Death by sterilisation in India: Chhattisgarh is just one horror
Krittivas Mukherjee, Hindustan Times New Delhi
The death of 13 women at a state-run sterilisation camp in Chhattisgarh underlines flagrant violation of rules on implementing population stabilising campaigns as well as inadequate monitoring of such projects by health authorities across the country. A woman (R), who underwent a botched sterilisation surgery at a government mass sterilisation 'camp', is moved to Chhattisgarh Institute of Medical Sciences hospital from a district hospital in Bilaspur, Chhattisgarh. (Reuters)
Although the coercive campaign spearheaded by Sanjay Gandhi in the 1970s has been replaced with a voluntary policy that promotes education of women and healthcare rather than demographic control, the Indian sterilisation programme remains deeply flawed, experts say.
For instance, the surgeries in Chhattisgarh were conducted in violation of a 2005 Supreme Court ruling that said a medical team could conduct only up to 30 surgeries a day with two separate laparoscopes. And, a doctor could do no more than 10 sterilisations a day.
But in Chhattisgarh, a lone surgeon performed 83 operations in less than 5 hours, showing that these operations were not done under standard protocols.
Official guidelines also say that all sterilisation camps must be organised in government facilities. The Chhattisgarh camp was organised in a private charitable hospital which had been closed for a year now. Media reports said rusty scalpels and tools were used and some of the medicines administered could have been spurious.
“The systemic failures which led to this incident need to be addressed,” said a joint statement of health workers and women’s groups said on Wednesday.
“The ‘camp method’ of sterilisation needs to be stopped with immediate effect as quality of care is seriously compromised in mass sterilisation programmes that are meeting earmarked targets.”
Sterilisation is the most popular form of birth control in India. Encouraged by cash incentives, about 4 million people a year undergo surgery. Almost all are women.
Experts say last week’s deadly incident is also a result of the pressure to meet the government’s sterilisation targets. In 2012, India committed to providing 48 million additional women and girls with access to contraceptives by 2020. However, in India about one in 5 women of reproductive age do not have access to modern method of contraception such as condoms and pills.
Chances are that India’s promises at the 2012 Family Planning Global Summit in London will reinforce the pressures of meeting ‘targets’, which has dangerous and long-term implications for the health of the people.
Many states such as Uttar Pradesh, Bihar and Rajasthan are accused of setting unofficial sterilisation targets, violating the target-free population policy of 2000.
The overt emphasis placed on sterilising women is also out of step with best practices because male sterilisation such as vasectomy involves comparatively lesser health risks. ~~~~~~~~~~~~~~~~~ Wednesday November 12, 2014
Sterilisation horror reveals India's mothers risk lives for $11
By Bibhudatta Pradhan
Life-threatening procedure: Sixty-eight women who were sterilised have been hospitalised. (AP)
Delhi: Soni Jangde felt good when she returned home after getting sterilised in central India four days ago. She had 600 rupees ($11) in her hand and a belief that she was doing the right thing for her young family.
A few hours later, the 23-year-old mother of three got a headache, followed by abdominal pains and vomiting. She assumed it was a normal side effect until Chhattisgarh state health officials showed up in her village and rushed her to the hospital. Of the 82 women sterilised with her, 11 have died. Sixty-eight women have been hospitalised.
"We are completely afraid," Ms Jangde said from her hospital room, where her six-month-old baby and husband waited by her bed. "With this kind of treatment the government is playing with the lives of women and poor people like us."
Tears: Relatives mourn for women who died after undergoing sterilisation surgery. (AP)
The tragedy is one of the worst in recent memory from the one-day sterilisation drives India regularly holds to keep its 1.2 billion population from growing too fast. Married women are the most at risk. While more than a third of them are sterilised, only 1 per cent of men have had a vasectomy, a 2006 National Family Health Survey shows.
The United Nations forecasts that India will surpass China as the world's most populous country in about 30 years.
In 2007, India increased incentives for women to undergo sterilisation, and focused efforts on Chhattisgarh and other underdeveloped states.
