The term Assisted Reproductive Technologies encompasses a diverse array of
methodologies, ranging from the comparatively straightforward procedure known as
Intra-Uterine Insemination (IUI) to various iterations of In-Vitro Fertilization
And Embryo Transfer (IVF-ET), typically denoted as IVF and colloquially
recognized as technology for the conception of offspring via laboratory-assisted
means. Over the past few years, ART has expanded dramatically.
There are several reasons why ARTs have grown in India into a veritable
fertility business. In terms of a number of cycles, India will very soon hold
the top position in the ART industry. Even in tier II and tier III cities in our
nation, techniques are still readily available, but the outcomes still vary
This article demonstrates a concise overview of the ART field in India with an
emphasis on its fundamental principles, characteristics, and development. By
focusing on the societal pressure on a woman to have children, the new Assisted
Reproductive Technology (Regulations) Act, and the difficulties associated with
ART, it seeks to investigate the industrial dimensions of ARTs. The paper also
examines the adoption of ART by LGBTQ+ people, and it concludes by talking about
the impact of assisted reproduction on the ageing population.
New genetic technology and globalization-related privatization practices are
interdependent. The government concurrently extols biotechnology as an
avant-garde contribution to the healthcare sector and as a technologically
advanced remedy for issues such as the deleterious consequences of
globalization. Nevertheless, contention arises regarding the feasibility of
rendering these technological advancements accessible within the framework of
public health. The number of technologies that aid reproduction has rapidly
increased during the past 20 years, improving the likelihood of conception and
Assisted Reproductive Technologies (ARTs) encompass a spectrum of medical
procedures, ranging from the uncomplicated intrauterine insemination (IUI) to
diverse iterations of in-vitro fertilization and embryo transfer (IVF-ET),
colloquially known as IVF and legally recognized as 'test-tube baby technology.'
In the latter half of the 20th century, significant advancements in technology
have swiftly progressed, exerting a profound influence on societal perspectives
concerning maternity, procreation, and gestation.
It's believed that Louise Brown, the world's first IVF baby, was delivered in
the UK in 1978, just a few months before the first IVF child was born in India.
The second IVF child ever born, Durga, was credited to Dr. Subhas Mukherjee of
Kolkata. In the annals of assisted reproductive technology, a historic milestone
was achieved in India on August 6, 1986, with the birth of a child purportedly
conceived through in vitro fertilization (IVF). However, the veracity of this
claim was subjected to rigorous scrutiny, leading to its dismissal due to
Subsequently, through a collaborative research endeavor between the esteemed
King Edward Memorial Hospital, a distinguished public healthcare institution in
Mumbai, and the eminent Indian Council of Medical Research's (ICMR) Institute
for Research in Reproduction, a legally and scientifically validated precedent
was established. This groundbreaking study culminated in the birth of Harsha
Chawla, marking a significant legal and medical triumph in the realm of assisted
Numerous technologies are frequently invasive to women's bodies, frequently
medically risky for both the woman and the child born as a result of ART,
occasionally experimental, and not always backed by solid proof of success and
safety. In India, most ART clinics and banks are in the private sector and
contribute to a multi-million dollar business that has exploded without any
regulation or set standards for care and services. In a setting where
unrestrained commercial interests drive reproductive services, these risks and
harms-especially to women-are exacerbated.
In the context of state restructuring and privatization, it is apparent that the
state's goals concerning healthcare have transitioned from safeguarding public
interests to promoting corporate interests, thereby establishing an environment
where healthcare operates as a platform for corporate financial gain.
It might be argued that the history of ART in India predates that of ART
overall. Louise Brown, who was born in 1978 and will always be remembered as the
first human born by in-vitro fertilisation (IVF) therapy in the world, served as
the catalyst for the field of assisted reproduction's enormous advancements over
the preceding 40 years.
In 1978, Kanupriya alias Durga, the nation's first test-tube child, was born in
Kolkata, commencing India's complex and drawn-out relationship with assisted
reproduction technology (ART). With it, a prosperous reproductive tourism
industry began to grow. Without an appropriate regulatory or legal framework to
restrain it, the sector grew significantly.
Utilizing a conservative approximation, the nation hosts over 40,000 Assisted
Reproductive Technology (ART) clinics, leading to a plethora of legal, moral,
and societal issues necessitating standardized protocols. In response to this,
the Indian Council of Medical Research (ICMR) introduced the National Rules for
Accreditation, Supervision, and Regulation of ART Clinics in India in 2005.
These guidelines, serving as India's inaugural national surrogacy directives,
were established to mitigate the prevailing legal discrepancies in the field.
Regulations on surrogacy have also occasionally been released by the Ministry of
Home Affairs. The Law Commission advocated for legislation to be passed in
2009's 228th report, which would have made surrogacy legal and facilitated the
proper use of ART.
