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Not only do unresolved questions of access to these expensive technologies for the majority in third world countries remain, there are far-reaching implications for economically vulnerable women from these countries who participate in ART programmes. This unequal power equation is present not just in cases of foreign clients but also when the recipient individual or couple is from the third world country in question.

Methodology This paper presents a brief picture of India's fertility industry with specific focus on its ground-level operation, nature and growth. It aims to explore the industry dimensions of ARTs, by highlighting the macro picture of health care markets and medical tourism in India, the proliferation of the ART industry, market features such as the social imperative to mother, costs, promotion and marketing, unverified claims, inflated success rates, deals and offers, actors and collaborations in the field, and finally, the absence of standards.

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This paper presents findings from the research 'Constructing Conceptions: The Mapping of Assisted Reproductive Technologies in India', by Sama, a Delhi-based resource group working on gender, health and rights. Along with exploring issues of access and regulation, a key objective of this research was to investigate the industry aspects of ARTs in India; this included the inter-linkages between ART clinics in metropolitan cities and those in smaller cities and towns, and the process of 'local globalisation'.

The design of the research was essentially exploratory and qualitative, and sought to document experiences and draw general conclusions based on analyses. The mode of primary data collection involved in-depth interviews, participant observation and focus group discussions.

A review of literature, including of promotional materials of clinics, was also undertaken. A team of advisors was instituted to oversee the ethical and methodological aspects of the research. While selecting research sites, a deliberate attempt was made to choose a sample that contained diverse geographical areas with diverse human development indicators, representing different stages of the development of the ART industry in India.

Tools prepared for data collection included informed consent forms in English and local languages , interview schedules, permission letter and field diary. ART providers identified through a mapping exercise were approached directly, and women users were approached through clinics. This research forms a significant part of Sama's ongoing work on women and technologies, particularly policy advocacy regarding the regulation of the ART industry.

In alone, around , foreigners visited India for treatment [ 13 ]. Medical travel expenditure in these five countries is growing at the rate of above 20 per cent every year [ 14 ].

According to Giuseppe Tattara, a professor of economic policy, in recent years, due to profitability, "more and more investors see the health sector as a good proposition" [ 12 ]. The Indian government promotes medical tourism by offering incentives like low interest rates for loans provided to establish hospitals, and subsidized rates for buying drugs, importing equipment, and buying land for clinics. According to the Indian Union Minister for Tourism, for easy access, the Indian government is issuing M medical visas to medical tourists and MX visas to accompanying spouses, which are valid for a year [ 15 ].

India's National Health Policy NHP , states: "To capitalize on the comparative cost advantage enjoyed by domestic health facilities in the secondary and tertiary sectors, NHP strongly encourages the providing of such health services on a payment basis to service seekers from overseas.

The providers of such services to patients from overseas will be encouraged by extending to their earnings in foreign exchange, all fiscal incentives, including the status of 'deemed exports', which are available to other exporters of goods and services" [ 16 ]. Further, the proposed National Health Bill replaces the provisioning obligations of the state with free access to health care.

It thus not only legalises both public private partnerships PPPs and medical tourism, but also promises additional state subsidies to the latter through third party payments [ 17 ].

Moreover, the General Agreement in Trade in Services GATS includes trade in medical services, thus enabling private hospitals treating foreign patients to receive financial incentives; these incentives include the ability to raise capital at low interest rates and eligibility for low import duty on medical equipment [ 18 ].

With the combined advantage of low costs and high quality of medical services, India has emerged as a major medical tourism market. Tattara outlines the push and pull factors that make this possible: "Medical tourists are pulled mainly because of reduced costs, the availability of latest medical technologies and a growing compliance with international quality standards, as well as the fact that foreigners are less likely to face language barriers in India. Whereas the cost of treatment in other developed nations, especially in the US, UK, is very high, India can provide quality healthcare at very low cost due to the availability of relatively cheaper but quality manpower, low-priced drugs and other infrastructure" [ 12 ] As Qadeer and Reddy assert, medical tourism is an industry that draws on cheaper air fares, internet and communication channels in developing countries, as well as hi-tech super-specialty medical services for people who can afford it - whether foreign or national medical tourists [ 17 ].

It also effectively deploys and markets Indian 'exotica', and packages health care with other traditional therapies and treatment methods. Services provided include knee joint replacement, bone marrow transplant, bypass surgery, cosmetic surgery, and hip replacement.

Assisted Reproductive Technologies form the newest major addition to this list. India is also turning into the surrogacy outsourcing capital of the world; commercial surrogacy and egg donor programmes are fast becoming significant services provided by the fertility industry. Anand [a town in the western state of Gujarat] has become the epicentre of the commercial surrogacy industry in India [ 19 ].