India has the world's third-highest female sterilisation rate after the Dominican Republic and Puerto Rico, among more than 180 countries tracked by the UN.
Most of the women sterilised on November 8 were under 30. The sound of crying babies filled the hospital in Bilaspur district this week as anxious relatives stood by.
Ms Jangde and her husband take home the equivalent of $3 a day working on a farm. They have three children and can't afford to have any more. So when a village health worker told her about the sterilisation drive, she jumped at the opportunity.
On the afternoon of November 8, Ms Jangde arrived at the clinic in Bilaspur district. Five medical staff were present: the doctor, two nurses and two other staff members.
They took her blood pressure and then she gave urine and blood samples. The operation room was neat and tidy with two beds. The procedure went smoothly and was over in 10 minutes.
"I don't know what went wrong," she said.
Chhattisgarh's chief minister, Raman Singh, pinned the blame on the surgeon, R. K. Gupta. He had been suspended and was facing a criminal investigation.
Dr Gupta used infected instruments to sterilise 83 women in about six hours, said a local medical official who asked not to be named.
Dr Gupta also breached guidelines that limited surgeons from performing more than 30 sterilisations a day, the official said.
However, Dr Gupta denied any culpability, saying the women were well when they left the hospital.
"They went back to their villages and went to the village quacks who gave them antibiotics," he said.
The vomiting and abdominal pain, he said, "are all a reaction to these medicines".
Dr Gupta confirmed having performed 83 surgical sterilisations in six hours with two assistants.
He said he had performed 50,000 sterilisations, both in private and government hospitals.
Conducting the surgery safely was time-consuming, since it took 25 to 30 minutes to sterilise and prepare the laparoscope used in the operation, said Raman Kataria, a doctor with Jan Swasthya Sahyog, a non-governmental organisation that carries out sterilisations in the Bilaspur district.
Under those constraints, he said, it would be unsafe to try to conduct more than two, or possibly three, per hour. "This incident is a reflection of a very bad, poor system, of a non-existent and non-accountable public health system, where such tragedies are waiting to happen," Dr Kataria said. He said there were regularly reports of one or two deaths after health fairs, as the events are also called, but this was the worst incident he could remember.
India has a tumultuous history with sterilisation, dating to the 1970s, when a ruthless coercive campaign was carried out under Indira Gandhi.
Though the country recoiled at those measures, in recent years many state-level policymakers favoured a tough approach to population control and began introducing incentives – often financial – to discourage families from having more than two children.
Ms Jangde said she was sorry she ever listened to government messages promoting sterilisation.
"I'll never encourage my relatives to do family planning," she said. "If they do, I'll stand in the way." Bloomberg, New York Times ~~~~~~~~~ UK ~ Thursday 13 November 2014
India mass sterilisation: Doctor arrested over botched operations after 15 die and 90 others are hospitalised
Police say Dr RK Gupta carried out surgeries in a 'filthy' disused hospital and cleaned scalpels between patients by 'dipping them in spirits'
By Heather Saul
A nurse tends to a woman, who underwent a sterilization surgery at a government mass sterilisation "camp", (Reuters)
A doctor who conducted the botched mass sterilisation of 130 women at government-run camps has been arrested after 15 died and 16 patients continue to fight for their lives in hospital.
Dr RK Gupta carried out tubectomy operations at two of the camps Indian state of Chhattisgarh, which offered free sterilisation surgery as part of a Government programme to curb the country’s population growth.
India’s population is among the fastest growing in the world and the country is expected to overtake China as the most populous by 2050.
The BBC reports Dr Gupta operated on 83 women within a five-hour period at one of the camps - a breach of government protocol which prohibits surgeons from performing more than 30 in a day.
The women were operated on in a room of an unused private hospital in a village called Pandari, according to the Reuters news agency.
Police said the operating theatre was filthy, dusty, hung with cobwebs and bloodied sheets were not changed between patients because of the high turnover.
The women were sent home after, but dozens became unwell hours later and were rushed to hospitals in Bilaspur. More than 90 remain in hospital.
