Ulhasnagar, India, is in that part of the world where things are made. The city is known for making cheap knockoffs of American jeans, and babies are made here, too, by women who cannot read or write but can become pregnant and will do so for money. Most of these women meet their clients once or twice, if at all. And until recently, they bore children for foreigners who never even saw this place.

Sonali, a widow of just six weeks when we met in January 2014, stood in the doorway of her one-room house. She was slender, in a green kurta, and seemed watchful even as she smiled. Her mother-in-law was filling steel pots with water. “When I did the surrogacy, she did all the work,” Sonali said in Hindi. On the floor, her children played with a cat in a patch of sunlight.

Sonali showed us a photograph of herself and her husband; a young man with brilliantined hair and a maroon shirt that was too big for him. He had died in an accident on the railway, leaving the family with weighty home loans. Sonali had already borne a child, despite her husband’s reservations, for an Israeli couple, in December 2012, for which she had been paid 2.5 lakh rupees (£2,580), which had not been enough to buy the house outright. To pay the loans, Sonali now planned to do a second surrogacy. She was also recruiting new surrogate mothers and egg donors for Padma, the neighbour who had recruited her in 2009. Padma in turn brought the women to a Mumbai surrogacy practitioner, Dr Meenakshi Puranik, whom the women called “Madam”, as maids often call their mistresses.

Between 2010 and 2014, Padma recruited about 25 surrogate mothers who delivered babies, and “so many” egg donors, some of whom – like Sonali – donated eggs three or four times.

For 10 years, transnational surrogacy was a thriving business in India. India’s total assisted-reproduction sector has been reported as being worth between £305m and £1.6bn (there is no reliable measure of commercial surrogacy’s real value).

While legal in India since 2002, the industry has never been regulated. There had been repeated attempts to draft and pass comprehensive surrogacy legislation. Then, in 2015, the Indian government effectively banned paid surrogacy for foreigners. In October that year, the government filed an affidavit in the Indian supreme court, arguing that commercial surrogacy on the part of foreigners invited the exploitation of poor women. Within days, the Indian Council of Medical Research, a government regulatory body, ordered fertility doctors not to accept new foreign surrogacy clients. The Indian home ministry followed up by denying visas to foreigners seeking surrogacy. Swiftly, international surrogacy became not illegal, but virtually impossible.

Arguably, the ban was inspired not just by concern for poor women, but by the unappealing image foreign surrogacy gave India. Stories circulated about stateless babies caught between countries, and about women who had died during labour. Memorably, the Times of India reported that “deserted or dirt-poor” women were delivering “vanilla-white babies from burnt-sienna wombs”. Jayshree Wad, the lawyer who acted on behalf of the government, told the New York Times: “There is a common opinion about India which hurts very badly – that because there is poverty they sacrifice their womb by renting it for their family.”

Critics say it is unlikely that banning foreign surrogacy clients will protect poor Indian women or end the practice. For one thing, surrogacy remains legal for heterosexual Indian couples. For another, transnational surrogacy is notorious for its elaborate work-arounds. When the Indian home ministry abruptly banned gay foreign surrogacy clients in 2012, Indian fertility clinics shipped Indian surrogates across the border to Nepal. When Nepal also banned transnational surrogacy in 2015, as did Thailand, industry insiders told me they believed that Indian surrogates were being rerouted to African countries instead. They also said that the ban will merely drive the practice underground.

The ban was inspired not just by concern for poor women, but by the unappealing image foreign surrogacy gave India

Surrogate mothers protested against the ban in Gujarat, and representatives spoke in favour of the practice on a popular Delhi talkshow. But Indian surrogate mothers have never had much control over how their story is told. In the media, the women are cast either as the lucky winners of a life-changing sum of money or as victims, forced by their poverty into “renting out their wombs”. Sociologists such as Amrita Pande argue that this binary deprives women of their agency, and that paid surrogacy should instead be framed as a form of work, no matter how problematic. Between 2010 and 2014, I spoke to 33 surrogate mothers and egg donors living on the outskirts of Mumbai. It was clear that, within their limited options, they made a choice to do these jobs. It was also obvious that they had little power in those deals and that they had the most to lose. Instead of sharing a meaningful connection, the foreign intended parents and surrogate mothers I met knew little more about one another than workers and customers on the far ends of any other global supply chain.

