Nepal´s returned HIV positive women face sad plight

Dewali Festival, Kathmandu, Nepal

Image via Wikipedia

By Surya B. Prasai
February 15, 2008

In dusty Raxaul south of Kathmandu, on a pale, cold winter´s morning the plight of a young Nepali woman being trafficked to India for the commercial sex sector is just beginning to unfurl. Sarswoti, from Dhading district bordering Nepal´s capital, Kathamndu, has been brought here promised of a lucrative job by Tirtha Ram a middleman, who actually is her first cousin. He has lured her with promises of posh South Extension flat in New Delhi´s well to do neighborhood, and many of Sarswoti’s friends and cousins have left for India earlier attracted by such promises. Tirtha´s narrated story to her parents is all too believable for Sarswoti, whose life all depends on her parent´s wishes as in most parts of Nepal where a woman has little individual rights particularly if she is uneducated. Tirtha has told them that that the Indian owner for whom Sarswati is going to work is in the Gulf region, she is going to be paid Rs. 3000 (US%5) for every month she has served. Sarswoti will get free accommodation, food, and be able to roam freely on weekends to go and watch the movies in the big eye catching Indian cosmopolitan city of New Delhi with new friends she will soon make once there. It is only when Sarswoti travels further south down the narrow dusty bus lane and reaches Gorakhpur she suddenly realizes that things are not as Tirtha Ram had promised. Tirtha has already left the day before making a clever alibi that he has to go and make a phone call to his wife in Nepal. Soon an unknown woman enters the small little dingy room she has been kept in. The woman tells Sarswoti that she is pretty, young, very fair and good looking. She is going to adopt her as her daughter; Tirtha has already gone back to the Indo-Nepalese border to get another group of women across to Gorakhpur.

At first this Indian ´guardian´ mother of Nepalese descent drugs Sarswoti and locks her up in a room for three days without food and only a sip of water. When Sarswoti protests, she starts cursing her, and soon physically punishing her. In a week´s time, Sarswoti is gang raped, intimidated with cigarettes, burning charcoal heaped on her arms and thighs, left hungry with bruises all over her body, with no one to complain to, in total misery and no one to help her out. Meanwhile her parents in Dhading seem all too happy with Tirtha for giving them Rs. 18,000 equivalent, or roughly US $280 for Sarswoti as a salary advancement.

From Nepal, anywhere between 10,000 to 15,000 women have been trafficked this way to India to serve as commercial sex workers in like manner. The major conduits are the infamous Makwanpur alley, Birtamod in the Eastern Region and Nepalgunj in the Far Western region. The Nepali girls and young women aged between 12-29 years old are sold through Nepalese and Indian commercial sex agents finally ending up in the sex outlets in bigger Indian cities such as Mumbai, New Delhi, Bangalore and Kolkata involving nearly three to four middlemen like Tirtha Ram.

Most girls who are impoverished in poverty until the ages of 12-16 years are booked in advance by their parents for as little as US $200 to the agents, the prettier girls fetch between US $300-400 according to reports from independent Nepalese survey on child and women trafficking and organizations such as Asia Foundation and Human Rights Watch Asia which have stepped in the forefront of trying to stop the crime.

Usually, the girls are transported in a group of 10-15 across the porous border to the various Indian cities. This is happening every day as Ind0-Nepalese border is a porous one and has been serving child traffickers for nearly one a half decades now with few interruptions. Also, in the absence of a strong government in Kathmandu, due to the failing policies of the seven party coalitions that rules Nepal at present; even the gravest crime goes unpunished.

For more than a decade, some of Nepal´s top legal experts have been drawing the UN and the world´s attention to the child trafficking issue occurring between India and Nepal. Well known Nepalese legal eagles such as Dr. Shanta Thapaliya, Shambu Thapa (former Chairman of Nepal Bar Association), and Sapana Pradhan Malla who all are child rights advocates, Believe the Constitution of Nepal has guaranteed the right of equality to women including property and self-development rights, but offers very little practicing equality. Mr. Gauri Pradhan who has been running CWIM for more than three decades in Kathmandu, dedicated to Child Welfare and education of street children also is in agreement that child rights has been perhaps forgotten as core area of understanding in Nepalese human rights practice.

