GS Paper: GS2-13.Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Introduction

The Surrogacy (Regulation) Act, 2021 stipulates that an “intending couple” is eligible for surrogacy only if they do not have any surviving child, biological, adopted or via surrogacy, except where the child is physically or mentally challenged or has a life-threatening disorder.A petition has been filed before the Supreme Court by a couple facing secondary infertility who seek to use surrogacy to have a second child. Their argument: the law’s restriction interferes with the reproductive choices of citizens and treats primary and secondary infertility differently.

What is the law’s objective and rationale

1. Objective of the Act: The primary stated purpose is to prohibit commercial surrogacy, regulate fertility and surrogacy clinics, and protect surrogate mothers and children born through surrogacy.
2. Eligibility restriction: Section 4(iii)(C)(II) mandates the ‘no surviving child’ condition for an intending couple.
3. Rationale for restriction: The government’s position is that the use of another woman’s body for surrogacy demands strict regulation; therefore, limiting eligibility helps prevent exploitation and commercialization.
4. Court’s interim view: The Supreme Court has indicated the restriction appears “reasonable” but is examining whether the ban on surrogacy for couples with a surviving child amounts to a violation of reproductive choice.

How does the law differentiate primary and secondary infertility

1. Secondary infertility defined: In this context, it refers to couples unable to conceive or carry a pregnancy to term despite having borne a child naturally earlier.
2. Law’s silence on distinction: The Act does not expressly differentiate between primary and secondary infertility in defining “infertility” for eligibility. The petitioners argue the statute uses “infertility” generically and should be read to include secondary infertility.
3. Effect of the distinction: As a result of the clause, a couple with one surviving (healthy) child is barred from surrogacy for a second child, even if they face medical infertility. The petition argues this amounts to unreasonable discrimination.

Why is this matter significant now?

1. Reproductive autonomy at stake: The case raises the question whether reproductive choice including whether and how many children to have falls under the fundamental right to privacy and reproductive autonomy (Article 21).
2. Scale of the issue: Secondary infertility affects a substantial number of couples; the law’s bar effectively restricts access to surrogacy for many intending parents. The article emphasises that restricting access solely because a couple already has a child may not align with the law’s stated objective.
3. Precedents of regulation being diluted: The Court recently relaxed age restrictions for couples who had frozen embryos prior to the law’s enactment, signalling willingness to interpret surrogacy law expansively.
4. Contradiction with other family-related rights: There is no law in India capping the number of children a person may have naturally; yet, the surrogacy law imposes a “one-child existing” rule. This invites scrutiny of rational basis for differentiation.

What are the potential implications of a broader interpretation”

1. Facilitating access: A more expansive reading allowing surrogacy for intending parents would align the law with reproductive autonomy and reduce arbitrary differentiation.
2. Safeguard against exploitation: The law can maintain its core safeguards against commercialisation and exploitation while enabling access for medically infertile couples seeking a second child.
3. Policy coherence: It would harmonise the surrogacy statute’s eligibility norms with the lack of statutory restriction on the number of natural children and prevent unjust exclusion of couples.
4. Legal precedent: A favourable interpretation could open up examination of other eligibility criteria under the Act (such as age or marital status) in light of constitutional rights.

What are the counter-arguments and concerns?

1. Risk of commercial surrogacy revival: Critics argue liberalising eligibility may inadvertently open doors to exploitation of surrogate mothers and a resurgence of commercial surrogacy in disguised form.
2. Resource and monitoring constraints: Greater eligibility implies more oversight burden on regulatory infrastructure (ART clinics, surrogacy boards, monitoring of insurance/compensation).
3. State interest in regulation: The restriction can be defended as within the State’s margin of appreciation to regulate surrogacy in public interest, preserving dignity of women and children.
4. Potential slippery slope: Expanding eligibility might raise questions about single individuals, LGBTQ+ couples or live-in partners accessing surrogacy, aspects the law currently restricts.

Conclusion

The surrogacy debate in India reflects the evolving tension between state regulation and personal autonomy. While the law rightly seeks to prevent exploitation and commercialisation, it must not overlook the constitutional promise of reproductive freedom and equality. A more inclusive, rights-based interpretation, sensitive to medical realities like secondary infertility, would uphold both ethical safeguards and individual dignity, aligning the law with India’s vision of gender justice and compassionate governance.

