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Cover Story

The new Indian family


With infertility growing at an alarming rate, artificial reproductive techniques (ART) have now become the proverbial stork that brings into many Indian homes a couple's 'own' baby that promises to keep intact notions of family ties and kinship. Pegged at a whopping Rs 25, 000 crore market annually, ART promises what adoption can't - at least one parent's genes. The idea of an inheritor. One's 'own'. Not just in India, societies across the world prioritise 'genetic substance' over any other links, such as adoption, to create parent-child bondages.

Yet, there's a hierarchy of preferences within these solutions, health and scientific considerations aside. Among all ART techniques, surrogacy remains the most closely-guarded secret. While IVF and other simple forms of ART procedures may not be held close to one's chest, the idea of surrogacy - admittedly a small segment of ART - is by and large kept from family and friends.

It took an Aamir Khan, head and shoulders above many, and wife Kiran Rao, to announce the arrival of their son through surrogacy, quietly making it public and, in part, paving the way for its social legitimacy. This was courageous - how many parents announce that their baby was born to a surrogate?

The manner in which the media reported the arrival of a baby boy for Aamir and Kiran is worth noting. A news report said, "Trust Amir Khan to always do things - correctly. The actor and his wife Kiran who recently delivered a baby boy (sic) through surrogate parenthood have named the boy...Azad Rao Khan. "

The phrasing in that sentence is interesting because it reflects a deep-seated understanding of childbirth and parenthood. The primary statement is that the actor and his wife Kiran delivered a baby boy. The surrogacy is only an additional piece of information.

In India, with few exceptions, all surrogate babies are a closely guarded secret and kept both from close family and a larger circle of kin. Only very close friends may know about it. Why the hush? Kinship ties intertwine with family, caste, ethnicity, among a host of other factors. Field studies have shown how particular a couple can be when choosing a surrogate: with precise requirements for even the 'looks' of the surrogate. Making a surrogate birth public can overturn the family's finely balanced sense of societal mores.

The restraint on making surrogacy details public stems not only from concerns of privacy. If an anonymous donor sperm or ovum is used, this too is hidden. There are many reasons for this. The infertility stigma is better managed this way - you only have to publicly, if somewhat suddenly, announce parenthood.

Shrouding the alien-kin and gene link is top priority. Shared parental, especially the father's, genetic substance, is critical to trace descent and lineage. Not letting the secret out keeps critical inheritance matters secure.

This is also where the role of blood comes in. Notions of purity, traditionally linked with family blood, are transformed to the sperm and ova in the case of ARTs. Blood is only the nurturing medium, as it were, in surrogacy. Even if the sperm or the ovum is the donor's, the fact is veiled and none but the parents need to know.

A surrogate, available as a commercial service in India, could carry an embryo implanted into her uterus to get a baby at the end of nine months. Unusual cases of grandmothers carrying an embryo for a daughter/ daughter-in-law with a son's or son-in-law's sperm hit the headlines but there's little awkwardness since the nurturing blood is from within the family. In contrast, in commercial surrogacy, the genetic substance matters more than the blood that nurtures the baby in-utero. It also suits the surrogate to keep the secret to overcome any apprehension of adultery within her social circle.

There was a time, not very long ago, when a couple's inability to have a child was treated as a social and religious curse. Women have borne the brunt of this to the extent of having to tolerate a co-wife whose role was to produce children for her husband.

The curse was more acute for the man whose reproductive failure (misconstrued as impotence ) was visible in social circles. Adoption was traditionally resorted to in the event of total reproductive failure but it is not easy option for most couples.

The need to propagate is not the only reason for Indian couples trying all means within their reach to have their own biological children. Bonds among kin are filial, fraternal and marital - the term for this being 'affinal'. The affinal tie between spouses, meaning association by marriage, is mostly not genetic. What then cements the marital bond between spouses is the genetic link brought about through the birth of children.

The desperation to have children is also driven by the need to strengthen the bond among affinal relatives. Childbirth is thus keenly awaited by families of both spouses, bringing about a unique genetic sharing between families linked by marriage. Family in India is the mainstay for its members. While it is universally critical for growing babies and children the world over, it is the sole institution that provides anchor in India life-long, more so since we don't live in a 'welfare state'.

Children are a social and cultural insurance. Parents may not be economically dependent on their wards, but for many of the middle and upper middle class, who are the main users of ARTs, children are a source of support and well-being.

Although in practice joint living/residence may no longer be a widespread reality, the ideal of the 'joint family' is a value to cling to. The very fact that children are 'there' is reassurance in itself. Contrast this to the sense of helplessness among elderly childless couples, economic considerations apart. The support of far-away children is notional but deep. And these children should ideally have the genetic substance of the parent(s).

ART has brought about two major changes in the thought and practices of reproduction. One, it has recognised rising infertility in the population in general. Two, it has made male infertility a public health issue. Depleting sperm counts are a reality, and life-style changes can trigger a host of complications leading to infertility. ARTs have succeeded in ensuring that the couple and not the woman alone is the patient for ART centres.

We need to bear in mind there are few ART services in India's public health institutions. Given the anti-natalist policies of the state and, of late, the target of population stabilisation, the rapidly rising demand for ARTs is met through the private health sector. Procreation is also not viewed favourably in most health insurance policies in India except Caesarean sections and hysterectomies. Again it is family resources that could steer the formation of new and unconventional ART-generated families which already exist in the West - lesbian, gay and transgender for example.

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