December 19, 2018
Dr Kakoli Ghosh Dastidar speaks on The Surrogacy (Regulation) Bill, 2016
Thank you Madam for giving me the opportunity to speak in favour of The Surrogacy (Regulation) Bill, 2016. This is a very, very important Bill, particularly with respect to women who have been exploited extensively in a certain part of Gujarat and elsewhere in the country.
Actually for surrogacy to take place, it has to be preceded by ‘In Vitro Fertilisation’ (IVF). It has been compared to man’s landing on the moon. In IVF, a woman’s ovaries are stimulated to give multiple number of ovum; they are then fertilised outside in the laboratory by a person who sits in the laboratory for hours together, controlling different parameters which support life – like oxygen, carbon dioxide, humidity and all the other protein molecules which let the embryo grow and survive.
IVF has been so difficult that it took nearly 100 years, before the birth of Louise Brown could be announced by Professor Robert Edwards and Patrick Steptoe in England in 1979, followed shortly by Subhash Mukherjee giving birth to Kanupriya or Durga in Bengal. This was followed in 1996 and 1997 by the birth of Imran. Professor Robert Edwards had been given the Nobel Prize for the IVF baby’s birth. Our very own Indian Council of Medical Research gave lifetime achievement awards to Dr Ghosh Dastidar and Dr Chakravarty for their work in India. So, only after IVF is done is the embryo available for transfer and a surrogacy to follow.
At the very outset I would like to bring to your notice that here it is given that the “embryo” means a developing or developed organism after fertilisation till the end of fifty-six days”. In this age of cryopreservation today, sometimes we can cryopreserve the embryo for years together. So 56 days, counting from the day of fertilisation should be replaced by any number of days that the baby is given in the mother’s womb – that period it can be cryopreserved. That has to be looked at.
Sub-clause (k) says, “foetus” means a human organism during the period of its development beginning on the fifty-seventh day following fertilisation or creation (excluding any time in which its development has been suspended) and ending at the birth;
This should therefore also be changed because the growth of the fetus takes place inside the womb so these 56/57 days, both would have to be changed.
Let us have a public debate, like we had for the ART (antiretroviral therapy) draft Bill. I think it was started in 1998-99 by the Indian Council of Medical Research. We had three to four public debates in different parts of the country; but I don’t know the fate of that Bill. Even today it has not been tabled. Surrogacy should have come along with the ART Bill because, like I had explained, without having an IVF laboratory, without having a test tube baby, we cannot have a surrogate. Therefore, these two Bills should have been brought together. May be we are trying to hinder those unscrupulous people who are exploiting women, but that should have been brought together.
So, I suggest that we have a public debate throughout the country and take the opinion of different categories of people including experts. Here, there is also a mention of embryologists but there has been a sea change in the subject of ART at the moment. When I was student in the 1980s, the situation then was definitely not the same as today. An embryologist today has the experience of ‘in vitro’ growth. So a specialised embryologist today is making the babies. This also has to be changed here.
As I understand there have been many meetings, with the ministry, with the officers and with the professional bodies. But when the final draft of the Bill was made and tabled here, the professional bodies like the Federation of Obstetrics and Gynaecological Society of India, ISAR (Indian Society for Assisted Reproduction), NGOs were not consulted. I think there has to be another meeting before this Bill is passed.
Madam, the Hon. Supreme Court has recently decriminalised Article 377 and the LGBT community has been accepted to be a part of the mainstream. So, we have same-sex couples now. But in the Bill there is no mention of the same-sex couples. Being a part of such a team which works on this, the doctor knows the demand from the transgender and the LGBT communities. Same-sex couples, whether there are two men or two women, come with a demand of a child. Two-men couple require a surrogate mother, two-women couple don’t require a surrogate mother if either of them is healthy. But we have to include them if we have to do justice. We just passed the Transgender Welfare Bill 2-3 days back. So, if we have to do justice to a transgender couple or a same-sex couple, then their mention has to be in this Bill. So we have to consider these points seriously. The drafting was hasty, we need another Bill.
It is also a matter of great concern and despair Madam, that we leave the treatment of infertile couples mostly to the hands of private clinics. Not many government hospitals have the set-up to carry out in vitro fertilisation and embryo transfer. To my understanding All India Institute of Medical Sciences (AIIMS) has a unit but that is not sufficient for the whole of the country. So, training should be given through people who have worked on this for more than 30 years now and then the doctors can be appointed and super-specialised embryo labs set up in the medical colleges and government hospitals to mete out these treatments for infertile couples who cannot afford expensive treatment. Each injection for stimulation of ovaries varies between 1000 to 3000 rupees. So the government has to step in (and stand) by the side of these couples to help them and also to keep these unscrupulous private clinics at bay from exploiting these couples.
And the Government should have some extra fund – a separate fund should be created for infertile couples. There might be couples where the woman has no uterus from birth. There might be couples where the woman has no external genitalia from birth, there is internal genitalia from birth. There is a disease called Mayer-Rokitansky-Küster-Hauser Syndrome where the woman has nothing.
It is useless for five years to wait for that treatment. The patient is ageing every day, and as her age increases, her reserve of cohort of follicles waiting to grow every cycle is reducing. So we have to have a provision for such women who have no uterus, where we are giving them medical surrogacy. The most important cause for medical surrogacy is a woman who has no uterus, who has no reproductive organ. Her mention should be here.
Also we must vehemently stop fashion surrogacy that is taking place in our country, not only commercial surrogacy in which the surrogate mother is being exploited. I don’t want to take names, but there are film stars and relatives of film stars who are using surrogate mothers only because they don’t want their figure to be destroyed. This type of fashion surrogacy must stop in this country.
We must only do medical surrogacy by which we must stand by these women who are suffering, and till today our society looks down upon women who don’t bear children. They are used to hearing in the morning; we don’t want to look at your face because you are infertile, and so my day will be bad. But it’s a disease. She’s not bad, she’s not trying to harm anybody, it is only that she has not been given the power to procreate. And when medical treatment is available why shouldn’t we stand by her?
We also have to compensate. I understand that we don’t support commercial surrogacy. But our own children, Indians living abroad, NRIs not being able to conceive children abroad should be included here. So we have not only Indian couples living in India but Indian couples living abroad and NRIs should be included in this so that we can give them the facility.
The Medical Council Act of 1956 has defines embryologist but we must have to change the definition because today’s embryologist is much different from what it was in 1956.
Another thing: an oocyte earlier meant a naturally ovulating oocyte but today an oocyte does not mean a naturally ovulating oocyte. In today’s science, a woman is given injections of follicular stimulating hormones to get multiple eggs. Those eggs are retrieved either by ultrasound or by laparoscopy and as a result, we might get 18 to 20 oocytes from a lady, and we might freeze them, and we might make babies from them. Those are also oocytes. So that is another mistake here.
When both the members of a couple are suffering from infertility then the altruistic purpose is applicable. We also have to keep in mind the LGBT community. We must have a public debate before we pass this Bill. Thank you, Madam.