Kalpita bore three children in two surrogate pregnancies, but she has only one photograph to show for it. It hangs on the wall of the narrow room she shared with her husband and three teenage daughters. In the photograph, taken in 2009, she stands between two handsome men with Mediterranean complexions, her head just reaching their broad shoulders. She told me the men were brothers. They were probably a gay couple, but the women I interviewed never acknowledged that their clients might be gay. (Gay sex is illegal in India, and homosexuality is often not a visible part of community life.)

For these men, Kalpita had carried twin boys. She was paid 2.75 lakh rupees (£2,840), in 2009. It wasn’t nearly enough money, she said, for such dangerous work, “delivering two babies, putting our life in risk”. She believed 4 lakh would have been fairer compensation (women who delivered one child were paid 2 lakh, or 2.5 lakh if they underwent a caesarean section). But Puranik, who arranged the pregnancy, set a fixed rate, and the clients spoke neither Hindi nor Marathi, the languages Kalpita knows. They had left no phone number. Kalpita did not know where they came from, or where they went. What the photograph failed to show was that, in this deal, Kalpita could not negotiate or speak for herself, even as her clients stood smiling by her side. “They did not ask us how much we had been given, or what happened,” said Kalpita. “They never asked.”

I was often struck by how little the clients knew about the women who bore their children, or the details of their payment and care. They all shared a powerful and reassuring assumption: that the surrogate mothers were earning the kind of money that could turn their lives around.

In 2004, Dr Nayna Patel, a fertility doctor in the city of Anand, Gujarat, began offering surrogacy services to Indian couples. She then extended the service to a couple from Korea, which made her the pioneer of transnational surrogacy in India. In her clinic, Patel implanted a local surrogate with a foreign client’s embryos. If a client could not produce her own eggs, the surrogate carried an embryo created with donated eggs, but never the surrogate’s own. This measure, doctors hoped, would prevent the surrogate from bonding with the baby.

Overseas clients came from countries where commercial surrogacy is illegal – for example Australia and most of Europe – or expensive. In US states where commercial surrogacy is legal, the process cost between $75,000 and $120,000 in 2015 – roughly three to four times what it cost in India.

From the beginning, Patel welcomed journalists. Her story was told on TV programmes including Oprah and NBC’s Today show. When I visited her office at the Akanksha Clinic – part of Anand’s Kaival Hospital – in February 2010, portraits of Oprah hung on the walls. Patel wore her black, silver-threaded hair drawn up. Her bearing was aristocratic, and pleasantries were brief. She did not want to be interviewed in depth because she was already the subject of two forthcoming books. On that trip and another, I learned little about her, but did see the charisma that had made her well known.

In Oprah Winfrey’s 2007 broadcast, the reporter Lisa Ling followed a childless American couple, Jennifer and Kendall West, as they visited Patel’s clinic to hire a woman to bear their child. Ling reported that Patel charged the couple $12,000, of which $5,000 went to the surrogate mother. That sum represented 10 years’ worth of ordinary income – enough to buy a house or fund a child’s education. Patel put the money in bank accounts she created in the women’s names to keep it in their control. This was the “win-win” story: two lives changed for the better, and all for a bargain price. “We were able to come together,” Jennifer West said, “and give each other a life that neither of us could achieve on our own. And I just don’t see what’s wrong with that.”

Patel’s story invited scrutiny, and it certainly got it. The New York Times columnist Judith Warner, looking at photographs of pregnant surrogates lined up for medical exams, saw “industrial outsourcing pushed to a nightmarish extreme”. Certain details rankled, including the implantation of multiple embryos, and the “surrogacy house” where women lived in a shared dormitory, closely monitored and removed from their families for the duration of their pregnancies. The house was described as a “baby factory”.