Dr Gupta, who was arrested on Wednesday, denied reports that his equipment was rusty or dirty and said it was the government's duty to control the number of people that turned up at the state-run family-planning "camp".
Women, who underwent a sterilization surgery at a government mass sterilisation "camp", lie in hospital beds for treatment
The BBC said Dr Gupta had one assistant during surgery, but Dr Gupta told Reuters he had two.
He said he wore gloves and a gown during the operations and he took between two and five minutes on each operation, giving his assistants time to clean scalpels.
"They are dipped in spirit after an operation and then reused. If I feel it is not working well I change it. I do about 10 operations with the same knife. Towel clips are also reused after being dipped in spirit," he said.
Dr Gupta said health workers gave the women ciprofloxacin, a commonly prescribed antibiotic, and ibuprofen, a pain killer, after the operations.
He faces charges of causing death by negligence.
The government of Chhattisgarh, one of India's poorest states, banned five batches of drugs and a batch of surgical cotton wool on Wednesday pending further investigations.
The banned medicines include Indian-made brands of ciprofloxacin and ibuprofen and were used in Dr Gupta's sterilisation camp, a government statement said.
Additional reporting by Reuters ~~~~~~~~~~~~ - India ~ Wednesday November 12, 2014
Chhattisgarh Sterilization Deaths: Better Financial Incentives, Promised Centre's Letter Just Weeks Ago
Reported by Um-E-Kulsoom Shariff, Edited by Deepshikha Ghosh
Women who underwent sterilization surgeries receive treatment at the CIMS hospital (Press Trust of India)
New Delhi: Three weeks before the deaths in Chhattisgarh after mass sterilization surgeries believed to be driven by targets, the central government had, in a letter, said that compensation would be doubled for men and women who agree to these surgeries.
NDTV has accessed the health ministry's letter on October 20 to 11 "high focus states" including Chhattisgarh, which begins by stressing on the "importance of performance in sterilization" and says that financial incentives will be increased in step with the rising cost of living.
The Centre said that men who go for sterilization surgery under the government's family planning programme will be given Rs. 2,000 instead of Rs. 1,100. For women, the amount would be hiked from Rs. 600 to Rs. 1,400.
Eleven women have died and many more are in hospitals after botched sterilization surgeries at a free state-run camp in Bilaspur on Saturday. Such camps are routinely held as part of India's attempts to control its billion-plus population.
An FIR or police complaint has been filed against the doctor, RK Gupta, who allegedly operated on 83 women in five hours that day with the help of one assistant at an abandoned hospital that has not treated any patients since April.
Two health officials suspended for fatal negligence have gone on record to say that they had targets to meet. "In April to March there are annual targets, this was done according to that," said RK Bhamge. Block Medical Officer Pramod Tiwari admitted, "The daily target of a team is 40 sterilizations, but the number of operations held on Saturday was double that figure."
The Centre's letter lists a chain of beneficiaries who are given incentives to join the sterilization drives. Besides the people who agree to the surgeries, the government pays the "motivator" Rs. 150 a person, the surgeon Rs. 75 and a nurse Rs. 15.
To many critics, including medical experts and politicians, the sterilization surgery exemplifies an inhuman programme that relies on targets, inducement and coercion.
Rich man, poor woman: the gender wealth gap widens
By Matt Wade/Senior writer
For years women have been banging up against the glass ceiling, but new figures reveal another problem – Australia's gender wealth gap has widened sharply over the past decade leaving single young women with a little over half the average assets of their male counterparts.
The disparity in average wealth between single men and single women across all age groups grew from $18,300 to $47,000 between 2002 and 2010, research has found.
Illustration: Matt Golding.
The findings mean that both the gender wealth gap and the gender pay gap have been rising in recent years. The earnings advantage for an average full-time male worker over an average full-time woman reached 18.2 per cent in August, the biggest difference since 1994. The growing gender disparity in both pay and wealth comes despite a long-term rise in female workforce participation and strong growth in the proportion of women with tertiary qualifications.