The Nepalese Constitution has also accorded childhood freedoms to every Nepali girl child since Nepal was one of the first countries to sign the Convention on the Rights of him Child, 1990, but the real achievement in realizing child rights in Nepal is next to nil, despite the claims of various international agencies. The truth, according to the Harvard educated Dr. Thapaliya. In a recent anti trafficking report appears to be that in Nepal women have long been discriminated upon when they are known to contribute to nearly 60% of the country´s Gross Development Product. The government has simply been turning a blind eye to the issue of women trafficking and child prostitution. Thus many legal voices in Nepal and also many powerful NGO leaders in India are now jointly trying to coordinate efforts and draw on the ethical argument that children should be given all the time until age 16 to enjoy their childhood freedoms, while the traffickers should be punished severely with imprisonment, not only meager fines.

Nepal, which had faced an internal civil conflict between 1986-2006, has seen a big stream of its children, particularly in Western Nepal, facing commercial exploitation through middle men in being transported to brothels in various Indian cities. Not only have these young girls ended up in Indian circuses and households as bonded servants, many have ended up working as life long commercial sex workers. Some graduate in a decade or two to become brothel owners themselves, employing between 7 to a dozen young Nepalese females in each commercial sex venue.

In 2007, various Indian and Nepalese estimates put the total number of Nepalese commercial sex workers in India at around 200,000 to 300,000, though this is considered a low estimate. Nearly half of the women in Mumbai, who ply commercial sex work totaling 120,000, are estimated to be Nepalese, a cording to various ILO estimates. The women are not only subjugated to various forms of torture, gang rape and different sexual acts, they face the risk of contracting HIV/AIDS openly.

According to recent available posted on BBC, HIV infection may have increased by more than 100 percent among Nepalese women and by 200 percent among children in the past 18 months. This has also been substantiated by several NGO officials working to bring relief to the Nepalese women in Mumbai and Bangalore. Nearly 18% of the customers also happen to be migrant Nepalese workers in India close to the cities who visit the brothels on weekends. The Nepalese government´s National Center for AIDS/STI Control publishes figures regularly on the number of HIV/AIDS case occurring in Nepal. But these figures are considered diminutive based on the actual number infected, particularly those forced to return to Nepal from Mumbai, New Delhi and Kolkata after contracting HIV/AIDS. For instance, the Nepal Government released figures that nearly 2200 housewives were infected with HIV in 2007, but the figure could be more as there is stigma and discrimination attached to revealing one´s HIV status in Nepalese society and this does not include the HIV/AIDS infected women who have been returned from Indian brothels. This is a serious problem that is also not reflected accurately in the various sentinel surveys on cross border sex trafficking between Nepal and India. The Nepalese government states that the number of children infected with HIV reached 428 from 138 in 2005, but the actual reality is, more than 2,500 known infections are recorded in various hospitals and clinics throughout Nepal in the same period.

The alarming fact is that among the Nepali women trafficked to India and forced into the sex trade, nearly 40 percent of them were HIV positive by the time they were repatriated, US researchers have verified. Human Rights Watch has published an explicit report outlining the plight of Nepalese women who have been trafficked to India and exploited for commercial sex work there and abroad. The main cause of this inhuman crime seems to be the impoverishment of Nepalese women which forces their parents to marry them off to middle agents or else to sell them off for the remaining families´ survival at an early age.

Another finding coming from a small study of 287 Nepalese women who found their way home after years of sex slavery in India’s brothels, underscored the challenge facing public health authorities as they battled to contain India’s HIV epidemic and prevent it from spreading throughout the region. Nearly 90% of them were infected with HIV, far more than the 40% figure guess estimated by various international media channels! According to Jay Silverman, Associate Professor of Society, Human Development, and Health at Harvard School of Public Health speaking to the BBC recently, “The high rates of HIV we have documented support concerns that sex trafficking may be a significant factor in both maintaining the HIV epidemic in India and in the expansion of this epidemic to its lower-prevalence neighbors.”

India already has 2.3 million people living with HIV/AIDS, more than any other country in the world except South Africa and Nigeria, and is also a major hub for sex workers from across the region, such as Nepal and Bangladesh. Lacking formal employment, the tide of poor Nepalese women willing to provide these services seems to go unchecked.

Currently Nepal is rehabilitating itself after an 11 year old civil conflict that left nearly 13,600 people dead. However with the current national infection numbers hovering anywhere between 80,000 to 120,000 more than 17,000 are expected to die each year throughout the coming decade due to HIV/AIDS related infections. Nepal earlier had traditionally very low rates of HIV/AIDS infection at less than 300 per 100,000 but now it cannot be sure it will remain the same for the rest of this decade. Many returning commercial sex workers sent back from various Indian cities in turn marry back into their villages, whether projected government figures are accurate or belie the truth. Many of the women are also giving birth to HIV infected children and continue engaging in commercial sex work in Kathmandu, Biratnagar, Janakpur, Pokhra, Nepalgunj, Bhairawa and Birtamod among major townships.

