Surrogacy Regulatory Act 2021: Redefining Reproductive Rights In India

Policy Update
Arjya Shree Pande

Background

The Surrogacy (Regulation) Act, 2021 (Act No. 47 of 2021) was enacted by the Parliament of India to regulate the practice and process of surrogacy. It received the assent of the President on 25 December 2021 (Ministry of Law and Justice, 2021). The Act constitutes the National Assisted Reproductive Technology and Surrogacy Board, State Assisted Reproductive Technology and Surrogacy Boards, and appropriate authorities for regulation of surrogacy and related matters (Ministry of Law and Justice, 2021).

Prior to this legislation, the absence of a comprehensive legal framework had led to the proliferation of commercial surrogacy, raising serious concerns about the exploitation of surrogate mothers, unethical practices, exploitation of poor women and the rights of children born through such arrangements. The Act was introduced to prohibit commercial surrogacy such as including the sale or purchase of human embryos and gametes and to permit only altruistic surrogacy, thereby protecting vulnerable women and ensuring ethical practices (Department of Health Research).

The Act came into force on 25 January 2022, as notified by the Central Government under Section 1(2) vide S.O. 292(E) dated 20 January 2022 (Ministry of Health and Family Welfare, 2022). The Surrogacy (Regulation) Rules, 2022, were subsequently framed to operationalise its provisions.

Target beneficiaries include intending couples who have been married for at least 5 years; legally married Indian men and women with a medical indication necessitating gestational surrogacy, who are aged between 23 and 50 years (female) and 26 and 55 years (male) on the day of certification, and who do not have a surviving child biologically, through adoption, or through surrogacy (except in cases of a child with severe mental or physical challenges or life threatening disorders). An intending woman (only an Indian widow or divorcee aged 35 to 45 years) may also avail of surrogacy subject to conditions. Surrogate mothers must be ever married women aged 25 to 35 years who already have a child of their own and may act as a surrogate only once in their lifetime (Department of Health Research, FAQs on Surrogacy (Regulation) Act, 2021).

Key provisions prohibit commercial surrogacy and mandate that surrogacy may be undertaken only for altruistic purposes when there is a medical indication for gestational surrogacy. Surrogacy clinics must be registered under the Act. Certificates of essentiality and eligibility are required from the appropriate authority, along with a certificate of medical indication from a District Medical Board. The surrogate mother must provide written informed consent, is entitled to insurance coverage, and may withdraw consent before embryo implantation. Sex selection and storage of embryos or gametes solely for surrogacy purposes are prohibited. Parentage and custody orders are to be obtained from a court of competent jurisdiction (Ministry of Law and Justice, 2021).

Subsequent developments include the Surrogacy (Regulation) Rules, 2022, and amendments such as the Surrogacy (Regulation) Amendment Rules, 2023. A notification dated 21 February 2024 clarified conditions under which donor gametes may be used when the District Medical Board certifies a medical necessity, subject to the requirement that the child has at least one gamete from the intending couple (or self eggs in the case of an intending woman). Further Amendment Rules were notified in 2026, and a comprehensive review of the Act has been initiated (National ART & Surrogacy Portal, Department of Health Research,2026).

Functioning

The Surrogacy (Regulation) Act, 2021 regulates surrogacy services across India, while prohibiting commercial surrogacy, sex selection, and associated exploitation of surrogate mothers; it requires surrogacy clinics to register with the appropriate authority, mandates that prospective parents obtain a certificate of medical indication from the District Medical Board followed by certificates of essentiality and eligibility from the appropriate authority, and requires the surrogate mother to obtain an eligibility certificate, provide written informed consent, and receive prescribed medical expenses and insurance coverage, with a court order confirming parentage and custody after birth, thereby safeguarding the rights of children born through surrogacy and establishing institutional mechanisms for oversight through National and State Boards along with appropriate authorities (Ministry of Law and Justice, 2021).

The institutional framework centres on the National Assisted Reproductive Technology and Surrogacy Board, chaired by the Union Minister of Health and Family Welfare, which advises on policy, reviews implementation, and supervises State Boards. State Assisted Reproductive Technology and Surrogacy Boards monitor activities within their jurisdictions and report to the National Board. Appropriate authorities at the State and Union Territory levels grant, suspend, or cancel clinic registrations, enforce standards, investigate breaches, and issue essentiality and eligibility certificates. District Medical Boards certify medical indications (Ministry of Law and Justice, 2021).

Implementation occurs through these bodies and the National ART & Surrogacy Portal under the Department of Health Research, Ministry of Health and Family Welfare, which facilitates registration, notifications, and oversight. Union Territory boards and authorities were notified on 4 May 2022. Nearly all States have constituted their Boards (except two) and Appropriate Authorities (except one) (Department of Health Research; National ART & Surrogacy Portal).