But for those committed to surrogacy, Patel’s story had undeniable appeal. Not only had she devised a new way to make children, she had packaged it into a free-market fairytale. She took a business deal between wildly unequal parties and made it sound not just fair but altruistic. Patel once wrote: “At one end of this world, there is one woman who desperately needs a baby and cannot have her own child. And at the other end, there is a woman who badly wants to help her own family. If these two women want to help each other, why not allow that?”

Foreign parents tended to have very little contact with the women they hired to bear their children. In fact, they usually flew to India just twice: once to drop off a sperm sample or to create their embryos, and once to retrieve their child. Guidelines issued by the Indian Council of Medical Research ensured that Indian egg donors remained anonymous at the time of the deal. (Under these same guidelines, children can learn the identity of egg donors when they reach the age of 18.) A couple might have met their surrogate once or twice, briefly, in a hospital room or consulate. Conversation took place through a translator.

As the transnational surrogacy business spread, with new practices opening in major cities across the country, Patel’s narrative of good and fair exchange spread too. By October 2015, Patel’s clinic announced the 1,001st baby born to a surrogate mother.

Facebook Twitter Pinterest A woman holds photographs of the twins she recently delivered for a foreign couple at Hiranandani Hospital in Mumbai Photograph: Chiara Goia

Patel’s work paved the way for a number of surrogacy entrepreneurs, including the Israeli businessman Doron Mamet, who launched a company that brought surrogacy clients from Israel to India. Mamet travelled to India to explore “outsourcing” paid pregnancies. He worked with IVF specialist Dr Hrishikesh Pai at the exclusive Lilivati hospital in Mumbai. Mamet claims that everyone has a right to be a parent.

He relied on Dr Meenakshi Puranik to recruit and work with the women, whom he described as shy and uncommunicative. Puranik organised surrogacy care from her clinic in the Mumbai suburb of Mulund. She told me that her role was to solve a surrogate’s problems: “She should be mentally happy during the pregnancy.” Puranik also handled payments. Depending on whether they required an egg donor, Mamet’s clients paid from $30,000 to $50,000 for surrogacy. “We paid Dr Puranik 12K,” he wrote in an email, “which was supposed to cover the surrogate compensation as well as all other pregnancy-related costs (delivery is excluded).” As to how much surrogate mothers were paid, “I never knew for sure,” Mamet told me.

In 2011, the base rate of pay for surrogate mothers in one Mumbai clinic was 2 lakh (£2,060). If they had a caesarean section – and almost every surrogate mother I interviewed did – they were paid an extra 50,000 rupees (£515). If they had a caesarean section and twins, they received an extra 75,000 rupees (£775). So, in 2011, surrogates were paid at most 2.75 lakh (£2,835). If the women stayed in hospital for a month or more, 3,000 rupees was docked from their pay and, if they delivered prematurely, another 10,000 rupees. A further 50,000 rupees was deducted for the cost of the surrogate’s monthly food and housing, even though some of the women spent much of their pregnancies at home.

Most of the women I spoke to did not keep copies of the contracts they signed. Despite the fact that neither Mamet nor his clients could say precisely what the surrogate mothers were paid, the text on the company website read as follows: “This process allows them to guarantee the future of their families and children.”

When Sonali, the young widow in Ulhasnagar, decided to become a surrogate mother, she travelled two hours by train to Lilivati Hospital for an ultrasound, the first stage in assessing every surrogate mother. At the time, she was still breastfeeding her son. Sonali was told she could not become pregnant while breastfeeding. The doctors gave her medicine to stop her producing milk. When it stopped, Padma, Sonali’s agent, took her to Puranik’s clinic for embryo transfer – the process by which fertilised eggs are placed in the uterus.

At nearly two months, an ultrasound showed that the foetus Sonali was carrying had no heartbeat. Puranik told her that she would need an operation in a nearby clinic. When the procedure was done, Sonali was shown the foetus, which had been placed in a plastic jar. “It was all cut into pieces,” she said. “And they handed it over to me, and seeing that, I got more scared.”