On December 8, 2021, the legislative body ratified the Assisted Reproductive
Technology (Regulation) Act, 2021, a measure subsequently sanctioned by the
President on December 18, 2021, thereby affirming its legal enactment. The Act
aims to establish comprehensive regulatory frameworks for Assisted Reproductive
Technology (ART) clinics and banks, ensuring diligent oversight and prevention
of misuse, while promoting the ethical and secure delivery of ART services.
Simultaneously, the Surrogacy (Regulation) Act, 2021, is introduced, exclusively
sanctioning altruistic surrogacy as the sole legally permissible form. Although
the Acts eventually control the industry, they also present a variety of legal
questions, including as rights, technical developments, international surrogacy,
obligations, and ethical dilemmas.
Challenges Of Societal Expectations On Women To Have Children
Public Perceptions of the Challenges Confronted by Women
Everyone acknowledges the strong social pressure that couples-particularly
women-experience when considering having children. They experience a lot of
psychological stress in these situations, as some have noted, "There is
sometimes a lot of pressure on the lady to become pregnant immediately away,"
and another has said, "Women frequently arrive with a lot of despair owing to
the public scorn they are exposed to."
These public declarations indicated that the existence of this societal pressure
was a justification for the fast spread of ARTs. They talked about how the
methods helped women. Another provider stated, "These technologies provide
answers to those couples who are anxious to have their children and are willing
to do anything to have a kid.
The rise of assisted reproductive technologies (ARTs) has provided some relief
for women struggling with infertility, allowing them to conceive and have
children even when traditional methods are not successful. However, the use of
these technologies can be costly, emotionally draining, and physically
demanding, and not all women have access to them.
They said that because women are more likely to experience infertility and
childlessness than males, they would be prepared to undergo any type of medical
intervention to become pregnant, regardless of the potential financial,
emotional, or physical implications. By doing this, they support the socially
created image of womanhood, which assumes a straight path from marriage to
parenthood. Alternative parenting arrangements or deliberate childlessness are
not acceptable in this ideal.
Unfortunately, infertility and childlessness are still seen as a "failure" on
the part of women, despite the fact that these issues can stem from a variety of
factors that are often beyond their control. This emphasis on traditional
motherhood also overlooks the many alternative parenting arrangements that can
be just as fulfilling and meaningful.
Adopting a child, becoming a foster parent, or choosing to remain childless are
all valid choices that should be respected and supported. It is crucial to
acknowledge that there is no universally mandated standard for womanhood or
parenthood, and that every individual is entitled to exercise their autonomy in
determining their own path in matters of family and personal life.
Challenges Through a Woman's Perspective
Globally, fewer women of childbearing age are giving birth to children.
There is a lot of pressure on Indian women to have children. The pressure on
women to have children is deeply rooted in societal expectations and gender
roles. Women are often expected to prioritize motherhood over other aspects of
their lives, including their careers and personal goals.
This pressure can be particularly intense for women in heterosexual
relationships, who are often viewed as incomplete without children.This societal
pressure can take a toll on women's mental health, as they may feel inadequate
or like they are failing if they are unable to conceive. Furthermore, women who
choose not to have children or who experience infertility may face
discrimination or judgment from others.
The major reason for getting married is to have children, and women are expected
to start having kids not long after being married. Children bring social
prestige, emotional fulfilment, and economic benefits by helping with domestic
and subsistence tasks. They also aid with home chores. Children constitute a
significant source of elder assistance when parents age.
Because children are highly valued, infertility can have negative societal
repercussions. For instance, infertile women typically endure severe
humiliation, emotional distress, and a potential rise in marital violence.
Studies have shown that many women describe feeling as though their
relationships are in danger because of their infertility.
The enormous pressure women experience to have children is a significant element
that has been recognized. These obligations become internalized in addition to
being externalized in the behavior of family members and neighbors, making it
challenging for women to fulfill what is seen to be their inherent
responsibility as mothers after marriage.
It might be challenging to tell the difference in such circumstances between a
woman's deliberate desire to become a mother and socialization that makes
married women feel incomplete without having children. Being a mother is seen as
a woman's destiny. Even when the guy is the one with a reproductive issue, women
frequently blame themselves for their infertility. The fast expansion of the ART
sector in India has been made possible by the social pressure on women to have
Some LGBTQ+ people will face infertility in addition to "situational"
infertility and social pressure, much like heterosexual couples do. Some LGBT
individuals who identify as intersex may also be infertile or have limited
fertility.Discrimination persists as LGBTQ+ individuals pursue parenthood,
despite the fact that it should not hinder or prevent them.