The process begins under the Act as an intending couple first obtains a medical indication certificate from the District Medical Board, then applies to the State Appropriate Authority for certificates of essentiality and eligibility; the surrogate mother must also receive an eligibility certificate and provide written consent. Registered clinics alone may perform the procedure, with insurance coverage mandatory for the surrogate. The National Board advises on policy and monitors implementation, while State Boards and Appropriate Authorities handle day-to-day registration of clinics, issuance of certificates, inspections, and enforcement (Department of Health Research, FAQs on Surrogacy (Regulation) Act, 2021; Ministry of Law and Justice, 2021).

No dedicated funding structure is prescribed under the Act. Expenses for Board and authority meetings are met from the regular budgets of the Central and State Governments, consistent with the policy design that avoids creating permanent new posts or structures (Press Information Bureau, earlier related notifications, 2016).

Performance

Since its enforcement on 25 January 2022, the Surrogacy (Regulation) Act, 2021 has established a functional regulatory architecture over approximately four years of operation. The National Assisted Reproductive Technology and Surrogacy Board was constituted on 4 May 2022, with the Union Minister of Health and Family Welfare as Chairperson. The National ART & Surrogacy Registry became operational on 22 April 2022 under the Department of Health Research (DHR). All Union Territories have constituted their Boards and Appropriate Authorities. All States have constituted State ART & Surrogacy Boards and Appropriate Authorities (Department of Health Research, Annual Report 2025-26).

Programme MIS data from the National ART & Surrogacy Registry dashboard show substantial registration activity. As of mid-October 2026, the live National ART & Surrogacy Registry dashboard recorded 1,332 applications for Surrogacy Clinics, of which 756 were registered and 315 rejected. Parallel figures for ART Clinics stood at 8,190 received, 4,710 registered and 1,647 rejected, while ART Banks recorded 1,874 received, 940 registered and 560 rejected. Thousands of application forms have been downloaded from the portal for submission to State/UT authorities, with continued inflows reported in DHR annual reports through 2025 (National ART & Surrogacy Registry, 2026).

Progress under the Surrogacy (Regulation) Act, 2021 includes the widespread constitution of institutional mechanisms, operationalisation of the National Portal, and progressive institutionalisation confirmed by DHR Annual Reports (2023-24 onwards, including 2025-26), encompassing the Surrogacy (Regulation) Rules, 2022, further Regulations in 2023, Amendment Rules in 2023, 2024 (including clarification on donor gametes), and 2026, along with ongoing issuance by DHR of Certificates of Recommendation for couples of Indian origin and No-Objection Certificates for gamete/embryo transfers; a comprehensive review of the Act was initiated in 2026 (National ART & Surrogacy Portal; Department of Health Research notifications). Secondary assessments note that while regulatory structures have been established, the restrictive eligibility criteria and multi-layered certification process can limit access for some intending parents, and uneven State-level constitution of bodies may affect uniform enforcement (National ART & Surrogacy Portal; Department of Health Research notifications).

Union Budget documents do not provide a dedicated budgetary allocation for the Act; implementation costs, including Board meetings, are met from the regular budgetary allocations of the Ministry of Health and Family Welfare and DHR, whose overall allocation has risen significantly in recent years (Press Information Bureau budget releases). Economic Survey, CAG reports and Cabinet notes do not contain specific performance metrics for the Act in the public domain searched. Parliamentary Select Committee scrutiny occurred at the Bill stage (pre 2021).

State wise analysis indicates a near universal constitution of institutional mechanisms, though earlier removal of difficulty orders (2022) temporarily extended registration deadlines for clinics in 17 States to facilitate compliance. Sectoral and trend analysis from Ministry updates shows a clear shift from the pre-2022 unregulated commercial environment to a registered, altruistic only framework, with rising clinic registrations and iterative rule refinements addressing operational gaps. Comparative progress against the pre-Act period demonstrates formal oversight where none existed, though quantitative outcome data on actual surrogacy procedures remain limited in official dashboards and reports (Department of Health Research Annual Reports; National ART & Surrogacy Registry).

Impact

Official reports indicate substantial progress toward structural and regulatory objectives. The National Assisted Reproductive Technology and Surrogacy Board and the National Registry were constituted and made operational in 2022. All Union Territories and nearly all States have established the required Boards and Appropriate Authorities. Commercial surrogacy remains explicitly prohibited, with penalties for violations including imprisonment and fines, and only altruistic arrangements are permitted under certified medical indications (Department of Health Research, FAQs on Surrogacy (Regulation) Act, 2021). The National ART & Surrogacy Registry has recorded hundreds of registered surrogacy clinics, reflecting formal oversight where previously none existed at scale.