The Curtin University economists who conducted the study – Siobhan Austen, Rachel Ong, Sherry Bawa and Therese Jefferson said the main driver of the widening gender wealth gap was growth in the value of housing assets owned by single men. Also, the debt held by single men recorded more modest growth which helped boost their their net wealth.
"All our theories, and common sense, say that education is an important route to higher earnings and higher economic opportunity," said associate professor Siobhan Austen, a co-author of the wealth study. "And yet, despite young women now outnumbering young men in our universities quite substantially, we are not seeing a dramatic shift in the gender pay gap or the gender wealth gap. Indeed, they have trended upwards in the last decade."
By far the biggest disparity in wealth was between younger men and women – a typical single man aged under-35 had assets worth $120,200 in 2010 which was $56,700 – or 89 per cent – more than the average for women in the same age cohort. That's up from a wealth gap in that age group of $9,000, or 16 per cent, in 2002. The gender wealth gap among mid-age singles (35-55 years) jumped from 4 per cent to 28 per cent between 2002 and 2010 although the disparity among older single households over 55 narrowed from 16 per cent to 2.5 per cent.
Associate professor Austen said a growing gender wealth gap had major implications for the standard of living that men and women can expect in retirement.
"The data suggests we are going to see substantial gender wealth inequalities in old age," she said. "There are already a lot more women than men dependent on the age pension, for instance."
Helen Conway, director of the federal government's Workplace Gender Equality Agency said it was concerning to see increasing gender inequalities in both the gender pay gap and the distribution of wealth.
"Women are likely to live longer than men and be more reliant on government benefits in retirement, so the fact that this group is financially disadvantaged over the life-course has serious economic and social implications," she said.
To calculate the gender wealth gap the researchers compared the net wealth of single male households and single female households using the highly respected Household, Income and Labour Dynamics in Australia Survey. Widows and widowers were excluded, because their wealth was likely to reflect a couple's accumulated assets over time.
"The thing that really stood out in the data over that decade was that the primary housing assets of single male households increased much more rapidly than the housing assets of single women," associate professor Austen said.
More single female headed households have children than single male headed households and this might have constrained women's participation in the property market and the types of housing they can purchase.
"Women's housing investments may not have had as much potential for high price growth as men's," Austen said.
The superannuation balances of single women across the age groups grew more quickly than men's between 2002 and 2010 but this was not nearly enough to offset the substantial growth in single men's housing assets.
Rosie Batty named Victorian of the Year: recognition for a mother who gives victims a voice
By Beau Donelly/Consumer Affairs Reporter for The Age
Rosie Batty at the announcement of the Victorian Australian of the Year awards. (Wayne Taylor)
Domestic violence campaigner Rosie Batty was named Victorian Australian of the Year at an awards ceremony on Tuesday night.
Ms Batty, whose 11-year-old son, Luke, was murdered by his father Greg Anderson at cricket practice in Tyabb in February, was recognised for her courage in speaking out against family violence.
She received a standing ovation when she was named as the Victorian of the Year.
Rosie Batty just after her award was announced. (Wayne Taylor)
"I can normally talk quite well but I'm speechless tonight," she said.
"Luke would be proud of me, but as a 12-year-old boy would be embarrassed. He'd say 'Mum, it's not a good look'.
"But I'm here because of Luke and I'm here because one on three women is affected by family violence. And one in four children.
Rosie Batty with Chief Justice Marilyn Warren. (Wayne Taylor)
"It's quite conflicting for me in this situation to be so recognised ... What has made it easier is every day I receive messages from people saying how much of a difference it makes to their lives with me talking and raising awareness.
"There's a long, long way to go before their journey is recorded, validated, supported. My journey is nothing unique. What made it unique is the worst happened."
She said domestic violence must not stay behind closed doors.
"I didn't want Luke to have died in vain and my quest was to do whatever I could," she said.
"My commitment is I will continue to push this message. I accept this award for all victims of violence who have no voice."
Ms Batty said she was not expecting to win. "I thought other people are more deserving. I guess it's so easy to see other peoples strengths and accolades before you see your own," she said.
"I was very overwhelmed ... in a way that I hadn't expected to be, and maybe in a way that I haven't been since Luke died. It is a real honour."