Both the World Bank and UNAIDS officials have warned that the cross-border sex trade presents a potential public health threat to Nepal, although there has been very little data or action to show what’s happening on the ground. This all paints a highly disturbing picture of young women and girls being forcibly introduced to commercial sex work outside of Nepal with high rate of HIV infections, and many dying of AIDS.

It is important for donors and international non profit institutions working in Nepal and helping the Nepalese overcome the post-conflict rehabilitation efforts to understand the depth of this problem. An increase of HIV infections burdens not only society, but develops astronomic health expenditure in their care and support, something a poor country like Nepal cannot afford. Thus, trafficking of women and children to India and South Asia from Nepal has fuelled in a very dangerous HIV/AIDS prevalence scenario throughout the South Asian continent, where the women infected with HIV have to bear a sad plight of being left untended and uncared for.

USAID has pointed out that poverty is still the fundamental problem that underlies all trafficking in Nepal. Due to the prevailing poverty, most Nepalese girls are illiterate and easily lured by the tiny attractions of work, higher salaries, easy life, and promises of a foreign job. This is now beginning to take its toll on the Nepalese women´s lives eventually having to face the threat of carrying HIV infections in working in India. This creates a larger problem of HIV spreading more rapidly through Nepalese society, where efforts at HIV/AIDS impact mitigation show a lack of concrete national planning and realization on the need to do something more urgently.

In fact, both the governments of India and Nepal have strong legal guarantees against the trafficking of women and young girls and even consider it a heinous crime. Both governments have signed most of the international statutes that deal with halting global trafficking of human beings particularly the UN, ILO and other abiding international treaties. Both governments recognize that this form of trafficking is slavery and serfdom, in short, another form of forced labor as during the Second World War. International donors have even put conditions on Nepal, since it is a party to various international legal instruments to put in concrete efforts to halt the trafficking of Nepalese women and young children in promises of more aid and assistance, but it is the scrupulous middlemen and not government that is the main problem here. It is nevertheless a moral obligation of the Nepal Government to adopt all necessary and effective measures to stop these cross-border activities.

Outsourcing Babies

Human oocyte with surrounding granulosa cells

Image via Wikipedia

Outsourcing babies!
Deccan Herald / Feb 16,2008

There is a growing demand for Indian surrogate babies from foreigners but there is a lack of a legal framework to deal with surrogacy, paving the way for unscrupulous middlemen who push uneducated and poor women into surrogate motherhood, says Neeta Lal

After years of trying and treatment, US-based couple Jason and Nancy are finally proud parents of a healthy baby girl. And their tiny bundle of joy, Tara, was delivered for them by Ashaben through a surrogacy arrangement at Kaival Hospital in Gujarat. An Israeli gay couple experienced similar joy when, at Mumbai‘s Hiranandani Hospital last September, they ‘fathered’ twins through a surrogacy programme.

Noted fertility expert Dr Indira Hinduja describes surrogacy as one of the well-accepted methods of assisted reproduction that benefits patients who can’t conceive or carry a pregnancy to term. Of late, there has been a growing demand for Indian surrogate babies from foreigners, infertile couples in India and even single mothers — making the country a preferred destination for such a service. As per the Indian Council for Medical Research (ICMR) estimates, due to the upward spiral in the number of surrogacy cases, the reproductive sector in India is expected to rake in a whopping US $ six billion this year.

“After IT services,” opines Dr Nisha Kathuria, a Delhi-based gynaecologist/obstetrician, “it’s now the turn of babies to be outsourced from India. In these times of globalisation and market-driven economies, there’s considerable demand for this service.”

Low medical costs

Indeed. And fuelling the demand is a slew of factors, including low medical costs and a competent workforce. According to Dr Anoop Gupta, Medical Director, Delhi IVF and Fertility Research Centre, the total cost of renting a womb in India works out to around US$10,000 as compared to about US$50,000 in the West. In the US, states the expert, surrogate mothers are typically paid US$15,000, while the agencies claim another US$30,000. In India, however, fertility clinics charge in the realm of US$2,000 to US$3,000 for the procedure, whereas a surrogate is paid anything between US$3,000 and US$6,000 — a fortune in a country where the average annual per capita income is US$500.

But, despite the demand, surrogacy has its share of critics in India due to the moral, legal and ethical debate that swirls around it. Opines lawyer/activist Preeti Katyar, “If surrogacy becomes an avenue by which women in richer countries choose poorer women in our country to bear their babies, then it is economic exploitation, a kind of biological colonisation.”

