review: SFIAAFF 29 “Made in India” a new documentary screening this weekend shows that outsourcing your pregnancy to India is cheap but delivers a heavy bundle of issues

As “Made in India “ opens, 40 year old Lisa Switzer tells us that she, like many women, defines herself by her ability to have children.  Sadly, she and her husband, Brian, have tried all the latest technologies but she cannot carry a baby in her uterus due to polycystic ovarian syndrome (PCOS) and complex endometrial hyperplasia.  Desperate for a child, they have put up their home and are going to gamble it all on having a baby through a surrogate in India.  Infertile American couples on average pay $110,000 for a domestic surrogacy while the cost in India is roughly $25,000 including clinic charges, lawyer’s bills, travel and lodging and the surrogate’s fee.  Surrogacy outsourced to India has become such an attractive option to couples unable to have their own children that it has spawned an entire industry in procreative or reproductive tourism, valued at more than $450 million in India. And that industry has a bundle of ethical, legal, moral/human rights attached to, making it all the more attractive to filmmakers who have the mettle to really dig into it.

In "Made in India," a documentary about procreative tourism, 40 year old Liza Switzer has tried to get pregnant for 7 years run out of options and decides to outsource her pregnacy to a surrogate in India who will be implanted with embryos created from her own eggs fertilized by her husbands sperm. Photo: courtesy Rebecca Haimowitz

Enter Rebecca Haimowitz (American) and Vaishali Sinha (Indian), two accomplished and determined women, whose feature-length documentary Made in India is of the best explorations of the subject to date.  Made in India film follows the white and middle-class Switzers, who live in the suburbs in Texas on a journey that leads them to India and to Aasia, the Indian surrogate who will gestate their baby to term.  

As the editor of many articles on adoption, I wondered why the Switzers, who had exhausted practically all their options, would not consider adoption.  Lisa Switzer answers straight out that they feel they need a child that carries their own genetic imprint and will settle for nothing less. Still, after 7 years of trying to conceive and carry a child, there is nothing to show for their emotional heartache and depleted finances.  Lisa’s desperation is palpable and her husband’s desire to fulfill her non-negotiable wish has been taxing and he speaks candidly about what they have gone through.  

After searching the Internet, Lisa finds Planet Hospital, a Los Angeles-based organization that serves as a third-party facilitator, outsourcing medical practices abroad to 38 hospitals in 13 countries.  She speaks with CEO, Rudy Rupak, who operates out of what appears to be an office he rents on a daily basis and learns that she and her husband will pay about $25,000 by using an Indian surrogate.  They will not be able to choose or to meet the surrogate and will have to travel to Mumbai to the Rotunda Clinic for egg extraction which is also cheaper and expedited.  Rudy explains that in the interest of efficiency, Lisa will arrive in Mumbai when she is at the appropriate time in her cycle and she will be matched with an Indian surrogate who is ready to accept the embryo for imlantation.  Later, they will return to pick up their baby.  Listening to Rupak speak, you get the immediate sense that the Switzers, like many couples, represent a business opportunity to be seized and mined.

In "Made in India," Assia, who is married with two children of her own, becomes a surrogate for Americans Brian and Liza Switzer. They are told she will receive $7,000 and she is told she will receive $2,000. Photo: courtesy Rebecca Haimowitz

Haimowitz and Sinha act as fly-on-the wall documentarians, capturing the moment by moment complexities of organizing this from Lisa’s perspective and from the perspective of Aasia, the surrogate.  Aasia is a poor, illiterate young woman who is married and already has two young children of her own.  She and her husband live in the slums of Mumbai and his work as a mechanic has been threatened by all the new cars on the market.   Her motivation for this is purely financial.  When her sister-in-law tells her about this opportunity, she too jumps on it and speaks of what it will mean to be able to save some money to better the lives of her children, especially her daughter.  

