Despite the physical and mental toll frequent egg donation or surrogacy takes on women, there are certain unsaid norms and standards that are a part of fertility treatments.

What is your caste and religion Questions women donating eggs are askedImage for representation
news Health Friday, March 06, 2020 - 15:02

Following severe criticism and after rounds of deliberation over the Surrogacy Regulation Bill, the union cabinet has approved it after accepting the recommendations of a Rajya Sabha Select Committee. The long pending Assisted Reproductive Technology Bill that covers a larger gamut of aspects under the assisted reproduction has also received the cabinet’s nod. As the Indian government is in the process of bringing in legislation for assisted reproduction, this series delves into on-the-ground realities.

Forty-year-old Sunitha*, a former surrogate mother who lives in a slum in Chennai's Vyasarpadi is unaware of all the debate around the assisted reproduction and surrogacy Bills. After our initial meetings, when I call her in November 2019 to meet again, Sunitha is a little busy.

“You know what happens even if there are slight rains in Chennai, right?” says Sunitha.

“We have been called (by Chennai Corporation) to clear the sewage water. I fell ill after working continuously for a week. Let the rain end, can we talk after that?” asks Sunitha.

Chennai’s stormwater drain system is one of the primary reasons for flooding during the northeast monsoon season. Clogged with sewage it becomes impossible for rainwater to drain, leading to inundation. Sunitha is employed as a casual worker by private contractors who have been tasked to clear the stormwater drain and sewerage by the Greater Chennai Corporation.

At her two-room house in Vyasarpadi, Sunitha is reminiscent of the child born to her through surrogacy, about six years ago. She admits that she was never involved in oocyte (egg) donation but has helped her friends and neighbours in reaching out to hospitals for surrogacy as well as selling fertile eggs.

“...not like an agent. But I help them,” clarifies Sunitha. She recently assisted her neighbour’s relative to turn surrogate and, “the woman had twins.”

Sunitha claims that she is not very active anymore due to her deteriorating health: Surrogacy, followed by the donation of one of her kidneys has affected her hugely. A mother of four, she opted to be a surrogate as she was unable to cope with the growing debt incurred by her husband.

Inherent casteism and racism 

In November, the DMK Rajya Sabha member P Wilson termed the previous version of Surrogacy (Regulation) Bill as “irrational, whimsical and arbitrary”. He questioned the rationale behind allowing only “close relatives” to be surrogates.

“I am saying this with a heavy heart that it will promote casteism and racism. It will be used to divide people by adopting reproductive restrictions and choices... (an) Act cannot select the surrogate mother. The liberty to reproduce and bear (a) child should be left to the option of the parent,” he said.

However, in February the Union Cabinet approved replacing the term “close relatives” with any “willing woman” in the Surrogacy (Regulation) Bill and its nod for the Assisted Reproductive Technologies (ART) Bill. But one cannot deny that a casteist and racist approach is already existent in the assisted reproductive healthcare.

Despite the physical and mental toll frequent egg donation or surrogacy takes on women, there are certain unsaid norms and standards that she should fit into.

Twenty-six-year-old Dhanam*, a native of Komarapalayam in Namakkal district says that criteria like age, health condition and weight, aside, other standards for egg donation include complexion and caste.

According to Sunitha, apart from the medical procedure, the paperwork also involves multiple stages in which the agents representing the hospital bring forms where details are filled along with the surrogate’s or donor’s photograph.

“Complexion, height, weight, caste and religion are noted. The fairer, taller and slimmer the woman is, the preference is more. While some are specific about the physical appearance of the donor, others are particular about caste,” explains Sunitha.

“I’ve heard others say that few are keen on food habits, but I haven’t encountered this,” she adds.

Her neighbor Rajeshwari*, 37, who was previously an egg donor says that she was rejected on several occasions because of her caste as well as dark complexion. Sunitha, who was never preferred for egg donation adds, “Often the aspect of caste comes into picture during egg donation more than surrogacy.”

Both Sunitha and Rajeshwari belong to the Scheduled Castes.

In gestational surrogacy, the child is not biologically related to the surrogate mother who is merely a gestational carrier. The embryo which may be produced through the in vitro fertilization (IVF) method, using the eggs and sperm of the intended parents or donors, is transferred to the surrogate who then carries the baby in her womb. As per the Indian Council of Medical Research (ICMR) guidelines and the proposed legislation, an oocyte donor cannot act as a surrogate mother for the couple to whom the oocyte is being donated.

Several women— especially egg donors— this reporter met across Tamil Nadu claimed that they were chosen based on complexion and/or caste. However, only in Sunitha and Rajeshwari’s case photographs were taken by the agents to the hospital.

Twenty-eight-year-old Saranya* who is from a most backward community says that though she was questioned about caste, she was preferred for egg donation due to her fairer complexion compared to her friend.

Unsaid standards

“My friend has donated twice. While the agent would regularly approach me, my friend would be ignored based on complexion,” claims Saranya.

Agreeing that questions related to caste aren’t directly asked, Dhanam who is from one of the denotified communities (DNC) that falls under the most backward class in Tamil Nadu says, “The agents are usually people from our locality or those who know us personally and it is easier to find out our caste. Usually, complexion or health conditions would be cited as reasons to ignore and caste wouldn’t be openly discussed.”

The donors as well as agents claim that the payment per donation varies depending on these unsaid standards too. 

According to doctors, there are patients who are keen on religion, caste and food habits of the donors. Dr Parikshit Tank says that the need to match the physical characteristics is obviously a universal phenomenon which is seen in adoption too.

“However, as providers of healthcare we can’t assure some very unrealistic things. It is like going to a blood bank and getting transfused with what is available and matches, irrespective of whatever religious beliefs or food habits one may have,” he says.

But Nayana Patel of the Akanksha Hospital in Gujarat’s Anand district, well-known across the globe for its surrogacy treatments, claims that it is “important to respect such beliefs.”

“It’s so hard to accept a donor gamete …it is not an easy thing. When there are donors available from every strata and religion, why to impose (certain aspects) upon them. We try to match as much as possible; if we aren’t able to, we inform the couple. Otherwise, I think it is important to respect the couple,” she says.

A 30-year-old woman in Coimbatore who is undergoing fertility treatments for about three years agrees that it is “of course difficult to accept donor eggs.” “There could be a mental burden that the child is not of my genes. Also, there is a little hesitation when we consider the social background of donors,” she says.

In Tamil Nadu and Gujarat, the two states where this reporter interacted with donors and agents, complexion and caste preference, is common. While religion and food habit preferences were found to be rare in Tamil Nadu, it’s a dominant factor in Gujarat.

A 33-year-old surrogate in Gujarat who is five months pregnant claims that she has been asked by her commissioning parents to follow a vegetarian diet and a prayer routine until her delivery. 

Back in Chennai, Sunitha is not convinced. “All these treatments are said to be an advancement in medical science. Yet, newer ways to discriminate continue to exist, isn’t it?” she asks.

*Names changed to protect identity.

This reportage was supported by the Thakur Foundation. Dharani Thangavelu, an independent journalist from Tamil Nadu is a recipient of a grant for investigative reporting in public health, 2019, awarded by the foundation.

Also read:

Forced to sell their eggs for fertility treatments, the stories of women from Tamil Nadu

Fatigue to excess bleeding: What women who donate eggs for fertility treatments undergo

Ban on commercial surrogacy in India is futile without addressing larger inequalities

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