Source: Africa Review
Sometime in 2010, a young Kenyan woman received an invitation to meet a couple she had earlier encountered at a Christian convention in the capital Nairobi.

The well-to-do couple lived in the coastal city of Mombasa but had arranged the meeting at one of Nairobi's posh hotels, betraying nothing of the extraordinary proposal that awaited the 35-year-old Vivian (not her real name).

Would she agree to carry a pregnancy on their behalf since the wife did not have a uterus of her own?

"It took me eight months to think about it," recalls Vivian, who cannot disclose her identity or that of the couple under the terms of a contract she eventually signed.

"I asked God to help me make the right decision. It was the toughest in my life."

When she finally made up her mind to do it at a fee of at least KSh650,000 (about $7,840) the mother of three effectively joined a growing list of young Kenyan women who are renting out their wombs to carry other people's pregnancies, with some being paid as much as KSh1 million ($12,000).

The trend, that has in the past been seen as a solution in developed countries for infertile women seeking to have their own children, is increasingly gaining acceptance in Kenya.

Women are usually unable to have a baby because they might have medical complications that make pregnancy impossible.

Those who carry the pregnancy, whether for a fee or for free, are known as surrogate hosts and the owner of the baby as the commissioning couple or genetic parents.

In the past three years, 20 couples have commissioned other women to carry their pregnancy for them at Nairobi IVF Centre, one of the clinics offering this service.

Secrecy and reservations

Statistics from the clinic show that close to 30 babies have been born by surrogate hosts during that period.

Last year alone, seven couples sought the services of surrogate hosts, signalling a growing acceptance of the practice. In a country where surrogacy is treated with a lot of secrecy and reservations, this is quite a high number.

It is also instructive that these statistics are from just one clinic, which also happens to be among the most successful in East and Central Africa, having delivered 700 test tube babies by the end of last year.

The clinic enjoys a success rate of 48 per cent, far above the 2011 global average of 36 per cent, according to the European Society of Human Reproductive and Embryology.

"It is amazing and encouraging to see couples who had been condemned to childlessness agreeing to have someone else carry and give birth to their child, something that was unheard of in the past," says the director of Nairobi IVF Centre, Dr Joshua Noreh.

Dr Joshua Noreh of Nairobi IVF Centre. FILE

And it was not an easy decision for surrogate host Vivian either. Her family and partner completely rejected the idea at first. However, after months of discussion, her partner eventually agreed.

She and the couple then made arrangements to rent a house for her and how her daily needs would be met for the nine months she would be pregnant.

An agreement was also drawn up stipulating the fee and that she would hand over the baby to the couple in the delivery room.

The fee would be paid in four installments — when she started the procedure, after the first and second trimesters, and the final payment being made after delivery and handover of the baby.

With all the details settled, the couple and Vivian went to the doctor. "We just told the doctor we were friends and did not disclose further details," says Vivian.

The in vitro fertilisation (IVF) procedure was done and the embryo transferred into Vivian's womb.

Left for 'Sudan'

When she was four months pregnant and the signs were becoming visible, she left home, telling family and friends that she had found a job in Sudan.

For seven months, her family assumed she was in the neighbouring country.

"This was the most difficult time of my life especially being away from my children. But I had to do it because I really needed the money," she says.

Vivian recalls how the couple monitored her on a daily basis. "They were so concerned that they would call me twice a day to find out how I was doing," she says with a broad smile.

One week to delivery, she was admitted to hospital. "Immediately I delivered, the baby was given to its parents. I did not even see her (the baby)."

They in turn paid her the final installment. Two months later, she went back to her family, having "spent 11 months in Sudan".

Up to date her family has no idea what happened. She says this will remain a secret because society is yet to accept surrogacy. "They see it as a very strange thing," she says.

Says Dr Noreh: "Some couples will be open about it, while others are very secretive. For us, our job is to ensure the couple achieves its goal of getting a baby using accepted medical intervention."

Every month, Dr Noreh's clinic, which pioneered IVF in the country, gets at least five inquiries about surrogacy, with some women inquiring how they can be hosts at a fee.

Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person — genetic parent(s).

