India's unregulated surrogacy industry.

The diffi culty and expense of having a baby through surrogacy in the West is driving thousands of couples to India where a lack of red tape and highquality medical care means that the process is easy, cheap, and hassle-free. Commercial surrogacy was legalised in India in 2002, as part of the country’s drive to promote medical tourism, an industry that the Confederation of Indian Industry predicts now generates US$2·3 billion annually. Estimates are hard to come by, but more than 25 000 children are now thought to be born to surrogates in India; 50% of these are from the West. But as with the rest of India’s medical tourism industry, surrogacy is entirely unregulated. Beyond the brief guidelines laid out by the Indian Council of Medical Research (ICMR), there is little medical advice to steer clinicians. The combination of profi tdriven clinics and fi nancially desperate surrogates has led to serious concerns about the ethics of surrogacy in India, especially the treatment of surrogate mothers. Now, the Indian parliament is considering new legislation on assisted reproductive technology that would mean better regulation and monitoring of this growing industry. In the developed world, surrogacy is legal in the UK and in some US states, but not in many European countries such as France and Germany. If the Indian legislation is passed, it would set a global precedent. Even in the UK and USA, there are many aspects of surrogacy for which there is no legislation and little medical guidance. For instance, says Vasanti Jadva, surrogacy specialist at the Centre for Family Research, University of Cambridge, UK, “there are no restrictions in the UK regarding the number of times a woman can be a surrogate”, though fertility experts seem to agree that three is probably the maximum. Several fertility experts that The Lancet spoke to also said they felt it was essential that a surrogate had children of her own, in case problems during the surrogate pregnancy prevented her ever giving birth again. However, this is not a legal requirement in the UK.