A factor that has contributed to the negative feeling is the lack of a definitive legal framework to deal with surrogacy and related issues. While commercial surrogacy is banned in many countries — including Italy, Australia, Spain and China — and permitted with restrictions in the US, France and Germany, the Indian government is yet to formulate any laws. In fact, the only guidelines, which regulate surrogacy — and the clinics that provide ART (Assisted Reproductive Techniques) — are the ones framed by the ICMR and the Ministry of Health and Family Welfare in 2005. But these, point out experts, are nebulous and patient and doctor-unfriendly. For instance, Section 3.10 of the ICMR guideline states, “No relative or person known to the couple may act as a surrogate.” This, experts believe, is ludicrous as it propels childless couples needlessly towards commercial surrogacy. In fact, in-vitro fertilisation (IVF) experts say that in 90 per cent of the surrogacy cases in India, the mother is related to the childless couple while only in five per cent cases, the surrogacy is altruistic and in the remaining five per cent, commercial. So, infertile couples are forced to think twice before going in for it due to the costs involved, which is unfortunate as India is home to 14 per cent of the world’s estimated 80 million infertile couples.

Legal ambiguity

Then there is ambiguity about a surrogate mother’s rights. Delhi-based lawyer Rita Row says, “The guidelines are skewed and thoughtless. There’s very little to protect the interests of the surrogate mothers.” The guidelines state that “a surrogate should be younger than 45 years” without mentioning the minimum age. So does that mean an 18-year-old, or someone even younger, can become a surrogate mother?

Also, what happens after the baby is born? “The biggest problem,” explains Dr Gupta, “arises after the baby’s birth. Foreigners are unable to get legal assistance when it comes to taking the child back home.” According to the ICMR guidelines, a child born through surrogacy “must be adopted by the genetic (biological) parents unless they can establish through genetic (DNA) fingerprinting that the child is theirs.” Ergo, the only option left open to them is to ‘adopt’ the baby — which is a very lengthy and cumbersome process in India.


The regulations don’t provide legal protection to Indian parents, either. The only legal recognition of the child’s parentage is the birth certificate, and it’s only the birth mother’s name that can be used for this purpose. Consequently, if the birth mother decides not to hand over the baby after birth, there’s nothing the intending parents or the doctor can do about it.

Unsurprisingly, with such ambiguous regulations in place, surrogacy in India has become a dangerous playing field for unscrupulous middlemen who entice and push uneducated and poor women into surrogate motherhood. This practice also encourages the misuse of a surrogate child for terrorism, prostitution or unethical genetic engineering research.

India can take a few pointers from the US, which has strict regulations in place — the law there mandates that surrogate agreements be meticulously drawn out to delineate the responsibilities of intending parents as well as the surrogate. “But in India,” says Dr Kathuria, “surrogacy has a high potential for abuse as the monetary stakes are high.” Admits Dr Raman Prakash, a Mumbai-based psychologist who also counsels commissioning parents and surrogate mothers, “When anything is influenced by economics, there’s invariably a dark side to it.”

No awareness

Experts believe that the basic problem is that people are not well informed about surrogacy and its related issues. For example, a surrogate’s health is not given due priority. Fertility doctors are allowed to implant up to six embryos in a donor’s womb — in other countries it’s limited to three — which creates the risk of multiple pregnancies and can lead to severe complications, stillbirth or even the surrogate’s death.

In many cases, the surrogacy option is used even when it is not necessary. “Sometimes patients have had repeated IVF failures or recurrent miscarriages,” says Dr Kathuria. “Usually, a simple egg donation is enough rather than a more complicated surrogacy option.”

Doctors agree that a mass awareness campaign is key to making the treatment more accessible to all. Many sensitive, surrogacy-related issues too, need to be tackled. As Dr Asha Jaipuria, a social activist and NGO worker puts it, “Who ensures that the woman’s unused eggs or embryos are not harvested/stored and then sold to couples who want fair-skinned children? Or to couples who don’t have viable eggs/sperms?”

Moreover, some questions need urgent answers, such as: what happens if the surrogate dies during childbirth, is there due compensation for her motherless children in that case; and what about the postpartum psychological and emotional support for poor women surrogates?

There’s also the issue of money. As the treatment is expensive, there should be a regular audit to oversee the funds distribution to the surrogates. It’s time the government seriously considers enacting a law to regulate surrogacy and related IVF/ART technologies in India to protect and guide couples going in for such an option. Without a foolproof legal framework, patients will invariably be misled and the surrogates exploited.

Women’s Feature Service

Kids Sold as Donors ?