Sonali was told that the foetus had to be shown to the clients. Her husband, who had accompanied her, carried the jar, and they walked together, terrified, to the clinic. At that point, Sonali had been paid 10,000 rupees (£105), the standard fee for an embryo transfer. She felt she deserved 5,000 rupees more – the monthly fee received by surrogates – but was told that women only received that payment if the ultrasound showed a heartbeat.

Sonali did not want to attempt surrogacy again. But the family needed money, so she donated her eggs three times that year – for 15,000, then 20,000, then 25,000 rupees, a total of roughly £620. Two months later, she agreed to another surrogacy. Five months in, she began to worry that the foetus would not survive, but this pregnancy did end in success.

Eight days before Sonali was expected to deliver the baby, the foreign clients visited her in hospital. “Both were men,” said Sonali. “They were not husband and wife.” She didn’t know what to say to them. They asked her how she was feeling and told the doctor to give her a normal birth, if possible. The doctors treated Sonali well, but in the end, she underwent a caesarean section. The incision swelled horribly. She never should have done it, her husband would later tell her – so much pain, and what was the use?

Sonali met the clients just once more, in court, where she had gone to sign papers. It was then that she finally met the baby she had given birth to. It was just like the clients, she said: their hair, nose, and blue eyes. She felt an impulse to keep the baby, even though she had “kept her mind ready” all along to give the baby up. The clients thanked her profusely, then gave her a 7,000 rupee tip. They were immensely happy. Sonali thought, “Whoever those people are, at least I have helped somebody.”

Sonali could not say what her clients paid for her surrogacy. She said that she and her husband had been given no time to read the contract. In the end, Sonali received a cheque for 2 lakh. But you cannot buy a house for 2 lakh in Ulhasnagar. So she and her husband took out a loan of 3 lakh more and bought their home.

Within months, Sonali’s husband was dead. She now sells Tide detergent door-to-door, for which she makes 5,500 rupees in a good month. When a loan payment of 100,000 rupees was due, she asked to borrow money from Padma, hoping to repay her after a second surrogacy.

Padma, a solid woman with a calm, steady bearing, had also worked as a surrogate mother for Puranik. She had learned about the work from her sister-in-law, the first of at least five women in their family to have paid pregnancies. When, one night after dinner, Padma proposed that she should act as a surrogate, her husband warned her not to do it. Many people believed that to become pregnant, a woman had to have sex with a strange man. Accordingly, surrogate mothers often kept their work secret. But Padma explained about test-tube babies to her husband. She also reminded him of their own children’s future.

At the time, Padma and her husband were desperate for money. His work, trucking bitumen, was irregular. Padma tried to make ends meet by cleaning houses. They had to pay fees for a pricey English-language school, as Padma considered the local state-run schools so useless that she once kept her children home for a year rather than send them to one. Four years earlier, when her husband was out of work, the family had gone hungry. Padma refused to let that happen again. She also wanted to buy a house.

Facebook Twitter Pinterest Anu prepares a hormone injection for one of her mother Padma’s clients in Ulhasnagar. Photograph: Chiara Goia

Padma bore a son for a couple from the north-eastern state of Bihar. When she gave up the baby, she felt sad: “You have kept the child inside of you and given it the same kind of care as your own child.” She tried calling the clients on the child’s first birthday, but they had changed their number. Padma was paid 1.25 lakh (£1,300). “It was not enough money,” she told me.

Still, Padma had learned some useful new English words: endoscopy, embryo transfer, egg pickup, ultrasound, patient, client, donor, surrogate. She said that the agent who was supposed to guide her through her pregnancy deserted her, so she taught herself the business. Agents such as Padma – referred to as “caretakers” by the doctors – shepherd women to their appointments, jot down the particulars of their care in mustard-yellow notebooks. They even inject them with hormones.

