The Surrogacy Act, explained for the clinics that carry it out.

For roughly two decades India was one of the world’s largest destinations for commercial surrogacy, operating with almost no statutory control. The consequences that drove legislation were not abstract: surrogates recruited from poverty with little understanding of what they had agreed to, disputes over payment, children left stateless when arrangements collapsed, and no register anywhere of who had carried whom.

Parliament’s answer was a pair of statutes passed together — the ART (Regulation) Act, 2021 governing the clinics and the laboratory work, and the Surrogacy (Regulation) Act, 2021 governing the arrangement itself. Both commenced on 25 January 2022. The design is deliberate: the ART Act says who may run a laboratory, the Surrogacy Act says who may be a surrogate, who may commission, and on what terms.

The practical consequence for a clinic is the one most often missed. They are two registrations, not one. A registered ART clinic that begins performing surrogacy procedures without separate registration under the Surrogacy Act is not operating in a grey area — it is operating unregistered.

The Act permits surrogacy only on an altruistic basis. In practice that means the surrogate may receive her medical expenses and the insurance cover prescribed — and nothing else. No fee, no compensation for her time, no payment routed through a third party.

The prohibition is wider than the payment itself. The Act reaches:

• Commercial surrogacy in any form — including arrangements structured to look altruistic while consideration passes elsewhere.
• Advertising. Publishing or facilitating any advertisement for commercial surrogacy, or for surrogacy services offered in contravention of the Act, is itself an offence. This is worth reading carefully before your clinic writes a word of marketing about surrogacy.
• Intermediation. Acting as an agent, broker or recruiter for a surrogacy arrangement.
• Exploiting or abandoning. Exploiting the surrogate mother, and abandoning or disowning the child born through surrogacy.
• Sex selection at any stage of the arrangement — the same absolute prohibition that runs through the PC-PNDT framework.

Penalties are serious — the Act provides for imprisonment that can extend to ten years together with a substantial fine for the principal offences, alongside cancellation of registration. Confirm the current provisions; what matters for a clinic director is that these are criminal, not regulatory, consequences.

This is the operational heart of the Act for a clinic, and the single most common point of failure. No procedure may be undertaken until the prescribed certificates have been obtained from the appropriate authority. In outline:

Two operational points follow. First, these are documents your clinic must hold and be able to produce years later — not documents you sight once and hand back. Second, they are gating: the clinic’s obligation is to refuse to proceed without them, which means somebody at your front desk needs a hard stop in the workflow rather than a note in a file.

The Act’s protective core, and the part a clinic must actively administer rather than merely observe:

• Written informed consent in the prescribed form, given after the implications of the procedure have been explained to her in a language she understands. That last clause is not decorative. A consent signed in English by a woman who reads only Gujarati is a defect on the face of the record.
• The right to withdraw her consent before the embryo is implanted.
• Insurance cover for a prescribed period, covering postpartum complications, arranged by the intending party and evidenced before the procedure.
• A limit on attempts — the number of times she may undergo the procedure is prescribed, and she may act as a surrogate only once in her lifetime.
• No abortion without her consentand the authority’s authorisation, subject to the MTP Act.

Every one of these produces an artefact: a signed consent in the right language, an insurance document, a counselling record, a dated withdrawal window. The clinic that can retrieve all of them in five minutes is in a very different position from the clinic that has to reconstruct them.

At the transfer. The surrogacy arrangement is regulated by one Act; the laboratory work that makes it possible is regulated by the other. A clinic performing gestational surrogacy therefore carries both sets of obligations simultaneously, and an inspection under either will look at the same records:

• Registration under both statutes, current and displayed.
• The embryology record — whose gametes, which cycle, which embryo, transferred to whom, witnessed by whom. This is ordinary ART traceability, but in a surrogacy arrangement the identity questions it answers are legal ones.
• Donor gamete rules. The position on using donor gametes in a surrogacy arrangement has been amended since 2022 and has been the subject of litigation. This is the provision most likely to have moved since anything you last read — verify it directly.
• The outcome record, reported as prescribed, closing the loop the same way an ART cycle outcome does.
• Form F for the obstetric scans that follow, under the PC-PNDT framework.

If your centre already runs ART Act compliance properly, the Surrogacy Act asks for the same discipline applied to a different set of documents. If it does not, surrogacy is the wrong place to start learning.

The failure mode is always the same, and it is the one we described for Form F: two parallel record systems that nobody reconciles until an inspector does. The fix is structural rather than diligent.

1. Make the certificates a gate, not a note. The arrangement should be impossible to progress in your system until essentiality, eligibility and insurance are recorded against it — with expiry dates where they apply.
2. Keep consents versioned and bilingual. Which consent form, which version, which language, signed when. MedStream prints consents in English and Gujarati for exactly this reason.
3. Bind the arrangement to the cycle. The surrogacy file and the embryology record should be two views of one patient record, not two systems that agree by luck.
4. Give it an audit trail. Who recorded what, when, and what changed. With 100+ granular role permissions, who was even able to see a record is itself answerable.
5. Assume you will be asked in five years. Retention and retrieval are the whole point; a record you cannot find is a record you do not have.

None of this makes a clinic compliant on its own — registration and the certificates are legal processes with your Appropriate Authority, and no software substitutes for them. What software does is carry the documentary load the Act creates. Put these five items on your demo checklist and make any vendor show them live; our twelve demo questions explain how to run that conversation, and our guide to starting an IVF centre covers the wider setup.