Wednesday, 21 August 2013

KENYA : MAKING A CAREER FROM A MIRACLE

KENYA MAKING A CAREER FROM A MIRACLE


One of the greatest gifts modern medicine has given us is In Vitro Fertilisation and surrogacy, which give couples who can’t naturally create children the chance to have a baby of their own. The trend is just beginning in Kenya, but as with any industry where large amounts of money are involved, there are already concerns as to where it is headed By Everlyne Mosongo.


Terence’s chuckle wracks up his little frame in excitement and this brings Joyce the kind of joy that begins at the soles of her feet and bubbles out to the rest of her body. And nothing tugs at her heartstrings more than when her son tightly clenches her finger with his whole hand as if holding on for dear life.


Babies can be incredible gifts for their parents, but for the women who can’t bear children the natural way, surrogacy is nothing short of a miracle, as Joyce will proudly attest of her son. This medical procedure is growing fast in Kenya, but it is also being converted into a business where women are cashing in by hiring out their wombs for vast amounts of money.


A Scientific Intervention


When the late Nobel Prize winner Sir Robert Edwards began his research into In Vitro Fertilisation (IVF) in 1972, it was amidst criticisms that his work was ‘immoral’ and ‘unethical’. Creating human life outside the womb was considered unnatural and his experiments did not conform to ethics of the day held by medical practitioners. But he turned a deaf ear, dug in his heels and continued working. After numerous failed cycles and years of criticism, he finally had a breakthrough in 1978, and Louise Brown became the first successful IVF baby, born to Lesley Brown in the United Kingdom.


Over the next decade, as people had time to get used to the idea, surrogacy started being used by couples who could not have children the natural way – a doctor would implant sperm into a surrogate mother, the sperm would fertilise her egg and she’d carry the baby to term. In 1986, American Baby M became the first baby born to a surrogate, Mary Beth, whom the couple found through an advertisement.


“It took time for Africans to understand what the procedure was all about,” says Dr. Okiki from LifeBridge, one of several IVF centres in Nairobi.


The first IVF procedure in Africa was conducted in South Africa in 1981 at Stellenbosch University. However, it did not take and the first successful procedure in the continent did not come for another 14 years, until the University of Lagos in Nigeria managed in 1995. Nairobi IVF Centre was the first facility in Kenya and became operational in 2004, with its first successful procedure, resulting in twins, coming two years later.


But why did it take almost 25 years for surrogacy to be introduced in the country?


“This has to do with our culture, the African culture,” shares Okiki. “Most people would want to get pregnant the natural way, through sexual intercourse. But when it becomes impossible, what do you do?”


Joyce’s hair is in a fringe which tapers to the right side of her face where it almost covers the dimple on her cheek from view. Her wide, infectious grin reaches her eyes as she lovingly looks down at her son bundled in her arms. The child’s big brown eyes, look curiously at his mother’s face as if trying to commit it to memory. Joyce had a painful medical condition which her gynaecologist advised could only be treated through the removal of her fallopian tubes. But even after the procedure her pain persisted.


“My cervix was closed and everything collected in the uterus. I could not pass my period and every month I went into the theatre for dilation where the doctor cleaned me up,” she says and shifts baby Terence to the crook of her arm as she sinks further into the beige couch.


 “But, blood kept collecting and I bled anytime and anywhere.” Joyce was in agonising pain and the only solution, doctors advised her, was to remove her womb.


She had always dreamt of becoming a mother, so despite the effects her ailment was having on her she stalled. “Nothing can fill the emptiness of being childless.” But the pain became unbearable and finally she had no choice. She proceeded with the operation.


She was once again physically healthy, but her heart ached for a child of her own. The search for a surrogate was on.


“There are numerous websites advertising for surrogate mothers who are willing to carry the baby to term for a fee,” she says.


The most popular here is Surrogatefinder.com where, in Africa, Kenya is second only to Nigeria in terms of registered women willing to be surrogates, with 174 to their 269.


Joyce, however, found the prospect of having a stranger contacted via the internet impersonal and uncomfortable. Instead, she approached her friend Chisanga with the prospect of becoming a surrogate mother. To say that Chisanga was perplexed at first is putting it mildly, as the idea of carrying another woman’s child is not something most Kenyans would consider without being confronted by the situation.


“It sounds easy when I say that I carried my friend’s baby doesn’t it?” she says, her towering silky black head gear bobbing as she laughs.


