India's new Muslim baby boom

A thriving domestic market for in vitro fertilization has made India the go-to spot for patients from Africa, Afghanistan and beyond.
By Jason Overdorf
(GlobalPost - September 13, 2012)

NEW DELHI, India — Business is booming at Dheerendra Singh's New Delhi-based medical tourism outfit, CureMax. But his biggest client base — Afghanistan — might come as something of a surprise.

“Every month, we do IVF [in vitro fertilization] for around 50 patients from Afghanistan,” Singh said. “They also come for other infertility-related procedures. And in the peak [winter] season [when the weather is more comfortable], we have 60-70 patients a month.”

Afghanistan isn't the half of it. Though infertility is commonly associated with the changing lifestyles of the West — where more and more women are putting off childbirth until their late 30s — India's IVF clinics are testimony that the trend is growing in developing countries and conservative societies as well.

Along with the much-talked-about medical tourist trade from the US and Europe, India is seeing an influx of patients from Muslim countries in Africa and the Middle East, thanks to a thriving, low-cost domestic fertility industry and cultural connections that make India a comfortable place for conservative Muslims, medical tourism professionals say.

More from GlobalPost: Designer babies, with an Indian twist

Statistics aren't readily available on the total number of patients coming to India for fertility treatments from predominantly Muslim countries. But anecdotal evidence from various doctors and other agents like Singh — as well as a thriving business in the Afghan refugee colony in New Delhi — suggests that the phenomenon is significant.

According to India's Outlook magazine, for instance, fertility experts like Dr. Kaberi Banerjee number their patients from places like Iran, Iraq, Uzbekistan and Tanzania in the hundreds. Meanwhile, companies like Care Medical say they see 10-15 foreign patients from Islamic countries every month, according to managing director D. Mahendran.

“Overall, we see [medical tourism] growth of about 15-20 percent annually, and I believe roughty the same kind of number holds for IVF,” said P.R. Ramesh, the chief executive of Aaarex Medical Services, another medical tourism firm. “But we're seeing a larger number of Muslim people than previously, including Muslims from Arabic countries and Muslims from countries like Nigeria and Tanzania and so on.”

Various factors help explain the baby boom. Because of India's massive population, and the cultural importance of bearing children here, private fertility clinics have mushroomed in recent years — until there's an IVF signboard on virtually every street in the upscale neighborhoods of New Delhi.

Reputable clinics offer a high standard of care for a small fraction of the cost of IVF in the West. A typical IVF procedure, for instance, runs to $3,000 in India, compared with $8,000 in the US or Europe, said CureMax's Singh. And patients receive more attention from doctors.

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To regulate fly-by-night outfits that have begun sprouting up, the Indian Council of Medical Research recently drafted regulations and began to crack down.

“Here in India, people take IVF very serious, and they give personalized care,” said Mahendran.

But there are other reasons India is attracting patients from Muslim countries.

Proximity and historical ties link India with Iran, Iraq, Afghanistan and other countries of Central Asia in ways that are impossible for other medical tourism hotspots, like Thailand, to match. Standards of dress and behavior are similar, for instance. And the long dominance ofBollywood movies in the target region means that patients there are comfortable with Indian culture, and, especially in Afghanistan, can often already speak Hindi.

Because fertility treatments can be time consuming, the low cost of living, and the ease of blending in and finding halal meat and other familiar foods, is also a factor. In New Delhi, for instance, CureMax and other medical tourism outfits connect IVF patients with landlords operating serviced apartments in neighborhoods in Lajpat Nagar and Jangpura, which are already home to Afghan refugees who migrated here to escape the fighting at home. By cooking their own meals — and buying Afghani naan from the local shop — they avoid exorbitant hotel costs.

More from India: First comes fraud, then comes marriage

Similarly, certain Iranian and African communities have ties with India that make it a more familiar destination than its competitors.

“India has got a large Muslim population, and there are many communities in Africa which relate very closely to their counterparts in India,” said Aaarex's Ramesh.

“For example, there is a community called the Ithna Asheri community in Tanzania, with strong connections to the same community in India. Many of these communities are Indian in origin. To some extent there are also family links.”

http://www.globalpost.com/dispatch/news/regions/asia-pacific/india/120911/IVF-in-vitro-fertilization-muslim-baby-boom-medical-tourism

India: First comes fraud, then comes marriage

In Punjab, a humble passport officer strikes back against “holiday marriages.”

By Jason Overdorf
(GlobalPost - September 9, 2012)

JALANDHAR, Punjab — Seated in the regional passport office in Jalandhar, a provincial city at the heart of India's breadbasket, 39-year-old Sarabjit Kaur tells a harrowing story.