Kids sold as donors?
Provided by: Sun Media
Feb. 15, 2008

Organ brokers prey on the ‘socially marginalized, desperate, disabled or young’

VIENNA, Austria — Are children being adopted for organ transplants? suggests just that, leaving UN officials wondering whether the so-called adoption agency is a hoax or another unnerving layer to the ever-growing human trafficking industry of organ transplants.

The web site, which surfaced at a discussion yesterday about organ trafficking during the second day of the UN’s global forum to fight human trafficking, claims to be a Kentucky-based adoption agency that sells parents the “perfect match … for the transplant of one or more of ‘non-essential’ organs to be donated to one of the adopting parents or your own children.”
At first glance, the findings are shocking: Children priced according to their category — platinum, gold, bronze or onyx, with first world children listed as platinum and third-world as onyx.

“Your new child will give of themselves the same love you will give unto them,” the web site says.

But upon closer analysis, the phone number given cannot be reached and the address — the same listed for other companies online — cannot be located on a map.

“It’s not beyond the realm of the possible that you could adopt a child and also use a child as a donor,” California-based Nancy Sheper-Hughes, considered a leading expert of organ trafficking, said in an interview.


“If you have baby markets, you cannot stop people from exposing those children to harm,” the Organs Watch director said. “There could be real instrumental reasons of wanting that child, which could include wanting that child to serve as a donor to an older child.”

Organ trafficking most recently came under fire with the arrest of Brampton resident Dr. Amit Kumar last week, who was dubbed “Dr. Horror” for his alleged ties to a massive organ transplant ring uncovered in India.

Authorities alleged up to 500 kidneys were sold to foreign clients over the last nine years, with some victims being forced at gunpoint to give up a kidney.

Though Canada’s Human Tissue Donation Act prohibits the purchase, sale “or otherwise deal” of any tissue, body or body part for transplants, said Sheper-Hughes: “Canadians turn out to be big buyers of organs, more than North Americans in the United States.”

Despite “serious efforts” by countries to regulate organ transplants and move toward the use of more deceased donors, “the number of illegal transplantations carried out between 2000 and now has increased tremendously,” said Nicole Maric of the U.N. Office on Drug and Crime.

“It’s fuelled by a growing demand and by unscrupulous traffickers and brokers,” Maric said. “While waiting lists for organs in richer countries are becoming longer and longer, it is an irresistible temptation for people selling organs, especially for those living in poverty.”

Since Sheper-Hughes began studying organ trafficking 10 years ago, she has been laughed out of bureaucratic gatherings and called a liar by medical professionals for talking about something that was, a decade ago, “largely seen as a rumour,” she said.

Studies have shown victims — often from Eastern Europe, India, South America and South Africa — are being coerced or forced into selling organs, yet there remains strong resistance to labelling it a serious crime.

“People really say it’s life-saving. It’s a value to society. It’s something that maybe we should regulate rather than prohibit,” said Sheper-Hughes.

The World Health Organization estimates organ trafficking accounts for 10% of annual kidney transplants.

“We conservatively estimate that some 15,000 kidneys are trafficked each year,” said Sheper-Hughes.

The crime lies in the vulnerability of the victims, experts agree. Most are displaced, socially marginalized, desperate, disabled or young and naive.

“The price on this commodity depends on the value of the population,” said Sheper-Hughes.

A kidney “donor” in the U.S. may be promised $35,000, while those in the Philippines are often quoted $1,500 — if they are paid at all.

“It reproduces all of the racial, ethnic, gender inequities in the world,” she said. “It always involves the exploitation of very poor and very desperate people who don’t wake up in the morning and say, ‘I think I’m going to sell a kidney,’ unless someone is there and telling them, ‘I’ve got a way to solve your problems.’ “

“Such payment conveys the idea that some persons lack dignity, that they are mere objects to be used by others,” Dr. Luc Noel of WHO said, adding there is a need for “unprecedented effort” in maximizing deceased organ donations, rather than utilizing living people.


It is a crime that involves everyone from top Mafioso players to respected surgeons, travel agents and independent organ brokers. Like human trafficking for the purposes of forced labour and sexual exploitation, organ trafficking involves networks of perpetrators, corrupt organizations and countless victims who are left stigmatized and ashamed.

“We have to start putting some kind of rationing on organs,” Sheper-Hughes said. “It has become a very special case as though one has a right to transplant, a right to organs, an absolute right.”

“Nothing makes me more angry than people saying to me, ‘I sold an organ because the doctor told me I have one for me and one to sell,'” she said. “Organ sharing among the living should be an exception, not a routine demand.” Let’s start with the dead. Don’t plunge into the bodies of the living.”