“Let me assure you that that is one of the hardest things I have had to do. The way I knew myself,” she splays both her hands on her chest, “let’s just say that I don’t think I would ever have done it, and it’s just because God used me as the vessel.”


After two weeks of doctors running tests on her, Chisanga was cleared as a healthy host and was implanted with Joyce’s egg which had been fertilised by Joyce’s husband’s sperm. The couple paid for the whole procedure and Chisanga didn’t ask for a dime from her friends. But, unlike Chisanga, not all surrogate mothers do it out of the kindness of their hearts. With the kind of money that is up for grabs, surrogacy for some is a lucrative business venture, not a helping hand.


Wombs for Hire


I meet Mary Wairimu* inside a trendy coffee shop in Nairobi. With its orange and brown hues, the café has a cosy, intimate feel. But Wairimu requests that we sit outside where there’s more space, where we’ll be out of earshot of the nearest patrons. I oblige, and once settled ask how she became a surrogate mother.


“I met the couple through a website for surrogates where I had registered,” Wairimu says, pulling her chair closer to the round table so that she doesn’t have to shout.


Wairimu had registered on several websites including Surrogatefinder.com.


“When this couple emailed me, that is when it dawned on me, the magnitude of what I had signed up for,” she smiles nervously. In the beginning Wairimu had been uneasy about carrying a strange couple’s child, but she quickly pushed the jitters to the back of her mind as she had big plans for herself that hinged on the financial payout.


Wairimu was the third born in a family of five and had been raised by a single mother who struggled to earn enough to keep the family afloat. Wairimu wanted a better life for herself.


 “My two older sisters got married fresh out of high school. I didn’t want that, I wanted something different.”


Then as chance would have it she struck upon an article about surrogacy in the paper and was shocked to see that the surrogate had been paid thousands of dollars. With a goal in her head, she started doing research on her own.


“I applied to several websites, and I was rejected by some. Most couples prefer surrogates who have children of their own.”


This is an international trend in surrogacy, as a woman who has already carried and delivered a baby without complications is seen as a safer bet.


But Wairimu eventually found a couple who were willing to take a chance on her. After months of communicating via email, they finally met face to face in a Nairobi hotel.


“The two were well into their 40s and didn’t have children,” she says, adding that she was impressed with their pleasantness.


Wairimu was first taken to a gynaecologist who gave her a clean bill of health before going to the IVF facility in Eldoret to be implanted with the couple’s embryo.


“I come from Nyeri and this was far from my home, and I didn’t want my family to know about this.”


At her request the couple rented a house for her in Eldoret for the last two trimesters. Wairimu spent her first three months of pregnancy carefully cobbling together a story to hide where she was actually going and what she was doing.


Clad in a striped blue and white V-necked T-shirt and black jeans, Wairimu is petite. During the first trimester, she stayed with her mother and younger siblings at home, then told her mother that she was going to visit her older sister and that she’d be gone for months.


“This didn’t sound unusual as I usually stayed with my sister for months on end, and my mother didn’t have a problem with that.”


To maintain the deception, she was careful to regularly call her mother so as not to raise suspicion.


The house was lavish and Wairimu lacked for nothing. The couple took care of all her needs, though they dictated what she ate, drank and how many hours she slept. It may seem grating but Wairimu didn’t take offense.


“They said it was for the good of the baby. And to me it was just a job,” she shrugs nonchalantly.


There are two kinds of surrogacy – gestational and traditional. In gestational none of the fertilised gametes belong to the surrogate. The sperm from the man fertilises the egg from his partner, then the embryo is implanted in the surrogate mother. In traditional surrogacy, however, the surrogate mother’s egg is fertilised by the man’s sperm.


Either way, the woman carrying the child needs to understand that the day of delivery will be the first and last time she will see the baby.


“The moment you allow a carrier to bond with that child, there are issues there. No woman, whether it’s from gestational or traditional ties, would want to give up her baby,” warns Okiki.


Wairimu’s surrogacy was gestational, and once she delivered, she handed the baby over to the couple. For her, bonding was not an issue. I ask if she would do it again, being familiar with the procedure now?


“A second time, no,” she says adamantly, shaking her head. “But would I do it over again? Yes.”


Without hesitation or emotion, she adds, “I won’t lie, I did it for the money.”


Currently, Wairimu is in her second year of university pursuing a degree in Sociology.


“This was my motivation. I wanted an education and if it meant giving away nine months of my life, well,” she shrugs casually, “then it had to be done.”


In 2009, Maureen Nduku* had also been in a financial rut when her friend Anne* introduced her to a couple in Mombasa who’d been looking for a surrogate mother.


