Outsourcing a Life

Anand, India - Eyes pressed shut, jaw clenched, Manisha Parmar strained beneath the delivery room lights. The exquisite pain of this moment was familiar. But little else was.

Years ago, after her second baby was born, a doctor had performed a tubal ligation, ensuring she would never conceive again. But now, somehow, here she was, moments from giving birth. And for this child, everything was different.

Manisha's son and daughter had been born at home, a tiny, ramshackle dwelling in northwestern India. Only after both infants were kicking and crying was a health worker summoned to snip the umbilical cords.

But here, at the Akanksha Infertility Clinic, nurses hovered, checking her vital signs, monitoring the progress of her labor. Nothing about this birth would be left to chance.

Manisha didn't quite understand how the clinic staff had made her pregnant again. She grasped their urgency, though.

For nine months, she had been paid more than she ever imagined to carry a baby created from the egg and sperm of an American couple. Now she was on the verge of delivering...