Statistics suggest that in the United States, approximately 3 million members of
the LGBTQ+ community have become biological parents, and around 6 million
children have an LGBTQ+ parent. In contrast to heterosexual couples, same-sex
couples exhibit a fourfold higher likelihood of parenting legally adopted
children and a sixfold higher probability of nurturing children placed in their
care through the foster care system.
Art (Regulation) Act, 2021
In 2005, the Indian Council of Medical Research (ICMR) established regulations
for clinics performing Assisted Reproductive Technology (ART) procedures,
including surrogacy. These guidelines permit single women and couples to access
ART services, authorize ART banks to compensate donors, and mandate the
registration of clinics offering these services. The rules also specify the
circumstances under which surrogacy may be opted for, outlining conditions
alongside surrogate compensation.
In July 2019, the government introduced the Surrogacy (Regulation) Bill, which
outlines specific requirements for individuals seeking to commission surrogacy
services and for those willing to become surrogates. It also allows for the
registration of surrogacy facilities and mandates the establishment of advisory
boards to assist in formulating surrogacy-related legislation. During the review
of this Bill, the Committee suggested the development of comprehensive
regulations to govern clinics and banks offering various reproductive services,
including Assisted Reproductive Technology (ART) and surrogacy services.
In October 2020, the Assisted Reproductive Technology (Regulation) Bill, 2020,
was referred to the Standing Committee on Health and Family Welfare for
examination after being presented in the Lok Sabha in September 2021. The ART
Bill was approved by Lok Sabha on December 1, 2021, with a few modifications.
ART Bill, 2021's most important clauses and the most important problems still up
for debate are covered in this note.
The Indian Act mandates all Assisted Reproductive Technology (ART) clinics and
banks to register with the National Registry of Banks and Clinics. This Registry
serves as the primary database for all facilities offering ART services in
India, including scientific and technical professionals. State governments are
required to appoint officials to facilitate the registration process.
The Act also establishes the National Reproductive Technology and Surrogacy
Board, tasked with setting a code of conduct for employees in ART clinics and
banks. It specifies minimum standards for their physical facilities, laboratory
equipment, diagnostic tools, and staffing levels. The Board is entrusted with
overseeing the functioning of the Registry.
The Act delineates the duties of ART banks and clinics, including verifying the
eligibility of commissioning couples, women, and donors for ART services.
Clinics must source donors' gametes from banks ensuring medical examination for
diseases. The Act mandates offering counseling to commissioning couples and
women about ART implications and safeguarding children's rights. Breaching these
terms results in severe penalties.
Repeat offenders face imprisonment for 8 to 12 years and fines ranging from 10
to 12 lakh rupees, while first-time violators may be fined between 5 lakh and 10
lakh rupees. Operators of clinics or banks that provide or advertise
sex-selective ART may be subject to a 5- to 10-year jail sentence, a fine of 10
to 25 lakh rupees, or both.
Identifying Deficiencies In The Regulation Of The Art Industry
The assisted reproductive technology (ART) industry has grown rapidly in recent
years, leading to new opportunities for individuals and couples to conceive.
However, this growth has also led to concerns about the regulation of the
industry. While some countries have established laws and guidelines to govern
the use of ART, others lack comprehensive regulations, leading to potential
ethical and safety issues.
Common concerns include the use of unproven treatments, inadequate screening of
donors, and the lack of oversight for clinics and providers. Addressing these
deficiencies in regulation is crucial to ensuring the safety and efficacy of ART
treatments and protecting the rights of patients.
The Act represents a significant effort to mitigate the risks posed by
unauthorized and unlawful Assisted Reproductive Technology (ART) facilities. It
aims to protect both donors and women undergoing ART from the health hazards
associated with unsafe and illegal treatments. However, the Act lacks
comprehensive measures to effectively tackle various crucial issues in this
The Act prohibits transgender people and gay couples (whether married or
cohabiting) as well as single males, divorced men, widowers men, unmarried but
cohabiting heterosexual couples, and unmarried but widowed men from utilizing
The exclusion of certain individuals from the scope of the Surrogacy Act has
been a topic of debate among legal and medical experts. While some argue that
the Act should be inclusive of all individuals who wish to pursue surrogacy as a
means of reproduction, others contend that certain limitations are necessary to
ensure that the practice is not abused or exploited.
The Surrogacy Act also prohibits the aforementioned individuals from using
surrogacy as a means of reproduction, hence this exclusion is pertinent. Only
commissioning couples who have been trying to conceive for a year without
protection from coitus are covered by the Act. Its applicability is therefore
restricted, and individuals who are excluded have much fewer options when it
comes to getting pregnant.
The absence of cost regulation in surrogacy services poses a significant
obstacle, especially for financially disadvantaged individuals. Therefore,
policymakers should contemplate enacting measures to enhance the accessibility
and affordability of surrogacy for those in need.