An unemployed mother of a 7-year-old, when Nduku heard the sums involved she could not refuse the couple’s proposal.


 “Here was a couple that was offering me the kind of money that I had never seen in my life, how could I say no to that?” she asks, raising a perfectly arched eyebrow. Anne, who’d already been a surrogate once, had been paid heftily.


“I believed her because she had started leading a different, more expensive lifestyle than before she became a surrogate,” says a bubbly Nduku.


In addition to patients who visit Life Bridge for IVF inquiries, Okiki shares that more Kenyan women are seeking them out to offer up their services as surrogates at the facility.


“They come up and say ‘Excuse me doc, I want to be a surrogate mother’. They ask if we have any couples looking for babies and they volunteer to carry the children to term.”


This has been largely due to the growing amount of information available on the internet. “Back in the day,” Okiki adds, “no one knew that you could carry the child of another person. Women got pregnant through natural means, but now we have laboratory concocted babies.”


And owing to the internet, Nduku is also a registered egg donor.


“It is good money. Carrying a baby for nine months is not an easy thing. But with the kind of money I got, I can do it again and again. Maybe I might stop at four babies,” she chuckles.


Surrogacy seems to be a growing business that has women clamouring to become hosts, but as with any emerging industry, there are legal and moral wrinkles yet to be ironed out.


Finances and Legalities


“After a woman, even if healthy, says she cannot carry the child, the next question is, can she afford [a surrogate]?” explains Okiki.


Currently, Kenya is one of the most expensive African countries on the continent for IVF treatment, second only to South Africa. Before a couple even gets to paying the surrogate, they have paid a minimum of KSH 300,000 for each try.


“Here in Kenya when you want to do all those procedures in surrogacy, you are going to spend between KSH 600,000 to KSH 700,000,” says Okiki.


In India, the rent-a-womb capital of the world, the procedure costs about USD $28,000 with the host earning at least USD $5,000.


During their second meeting, Wairimu’s couple had come prepared with a lawyer and a contract for her to sign.


“It was simple really. All it stated was that I was to hand over the baby immediately after delivery and that I hadno legal claim to it.”


Once she had agreed to that they discussed her fee, to be paid incrementally.


 “After I was implanted with the fertilised egg and it started growing, the couple paid me KSH 250,000 then KSH 200,000 after my first trimester. When I delivered, they gave me a further KSH 250,000,” she explains.


That KSH 700,000 was her ticket to the better life she craved. A few months after giving birth, Wairimu enrolled in university for her degree programme.


It’s not clear how many Kenyan children have been born out of surrogacy because, as is the case in many elective medical procedures, many couples prefer to have their IVF treatments managed abroad. In 2011, Okiki worked in the Middle East in Hamada Hospital in Qatar where, of the 200 IVF procedures performed that year, three quarters had been on East African patients. Hospitals in Dubai don’t take anything less than USD $40,000, so it’s not immediately clear why these couples are opting to do the procedure abroad.


Okiki adds that, “There are doctors in Kenya who claim to have a success rate of 46 percent, but even the leading IVF facilities in the world have not recorded that kind of success rate. In Dubai, which is [one of the global leaders], they have a success rate of 22 percent.”


Both of Nduku’s procedures took the first time she was implanted with the embryos. For her first surrogacy she was paid KSH 650,000 and in 2012 she was paid KSH 720,000 by the second couple, whom she met on the internet. Like Wairimu, she was also required to sign a contract waiving all legal rights over the child.


After being implanted with the embryo, Nduku sent her son to live with her sister who she’d disclosed her plan to.


“They rented a house for me in Kileleshwa and paid me half the money at the beginning of the pregnancy and the rest after I had given birth,” she says, delicately smoothing down the red fringe of her bob cut with perfectly manicured nails coated in neon blue polish.


While pregnant, the couple also dictated her day-to-day life. She didn’t do anything without consulting them first.


  “[Surrogacy] pays better than most jobs. I earn over KSH 70,000 per month when I carry a baby. How many Kenyans earn that kind of money?”


 IVF has been available in Kenya for 10 years now and we have six centres – one in Mombasa, one in Eldoret and four Nairobi – that carry out IVF procedures. But there still remain few, if any, professional guidelines that have been put in place, like fee regulation in the facilities, and there are also legal hiccups when it comes to surrogacy. For example, the woman who carries the baby is registered and recognised as the baby’s legal mother on the birth certificate, even with the contracts drawn by lawyers to protect the rights of the would-be parents.


