The Indian government has decided to ban commercial surrogacy in an attempt to curb “exploitation of women”. The key aspects of the Surrogacy (Regulation) Bill, 2019 has come under severe criticism and the latest Select Committee report recommends major changes to the Bill. While it is to be seen if the government will accept the suggestions or ignore it like previous instances, the following series of reportage from Tamil Nadu and other states attempts to find out if the ban would make sense, and focuses on the actual socio-economic inequalities around the assisted reproductive healthcare.
It was less than a week into the new year in 2014. Pon Kathiravan, a member of the CPI (ML), as per his daily routine at the party office in Namakkal district’s Komarapalayam was busy reading the morning newspaper. As he flipped through the pages, he realised the presence of a man in his 30s sitting across the table.
Before Kathiravan could realise what was happening, the man jumped from his chair and attacked Kathiravan. As Kathiravan, with multiple cuts on his head, hastily climbed down the stairs to get out of the building, he was stabbed again.
“Navaraj is his name. I had never seen him before, never saw him again,” recounts 59-year old Kathiravan, six years after the incident that completely shook his life.
He quickly clarifies: “After the incident, I saw him once when the police wanted me to identify him before the arrest. He is now out on bail.”
Just days before Kathiravan was stabbed, a then 27-year-old Sakunthala had approached the party office along with a neighbour who was also a party member. She wanted help in filing a complaint against her abusive husband Navaraj, and Kathiravan had helped her draft it. Later, police officials, after counselling the couple, arranged a mutual separation. Triggered by the series of incidents, Navaraj attacked Kathiravan and later stabbed Sakunthala, who too survived after multiple injuries.
In the eight years of her married life, Sakunthala was forced by Navaraj and his mother to donate her oocyte (egg) 18 times at various hospitals in Tamil Nadu and Kerala. According to the police report, she was also forced to sell one of her kidneys soon after her wedding in 2006.
When Sakunthala finally resisted, she was attacked.
Ignoring such regressive domestic environments that women like Sakunthala are forced to encounter, the latest Surrogacy Regulation Bill also conveniently evades other complexities around assisted reproduction like egg donation. In an attempt to “curb exploitation” of surrogate mothers it bans commercial surrogacy and allows only “close relatives” to be surrogates.
If the prime concern of the government is to curb exploitation of women, it should have brought in a regulative mechanism for egg donation too. More than surrogacy, it is the egg donation that is more rampant and exploitative, says Nikhil Datar, a Mumbai-based senior gynaecologist and advocate of reproductive rights.
Just days after Sakunthala was attacked in Tamil Nadu, Yuma Sherpa, a 23-year-old shop assistant, died mysteriously in the national capital of New Delhi, following a medical procedure that involved oocyte extraction procedure.
Four years before Yuma’s death, 17-year-old Sushma Pandey died in Mumbai of “brain haemorrhage and pulmonary haemorrhage due to ovarian hyper-stimulation shock syndrome”, after donating eggs thrice within 10 months. This was a brazen violation of the Indian Council of Medical Research (ICMR) guidelines which has fixed the age of those donating eggs to between 18 and 35.
The deaths of Yuma and Sushma gained national attention and raised a lot of questions on the legal and ethical aspects of Assisted Reproductive Technologies (ART). But no stringent rules were brought in. Earlier this month, a Select Committee made recommendations to the strongly criticised Surrogacy (Regulation) Bill, 2019, after the government failed to acknowledge the suggestions of a Standing Committee. And, last week the Union Cabinet approved the ART Bill that covers a larger gamut of medical procedures, unlike the Surrogacy Bill.
Besides all the legislative process, a curious case emerges in Tamil Nadu, where issues like prohibition, pollution and the current economic downturn are connected through an invisible thread: a $20 billion global fertility market services.
Domino effect 1: A secret called ‘batch’
In Komarapalayam, it is exactly six years since Sakunthala was attacked: neither the police officials nor the CPI (ML) members know her whereabouts. As I unsuccessfully search for Sakunthala’s house through the streets of powerloom towns – Komarapalayam and the neighbouring Pallipalayam – a very closely guarded secret unfolds: a secret that the women hold to themselves, tucked in the midst of closing down of powerlooms and growing debt. It is called the ‘batch’.
Twenty-six-year-old Dhanam* is also part of the secret, something that her family doesn’t know and only her close friend and neighbour knows. She is hesitant, initially, to talk about the ‘batch’ that is filled with agony and pain, but often coloured in shame and stigma.
Dhanam was only 13 years old when she got married and hardly 18 when her husband, a powerloom worker in Komarapalayam, died. Dhanam, also employed in the powerloom industry, struggled to bring up her two sons. Even as she worked hard, her debts grew.