The procedure is undertaken to help women who cannot have their own children, either due to lack of a uterus, or medical complications. Cancer of the uterus or other illnesses may result in its removal.

The procedure involves the retrieval of eggs from the woman who is unable to carry the baby and fertilising them in a laboratory using the husband's or partner's sperm.

Contractual terms

The resulting embryo is then transferred into the surrogate host's womb to conceive and carry the pregnancy to term.

Once the child is delivered, the surrogate host hands it over to the commissioning couple guided by terms of a contract signed between the two parties.

The increasing interest in surrogacy in Kenya has been triggered by the number of women with a dysfunctional uterus, no uterus at all, or have serious medical complications.

At the Nairobi IVF, close to 30 women who consulted the clinic in the last three years did not have a uterus or had a dysfunctional one.

"While these women qualify to use surrogate hosts to have their own babies, many cannot afford the procedure," says Dr Olegs Tucs, a clinical embryologist.

According to Dr Noreh, the least amount a surrogate host has been paid in the cases he has dealt with is KSh600,000 ($7,240), but in some cases the figure can be as high as KSh1 million ($12,000).

Attitudes towards surrogacy in Kenya are ambivalent. FILE

"We play no role in such negotiations. Ours is to offer treatment once the parties agree on the fee. But we first advise our patients to get relatives or friends who may agree to do it for free," says Dr Noreh.

He adds that they have handled surrogate cases where the host, who is either a sister or friend to the commissioning parents, has agreed to carry the pregnancy cost-free.

Besides the fee, the commissioning couple also meets the rent and subsistence costs of the surrogate host.

Judith Ogeto, who was a surrogate host two years ago, says the commissioning parents used to give her KSh40,000 ($480) every month for rent and subsistence.

They also paid her KSh650,000 ($7,840) for carrying the pregnancy to full term. The commissioning couple also pays KSh300,000 ($3,620) IVF fees and meets the hospital costs where the surrogate host will deliver the baby.

Other obstacles

In total, commissioning parents require a minimum of KSh1.5 million ($18,000) to manage a surrogacy arrangement.

In addition to finances, there are other obstacles the commissioning couples have to overcome. For increased chances of success, the surrogate host has to have had children before.

At Nairobi IVF Centre, married women and single mothers are the main surrogate hosts. Problems, however, sometimes arise where the woman is married. Her husband has to be involved from the onset.

"He is informed that the wife is going to carry a baby that is not theirs and the strict conditions he has to abide by before and during that pregnancy," says Dr Noreh.

Some of the conditions include giving up the baby immediately it is born, avoiding sex for the first two months from the time the surrogate host gets the embryo, and not engaging in anything that may endanger the life and health of the baby.

The surrogate host or her husband is not allowed to make any future claims on the baby, thus the requirement to hand over the baby immediately to avoid bonding.
To ensure the surrogate host and the husband abide by these conditions, a contract is prepared and signed by the surrogate host and husband and the commissioning parents.

While the cost of the surrogacy arrangement is high, the number of couples who need the service, but cannot afford it, is rising.

Not for convenience

At the Nairobi IVF Centre, nine women who were seen in the past one year did not have a uterus. One of them was born without it.

The latter case happens due to a chromosomal abnormality where a woman inherits only one of the X chromosomes instead of two.

"The other missing X is in most cases manifested in the lack of a uterus or other abnormalities," says Dr Tucs.

For other women, a dysfunctional uterus caused by fibroids which are difficult to treat or other diseases, makes it difficult for them to carry a pregnancy.

But there are also cases where women with a normal uterus may have to rely on surrogacy to have children.

A woman with a heart disease or other medical condition which might be complicated by the pregnancy leading to death also qualifies for surrogacy.

But Dr Noreh warns that surrogacy is not a procedure of convenience especially for those women who might opt for it because they fear carrying a pregnancy.

Although there have been questions that the surrogate host may influence the behaviour and character of the child, Dr Noreh says this is not true.

"There is nothing transferable to the foetus from the surrogate host. Only nutrition and oxygen is what the host conveys to the baby. The rest is the genetic material of the commission parents," he says.

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