In the center of Anand, a sleepy rural town of Gujarat,  is a small clinic that is doing good business. The Akanksha Infertility Clinic , founded by Dr. Nayna Patel, showed up on the radar of international media when in 2003, she orchestrated the surrogacy of a local woman who wanted to “lend” her womb to her U.K.-based daughter. Since then dozens of surrogate pregnancies have been carried out successfully on behalf of foreign couples.

Indian surrogacy is already a $445-million-a-year business.  It isn’t surprising that the market is so big, as the expenses here are only a fraction of what the couples would have to spend in the western world. A surrogate pregnancy can cost around 70,000 USD in the UK or the US, while only 12,000 USD in India.

Doctor Patel’s Clinic has 45 surrogate mothers on its books. Twenty-seven of them are currently pregnant, and each will be paid between $5000 and $7000 — the equivalent to upwards of 10 years’ salary for rural Indians. More than 50 babies have been born at the clinic in the past three years, half of them to Westerners or Indians living overseas.

While the system lends itself to the criticism of being just another form of exploitation of the poor by couples happy to spend only a tenth of what it would cost them back home, it might as well be seen as a form of cooperation. Being a surrogate mother actually gives impoverished women of India an opportunity to build a better future for their kids, by paying for their tuition and buying a new house.

Anand, Gujarat, India – July 2009

Surrogate mothers during their evening prayers. Many of them are Christian and hide the true reason of their journey to their relatives and neighbours fearing their disapproval.

A view of the neighbourhood from the mothers’ house terrace. Women enrolling into the surrogacy programme are often referred to as “carriers”.

Hamza (28) at the surrogate mothers house in Nadiad with her sons. Surrogates spend their pregnancy under strict observation and they are not allowed to leave the house. Visiting relatives are only let in during weekends.

Sejan (20) is one of the youngest ladies ever enrolled by the Akanksha Infertility Clinic founded by Dr.Nayna Patel in Anand. Sejan is 6-months pregnant.

A detail from the inside of the surrogate mothers house in Nadiad.

A daily life scene in Amud, 20 km in the countryside from Anand, one of the villages where the surrogates came from. Poverty and hard labour are the ordinary life conditions women are fleeing.

The lab where the embryos resulting from the eggs and sperm of the parents are developed before being implanted into the surrogate’s womb.

Dr. Nayna doing a baby scan on a surrogate mother at the clinic.

Shreena Patel and her new-born twins. They will be flying to US with her as soon as the DNA test required for expatriation is ready.

Shreena and Manicha in the room where the latter spent her pregnancy. Shreena will soon fly to the US carrying the twins with her, but promises to keep in touch with Manicha as the babies grow up.

Surrogate mothers must agree to cede all the rights on the new-born baby to enroll in the programme.


Massimiliano was born in Genoa, Italy in 1979.

Massimiliano’s photography focuses mainly on humanitarian and social issues, with the firm belief that the photographic image can tell a story and help gaining a better understanding of the world around us.  He believes that photos still retain the ability to touch our souls and inspire us to act against injustice.

He attended the international semester at the Danish School of Journalism in 2006, and the same year his first photo story “Calais: the last dream” won him the Canon Young Photographers Scholarship. Since then he traveled all over Europe and Asia freelancing for Courier International, News Week, Vanity Fair and Time.

In 2009 and 2010 his works have been shortlisted by the Anthropographia humanitarian photography award, and in 2009 they have received an Award of Excellence by the China Press Photo Contest. Massimiliano’s images have been exhibited in Milan, Montreal and New York as well as they have helped Amnesty International, Action Aid and Terre Des Hommes to spread awareness about their projects in underdeveloped countries. In 2010 his work received an honorable mention at the China Press Photo. In 2011 he enlisted among the finalists at the UNICEF Photo of the Year Award. In 2012 his story “Swim for Life” is exhibited by UNICEF during the Fotokina fair in Cologne, Germany.

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