For more than a decade, she has endured a miserable sham marriage. Soon after she married, her husband fled to the UK. To force her parents to pay an illegal dowry, her in-laws have allegedly beaten her, forced her to do menial chores, denied her food, and cut off the electricity to her room.

At first, Kaur's in-laws refused to acknowledge the birth of their granddaughter at all. Today, having nominally disowned their son, they force Kaur and her daughter, now 10, to live as unwelcome guests in a tiny room, sequestered from the rest of the house.

“I'm not allowed to put my clothes on the wire for drying,” Kaur said. “I'm not allowed to use the water pump. My daughter is not allowed inside the garden for cycling. I'm not allowed to wash my clothes in the washing machine — which has been given by my parents!”

Kaur is one of thousands of women in Punjab who have fallen victim to such marriage scams.

Armed with a passport and a plane ticket, unscrupulous men and their families exploit the value of a green card or foreign work permit to extort exorbitant dowries from their brides. They marry and then flee.

More from India: Is China right about the internet?

They may take on second wives to obtain a virtual slave. Or they may simply make a trip to India for a so-called “holiday marriage” — complete with a big party, lavish gifts, and a week of free sex.

According to India's National Commission for Women, as many as 20,000 brides have not even seen their husbands since their supposed honeymoon.

Recently, however, these women have received a lifeline from an unlikely hero: Passport officer Parneet Singh.

Using an obscure footnote in Indian law, Singh has begun canceling the passports of runaway husbands — forcing them to face the music or go into hiding abroad as illegal aliens. And it's already working.

“We have been able to solve about 60 or 70 cases with this experiment,” said Singh.

More from India: The story of a highway

For decades, the Doaba region of the Punjab — the fertile lands between the Beas and Sutlej rivers — has been known for offering its daughters in marriage to “non-resident Indians” or “NRIs” working in Canada, the UK and the US. Fraud seems nearly as common as love in these arranged unions.

“We have a real problem here in our region. There are 30,000 women [with problem NRI marriages] in Punjab,” said Singh. “NRIs come here, they marry those innocent girls, and they leave for abroad. The girls are mostly from poor backgrounds, and the guys are rich. When they leave this country, they are not bothered. And the girls are left to their fate.”

Out of those 30,000, Singh says some 15,000 come from his region, which comprises four districts: Kapurthala, Jalandhar, Hoshiarpur and SBS Nagar.

For women like Kaur, who is still fighting in court to force her husband to take financial responsibility for their daughter, there was virtually nowhere to go for help. Due to the low status afforded to women in most Indian communities, the police generally side with the husband's family.

India's courts are notoriously slow, and extradition from the US or Canada for murder — much less a marital dispute — is virtually out of the question. And the social stigma associated with being divorced, or even returning home to live with their parents, leaves many women with no choice but to endure.

As Officer Singh discovered, however, where the NRIs' ability to run for foreign shores helped husbands to cheat with impunity, unless they'd been granted foreign citizenship, their freedom and their livelihood depended on their ability to get and maintain a valid Indian passport.

“When the passport is canceled, what are the problems they have? First, if they are in this country, they'll not be able to leave,” Singh said. “Second, if people come to visit their relatives here in India, when they land at the airport their passport is taken by the immigration authorities. Third, suppose a person is staying in Chicago. His passport gets expired. If we have already canceled this passport, he will not be able to get it renewed. He has two choices: either to stay illegally in that country or to come back.”

For most men, that creates a huge incentive to resolve their marital disputes as swiftly as possible.

Navdeep, a 29-year-old doctor from Jalandhar, had been married to a marine engineer for nine months before he and his family started to insult her and demand money — even going so far as to throw her from a speeding car and attempt to strangle her on two separate occasions.

“This is not a good country for women,” Navdeep told GlobalPost in Singh's office. “You can beat her like an animal, and she won't be able to do anything.”

Today, Navdeep is divorced. But that's thanks to Singh's passport office, rather than the court system.

“If a husband [involved in a dowry or divorce case] holds a passport with a foreign visa, he's supposed to surrender it in court,” Navdeep said. “But none of the courts, not the high court, not the civil court, asked him to surrender his passport.”

Her husband was on his way out of the country when Navdeep rushed to Singh's office to lodge a complaint that he was trying to flee from a merchant ship leaving one of India's dozens of ports. Soon, though, he was back in Jalandhar.

“Because his passport was impounded, I got justice," said Navdeep. "I got divorced.”