Apart from being a casual worker at construction sites she works in powerlooms too whenever she gets a job, while her debts have ballooned to more than Rs 1.5 lakh.
Dhanam remarried in 2014 in hopes of a better life for her and her sons. However, this time it hit her severely when the man turned abusive. With debts piling up and subjected to domestic violence, she was “offered help” by a friend.
“I was told there was an easier way to solve all my problems. The lady at the construction site told me she’d take me to a hospital where I’d be injected to take my fertile eggs and would be paid for it. At first, I was a little sceptical and thought about it for a while before agreeing.”
Name boards of hospitals, fertility clinics and scan centres at a junction in Erode
Unable to recollect when she first donated, Dhanam says it was “less than three years ago”.
She adds, “You remember when Rs 500 and 1,000 notes were scrapped? Since then it has become difficult to find regular jobs at construction sites and powerlooms. So, I went to the hospital for my first ‘batch’ with the lady who had suggested the idea.”
Sitting next to Dhanam, her 33-year-old friend Seetha* who is also an egg donor, nods in agreement. She adds that most of their friends decided to take up egg donation as a means of earning after they went through job cuts in the last couple of years.
“I was rejected in my first attempt as my ovulation was not good enough for (egg) retrieval. I was given medication and told to visit the hospital after a month. This time it was successful and I was paid Rs 15,000. Every single visit we make to the hospital to donate eggs is termed as ‘batch’,” claims Dhanam.
“Agents say ‘batch’, so we call it that too,” admits Dhanam, who has gone for “10 batches in three years,” neglecting the fact that repeated ovarian stimulations would take a huge toll on her health.
Domino effect 2: The two headwinds between warp and weft
The noisy yet rhythmically alternating clackety-clack sounds of the powerlooms’ weft and warp fill Pallipalayam’s earthy scent on a hazy afternoon. In one of the lanes, off the Erode main road, is a small powerloom unit that manufactures lungis, towels and bedsheets, and has 10 employees.
Forty-year-old R Sumathi, who has been working in the powerloom sector for over 20 years, is busy segregating the sized yarn before it is transferred to a ring package. Her parents were in the handloom sector and she started off assisting them since she was 13. She dropped out of school after Class 8 and since then her world has been spinning around looms.
“There are very few large powerloom units around Erode and Namakkal, most are smaller units run like cottage industry. Children assist parents, siblings would have a joint unit, spouses would do business together: all it needs is a little space. Every alternate house would have at least a single unit running throughout the day,” says Sumathi, who has witnessed the rise of the powerloom industry in the 1990s as a kid along with the downfall of handloom.
“And now, this too,” she adds, pointing to the large units in front of her.
Sumathi adds that the powerloom business has been hit very badly in the last two years. Even as they were struggling to realise the impact of demonetisation, the new taxation – Goods and Services Tax (GST) – pushed things from bad to worse, and things have further plummeted in the last few months.
Inside a powerloom unit, Pallipalayam
Sumathi, whose factory has halved its production from 12 powerlooms, points towards two buildings on the opposite road and says that the factories have remained non-operational for four months.
With over 5.62 lakh powerlooms and more than 10.18 lakh people employed in the sector, Tamil Nadu has the second largest powerloom industry in the country, next to Maharashtra which employs over 15.54 lakh people across its 9.5 lakh looms.
Five years ago, D Rathna, while working on women’s issues in Pallipalayam, came across women who sold oocytes due to financial constraints. She adds that the number of women from smaller towns around Erode and Namakkal who have turned to egg donation as a means of income has only increased in the last few years.
This increase closely coincides with the growing debt and the shutting down of powerloom units in the twin towns of Pallipalayam and Komarapalayam following the two headwinds – demonetisation and GST. The cycle of economic crisis, job cuts and debt are not new to these towns. However, mapping the three-decade trajectory points to the larger socio-dynamic transition from kidney to oocyte sale.
The Textile Policy of 1985 followed by liberalisation of the Indian economy came as a huge blow to the handloom sector. As Pallipalayam and Komarapalayam – major centres for handloom – switched over to powerloom, there were major job losses and debt, turning the towns into a hub for a kidney racket in the late 80s and 90s. Kidney theft cases were emerging even after the adoption of the Transplantation of Human Organs Act by Tamil Nadu in 1994, leading the state to implement a set of rules for streamlining organ donation and transplantation in 2008. Now, more than a decade later, Tamil Nadu leads the country in organ transplantation.
In the last few years a newer problem has hit these towns in the name of oocyte sale, as the cycle of economic crisis, job cuts and debt recurs.