Assisted Reproduction In Relation To Reproductive Decline
Although demography and population studies still play a significant role in many
respects, the link between age and fertility goes beyond how it is
conceptualised in those fields. Women's age-related reproductive illnesses,
according to Daly and Bewley, include decreased egg production, decreased
fertility, an increase in miscarriages, ectopic pregnancies, pre-eclampsia,
caesarean sections, stillbirths, neonatal deaths, maternal deaths, and a decline
in uterine receptivity.
By attempting to comprehend the connections between social positions and ageing
in various cultural contexts, this relationship has shaped discussions on the
life cycle in anthropology. The concept of the "biological clock" has been the
most influential one regarding age and fertility.
Media coverage and portrayals in popular culture have encouraged its current
significance. The idea of the ticking clock concerning decreased fertility has
emerged as a topic of current research in anthropology and sociology.
The concept of aging and falling fertility is ingrained in Western medical
discourse that situates it within the confines of eggs and their decrease. The
concept of age is increasingly linked to medical processes and technological
interventions, departing from the traditional natural representation of
menopause. According to Friese in 2015, within ART, eggs serve as the storage
locations for reproductive aging. This finding is crucial since menopause was
often thought to be the final sign that female fertility had died.
In the Gambia, for example, elder women who have given birth are viewed as
having accomplished an important societal role and wear the badge of mothering
and caring with great pride. This is what Bledsoe in 2002 observed in this
situation. In Japan and India, menopause signifies the end of a woman's
reproductive life but not her social life.
As a result, the reproductive decline is marked in a gendered form on the female
body even if its expressions may differ among cultures. We are forced to think
of the early loss of fertility as solely impacting women as a result of this
conceptualization, which also has an impact on the linkages to the biological
But when reproduction rates decline, more and more men are also under the
critical spotlight. In doing so, there is a deliberate shift in focus from
worries about impotence and sexual performance to worries about infertility. The
later males have children, the more likely it is, according to new medical
research, that they would have children who have specific genetic problems.
Reproduction and its connections to finite time play a significant role in
medical and anthropological encounters, and they are framed by age and ageing.
However, the idea of temporal vicissitudes on reproduction appears to be
restricted to the IVF procedure for overcoming infertility.
The path towards technologically curated families in India has been fraught with
years of misdiagnosis, neglect, and invasive treatments targeting the uterus.
While ART management has made strides in addressing the reproductive system of
younger women, there is still much progress to be made in ensuring ethical and
The Act marks a significant milestone in the quest to tackle the unethical
practices that have plagued the field of assisted reproductive technologies in
India for years. However, the road ahead remains long and winding, and constant
vigilance will be required to ensure that this legislation keeps pace with the
changing times and evolving moral and technological landscapes.
Years of infertility, misdiagnoses, and unaddressed issues in older women led to
a focus on the uterus, assuming ovarian decline due to menopause. In younger
women, assisted reproductive technology (ART) management addresses the entire
reproductive system incrementally, including menstrual cycles, uterus, tubes,
This complex treatment approach has been criticized for its intrusiveness and
aggressiveness. The Act represents a positive step forward, especially in India,
a significant hub for such reproductive abuses, as it aims to address these
issues. To guarantee that the law keeps up with social changes, moral
requirements, and technology's rapid advancement, there must be a dynamic
As we reflect on the impact of this historic legislation, we must remain
vigilant in evaluating its effectiveness and weighing its benefits and
drawbacks. The future of technologically curated families in India is being
shaped before our very eyes, and it is up to us to guide it towards a more just
and compassionate path.
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baby. Kanupriya Agarwal, 45, now champions IVF", INDIAN EXPRESS (Oct. 17,
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- Supra note. 2
- Supra note. 3
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- Supra note. 11
- Therese Shechter, "A Brief History of Bullying Women to Have Babies",
TOPIC (Oct. 17, 2022) - https://www.topic.com/a-brief-history-of-bullying-women-to-have-babies
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NEW YORK TIMES (Oct. 17, 2022) - https://www.nytimes.com/2020/04/15/parenting/fertility/lgbtq-pregnancy-ivf.html
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- Supra note 10
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- Supra note. 9
- Anindita Majumdar, "Ageing and Reproductive Decline in Assisted
Reproductive Technologies in India: Mapping the 'Management' of Eggs and
Wombs", 13(1) ASIAN BIOETH REV. 39�55 (2021).
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REPRODUCTION, 1548�1553 (2004)
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- Supra Note. 22
- Caroline H. Bledsoe, "Contingent lives: fertility, time, and aging in
West Africa" (Chicago: University of Chicago Press, 2002).
- Supra Note 22
- Maria C. Inhorn and Daphna Birenbaum-Carmeli, "Assisted reproductive
technologies and culture change". 37 ANNUAL REVIEW OF ANTHROPOLOGY 177�196