Iterative refinements, Rules and Regulations notified in 2022, further Regulations in 2023, Amendment Rules in 2023, 2024 (clarifying conditions for donor gametes), and 2026, alongside a comprehensive review initiated in 2026, demonstrate adaptive policy monitoring by the National Board and DHR (Department of Health Research notifications). Certificates of Recommendation for couples of Indian origin and No-Objection Certificates for gamete/embryo transfers have been issued, supporting access for eligible beneficiaries within the ethical framework.

However, official reports and Ministry updates do not provide quantitative outcome data on the volume of altruistic surrogacy procedures completed, measurable reductions in exploitation, or long-term protection of child rights. While the institutional architecture and ban on commercial practices have been substantially achieved, the absence of detailed performance indicators on beneficiary outcomes and enforcement efficacy in available government documents limits a full assessment of impact on the ground. The ongoing comprehensive review signals recognition of the need for further evaluation and possible adjustments (Department of Health Research, Annual Report 2025-26).

The Act has achieved its core structural objectives: commercial surrogacy is prohibited, the National Registry and Boards are operational, and 756 Surrogacy Clinics have been registered (Department of Health Research, 2026). However, official data remain limited to clinic registrations and certificate issuances; no public figures exist on the number of completed altruistic procedures, enforcement actions, or long term outcomes for surrogate mothers and children, leaving the full impact on exploitation reduction and rights protection difficult to quantify (Department of Health Research, Annual Report 2025-26).

Emerging Issues

Restrictive Eligibility and Access Barriers

The Act limits surrogacy to legally married Indian couples within specified age ranges who lack a surviving child (except in limited medical hardship cases) and to widows or divorcees aged 35–45. Foreign nationals and unmarried single women are excluded. Official FAQs confirm these criteria, which, while aimed at preventing misuse, may constrain access for certain categories of intending parents who face genuine medical infertility, who fall outside the prescribed age limits, marital status, or “no surviving child” requirements (Department of Health Research, FAQs on Surrogacy (Regulation) Act, 2021).

Limited Transparency and Public Data Availability

Official sources, including the National ART & Surrogacy Registry and Department of Health Research reports, provide data only on clinic registrations and applications. No comprehensive public statistics are available on the number of completed altruistic surrogacy procedures, enforcement actions against violations, or long term outcomes for surrogate mothers and children. This gap in transparent, outcome oriented data limits independent assessment of the Act’s effectiveness and accountability (Department of Health Research, Annual Report 2025-26).

Complex Certification and Procedural Layers

Applicants must obtain a medical indication certificate from a District Medical Board, followed by certificates of essentiality and eligibility from the Appropriate Authority, and, for couples of Indian origin, a Certificate of Recommendation from the National Board. This multi-stage process, detailed in the Act and Rules, can prolong timelines and create administrative hurdles (Ministry of Law and Justice, 2021; Department of Health Research, FAQs).

Implementation Gaps at State Level

Although most States and all Union Territories have constituted Boards and Appropriate Authorities, earlier notifications recorded delays in several States that required temporary removal of difficult orders to extend registration deadlines for clinics (Department of Health Research notifications, 2022). Residual unevenness in institutional readiness can affect uniform enforcement.

Monitoring and Outcome Data Limitations

The National ART & Surrogacy Registry tracks clinic applications and registrations, yet official annual reports and the portal provide limited public data on the actual number of altruistic surrogacy procedures completed, enforcement actions against violations, or long-term outcomes for surrogate mothers and children. This constrains evidence based assessment of impact (National ART & Surrogacy Registry; Department of Health Research, Annual Report 2025-26).

Financing and Institutional Coordination

No dedicated budget line exists; costs are met from regular Ministry and DHR allocations. Coordination between the National Board, State Boards, and Appropriate Authorities relies on reporting mechanisms, with the National Board tasked to review and recommend changes. The initiation of a comprehensive review in 2026 indicates recognition of the need for further refinements in design, monitoring, and coordination (Department of Health Research, Annual Report 2025-26; National ART & Surrogacy Portal).

Way Forward

Strengthening Monitoring and Outcome Measurement

The National ART & Surrogacy Registry already captures clinic registrations. Expanding it to systematically record the number of certified altruistic procedures, enforcement actions, and basic outcome indicators for surrogate mothers and children would enable evidence-based oversight. The National Board’s mandate to review implementation and recommend changes provides a ready institutional channel for introducing such metrics (Department of Health Research, Annual Report 2025-26; National ART & Surrogacy Registry).