“According to Kenyan law, the hostis the real mother. And we don’t yet have a law that validates or recognises surrogacy,” says Valentine Bundi, a lawyer at Swanya and Swanya Advocates.


Childless for years, when Muchoki and Waithera heard of IVF alternatives, they contacted Waithera’s sister in Nairobi and asked for her assistance in searching for a surrogate. Last year, the couple travelled from the UK to Nairobi where the woman who would carry their child was waiting. The host was implanted with the fertilised embryo and everything went according to plan. In fact, the Muchokis soon found out that they were expecting – via their surrogate – twins. Things took an unexpected turn immediately after the babies were delivered. Waithera went to register as the mother of the twins but instead was detained by officials at Kenyatta National Hospital who suspected that the two women were trading babies.


According to hospital officials, the host was the legal mother, and Waithera’s excitement swiftly turned to worry as the case was taken to court. After a lengthy explanation (that took almost two months) where the distraught couple had to prove to the Kenyan government and the UK’s immigration department that the babies were theirs, they were luckily granted rights over the children. But things do not always end so brightly.


Bundi’s firm has handled four cases where the rights of gamete donors over the children were questioned.


“Clearly surrogacy is here to stay and what the government needs to do now is to come up with a law that spells out the rights of gamete donors and surrogates,” she adds.


But it’s not only the government that is reluctant to discuss and recognise surrogacy – even many of the couples and surrogates are reluctant to tie themselves to this new phenomenon.


Not All Good News


In India where the government is promoting the country as a medical tourism destination, husbands encourage their wives to become surrogates for rich couples in need of babies. This is a booming business with brokers and agencies, earning the country approximately USD $2 billion annually.


A website like Surrogatefinder.com, where most registered Kenyan surrogates are from Nairobi, is awash with bios like: “It would be a great honour to help make you happy by carrying your baby,” “You will never regret choosing me, I’m ready to be of help,” and “Hi, to all of you who may need my support, I will be there.” The surrogate mothers also have the option of choosing what type of family they’d like to help – single parents, heterosexual couples or gay couples.


 Chisanga’s face lights up as she speaks of Joyce.


“I can’t explain the joy I feel when I see my friend with the baby,” she says, her voice thick with emotion.


“If it were possible for people’s hearts to burst with joy, then mine would have exploded by now.”


 Feeling the baby’s first kick and knowing that there is life growing inside her belly makes pregnancy one of the most fascinating experiences of most women’s lives. Chisanga became a host to help out a friend, but for women like Wairimu and Nduku, this is simply a job that calls for psychological detachment on their part.


In the UK and Western Australia, where commercial surrogacy has been banned, the procedure goes against public policy. Other countries where surrogacy is forbidden, whether commercial or altruistic, include Japan, the province of Quebec in Canada, France, Hungary, Iceland, Italy, Pakistan, Germany, Bulgaria and the state of Michigan in the US.


In European Union countries, where surrogacy is not completely banned, advertisements, agencies and brokers are prohibited because they contradict local morals.


Couples searching for surrogate mothers are basically buying pregnancies where the child is used as a tool of trade that can be bought. In African beliefs, other than love, the primary purpose of marriage is children, who are generally seen as a blessing. If they are not born the natural way, parents use the other option– adoption. However, in African culture, adoption is also rather rare.


Surrogacy now presents them with an opportunity to have what they thought was impossible – a child of their own. While it’s hard to look at parents, like Joyce, who have the child they never thought they’d get and see anything wrong with surrogacy, the truth is that surrogacy can lead to challenging situations. For instance, what would happen if the pregnancy became dangerous for the surrogate, and doctors recommended an abortion? What happens if the surrogate mother dies while giving birth?


Another issue is the potential exploitative nature of the procedure. While Kenyan surrogates are, to date, receiving what would generally be considered fair sums, poverty and desperation could drive prices down. If the system devolves into similar circumstances as those found in India, the creation of surrogacy brokers would almost certainly result in women receiving less money than they do now. In Kenya, the price tag associated with surrogacy is still well out of reach of most families. But couples here are currently paying roughly USD $5,000 less than they would in India, leaving room for our budding IVF industry to pull international customers away from their clinics. But as it grows, there will undoubtedly be more issues, both moral and legal.


For the time being, surrogacy in Kenya is a beautiful thing for those lucky enough to be able to afford it, but it is also seemingly at the intersection of two paths with no indication as to where we are heading.



KENYA : MAKING A CAREER FROM A MIRACLE

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