that surrogacy on surrogate mothers especially transnational gestational surrogacy practice and specifically in india has been under researched and there's long-term evidence of long-term psychological impact on the surrogate mother in the form of post-natal depression or psychosis but very few studies have actually examined them people have mentioned about it without empirical evidence to back it up and with evidence supporting surrogate mothers experience of psychological issues post-child-relinked fishmen it is important to gain further understanding of this particular phenomena and so this brings me to my uh i mean this is going to be my research and hopefully you'll hear from me in a in a few years or in a year and i'll talk to you and report my evidence from my phd web also conclude by saying that while indian surrogacy did require a revamping and you know relook into it but a complete ban of fit i'm not too sure if it was really necessary regulation yes but then i'm not too sure again coming from the perspective of the surrogate mothers when they say when they say that this was a great option for us to have namaste thank you