Streamlining Certification while Preserving Safeguards

The multi-stage certification process ensures medical necessity and eligibility. Standardising timelines for District Medical Boards and Appropriate Authorities, together with clearer digital workflows on the National Portal, can reduce delays without diluting ethical checks. Recent Amendment Rules and the ongoing comprehensive review offer an opportunity to refine procedural efficiency (Department of Health Research notifications; National ART & Surrogacy Portal).

Deepening Institutional Coordination and Capacity

The near universal constitution of State Boards and Appropriate Authorities is a strong foundation. Regular capacity-building for these bodies, facilitated by the National Board, and structured information exchange between national and state levels will promote uniform application of standards across States and Union Territories (Department of Health Research, Annual Report 2025-26).

Aligning with Broader Reproductive Health and Development Priorities

Integrating regulated surrogacy services more closely with the wider assisted reproductive technology framework and national reproductive health programmes can support India’s goals of equitable access to ethical medical care and protection of vulnerable women and children. Simplifying the application process for Certificates of Recommendation through enhanced digital interfaces on the National ART & Surrogacy Portal, coupled with clear guidelines and time-bound processing by the National Board, can improve accessibility for eligible couples of Indian origin. (Department of Health Research, FAQs on Surrogacy (Regulation) Act, 2021).

Sustaining Adaptive Policy Review

The comprehensive review initiated in 2026 should be institutionalised as a periodic exercise. Recommendations emerging from the National Board, informed by Registry data and State feedback, can keep the regulatory framework responsive to emerging medical, social and ethical developments while remaining aligned with the Act’s core objectives of preventing commercialisation and protecting rights (National ART & Surrogacy Portal; Department of Health Research, Annual Report 2025-26).

References

Department of Health Research (2021). The Surrogacy (Regulation) Act, 2021. Ministry of Health and Family Welfare, Government of India. https://dhr.gov.in

Department of Health Research (2022). Notification for commencement of the Surrogacy (Regulation) Act, 2021 (S.O. 292(E)). Ministry of Health and Family Welfare, Government of India. https://www.icmr.gov.in

Department of Health Research (2022). Surrogacy (Regulation) Rules, 2022. Ministry of Health and Family Welfare, Government of India. https://artsurrogacy.gov.in

Department of Health Research (2023). Surrogacy (Regulation) Amendment Rules, 2023. Ministry of Health and Family Welfare, Government of India. https://artsurrogacy.gov.in

Department of Health Research (2024).

Surrogacy (Regulation) Amendment Rules, 2024. Ministry of Health and Family Welfare, Government of India. https://artsurrogacy.gov.in

Department of Health Research (2025).

Annual report 2024–25 . Ministry of Health and Family Welfare, Government of India. https://dhr.gov.in

Department of Health Research. (2026). Annual report 2025–26. Ministry of Health and Family Welfare, Government of India. https://dhr.gov.in

Department of Health Research. (n.d.). Frequently asked questions on the Surrogacy (Regulation) Act, 2021. Ministry of Health and Family Welfare, Government of India. https://www.dhr.gov.in

Ministry of Law and Justice. (2021). The Surrogacy (Regulation) Act, 2021 (Act No. 47 of 2021). Legislative Department, Government of India. https://thc.nic.in

National ART & Surrogacy Portal. (n.d.). Boards, authorities and notifications. Department of Health Research, Ministry of Health and Family Welfare, Government of India. https://artsurrogacy.gov.in

National ART & Surrogacy Registry. (n.d.). Dashboard and registration statistics. Department of Health Research, Ministry of Health and Family Welfare, Government of India. https://registry.artsurrogacy.gov.in

Press Information Bureau. (2016). Cabinet approves introduction of the Surrogacy (Regulation) Bill, 2016. Government of India. https://pib.gov.in

Press Information Bureau. (2020). Surrogacy Regulation Bill 2020. Government of India. https://pib.gov.in

About the contributor

Arjya Shree Pande is a Research and Editorial Intern at IMPRI. She is currently pursuing a Masters in Sociology and Advanced Post Graduate Diplomas in Communication for Social Behaviour Change, technical support (UNICEF) and Global Politics. She is seeking analytical, policy, or programme oriented roles in international, governmental, or development settings where she wants her experience in research, behavioural insights, and governance expertise can be applied to evidence based decision making, public service delivery, and technology enabled social impact.

Acknowledgments

The author sincerely expresses gratitude to the reviewers ( Madhuritha D, ), IMPRI India and the editorial team for their valuable comments, constructive suggestions, and continuous guidance throughout the preparation of this article.