The film unfolds in real time and does an excellent job of covering the emotional roller-coaster of surrogacy for the parents as well as for the surrogate, who must agree to relinquish the baby at birth, and her family.  Aasia must also convince her husband to sign papers that agree to the surrogacy, no easy task in a society where a women’s value is largely derived from her purity.  At first, the Indian couple is not even aware that conception can occur via embryo implantation and that intercourse is not necessary.  Aasia explains the procedure to her husband but not risking his refusal, doesn’t explain fully the papers he is signing.  As her pregnancy becomes visible, she concocts a cover story for the neighborhood—she is doing this for her sister (fabricated) who is unable to conceive and will give the baby to her.  

"Made in India" explores the cost efficiency of surrogacy in India and the booming reproductive tourism industry. Here, at the Rotunda Lab, in Mumbai, a technician is preparing Lisa Switzers freshly harvested eggs for fertilization and implantation into the Aasia, the Indian surrogate who will Lisa and Brian Switzers baby to term. Photo: courtesy Rebecca Haimowitz

While there are many opportunities for the filmmakers to insert strong bias unto this film, Haimowitz and Sinha do an excellent job of remaining as editorially neutral as possible recognizing that the Switzers are desperate for a child, Aasia is desperate for money, Planet Hospital is doing this for profit and in India every single person along the way is expecting slice of the action.  As might be expected, the “truth” about who gets paid what is muddled and it becomes apparent very early that the Switzers are being told that the surrogate will get $7,000 while Aasia is told she will get $2,000.   The filmmakers, who know what is happening to both parties, do an excellent, and what must have been ethically grueling, job of letting the story unfold.   

Made in India also explores the complex ethical issues involved in international surrogacy through brief conversations with well-versed experts.  In all, the film sensitively explores the emotional and financial desperation that is driving this industry in India and some measures that are currently under consideration in India to regulate surrogacy and offer some protection to both surrogates and foreign couples.  The most immediate and glaring risk is the medical risk to the surrogate which in this case seems responsibly minimalized through regular medical check-ups, the opportunity to live in a maternity home with other surrgoates, a hopsital delivery, and post-natal attention.  This is not always the case and all sorts of disasters have been reported in the media.   We are left to imagine what might happen if she miscarries–is she compensated at all?  or if the pregnancy or delivery results in some permanent impairment, how is she cared for long-term?  

The film also makes it very clear that the risk is not all born by the surrogate.  The parents can face hurdles with obtaining birth certificates that name them as the parents, as well when medical complications arise before, during and after birth.  In the end though, for families like the Switzers, having a baby made in India has been an unexpected but worthwhile path to parenthood.  And for the surrogate, the money earned even from a grossly unbalanced exchange, is a windfall that would not otherwise be available.   This film is a must-see for those contemplating international surrogacy.    

Made in India: (2010, 97 minutes)  Directors/ Producers: Rebecca Haimowitz and Vaishali Sinha, Cinematographers: Adri Thakur, Basia Winograd, Rebecca Haimowitz, and Vaishali Sinha, Editor: Myles Kane, Music: Amrtha Vaz. Made in India was supported in part by Chicken & Egg Pictures, Center for Asian American Media, The Fledgling Fund, Gucci Tribeca Documentary Fund, New York State Council on the Arts, The Playboy Foundation and other generous donors/foundations.   

Details:  Made in India is part of the 29th annual San Francisco International Asian American Film Festival (SFIAAFF) sponsored by the Center for Asian American Media (CAAM), San Francisco.   Screens— SUN 3.13 (6 PM, Sundance Kabuki Cinemas, San Francisco), WED 3.16 (6:45 PM, Sundance Kabuki Cinemas, San Francisco), SAT 3.19 (6 PM, Camera 12 Cinemas, San Jose).  General Admission Tickets: $12 available online at and in person on day of show for cash at the venue before the screening.  Advance sales tickets are available in person only at Sundance Kabuki Cinemas until March 17.   A limited number of rush tickets will be available for each screening after advance sales tickets are sold out.  The line for rush tickets will form about one hour before show time outside the theatre.  No rush tickets for PFA screenings.