When we met in January 2011, Padma lived in a dingy one‑room apartment off a narrow lane. By March that year, she had moved her family to an airy one-room apartment with a balcony and pink walls, for twice the rent. When I visited Padma and her family in 2014, they were living in a two-room house with a kitchen. That very month, she said, she’d earned 50,000 rupees – 10 times Sonali’s monthly salary selling Tide. Her 19-year-old daughter Anu was in college. Padma had bought her a laptop on instalments. In addition to her classes, Padma’s daughter was doing some agenting work of her own, sending egg donors to a practice in the southern state of Kerala.

Padma’s surrogacy did indeed transform her life – but not until she began working as an agent. Now, when the women came to see her, they bowed and touched her feet.

Dr Sukhpreet Patel, an IVF doctor in Mumbai who spoke passionately about her surrogacy practice, told me that she was troubled by the number of women returning to her clinic for second surrogacies. She considered these repeat pregnancies medically dangerous and evidence of the clinic’s failure to transform the lives of the surrogates. For that reason, she said that she wanted to teach surrogates skills such as embroidery and accounting. “I think they come with that hope that we can make their lives better,” she said, “and then I think that becomes our responsibility.”

In the absence of that elusive payday, women such as Sonali carry on donating eggs and performing surrogacies. Surrogate mothers, often illiterate, also move in a deeply entrenched class and social hierarchy. They may not have the confidence to question medical procedures, or ask for information.

“Every surrogate pregnancy is a high-risk pregnancy,” said Dr Anita Soni, an obstetrician who also recruited surrogates for six or seven practices in Mumbai’s Hiranandani hospital. She had done a study based on 900 surrogate deliveries. She concluded that the risks were typical of poor women who had undergone multiple pregnancies, including hypertension and anaemia. Thanks to the implantation of multiple embryos, permitted by Indian Council of Medical Research guidelines, 42 % of the surrogates had multiple births, which carry an increased risk of premature labour. Sixty-eight to 70% had caesarean sections, which are more dangerous than natural deliveries. So, did these risks mean that foreign surrogacy should be banned? Not at all, Soni said. To her, it simply meant that surrogate mothers required expert care.

Another surrogate mother who had delivered twin girls in Delhi to clients she guessed were from Australia, described her labour as traumatic – she required a blood transfusion after the baby was born. And yet what she wanted to discuss most was how her clients had disappeared: “I wanted to see the children,” she said. “But as soon as they were born, those people took them and went away. They should have come to see me – the one who has given them two children.”

In Hiranandani Hospital, Soni kept surrogates and “biologicals” on separate floors, and whisked babies out of sight after delivery. “You don’t want a bonding of any sort,” she said. For that reason, the 2010 draft of the surrogacy regulatory bill recommended that the baby be removed from the surrogate directly after the birth. The surrogate mothers themselves, however, portrayed this separation as harmful.

I wanted to see the children. But as soon as they were born, those people took them away. They should have visited me A surrogate mother of twins

Researching surrogate motherhood in Israel, medical anthropologist Elly Teman found that being thanked was crucial for surrogate mothers. According to Teman’s research, when surrogates were not thanked, they grieved.

Why did the foreign clients often have so little contact with surrogate mothers? The couples I met spoke of not wanting to intrude on women’s privacy or, in some cases, of being worried about how they would be received as gay fathers. Some couples believed that too much communication with a surrogate mother could be dangerous – a surprisingly common idea.

Sukhpreet Patel said that clients could be vulnerable to the demands of surrogates. “Who’s to say that she won’t blackmail them for something that she wants,” said Patel. For that reason, Patel encouraged couples to meet the surrogate mother only after the delivery. Medical anthropologist Daisy Deomampo, who has written an ethnography of surrogate mothers in Mumbai, argues that this image of the “deceitful surrogate” has helped doctors and parents conceal the power imbalance that made foreign surrogacy possible. For Deomampo:“Transnational surrogacy thrived in India in part because it relied on the fact that surrogate mothers and intended parents rarely, if ever, met face-to-face.”

