In separate photos, the twins are wrinkled and pale. Both boys lie on a blue-green hospital sheet—one with limbs outstretched, the other curled up—and their faces are scrunched; perhaps they’re crying. The twins’ father, Trevor1 flips back and forth between the two photos on his cellphone. At 53, he is married and has two daughters, 15 and 8, but he has the restless energy of a first-time father. “Just looking at the pictures every night, I pray for them. I tell them good night. I kiss them, and I say, ‘This looks like it’s real.’”
The photos are how Trevor knows his sons exist. At this point, he hasn’t met them yet because they were born to a surrogate mother in New Delhi, India, thousands of miles away from his home in Philadelphia, Pennsylvania. When they were born on October 16, at 37 weeks, he hadn’t booked his plane ticket. “It still hasn’t felt real,” Trevor said. “Not until I touch those babies, until I start hugging those babies.”
Trevor’s strange limbo isn’t unusual for those who pursue surrogacy abroad, one kind of fertility tourism that's on the rise as singles and couples, both gay and straight, seek ways to overcome the limits—biological, financial, legal, technological—of having children. For U.S. residents in particular, surrogacy costs are cheaper overseas—by tens of thousands of dollars. But there are trade-offs. The child is born in another country, a distance that's more than physical; it spans language and culture. And parents need paperwork and embassy appointments and an international flight to bring their baby home.
That’s partly what brought Trevor to this booth in a Cosi in Philadelphia. Next to him sits Crystal Travis, founder of World of Surrogacy, which helps parents with surrogacy abroad, primarily in India. Trevor is one of her clients. This is their last meeting before he leaves for India, where she'll later meet up with him and help him fly home with the boys. Travis has arranged as much as possible beforehand, and now she pulls out a stack of white letter envelopes, laying them in front of Trevor like she’s dealing cards. They're thick with papers—applications for the twins’ passports, copies of embassy appointments. “This is all the stuff that you’re going to have to do there,” she tells him.
Travis has been through this process herself. She's married with three kids—a five-year-old son, and three-year-old twins—all born through surrogacy in India. She is open and empathetic but direct about the difficulties, and potential disappointments, of Trevor's decision. Surrogacy in India is “never the first option,” Travis says. “It’s people who’ve expended a lot of effort, money, energy trying to get [children] in other ways.”
India is one of a few countries, though perhaps the most popularized, where commercial surrogacy is legal. The country emerged as a “hotspot” in part because of lower costs and laws passed in 2002 allowing commercial surrogacy. In the U.S., surrogacy can cost between $80,000 and $150,000, while in India it ranges from $20,000 to $60,000, depending on the types of services and the clinic. That amount rarely includes unforeseen expenses like surrogate hospitalizations, or the basic travel costs such as flight and hotel stay. Yet those “savings can be the difference between being a parent and not being a parent for a lot of people,” says Kathryn Kaycoff Manos, founder of Global IVF, a resource for fertility tourists.
Exact numbers of U.S. citizens going to India—or anywhere else—for surrogacy are hard to pin down, but are a fraction of those seeking surrogacy within the U.S.. A recent report by the American Society for Reproductive Medicine estimated that 4 percent of surrogacy deliveries in the U.S. are to foreigners, and that, conversely, the "incidence of U.S. patients traveling abroad for care is estimated to be far lower than the rate of patients coming into the United States." Even that is just a rough estimate; there is no international registry to track where patients are from, or where they’re traveling for reproductive care.
Surrogacy in India is largely unregulated, though the Indian Council of Medical Research is moving toward greater control, including the registration of clinics, says Hari Ramasubramanian, a lawyer who founded the Indian Surrogacy Law Centre. An estimated 2,000 foreign babies are born to Indian surrogates each year, according to research in the forthcoming book Patients With Passports: Medical Tourism, Ethics, and Law, by Harvard law professor I. Glenn Cohen. A recent study by Sama, a resource group for women and health in India, concluded about 3,000 clinics offer surrogacy services to foreigners, generating more than $400 million per year for the economy; the Confederation of Indian Industry analyzed data that put India’s commercial surrogacy even higher, at more than $2 billion.
But tighter restrictions may alter the scope of India’s surrogacy tourism. In July 2012, the Indian Ministry of Home Affairs ruled that foreigners needed medical, not tourist, visas to pursue surrogacy. The ministry limited those visas to straight couples who've been married at least two years, and who come from countries that also permit surrogacy. The rule change amounted to a bar on singles, gay, and unmarried couples, and on those circumventing their home laws to have children. Though the ministry relaxed regulations so foreigners who had already begun surrogacy in India could complete the process, the Indian government began enforcing the new rules this fall, Ramasubramanian says.
