ANAND, India (Reuters) - Shabnam had dreamed of owning a home for years, but with few prospects for her husband, she followed the lead of many poor women in her town in western India: she signed up to carry a baby for another couple.

Nayna Patel, an Indian gynaecologist, carries out an ultrasound examination on Shabnam, a surrogate mother, at Patel's clinic in Anand in the western Indian state of Gujarat March 4, 2009. REUTERS/Arko Datta

At the clinic of Nayna Patel, perhaps India’s best-known “surrogate doctor” who delivered Anand town’s first surrogate baby, more women are signing up to be surrogates, with even nurses and teachers lining up, as their husbands lose their jobs.

“The women who come here usually want the money to buy a home, pay off loans, or for their childrens’ college education,” said Patel in her small clinic, the walls of which are covered With clippings and pictures of Patel with babies and parents.

A surrogate is generally paid about 250,000-400,000 rupees ($4,000-$8,000), a huge sum of money in a country where many live on less than $2 a day.

Doctors with a western education, top-notch facilities and lower prices have already made India an attractive destination for procedures ranging from bypass surgery to liposuction.

Lax legislation and an entrepreneurial streak in Gujarat state have helped make Anand a last stop for many childless couples at home and abroad, after its first surrogate baby five years ago.

In this bustling town known for India’s best-known brand of butter, Patel has delivered more than 100 surrogate babies, 40 percent for Indians living abroad and 20 percent for foreigners.

It all began with a grandmother surrogate for a UK couple five years ago that pitched Anand and Patel into the spotlight.

Following their lead, locals and foreigners began to flock to Patel’s clinic, drawn by the lower costs, relaxed attitude toward surrogates and lack of legislation.

A draft bill on surrogacy is pending before parliament, and meanwhile, hundreds of clinics have mushroomed across the country, with critics saying touts promoting this “reproductive tourism” care little for the health or rights of the surrogates.

Patel, who was featured on a special show on Oprah Winfrey two years ago, raises her voice in defense.

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“My argument is: the surrogate is not killing anyone, not committing an illegal or immoral act. And if a surrogate’s child is able to get an education, if one family is able to buy a home -- and help a needy couple in the process, where is the harm?”

ETHICAL ISSUES

Not everyone sees it that way.

Patel and the couples, more than half of whom are either non-resident Indians or foreigners, have come under a barrage of criticism for “exploiting” surrogates and for glossing over the ethical debate.

Many surrogates themselves do not tell their parents or in-laws for fear of being ostracized, and several of Patel’s surrogates live in a Surrogate House to ensure they have a proper diet, and are safe from drunken husbands and nosey neighbors.

Shabnam, 26, has not told her two older daughters or her in-laws that she is a surrogate; she lives with a few other surrogates at the hospital with her youngest child, while her husband, who is out of work, cares for the two others at home.

“I don’t think I can ever tell them; I don’t think they’ll understand,” she said, insisting on using just one name. Her husband used to earn less than $1 a day washing dishes.

Some experts say surrogates, who are often barely literate, do not understand all that the process entails, and are putting themselves at physical and emotional risk but have few rights.

“The primary concern is the physical and mental health of the surrogate: there are several risks, including maternal mortality, associated with assisted reproductive technologies,” said Preeti Nayak at Sama Resource Group for Women and Health.

India’s maternal mortality ratio is 301 in 100,000 births, the highest in south Asia after Bangladesh, the World Bank says.

For Chris McDaniel and his wife Shannon, who came to Anand last April from San Diego after having tried every option in the United States, where hiring a surrogate can take months and cost up to $100,000, the decision to go to Patel was clear.

“It wasn’t in our life plan to fly half-way around the world to a country we barely knew about to have our child,” said Chris, who is writing a book on their experience.

MORE CONFIDENT

It is hard to come by numbers of surrogates in the country, but Patel has a list of nearly 200 and is seeing more women walk in everyday because they are feeling the pinch of the slowdown.

In the absence of legislation, Patel sticks to guidelines of apex body Indian Council of Medical Research, which say a surrogate may only be implanted with the egg and sperm of the couple or anonymous donors, and that she must be below 45 years.

Patel also insists couples seeking surrogates must have a medical condition that makes child bearing impossible or risky, and draws the line at gay couples and single parents.

The surrogate, who must have her husband’s consent, has no rights over the baby, but feels empowered nevertheless, she said.

“Until then, they have felt powerless, helpless; now, they feel like they can be of some use to their family,” she said.

Shabnam’s ambition is far more modest.

“I was very scared thinking of our situation, thinking how will we manage?” said Shabnam, who is eight months pregnant with the baby of an Indian couple living in the United States.

“Now I feel a bit more confident. At least if we can buy a house, then things will get better.”

($1 = 50 rupees)