The women, who are almost an equal workforce in the unorganised powerloom sector, end up becoming suppliers to the infertility market, valued at nearly half a billion in India. The semi-urban setup of the two towns with a good mix of migrant population makes it easier for women to take up egg donation (and occasionally surrogacy), which would otherwise be viewed with stigma in a closely-knit rural setup. Many of the egg donors claim that they were initially stigmatised by their families, only to be later coerced into it once the family began to reap the financial benefits.
“When someone sold off one of their kidneys it was equated to a sacrifice, like the person did it to save (her/his) struggling family. But when women like us become a surrogate or egg donor for the well-being of the same family, it becomes a matter of shame for everyone around us,” says Dhanam.
Domino effect 3: Pollutants in Bhavani river
The heavy rains from the previous week have led to a good flow in the Bhavani river, the banks on which the powerloom towns are situated. After a small hiatus, the November rains are gearing up to pour again in the western region that has significantly contributed to the rise of fertility clinics in Tamil Nadu, a state with the second highest number of ART centres, next to Maharashtra.
Talking about the mushrooming of fertility centres in Erode and Namakkal, Dinakaran, who is with a non-profit organisation that works with women in Namakkal, claims that the districts of Erode, Tiruppur, Karur and Namakkal have all the elements required for the “infertility market’s supply chain”.
Apart from the availability of egg donors as “suppliers”, there is a “natural demand – infertility” that has developed due to the extreme contamination of the Bhavani river over the last three decades due to discharge of untreated water from the numerous dyeing and bleaching units of the textile industries.
One of the streets lined with powerloom units
The 217-km-long Bhavani river that courses through Coimbatore and Erode before its confluence with the Cauvery is Tamil Nadu’s second largest river and stretches around 91 km in Erode district. It’s a major source for agriculture and drinking water.
Various studies at different time periods by both union and state Pollution Control Boards have reported that the effluents severely affect the river and several legal proceedings have led the courts to direct the state to ensure that water is let out into the river only after effluent treatment. Yet, it remains unregulated and the river contaminated, according to locals.
“The pollution affects all those who live along the river. At least if there was sand on our river beds, it’d have filtered out the chemicals that are let off. But continuous plunder of the river sand has made even that impossible,” claims Dinakaran.
Mumbai-based ART expert Parikshit Tank states that it is important to start viewing the environment as a possible contributor to rise in the infertility rate.
“While pollution cannot be the sole reason, it could also be one of the possibilities. Lots of pollutants contain estrogen-like-chemicals and even if the concentration is very low, prolonged exposure to it will have ill-effects,” says Parikshit.
Medical practitioners in Erode and Namakkal point out that those in the age group of 30 to 40 are the first generation to have lived their entire lives with pollutants from dyeing and bleaching units.
Senior doctor V Jeevanandham, a pioneer in initiating co-operative hospitals in Erode, says that along with the contaminated water, extensive use of chemical fertilisers and pesticides in agricultural produce could also be a reason for infertility.
The doctor, who is currently running a de-addiction centre, adds that increasing levels of alcoholism in Tamil Nadu could be another reason too.
Domino effect 4: TASMAC, Tamil Nadu’s cash cow
Health implications aside, the social effects of alcoholism are numerous in Tamil Nadu where the state government is the sole wholesale and retail seller of liquor through its Tamil Nadu State Marketing Corporation (TASMAC), which is one of the largest contributors to the state’s coffers. Protests for prohibition galvanised around 2015 and since then there have been on and off agitations across the state. It became one of the prime promises of all political parties before the 2016 assembly elections and the AIADMK came back to power promising a “step-by-step prohibition”.
Back in Komarapalayam, as Dhanam contemplates going for the next ‘batch’, her friend Seetha is enquiring about the possibilities of selling one of her kidneys or becoming a surrogate.
National Family Health Survey (NFHS)- 4 data, Tamil Nadu
Dhanam’s second marriage broke up after her husband started forcing her into frequent sale of eggs.
“He would take away all the money for drinking and I’d be left with nothing to feed my children. So, I don’t live with him anymore,” she says.
Seetha, another victim of child marriage, is also separated from her alcoholic husband and lives with her 18-year-old son, who has just begun to work at a retail outlet. Seetha, who has so far donated on seven occasions, is completely aware that her poor health will not allow her to stress her body any further.
“What else can I do; I’m in need of money to repay my loans,” she says.
Dhanam quickly adds: “If there is anything that should go, it’s the TASMAC shops… root cause of everything. If the men in our families weren’t alcoholic, we could’ve easily managed with the available income… it has ruined our lives.”
Meanwhile, attempts to trace Sakunthala are still futile as someone in Komarapalayam claims that she has moved to Coimbatore and no one seems to have her contact. But, in a span of six years there have been many Sakunthalas with similar, if not more harrowing, tales to tell.
*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 the grant for investigative reporting in public health 2019, awarded by the foundation.
Photos by Dharani Thangavelu