Kaur's husband is still abroad. But she's confident that Singh's move to cancel the man's passport has turned the tide in her fight, too. Because of Singh, her husband has not been able to renew his visa, so he has been living illegally in the UK since 2010 — unable to work as a university professor.

And just the day before she met with GlobalPost, she won a court judgment saying that she had the right to live in the matrimonial home, regardless of whether the deed says it belongs to her husband or to his parents.

She believes that a financial settlement for her daughter can't be far down the road.

“Parneet Singh has totally changed the scenario of the case,” Kaur said. “I was begging shelter and maintenance for me and my daughter. Now, they are begging in front of me — 'Please, do not do this to our son.'”

http://www.globalpost.com/dispatch/news/regions/asia-pacific/india/120907/marriage-scam-fraud-womens-rights

In a country plagued by woefully inadequate infrastructure, the Yamuna Expressway could well transform the economy of the capital region.

By Jason Overdorf
(GlobalPost - September 5, 2012)

PATTA, Uttar Pradesh — This August, India's multibillion dollar Jaypee Group flagged off a sparkling, six-lane expressway.

The new roadway cuts in half the travel time from New Delhi to Agra, the city that is home to India's top tourist attraction, the Taj Mahal.

The company responsible for bringing Formula One racing to India last year, the Jaypee Group has never been short of ambition. Far more than a simple highway, the Yamuna Expressway project — which extends the suburbs of New Delhi deep into Uttar Pradesh — encompasses high-rise condominiums, universities and technical institutes, an exhibition center, a “sports city” of golf courses, cricket grounds and other facilities surrounding the Formula One speedway, as well as a second international airport to serve the capital area (yet to be built).

Moreover, its planners project that the promise of speedy travel will draw multinational firms like Honda, Daewoo, and Samsung — which already have factories in a township outside New Delhi called Greater Noida — deeper into Uttar Pradesh.

“The economic impact is going to be huge in the coming years,” said Sachin Gaur, chief financial officer of Jaypee Infratech, the unit that built the expressway.

“Uttar Pradesh, till now, was not developing as fast as it could. Today, with Agra just an hour-and-a-half away, slowly this entire area between Greater Noida and Agra will work like a satellite city for [the capital region].”

In a country plagued by woefully inadequate infrastructure, the project could well transform the economy of Uttar Pradesh, India's most populous state, and one of its least developed.

But despite the project's powerful potential, it took more than a decade to bring local stakeholders on board, acquire the land for the highway from farmers, and complete construction — illustrating both the challenges and the opportunities behind India's notorious infrastructure deficit.

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First announced by then-Uttar Pradesh Chief Minister Kumari Mayawati in 2001, the expressway was derailed when her government fell in 2003, resurrected when she regained power in 2007, and only came to fruition shortly after she was again ousted by elections this May. In the early stages, land acquisition proceeded smoothly — accomplished by the government on Jaypee's behalf, using India's laws of eminent domain.

But as the state sought to capitalize on the project by acquiring more farmland for development alongside the highway, the Yamuna Expressway became a flashpoint.

In May 2011, farmers from the village of Bhatta-Parsaul, about 50 miles from New Delhi along the planned highway, kidnapped three officials from the Uttar Pradesh State Road Transport Corporation in the area to conduct a land survey. A three-hour gun battle ensued when police moved in to rescue the hostages, and two villagers and two policemen were killed. After a number of farmers were arrested, the protest swelled. Violence continued, and the state deployed as many as 2,000 police to restore order.

Remarkably, the expressway was not derailed — though Jaypee was unfairly tarred for the conflict, which involves real estate acquisitions by the state-owned Yamuna Expressway Industrial Development Authority.

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“Bhatta-Parsaul is probably two to three kilometers from where the expressway was built up,” said Gaur, whose father, Jaiprakash Gaur, is the founder and chairman of the Jaypee Group. “When [the protest and police firing] happened, the entire land acquisition of the expressway was over two years before that. Just because the area was near the Yamuna Expressway, people linked it with Jaypee.”

Even today, farmers continue to demand a renegotiation of land prices, toll-free travel on the expressway, the construction of new underpasses to make it easier to pass from one village to another, and on and on.

The struggle for land

Land acquisition remains the largest hurdle to industrial development in densely populated India.

Over the past decade, opposition has mounted to government drives to create special economic zones for industry — which critics say netted billions of dollars for politicians and business tycoons at the expense of small farmers. But despite a bloody conflict in Nandigram and Singur, West Bengal — which was the catalyst for the end of the 30-year reign of the Communist Party of India-Marxist in that state — the government has yet to push through aland acquisition bill intended to streamline the process and ensure fairness.

