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Surrogate Mother Industry Carries On After Nepal QuakeÂ

Despite the devastation, growing demand among foreign couples continues to feed medical tourism in Nepal, where surrogacy agencies recruit women to carry babies for infertile couples.

A woman carrying her baby through the debris of Kathmandu on May 16
A woman carrying her baby through the debris of Kathmandu on May 16
Caroline Michel

KATHMANDU — The day after the devastating earthquake that killed nearly 9,000 people in Nepal, a young dad was feeding a newborn baby in the middle of the night on the tarmac of Kathmandu's airport. Behind him was the aircraft that the Israeli government hurriedly sent to retrieve its citizens. At the same time, thousands of people were stuck in traffic jams as Nepal's tourists rushed to the airport, trying to flee the country as quickly as possible.

Israeli authorities made it their priority to retrieve the 25 babies born of Nepalese surrogate mothers and their families. The photos of these infants and their parents landing in Tel Aviv on April 27 with radiant smiles on their faces were seen around the world.

In Nepal, nobody even knew that surrogate mothers were giving birth to babies for other families to raise. The subject is a taboo topic, a well-kept secret. There isn't even a word in Nepalese for "surrogate mother." The only article about that topic in the local press came out in January of this year in the Nepali Times and included infographics and animations to explain how in vitro fertilization works.

The article tells the story of a 27-year-old Indian whose husband left after their first baby was born. She returned to her parents' home and took care of her baby there. "We were so poor there was no money to even feed my baby," she told the reporters.

Her mother suggested that she could make money renting her womb. In the slums of Mumbai, middlemen working for surrogacy clinics are legion. They earn $1,000 per birth. The Indian woman was transferred to Nepal and sheltered in a guesthouse paid for by a local clinic. She kept a picture of the child even though the middlemen warned her not to get attached to her baby. "Sometimes when I'm alone, I look at the baby's picture," she said.

An underground business

There are at least 100, probably more, women in this situation in Kathmandu alone, women whose names and faces are unknown. They hide inside guarded buildings. They're provided with room and board, get paid, have access to television, the Internet, English and computer lessons. The companies that recruit them describe it as "the good life."

But the reality is that these women are cloistered. In March, police raided a little hotel in Thamel, Kathmandu's tourist neighborhood, where a few of these women were living. People were gossiping. Rumor had it they were giving birth to blue-eyed, white-skinned babies.

Assuming there was some sort of shameful business with Western men going on, neighbors called the police, who were at a loss to understand that the mothers had not had sex with the fathers and that, more often than not, they hadn't even seen them. The agencies then moved the women to a quieter part of town, away from the city center.

About 10 such companies have started working in Kathmandu over the past year. Some are multinational companies with branches in South Africa, Mexico, Greece, Poland, Cambodia and China.

India created opportunity

Nepal is one of Asia's poorest countries. There are no highways, little infrastructure, no health system. Surrogacy agencies would probably never have thought to establish themselves there if India hadn't banned them from working for same-sex couples and single people. They made do with Nepal, which has become the new promised land for gays and lesbians.

Nepalese agencies lure clients on the Internet with rates that are about a fourth of the prices in the United States. The packages cost between $35,000 and $65,000. The mothers earn between $5,000 and $6,000 of that, the price of a house in that part of Asia. The rest goes into the pockets of doctors and agencies.

In 2014, an Australian couple sparked worldwide outrage when they refused to take a baby they had ordered, who was born in Thailand with Down's syndrome. Since then, agencies have tried to keep a low profile. "We don't give any interviews," says Ranbeer Singh, head of the Kiran Infertility Center in Kathmandu. But she agreed to offer a few details by email about their work after the earthquake.

"We had two births in early May, twins for an American couple and twins for an Australian couple," she writes. Brian Yaden, co-founder of the Family Surrogacy association, also wants to appear reassuring. "All our staff and surrogate mothers are doing fine," he says. "Our activities haven't been affected by the earthquake. We're doing business as usual."

Often, agency telephone numbers listed on their websites are from India or the U.S. Not a single agency agreed to let us into their "guesthouses" for surrogate mothers.

At one point, Medical Tourism Nepal opened an office for the public on the second floor of a small mall. "They closed it down the day after the earthquake," a security guard explains.

Early this year, an in vitro fertilization center opened at Grande Hospital, a modern building just outside the city. There's no equivalent in the whole country to match its 14 stories and rooftop helicopter runway. And yet, it's half empty. Health care there is too expensive for most of Kathmandu's residents. A C-section costs 80,000 Nepalese rupees ($780), roughly nine times the average monthly wage.

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Nepal's Grande Hospital — Photo:Â Fundación Garcia Cugat

Some nurses have seen a "Dr. Rita" bring in patients who gave birth to white babies. Hospital chief Dr. Chakra Raj Pandey welcomes us into his ground-floor office, where the salmon walls have deep cracks that he says are merely cosmetic.

