title: Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India.
abstract: 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.
authors.affiliation: Institute of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Brendstrupgaardsvej 100, 8200, Aarhus N, Denmark. mts@clin.au.dk.
authors.forename: Malene
authors.initials: M
authors.lastname: Tanderup
authors.affiliation: Centre of Social Medicine and Community health, Jawaharlal Nehru University, 110067, New Delhi, India. sunitareddyjnu@gmail.com.
authors.forename: Sunita
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Sociology, Delhi School of Economics, Delhi University, Delhi, 110007, India. pateltulsidse@gmail.com.
authors.forename: Tulsi
authors.initials: T
authors.lastname: Patel
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200, Aarhus N, Denmark. bbn@dadlnet.dk.
authors.forename: Birgitte Bruun
authors.initials: BB
authors.lastname: Nielsen
mesh_terms: D001291:Attitude of Health Personnel; D003132:Commerce / Q000941:ethics*; D003657:Decision Making / Q000941:ethics*; D004624:Embryo Transfer; D036262:Empirical Research; D026690:Ethics, Clinical; D004992:Ethics, Medical; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007194:India; D007246:Infertility; D038622:Internationality; D057193:Medical Tourism / Q000191:economics / Q000941:ethics; D009035:Mothers; D010820:Physicians / Q000941:ethics; D011057:Politics; D011247:Pregnancy; D012098:Reproduction / Q000941:ethics*; D027724:Reproductive Techniques, Assisted / Q000191:economics* / Q000331:legislation & jurisprudence; D012306:Risk; D012935:Social Justice; D013533:Gestational Carriers
keywords: Decision-making; Delivery; Embryo transfer; Fetal reduction; Informed consent; Reproductive ethics; Surrogate mothers