On a recent afternoon in Bhatta-Parsaul, 60-year-old Saukin, a wizened farm laborer, was bathing in a vacant lot near the rutted village road. Shot in the shin bone by police during last year's altercation, he still wears a painful-looking steel brace on his withered leg, screws twisted into his tibia.

Pouring a bucket of water over his head, he propped his injured leg on a lawn chair in an attempt to prevent his bandage from getting soaked.

“I can't work any more, so the village people are supporting me, and my wife and daughters are working,” he said.

After he was shot, the government awarded Saukin with 50,000 rupees (about $1,000) in compensation, he says. But the operation to repair his leg cost double that amount, and the doctor is asking another 80,000 rupees to finish the job. A wealthier villager has floated him a loan, but it will accrue 3 percent in interest every month until Saukin gets back on his feet. And by that time, there may not be many farms left in Bhatta-Parsaul.

Along with more than 100 villages and towns, Patta has already sacrificed acres and acres of farmland to the state government. And though the ensuing residential and commercial developments are projected to create an economic boom, locals like 61-year-old Maumchand, a farmer who was forced to give up his 2.5 acre farm, fear their lives will never be the same.

“Many people will lose everything due to this expressway,” says Maumchand, who was once Saukin's employer.

The successful completion of the toll road could be an important milestone in India's long battle to improve its woefully inadequate transport infrastructure — the key to jumpstarting the country's moribund manufacturing sector and putting millions of people to work. But just as the opening of the highway promises hope for investors and developers keen to cash in on India's massive domestic market and the super cheap labor available outside its major cities, the story of Saukin and other villagers like him illustrates the tremendous challenge involved in transforming a country of farms into a country of factories.

“The big people and the government have taken this land by an emergency clause for industrial purposes, but they're selling it to builders for residential projects,” says another villager, who refuses to give his name, noting that several others who were involved in last year's protests are still behind bars.

“The economic boom will help rich people, not us. We will have to leave this place.”

Villagers say that the government paid land owners 880 rupees (about $16) per square meter in compensation for any land that was acquired for the project, which was arguably a fair price for isolated farm plots. But once those plots were lumped together, and the expressway neared completion, prices skyrocketed to 6200 rupees per square meter for residential property and 22,000 rupees for commercial plots, displaced locals say.

The promise of infrastructure

Across the expressway in Atta Gujran, though, villagers have already built two- and three-story homes with money they received for their farmland. Satellite dishes festoon the rooftops, and nearly every compound has an expensive new car parked out front. Farther down the highway, in the town of Tappal, a group of locals gathered outside a bank, are excited about the promise of new economic opportunities that comes with modern infrastructure.

“This area was totally undeveloped, really rural,” said Rang Lal Attari, a bald retiree dressed in a white kurta pajama and seated on a rope bed by the roadside. “Now some development will come here.”

According to a 2009 report on India's infrastructure problems by the consultancy McKinsey & Co., India then boasted one of the world's largest road networks, but only a quarter of its supposed “national highways” had even two lanes, and nearly 90 percent of India's highways are “structurally inadequate” to support the 11.2 ton per axle that trucks are allowed to carry.

Nothing much has changed in three years. A typical highway journey means plunging through yawning potholes and weaving around bullock carts, not to mention school children, working elephants and the odd farmer chasing a herd of rawboned cattle to market. So it's not surprising that transport delays cost Indian industry an estimated $725 million per year, according to a new report from the Ministry of Road, Transport and Highways.

“Before, traveling from here to New Delhi took six hours one way,” said Neeraj Sharma, a property dealer who has profited from escalating land prices. “Now, it takes four hours roundtrip. Property values have increased by more than 10 times.”

Because of the infrastructure deficit elsewhere, the impact here — and all along the expressway to Agra — could indeed be dramatic, according to experts like Parvesh Minocha, group managing director of Feedback Infrastructure, a consulting firm.

The expressway slashes travel time from New Delhi to Agra — where leather factories and other industries will benefit from the faster connection to one of the country's most lucrative markets. But, more importantly, it passes through one of India's richest agricultural zones and links area towns and villages to the Delhi-Mumbai Industrial Corridor — a $90 billion, dedicated freight corridor comprising 24 planned cities.

“Because of the corridor, the growth will probably be far more than it would be for a general road anywhere else,” said Minocha.

“I'm not only depending on the tourist traffic to Agra. That's only going to be a small component. Industry, freight, logistics — the connectivity for the rest of western Uttar Pradesh could actually grow very drastically, and therefore it could have a much bigger impact than one would have imagined even a few years ago.”