Of her son, Ms Batty said: "Luke liked to be the funny guy, known as a funny person, and he was. We had fun together."
"He had a lot of integrity and a lot of honesty, and he would have been a really good man."
In the hours following her son's death, Ms Batty made a heartfelt speech to the media detailing her 11-year battle as a victim of family violence.
"I want to tell everybody that family violence happens to everybody, no matter how nice your house is, how intelligent you are," she said at the time. "It happens to anyone and everyone."
Since then, Ms Batty has championed efforts to fight domestic violence, calling for an overhaul of the court system and criticising systemic failings and a "lack of leadership" in dealing with the problem.
Her actions have prompted speculation that she may also be considering entering politics, but she was non-committal on Tuesday night.
"I don't know what the future holds for me," she said.
"All I know is I don't have Luke anymore and I have to do something that gets me up in the morning and gives me a sense of purpose and direction. It could be politics, it may not be.
"I have to work out the most effective way of making a difference."
An inquest into Luke's death that is underway in Melbourne has heard there were four arrest warrants out for Anderson at the time of Luke's murder. Intervention orders were also in place against him.
The National Australia Day Council on Tuesday said Ms Batty had risen above personal tragedy to shine a spotlight on domestic violence.
"Rosie's story jolted Australia into recognising that family violence can happen to anyone and she has given voice to many thousands of victims of domestic violence who had until then remained unheard," the council said.
"Her incredible strength and selfless efforts are an inspiration to many other victims of domestic violence, while her courage and willingness to speak out will make Australia a far better and safer place."
Other Victorians honoured at the ceremony included neurologist Sam Berkovic, AC, who received the Victorian Senior Australian of the Year award for his research into epilepsy spanning 25 years.
Thomas King, 18, was named Victorian Young Australian of the Year for his work educating consumers about unsustainable palm oil and raising money for rainforest conservation.
Louise Davidson, who co-founded the Mother's Day Classic walk-run, received the Victorian Local Hero award for her work as a breast cancer fund-raiser.
Chief Justice Marilyn Warren paid tribute to the recipients.
"Each of the Victorian recipients have not only demonstrated excellence in their field but have significantly contributed to the benefit of our vibrant and dynamic community," she said.
Premier Denis Napthine said the finalists were symbolic of the many Victorians who made a difference in promoting social justice, equality, leadership and medical research across the state.
"They epitomise what we need in our society to make our society richer, stronger, better," he said.
"The stories of these finalists are stories of excellence, stories of great achievement. But most importantly they're stories of of individuals simply wanting to make a difference."
The Victorian award recipients will join recipients from across Australia as finalists for the national awards, which will be announced on January 25 in Canberra.
Taming the international commercial surrogacy industry
By Sally Howard, freelance journalist, London, UK
With no worldwide regulatory framework, south Asian countries are struggling to legislate to protect children born through “fertility tourism”and the surrogates who carry them.
The recent case of surrogate baby Gammy, rejected by his commissioning parents after being born with Down’s syndrome and a congenital heart defect, provoked censorious press coverage worldwide. “Surrogate mom vows to take care of abandoned twin,” ran the typical headline when the story broke in August. Outrage grew when it emerged that the father had 22 child sex convictions.1
But behind its sensationalised aspectsthe cold transaction of cherrypicking one healthy child from twins and the questionable background of the Australian fatherthe case was more legally and ethically nuanced than it might have seemed.
Gammy’s gestational mother, 21 year old Thai food vendor Pattaramon Chanbua, told news agency Agence France Presse that she had found out that one of the twins had a chromosomal disorder four months into the pregnancy.1 The commissioning parents, David and Wendy Farnell, told Australia’s Channel Nine television (60 Minutes, 9 August) that they had then urged Chanbua to selectively abort the abnormal fetus.
