If you could pick one place where you could find dramatic effects of medical technology taking on Frankenstein-like ramifications, India would definitely jostle for first place. Here, the gap between the haves and have nots just seems to be widening, as the country and a small part of its privileged population gallops ahead in this global race.

Medical tourism was a happy phrase: even in the troubled history between the ever-warring neighbours (India and Pakistan), one heard humanist stories of surgeries on little Pakistani babies in Indian hospitals to save their lives. Now, medical tourism has swung rather drastically to a plaguish scenario of women from underprivileged backgrounds ready to carry through a pregnancy for women from the west for a variety of reasons. At nearly one-fifth the price of what a surrogate would charge in the home country in the West, the bargain is a clincher here. According to estimates – which might be conservative – the business of surrogacy in India is already touching $445-million-a-year.

That only child-bearing and child-rearing are acknowledged as a woman’s primary duties especially in conservative cultures only helps to justify the situation. But in its own twisted way surrogacy restricts even that to simply child-bearing (and not the latter) since the paying parents are to be the rearers of the child, in accordance with earlier Indian law. Often in situations of a divorce the father as the provider would automatically earn custody of the child (most often a boy) since the mother had no known means of looking after the child. From stories of surrogacy in hushed tones a few decades ago we now have clinics that openly negotiate the business for both sides flourishing in and around the poverty-stricken areas of the country today. Women who have faced several pregnancies think nothing of another one when they stand to earn multiple times what the family would have otherwise earned in a year. Earnings that stand to turn the fortunes of the entire family around.

There are abundant reasons to claim this situation as a win-win for both sides. During the paid pregnancy women are cared for medically in a manner they would not have otherwise experienced. Doctors at many of these clinics claim to house these women to be able to monitor them constantly and ensure medical care (more so because the paying client at the other end is far more crucial than the actual pregnant woman). And that the service has been satisfactory is apparent from the fact that past clients have come back for a sibling for the earlier child.

Besides, those negotiating for the surrogate mother claim to ensure that each surrogate woman retains actual control over her money and can use it as and how she pleases. But many who understand the position of women in rural societal set-ups such as India’s also recognize the reality behind these claims. How can one fully protect a poor, uneducated woman who has spent her life in a patriarchal set-up, fed on those patriarchal beliefs even when laws have failed to give her any relief? What stops the middle men here (clinics/doctors) from exploiting her, let alone her own family?

Added to this, in traditional rural, largely uneducated societies where people understand little about medical technology surrogacy comes with its own set of moral complications. For many there is no comprehension of conception without sex, which places the surrogate in a twilight zone of legality and immorality. Hence, many families during the course of the surrogacy actually have to abandon their communities to keep the situation under wraps. With little regulation by the Indian Medical Council (the body to administer such practices) and amidst all these socio-legal complications, some of the doctors assisting surrogacy have come up with their own ethical positions. While they accept clients only with a ‘genuine’ need – the genuine need being an established infertility problem – they are unwilling to help gays and lesbians. With the growth in this particular aspect of medical tourism it is time to put in place laws that ensure protection to the women in the midst of the trade.

The women renting their womb are in it for their own set of reasons. One woman became a surrogate to pay for her daughters’ dowries. How do you accept and legitimize something like that when dowry is illegal, yet still one of the core widely-used and socially-sanctioned tools of exploitation of women and their families? At the other end of the spectrum is the desperation of another woman to cover the medical expenses of an ailing child. Many of these women have spent endless years in low-paying, back-breaking, physically and economically exploitative and hazardous work conditions. Not surprising then that that for them pregnancy seemed a less exploitative option.

Debates on the issue are bound to be endless. But who is to decide which exploitation is lesser and more acceptable? A woman renting her womb or working low-paying jobs in inhuman conditions? Perhaps neither as both are accompanied with their own set of complications. The debate will rage in every direction: from the right of a woman over her own body to the extent that medical technologies can be used with disastrous consequences as has been the case with the imbalance in sex ratios in the region. Ultimately it is poverty which is at the root of it all; that determines the tools that people use both for exploitation and to contend with exploitation. And yet, the poignant truth is that the care that these women are promised and get during the course of the surrogate pregnancy is what would have been denied to them not just during their personal pregnancies but even in their paternal and marital homes on a daily basis. And that really is at the heart of the issue. How women are viewed in the personal spheres they inhabit, the social spheres they occupy, the professional spheres they toil in?