In January, he signed a partnership with Dr. Rita Bakshi, an in vitro fertilization expert who heads a surrogate mothers' clinic in New Delhi. Pandey swears he has no connection whatsoever to that part of her work. "We're benefiting from Dr. Bakshi's expertise in in vitro fertilization," he says. "But that's all I know. When women come to give birth, we don't ask them who the father is."

Before we leave the hospital, a senior manager who witnessed the interview anonymously tells us that "our investors are the ones pressuring us for surrogate mothers," because the hospital cost $40 million to build and they want to earn money.

Defending surrogacy

One of Grande Hospital's biggest investors is a businessman named Roop Jyoti, one of Nepal's richest men. His grandfather started out by importing Honda and Philips products. Jyoti's business empire now includes steel, pure oxygen and fabric factories. The Jyoti Group's headquarters is situated just next to the Grande City Clinic, a private establishment in the city center that many surrogacy agencies use.

This clinic is officially headed by Sahil Gupta, a young Nepalese whose online bio says he quit his job at a New York bank in 2011 to try his hand in the womb-rental business. He didn't respond to our inquiries, but we soon discovered that Roop Jyoti, whose name appears nowhere, is the owner of Grande City Clinic. And its real boss.

"I built this clinic to give my country a world-class hospital," Jyoti explains, sitting in his conference room. "Nepalese, including members of my family, go to India or Thailand to get treated. I've spent close to $2 million to bring the best equipment from the U.S., Europe and Japan. We have five private rooms, an infant care unit with six cradles and a specific unit for premature babies. The whole conception was supervised by Bangkok's great Samitivej Hospital."

Jyoti brags about the clinic as he offers a tour. The wooden floors are golden, the marble grey. The atmosphere is calm and serene. The noise of traffic jams is shut out by the windows' double-glazing. The dust from the city doesn't penetrate here.

The businessman can barely hide his enthusiasm for surrogate motherhood. "It's a terrible thing not to have children," he says. "When you adopt, the child doesn't look like you. With surrogate mothers, the child has your blood. The parents are so happy." After the humanist speech comes the business reality.

"Surrogate mothers can help develop our medical tourism," he continues. "It's good for our economy and our health care system. Agencies have brought us a know-how that it would have taken us years to acquire. Now it's up to the government to decide whether they want surrogate motherhood to develop."

There's no legislation in Nepal regarding surrogacy. It's neither forbidden nor legal. For now, the government has been tolerating it, on the condition that both adoptive couples and surrogate mothers are foreign. They are recruited by middlemen, or "sellers," in Indian slums, in Bangladesh or on the border between India and Nepal.

The Nepalese call them "Indians"Â because of their dark skin, but they speak Nepalese. Candidates must then pass a medical review.

Surrogate mothers are given a monthly stipend, most of which is put aside to pay for a house or their children's studies. The majority of their the payment comes after they give birth.

They must sign a 10-page contract written in English, which many aren't able to read and which lists the requirements of their surrogacy: no tattoos, no sports, no smoking, no alcohol, no drugs, no X-rays and no physical therapy. Finally, they must abandon all claim to the babies they're expecting.

Public opinion says "no"

"In our culture, women can't have children outside of marriage,"Â says Krishna Gautam, head of the women and children's protection unit at the Nepalese national police. "To carry a baby for another couple is similar to human trafficking,"Â he says.

The police opposition to surrogacy reflects public opinion. Women have no rights in this patriarchal society.

Faced with these opposing pressures, the government is trying to play for time. "Nothing's been decided concerning surrogacy," says a Ministry of Health spokesman. "We're thinking about creating a committee, but everything's been postponed due to the earthquake."

On its website, the American Embassy published instructions for its citizens. Adoptive parents should make sure that the doctor doesn't write the biological mother's name on the child's birth certificate. Couples should also use DNA test kits to prove their blood relationships to the babies.

It doesn't work every time, though. In January 2014, a Nepalese court ruled that the adoptive parents and a surrogate mother who wanted to keep the daughter she delivered had "equal rights."

Still, demand from foreign couples continues to rise. "I've lost count of how many requests I get every month," says 23-year-old Preeti Bista, who heads New Life's Nepalese branch. "About 50, maybe? They come from all over the world: United States, Australia, Britain, Ireland, Sweden, Japan, Taiwan." She has an American education, speaks perfect English and has big ambitions. Her mother is a women's rights advocate.

"When I told her about New Life, my mother reacted badly," she recalls. "I managed to convince her that we were making people happy and that it was good for women here. They earn 10 times more money by renting out their wombs than with a housemaid job."

She has recruited six surrogate mothers from Bangladesh. The earthquake left them terrorized, but sending them back home isn't an option. They must stay in Nepal until the birth. Bista is convinced she embodies modernity for Nepal, like an open door to the Western world.

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