Abortion is illegal in Thailand, except in cases of rape or incest or endangerment to the mother’s life or mental or physical health.2 It is unclear whether abortion for a birth defect was stipulated in the surrogacy contract between Chanbua and the Farnells. However, Chanbua claimed that she refused to abort the child because it was against her Buddhist faith. She also complained that she has been promised $9300 (£5800; €7300) to carry the children but had not been paid in full.3
Gammy remained in Thailand under the care of Chanbua who, under Thai law, was considered the child’s mother. After the case gained media attention, pressure grew to repatriate the 7 month old to Australia, where he was also offered citizenship and where he would be entitled to free healthcare for his complicated birth conditions.
“A bodge job or worse” The family law barrister Barbara Connolly QC says that the labyrinthine tangles of family, immigration, and contract law exposed by Gammy’s case are typical of international commercial surrogacy.
“When it comes to commercial surrogacy our laws are a bodge job or worse,” she told The BMJ. “Unlike international child abduction and adoption, there are no international conventions and agreements in this area. Legal issues relating to parentage and immigration vary so widely that the process can result in dramatic outcomes, such as a child born via surrogacy who is both legally orphaned and stateless.”
The legal status of commercial surrogacy varies from country to country. In some countries, including Georgia, Ukraine, and South Africa, all surrogacy agreements are legal and enforceable. Other nations, such as the United States and Australia, regulate or criminalise commercial surrogacy with a patchwork of common law and case legislation that is enforced at state level. France, Italy, and Switzerland ban all forms of surrogacy and will not recognise children born through commercial surrogacy abroad as legal citizens. In the United Kingdom and Denmark altruistic surrogacy (when the mother can receive only reasonable expenses) is permitted but agreements are unenforceable and commercial surrogacy is banned. However, when couples have sought commercial surrogacy abroad, the courts may retrospectively sanction payments that have already been made in the interests of the child.
Asia legislates The call for a unified legal framework around commercial surrogacy is loudest in the “fertility tourism” destinations of the global south. In Thailand, where the commercial surrogacy industry is worth $125m according to the Thai Department of Health Service Support, the military government responded trenchantly to the baby Gammy case by approving a draft law to criminalise commercial surrogacy. If the law is approved by Thailand’s National Legislative Assembly in early 2015, it will criminalise both commercial surrogacy agencies and commissioning parents, allowing only altruistic surrogacy for infertile, married Thai nationals.
Reverberations are being felt most keenly in India, the world’s largest destination for fertility tourism. (The Indian commercial industry, legalised in 2002, was valued at $449m in 2006.) Last month the Indian government introduced into parliament the 2010 Assisted Reproductive Technologies Regulation (ART) Bill, which has been grinding on to the statute book since 2008.4 The bill, in its current draft, includes a chapter that considers oocyte donors, gestational surrogates, and surrogate born children in altruistic and commercial surrogacy agreements. When the bill is enacted, surrogacy agreements will become legally enforceable, and the age and background of surrogate mothers will be restricted. All foreign surrogacy arrangements will require the appointment of a local guardian who is legally responsible for the surrogate mother throughout the pregnancy as well as the resulting child if the commissioning parents fail to claim him or her.
Indian wombs for hire This law change comes after the Indian Ministry of Home Affairs issued new guidelines on surrogacy in January 2013. These included a visa requirement for foreign nationals commissioning surrogacy in India, with such visas being restricted to married couples from countries where surrogacy is legal.5 N B Sarojini, founder of the non-profit making Delhi based women’s health advocacy and research organisation Sama, thinks that these regulations have done little to curb what the Indian press has derisively referred to as the trade in “Indian wombs for hire.” Sarojini, who has lobbied for amendments to the ART bill, hopes that the new legislation will check the untrammelled commercialisation of India’s assisted reproduction industry but fears that the bill will be “hugely lacking” in its reach.
“The ART bill has been led by the ART industrythat is, by commercial clinics and gynaecologists, largely for the purpose of validating this lucrative business,” she says. “It fails to regulate big players in the industry, such as surrogacy agents. And it provides little support, or legal recourse, for the gestational surrogate. It seems the free trade mandate brushes aside all ethical questions.”