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While official statistics on the number of surrogacies being arranged in India are not available, anecdotal evidence suggests a sharp increase. Between and , the number of websites advertising ART more than quadrupled with marketing heavily geared to foreigners[ 20 ]. Similarly, a newspaper article reports that 50 clinics are added every year to the current IVF clinics in the country, and egg donation is on the rise among women aged [ 21 ].

In the absence of a national registry, accurate statistics for the number of infertility clinics, or even surrogacies and ART births in the country are not available. A recent article quoted Dr. Nonetheless, ART clinics are no longer concentrated in the metros and big towns, but are also reaching semi-urban areas that otherwise lack even basic civic amenities and essential health care facilities. The number of ISAR members has shot up from in to over in , which may yet be a conservative estimate [ 23 ].

News reports also point to the increasing numbers of foreign clients at ART clinics, and the aggressive promotion strategies adopted by Indian ART providers [ 24 ]. Like any other market, the ART market also deploys common strategies to generate demand, such as offering packages, schemes, and concessions; inflating success rates; and undertaking aggressive advertising through the use of attractively designed websites, brochures, wall advertisements, street hoardings, bus stop signs, and announcements on local television channels [ 25 ] The industry is functioning through actors and collaborations at various levels, in an environment where the lack of binding standards or regulation is giving rise to medical malpractice and ethical concerns.

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The Logic of Demand and Supply: What women want? The predominantly private ART industry is characterized by market rhetoric and the language of demand and supply, and takes advantage of the prevailing ideology of patriarchy in society, as well as a collapsing public health system to promote itself. ART providers argue that with infertility "rampant and rising steadily" today, ARTs have become the "need of the hour".

They cite higher rates of infections and ensuing complications, particularly in the absence of adequate gynaecological and obstetric services, as factors that contribute to the high infertility in India. Providers thus claim that they are merely responding to the demand of women "desperate" to become mothers [ 26 ]. There is an increasing medicalisation and pathologisation of the condition of infertility, with the industry pushing for early medical intervention.

It is not surprising to find that women bear a disproportionate burden of the blame for infertility, including in cases of male factor infertility. Many women internalise this burden. In the event of childlessness, women are routinely harassed mentally and physically, directly and indirectly, by the community and the family , denied their rightful share in the family's ancestral property, and even abandoned by their husbands [ 27 ].

As such, ART providers label these technologies 'pro-women', and as expanding women's reproductive choices. They claim ART is a 'gender-sensitive' technology, and alleviates the suffering that infertile women have to otherwise experience. The images, language, and slogans used to promote ARTs serve to reinforce the 'tragedy' of childlessness and the sentimentality of childbearing, particularly motherhood, while deliberately ignoring, omitting, or playing down the concerns and complications that come with medical intervention, such as side-effects, efficacy, and costs.

While ARTs may 'deliver' women from the social pressure to be mothers, they do not question or challenge this pressure. Further, given the culture of son preference that prevails in Indian society, and India's abysmally low child sex ratio, ARTs raise the fear that the unethical and discriminatory practice of sex selective abortion may be promoted through these technologies [ 26 ].

Besides, Indian doctors have a good reputation as being highly competent and compassionate. Undergoing ART procedures involves many hidden costs, such as drugs, travel to the clinic, accommodation near the clinic, loss of work or wages due to repeated clinic visits, etc.

When doctors quote treatment prices to users, these costs are often omitted. Nonetheless, despite hidden costs, which could be quite high, the research sample consisted of users from different classes, with several who were willing to push the limits of what they could afford in their quest for a biologically related child. While the amount of space dedicated to this varies, almost all the websites try to seek 'clients' from abroad through promotion of 'medical tourism packages' and incentives, such as discounts and deals on services provided.

These generally combine boarding, lodging and other facilities for enjoying the local tourist attractions alongside the ART 'treatment' schedules.

Clinics in metropolitan cities like Delhi and Mumbai, where there is large influx of foreign couples and individuals for various ART services, offer IVF cycles in packages that include excursions to nearby tourist attractions like the Taj Mahal, Jaipur palaces, spas in Goa or Kerala etc [ 25 ].

The procedure of IVF does not need any hospitalization it is a day care procedure. You have to visit our clinic for only consultation or Scan or for procedure and that takes not so much of time.

The total Stay at Delhi will be around 15 to 20 days for a cycle. For stay in Delhi you can contact our Travel Agent All types of accommodation facilities can be managed from budget to Five Star Category, it's depend on your Budget. This Book have some digital formats such us :paperbook, ebook, kindle, epub, fb2 and another formats.

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