Surrogate mothers are seen at Kaival Hospital in Anand, India. The small clinic at Kaival Hospital matches infertile couples with local women; more than 40 babies have already been born and about 50 pregnancies are now in progress.

Anand, India ? Every night in this quiet western Indian city, 15 pregnant women prepare for sleep in the spacious house they share, ascending the stairs in a procession of ballooned bellies, to bedrooms that become a landscape of soft hills.

A team of maids, cooks and doctors looks after the women, whose pregnancies would be unusual anywhere else but are common here. The young mothers of Anand, a place famous for its milk, are pregnant with the children of infertile couples from around the world.

The small clinic at Kaival Hospital matches infertile couples with local women, cares for the women during pregnancy and delivery, and counsels them afterward. Anand’s surrogate mothers, pioneers in the growing field of outsourced pregnancies, have given birth to roughly 40 babies.

More than 50 women in this city are now pregnant with the children of couples from the United States, Taiwan, Britain and beyond. The women earn more than many would make in 15 years.

But the program raises a host of uncomfortable questions that touch on morals and modern science, exploitation and globalization, and that most natural of desires: to have a family.

Dr. Nayna Patel, the woman behind Anand’s baby boom, defends her work as meaningful for everyone involved.

“There is this one woman who desperately needs a baby and cannot have her own child without the help of a surrogate. And at the other end there is this woman who badly wants to help her (own) family,” Patel said.

“If this female wants to help the other one … why not allow that? … It’s not for any bad cause. They’re helping one another to have a new life in this world.”

‘Wombs for rent’

Experts say commercial surrogacy – or what has been called “wombs for rent” – is growing in India. While no reliable numbers track such pregnancies nationwide, doctors work with surrogates in virtually every major city. The women are impregnated in-vitro with the egg and sperm of couples unable to conceive on their own.

Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment. Experts say it could take off for the same reasons outsourcing in other industries has been successful: a wide labor pool working for relatively low rates.

Critics say the couples are exploiting poor women in India – a country with an alarmingly high maternal death rate – by hiring them at a cut-rate cost to undergo the hardship, pain and risks of labor.

“It raises the factor of baby farms in developing countries,” said Dr. John Lantos of the Center for Practical Bioethics in Kansas City, Mo. “It comes down to questions of voluntariness and risk.”

Patel’s surrogates are aware of the risks because they’ve watched others go through them. Many of the mothers know one another, or are even related. Three sisters have all borne strangers’ children, and their sister-in-law is pregnant with a second surrogate baby. Nearly half the babies have been born to foreign couples while the rest have gone to Indians.

Growing demand

Health experts expect to see more Indian commercial surrogacy programs in coming years. Dr. Indira Hinduja, a prominent fertility specialist who was behind India’s first test-tube baby two decades ago, receives several surrogacy inquiries a month from couples overseas.

“People are accepting it,” said Hinduja. “Earlier they used to be ashamed but now they are becoming more broadminded.”

But if commercial surrogacy keeps growing, some fear it could change from a medical necessity for infertile women to a convenience for the rich.

“You can picture the wealthy couples of the West deciding that pregnancy is just not worth the trouble anymore and the whole industry will be farmed out,” said Lantos.