Sarojini argues that, although the new bill imposes restrictions on the number of embryo transfers a surrogate can accept for a commissioning couple (three) and the number of children a surrogate can bear (five, including her own children), the bill makes no provision for the health of the surrogate beyond the bounds of the nine month gestational contract. In a climate where the public healthcare sector is under-resourced, says Sarojini, such omissions are unethical.
An early draft of the bill said that the health risks to the surrogate mother were small. But Deepa Venkatachalam, who also works for Sama, says the organisation’s research shows that surrogacy “can have grave effects on women’s health. The surrogate is subjected to repeated hormonal injections in preparation for implantation, putting her at risk of ovarian hyperstimulation syndrome, and most surrogates undergo non-indicated caesarean sections to time the birth for the commissioning parents’ convenience.” Human trafficking Anil Malhotra, a lawyer based in the north Indian city Chandigarh, is also a critic of the upcoming legislation. At a conference on surrogacy organised by the Centre for Social Research, a New Delhi non-governmental organisation, in September he raised concerns that the bill fails to consider the background and credentials of commissioning parents, a problem that emerged in the baby Gammy case.
“As the bill stands, there is no requirement to verify the background of commissioning parents,” Malhotra told The BMJ. “At the minimum, the home study reports mandated under CARA [India’s Central Adoption Resource Authority] guidelines on inter-country adoptions should be applied, under the bill, to cross-border surrogacy arrangements.” 6
Malhotra also noted the absence of a clause pertaining to human trafficking for surrogacy. In 2009 the United Nations Development Programme warned that trafficking of women for commercial surrogacy would eventually develop.7 Just two years later, 13 Vietnamese women, seven of whom were pregnant, were rescued from a surrogate “baby breeding ring” in Bangkok.8
“You cannot just close your eyes and hope that baby breeding cartels won’t develop,” Malhotra said. “With such financial incentives involved, it’s a false hope.”
Malhotra argued that India is losing its opportunity to set a legislative standard for surrogate source nations: “To have any hope of keeping pace with socioeconomic conditions and technological advancements, we need a one-stop-shop piece of surrogacy legislation that covers both domestic and international surrogacy arrangements,” he said. “Scattered pieces of legislation won’t do.”
China’s ban China is one of the few Asian nations to have taken a firm stance on commercial surrogacy from the outset. In 1994, as gestational surrogacy was emerging, the Chinese government banned commercial surrogacy on the grounds of its implications for defining true parenthood. However, by the early 2000s an unregulated market was flourishing. In 2009 the Chinese government strengthened the criminal enforcement of the surrogacy ban, and reports emerged of surrogates having forced abortions.
Health and human rights campaigners say there is a pressing need for an international legal framework to regulate the commercial surrogacy industry. But such agreements will be a long time coming. The Hague Conference on Private International Law convened to consider international surrogacy arrangements in March 2012 and April 2014. It will reconvene in early 2015. To Connolly, the conferences’ preliminary reports make for sober reading.9 10
“The reports highlighted the huge problems in these cross border arrangements,” she said. “But they also pointed to the real obstacles in the way of reaching any kind of international consensus, let alone a convention, on the issue. As an indication of how long these conventions can take, Japan only signed up to the Hague Convention on International Adoption, which was drafted in 1993, earlier this year.”
Meanwhile there is pressure for affluent nations to legalise the commercial surrogacy market within their own borders. Connolly agrees that the argument is attractive. “But you have to be realistic about market forces,” she said.
“If you liberalise commercial surrogacy in the UK you won’t prevent UK nationals from seeking a cheaper surrogate abroad. For example, as India and Thailand impose restrictions there are signs that an unregulated commercial surrogacy industry is emerging in Mexico.”
For baby Gammy the future is bright. He will soon live with his surrogate mother in a new three bedroom apartment paid for with funds from the reported $AU240 000 (£130 000; €165 000; $210 000) donated to a charitable endowment established for his long term care.11 For the industry that brought Gammy into being, the future is less certain.
Modern surrogacy: the birth of an industry
In 1980, two years after the birth of the first baby conceived in vitro, Louise Brown, the US lawyer Noel Keane wrote the first legally binding surrogacy contract through his own infertility centre, a business that sought to connect couples to willing surrogates.