Enter Thailand and the Mexican state of Tabasco, two places where surrogacy clinics now cater to international singles and couples—particularly same-sex couples. Thailand has been a popular surrogacy choice for Australians, but has become more appealing to Americans because of the new restrictions in India, says Kim Hendrix, a Dallas-based facilitator who owns Complete Surrogacy Solutions and works with clinics in India and Thailand. Hendrix—who travelled to Bangkok last month to meet with doctors, visit clinics, and to find out the entry and exit processes for new parents—says they’re still trying to get a better sense of the landscape in Thailand, where surrogacy is de facto legal; there are no laws against it, but that also means few protections in place for surrogates, doctors, and expectant parents (though Thai officials have considered regulations).
As for Tabasco, many people I talked to say they have outstanding questions. “It’s still new,” says Lauri Berger de Brito, co-founder of Global IVF with Kaycoff Manos. “So everybody’s starting to flock there and flock to Thailand. The stories will soon start coming out, the good stories and the bad stories.”
No matter the destination, real risks exist. Clinics sometimes make false promises about results, or inflate success rates. Would-be parents can spend tens of thousands without ever having a baby. There is little, if any, legal recourse for foreigners who fall victim to scams.
Citizenship laws also haven’t kept pace with reproductive technology, or global access to it. Children born to surrogate mothers in India are not considered Indian citizens. But the U.S. grants citizenship to children born to surrogates only if they have a genetic link to at least one parent. Yet DNA mismatches—because of lab error, or when eggs or sperm are deliberately substituted to increase the chances of a fertilized embryo—have left babies "stateless," unable to obtain an Indian or U.S. passport. “If you don’t have a passport, you can’t get on an airplane and come home,” says Catherine Tucker, an attorney who specializes in family and reproductive law. Though cases of stranded children are rare, Tucker has heard of parents going to extreme lengths: “Smuggling, physically smuggling, to get their children out of India."
But the surrogates also face risks. Because these women are paid, on average, $6,000 to $7,000, many see surrogacy as a pathway out of poverty. “It raises the status of them in their whole community. It is a positive thing,” says Kaycoff Manos. But women can miscarry, or develop health problems during and after pregnancy. Clinics don't always provide follow-up medical care or compensation for families if something goes wrong. Surrogates often come from the poorest households, and though many sign up willingly, they do so because they lack other options. Dr. Ranjana Kumari, a woman’s rights advocate and leading critic of Indian commercial surrogacy, told CBS News in April that “the vulnerability of poverty has been exploited in this whole system.”
Surrogacy supporters believe regulation—guarding the rights, health, and just compensation of surrogates—is crucial. Groups such as the Indian Society for Third Party Reproduction want to establish minimum compensation and treatment standards. Ramasubramanian’s Law Centre is trying to recruit both surrogates and parents willing to make agreements independent of the clinics or hospitals, which he says will protect surrogates’ rights. Clinics, not the surrogate, are the connection with foreign parents, which puts many surrogates in a vulnerable spot because they can’t change doctors, or pick which hospital they deliver in. “That part has to change,” he says.
Jean,2 another of Travis's clients at the Cosi get-together, thought when she was younger she'd have the husband, the kids, the white picket fence. “But it didn’t happen that way,” she says. She survived a bad, and childless, first marriage. Then twelve years ago she met her husband, her junior by about ten years. She calls him Mr. Bear, and she talks about him like a schoolgirl with a crush. But still there's something missing: children. Jean has spent thousands on failed attempts to build a family. She looked into adoption. She found an egg donor and surrogate in the U.S., but the surrogate fell through. Now, at 67, she will attempt surrogacy in India in late December.
But even if she and her husband can finally bring a baby home, her struggle won't necessarily be over once she's back in the United States. As Trevor explains about seeking surrogacy in India, "It’s not everyone you can tell.” Some of his immediate family, even his wife for a time, opposed his decision. “You gotta pick who you want to tell. Some people will agree, some people will not agree. Some people will support you, some people will not.”
Crystal Travis says she didn’t expect to be questioned about her decision. She’s been asked how much her children cost, where she adopted them from, whether she was really their mother. “I don’t think there’s acceptance of it,” she says. “It’s a very personal and private type of thing."
But it's also something to bond over. Travis meets up with old clients, now friends, often. They decided they’ll celebrate the Hindu festival of Diwali together next year. Trevor and Jean and Travis are already are making their own plans. Spending time together is comfortable and easy, a play date free from judgment.
“The kids are going to have fun,” Trevor tells Jean. “Trust me.”
“Yes,” Jean answers, sounding both nervous and hopeful. “Yes I know.”
“Your kids are going to go to Jamaica with us, and go to the beach and hang out with us. We’re going to have fun.”
Image via shutterstock.com.
Trevor asked that we use his first name only, to protect his privacy.
Jean also asked that we use her first name only.