Facebook Twitter Pinterest Padma gives a hormone injection, as part of a therapy to get the women ready to have embryos implanted, to one of her patients at her home in Ulhasnagar Photograph: Chiara Goia

After the babies were released from the hospital, they generally went to a hotel with their intended parents. A lengthy bureaucratic procedure then followed. First, the foreign clients went to their country’s consulate for a cheek swab. This was to confirm a genetic relationship to the baby – the first step in the process by which the child would gain citizenship in their home country. Then, they waited for the Foreigner Regional Registrational Offices to issue an exit visa, which could take up to eight weeks. Once this visa had been received, the parents took their new babies home – to Australia, Israel, the United Kingdom, Japan, the US. Surrogates, meanwhile, were left with photographs of the babies, if they were lucky, or thank-you notes written in English on hotel stationery, which they could not necessarily read.

Intended parents shared a reassuring assumption: that the surrogate mothers were earning a life-changing sum of money

Edward and Paul, a New York couple who have three daughters – twins and a single child born eight days apart from two surrogate mothers in Delhi – told me that they chose surrogacy in India in part to help poor women. “In the United States, $25,000 is not going to change the life of the surrogate,” Edward explained. “But an Indian surrogate, you are fundamentally changing the trajectory of her life.”

In June 2014, I went to visit Edward and Paul at their house in New York. The road narrowed and tunnelled through the lush woods. I drove up a steep private drive, which curved around to an open lawn and a white colonnaded house. In the garden stood a bronze fountain of three girls dancing, hands linked, around an altar of lotus leaves.

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Edward led me down into the playroom, where their daughters, then three years old, were playing with an assortment of plastic toys. One hid behind a miniature kitchen; another teetered in a pair of purple glitter heels, which her fathers said she insisted on wearing. When the girls were small, their fathers dressed them up in silk kurtas for church. It was important, they felt, for the girls to have access to their Indian heritage.

Later, sitting on the porch, Edward showed a YouTube video of Paul’s recent visit to Delhi, where he had been able to visit the surrogate mothers in their doctor’s clinic. On the video, the women smile, holding boxes that contain saris and cheques for $1,000 each, and peer at photos of the girls. The trip had eased Edward and Paul’s minds because they were able to directly give a gift of money to the women, and show them the girls. Edward wanted the women to know that he and Paul they were grateful. He would, he added, send them money every year if he could, but they probably had no bank accounts, so there was no way to do so “without corruption”.

Edward also seemed reassured by the fact that both women did second surrogate pregnancies. “I have to assume if they did it again, it wasn’t an awful experience,” he said.

After reading about the ban in India, I contacted Padma, curious to know what she made of it. She was with her daughter Anu. “The government should remove that ban,” Anu translated for her mother. “The government is not giving any sort of loans to poor people – they are not helping with anything.” She added, “Surrogacy is the source from which these women are earning for the future. Maybe only a little bit, but something.”

Padma’s argument echoes the ethical debate surrounding sweatshops: workers must be both free to make a living and protected from harm. Fair-trade models offer a solution to this dilemma by giving a human face to the producers of what we buy. This idea should surely work in a transaction as personal as bearing a child. Anu told me that she planned to create a surrogacy practice to serve Indian couples, where she would teach surrogates financial planning and cut out the middlemen.

When I discussed the “fair-trade surrogacy” idea with the sociologist Sharmila Rudrappa, she smiled wearily. She told me of one group of women who wanted to start a surrogacy cooperative and deal directly with their clients. “I asked some of the intended parents I’ve got close to if they would use a co-op, and they answered no,” Rudrappa said. “There’s just so much distrust.”

Sonali did not want any sweeping reforms to the surrogacy system – just a chance to visit the intended parents monthly, even if they were foreign or both male. “We will feel that they are our clients and they have care for their baby,” said Sonali. “And that they see us.”

• Main picture: Chiara Goia

This is a version of an essay published in the Spring 2016 issue of the Virginia Quarterly Review. Some names have been changed

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