In 1986 Keane wrote the contract pertaining to Baby M, a controversial case in which surrogate Mary Beth Whitehead refused to cede custody of the resultant child, Melissa, to the couple with whom she made the surrogacy agreement. The case led many US states to ban commercial surrogacy arrangements.
In traditional surrogacy the egg of the surrogate mother and the sperm of either the intended father or a sperm donor are used. From the 1990s advances in in vitro and implantation methods enabled gestational surrogacy, in which the surrogate carries a child she is not genetically related to, created from eggs and sperm of the intended parents or donors.
The arrival of gestational surrogacy led to a boom in commercial surrogacy worldwide. The global industry is now estimated to be worth $6bn12
Footnotes Competing interests: I have read and understood BMJ policy on declaration of interests and have no interests to declare. Provenance and peer review: Commissioned; not externally peer reviewed.
The time has come to demand immediate and effective action to significantly reduce carbon emissions.
View the Monster Petition Website and download a copy for a pen to paper signature HERE
What Is The Monster Climate Petition?
A petition by Australians to the House of Representatives demanding immediate and effective action to significantly reduce carbon emissions. Original, pen on paper signatures will be collected in time for the G20 in Brisbane 14-15 November. These signatures will demonstrate to the world that many Australians want effective action on reducing carbon emissions.
The Monster Petition will then be presented to our national Parliament in late November 2014.
We need a truly MONSTER petition, with hundreds of thousands of signatures. The need for action is urgent.
If you have any trouble downloading the Petition, please email
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Please join us. Let’s make our voices heard. Download the petition now. Ready to act?
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General information sheet to accompany petition collection such as leaving in a cafe or bookshop etc.
The Petition Says The Following:
To The Honourable The Speaker and Members of the House of Representatives
This petition of Australia’s daughters and sons, parents, grandparents, godparents, aunts and uncles, draws to the attention of the House the damage to the earth’s climate and its oceans from humanity’s continuing and increasing carbon emissions and the consequent severe risks to the future health, safety and well-being of our children and our children’s children and future generations. We remind the House that it is the fundamental duty of parliament, including this House, to protect Australia’s people, land and seas.
We therefore ask the House to respect the science and build a safe climate future for our children and grandchildren and generations to come by enacting immediate and deep reductions to Australia’s carbon emissions. We also ask the House to commit to and actively promote and support global strategies for immediate and deep reductions to global emissions at every relevant international forum.
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Who Can Sign The Petition?
Everyone of us can sign our names. There are no formal eligibility requirements. Signatories do not have to be on the electoral roll. Addresses are optional, but they add legitimacy. The only people who can’t sign are current members of the House of Representatives. While the Monster Climate Petition is organized and led by women, it is for all Australians to sign, men and women, boys and girls. Climate change is affecting us all.
State parliamentarians and senators can sign. Ex-parliamentarians can sign.
Why Should You Sign?
• In a 2014 Lowy Institute Poll, 63% of Australians said they wanted the government to take a leadership role in reducing emissions.
• To let our politicians know that huge numbers of ordinary Australians want urgent action to reduce carbon emissions.
• To make climate change a bi-partisan national priority rather than a political football.
• To let world leaders in Brisbane for the G20 know that ordinary Australians desperately want their national government to step up and act on climate change.
• To stand up and be counted for the sake of Australia’s children and the land and seas we love.
• To do something that will make a constructive difference rather than languish in despair or cynicism.
it’s 3:23 in the morning and I’m awake because my great great grandchildren won’t let me sleep my great great grandchildren ask me in dreams what did you do while the planet was plundered? what did you do when the earth was unraveling?
Drew Delinger Extract from Hieroglyphic Stairway
Download all the forms you need and start collecting signatures from your family, friends, clubs, businesses and community.
Importantly, please mail all petition forms by 8 November to the Victorian Women’s Trust Level 9/313 Latrobe Street Melbourne Vic 3000
The Monster Climate Petition is an independent initiative without any party political affiliation.