Value Addition: Surrogacy Law in India

Legal Framework: Surrogacy (Regulation) Act, 2021 Objective: Regulate surrogacy procedures, prohibit commercial surrogacy, and ensure ethical practices in assisted reproduction. Type allowed: Only altruistic surrogacy (no monetary compensation except medical expenses and insurance). Assisted Reproductive Technology (Regulation) Act, 2021 Objective: Regulate ART clinics and banks; maintain records, screening, and ethical standards for gamete donation and IVF processes. Together, these Acts create a twin legal framework governing all forms of medically assisted reproduction in India. Key Provisions of the Surrogacy (Regulation) Act, 2021 Eligibility of intending couple: Must be Indian citizens, legally married, and aged: Husband: 26–55 years Wife: 23–50 years Must possess a certificate of infertility from a District Medical Board. Must not have any surviving child (biological, adopted, or through surrogacy), except if the child is mentally/physically challenged or suffers a life-threatening disorder. Eligibility of surrogate mother: Must be a married woman with a child of her own. Age limit: 25–35 years. Can act as a surrogate only once in her lifetime. Must be a close relative of the intending couple. Must obtain a certificate of medical and psychological fitness. National and State Surrogacy Boards: Oversee implementation, formulate policies, and ensure ethical compliance. Penal provisions: Commercial surrogacy, sale/purchase of human embryos, and exploitation of surrogate mothers attract imprisonment up to 10 years and fine up to ₹10 lakh. Objectives and Rationale Prevent commercial exploitation: Protects poor women from being coerced into surrogacy for financial gain. Ensure child welfare: Guarantees the child’s legal status and parentage from birth. Promote ethical medical practices: Prevents unregulated fertility clinics and misuse of technology. Align with constitutional morality: Balances individual reproductive rights with social ethics and public health considerations. Judicial and Policy Developments SC observations (2023–2025): Examining secondary infertility cases to test whether barring surrogacy for a second child violates reproductive autonomy under Article 21. Previously allowed age relaxation for couples with frozen embryos prior to enactment of the Act. Delhi High Court (2023): Directed the government to reconsider rules preventing single women or widows from accessing surrogacy, citing discrimination concerns. Policy evolution: Shift from the 2015 ban on foreign commercial surrogacy to a 2021 framework permitting only altruistic domestic surrogacy.

PYQ Relevance

[UPSC 2023] Explain the constitutional perspectives of Gender Justice with the help of relevant constitutional provisions and case laws.

Linkage: This question is key as it tests understanding of Articles 14, 15 and 21 on women’s equality and autonomy. This is central to debates like the Surrogacy Act 2021, which restricts reproductive choice and raises issues of bodily rights and gender justice.

Introduction

Vaccination is among the most effective and cost-efficient public health measures, credited with saving millions of lives globally. India, with its Universal Immunisation Programme (UIP), runs the world’s largest vaccination campaign annually, covering over 2.6 crore infants and 2.9 crore pregnant women. From eliminating polio and maternal/neonatal tetanus to spearheading COVID-19 vaccine development, India has emerged as a global leader in immunisation. Yet, challenges remain in ensuring last-mile delivery, tackling vaccine hesitancy, and integrating disease surveillance with vaccination systems.

Expanding Reach through Mission Indradhanush

1. Mission Indradhanush (MI): Launched in 2014 to achieve 90% full immunisation coverage, up from 62% in 2014 (NFHS-4).
2. Intensified Mission Indradhanush (IMI): Began in 2017, targeting low-coverage and missed populations.
3. Impact: By 2023, 12 phases of MI/IMI had vaccinated 5.46 crore children and 1.32 crore pregnant women.
4. Integration: Linked with Gram Swaraj Abhiyan and Extended Gram Swaraj Abhiyan for greater outreach.

What Has India Achieved through UIP?

1. Decline in Mortality: Under-5 mortality dropped from 45 to 31 per 1,000 live births (2014–2021, SRS 2021).
2. Expanded Vaccination Basket: 6 new vaccines added in the last decade (e.g., Rotavirus, Pneumococcal Conjugate, Measles-Rubella).

Disease Elimination Milestones:

1. Polio-free since 2011.
2. Maternal and neonatal tetanus eliminated in 2015.
3. Yaws eradicated in 2016.
4. Recognition: Measles and Rubella Champion Award (2024).

What Challenges Continue to Plague India’s Vaccination Efforts?

1. Remote Populations: Hard-to-reach and migratory groups remain under-covered.
2. Vaccine Hesitancy: Clusters with low awareness and misinformation hinder uptake.
3. Pandemic Disruption: COVID-19 disrupted routine services, leading to measles outbreaks (2022–2024).
4. Immunity Gaps: Outbreaks showed clustering of unimmunised children.

How Has Technology Transformed Vaccine Delivery?

Digital Platforms:

1. U-WIN: End-to-end vaccination record tracking, modeled on Co-WIN.
2. eVIN & Cold Chain MIS: Real-time vaccine stock and logistics monitoring.
3. SAFE-VAC: Vaccine safety reporting.

Pandemic Success:

1. COVID-19 vaccination began Jan 16, 2021.
2. By Jan 2023: 220 crore doses, 97% with one dose, 90% with both.
3. Equity & Outreach: Enabled “anytime-anywhere” access for migratory groups.

What Lessons Has India Shared with the World?

1. Vaccine Maitri: Supported low- and middle-income countries, reflecting Vasudhaiva Kutumbakam.
2. Domestic Manufacturing: Self-reliance through Make in India strategy.
3. Global Leadership: World’s largest vaccine manufacturing hub, shaping global vaccine futures.

Conclusion

India’s vaccination drive demonstrates the transformative power of political will, technological innovation, and community participation. While achievements like polio eradication, COVID-19 vaccine success, and award-winning Measles-Rubella campaigns inspire global emulation, challenges of equity, hesitancy, and surveillance integration demand continued attention. The future lies in adopting a One-Health approach and strengthening linkages between disease surveillance and immunisation to ensure pandemic preparedness and universal vaccine coverage.

PYQ Relevance:

[UPSC 2022] What is the basic principle behind vaccine development? How do vaccines work? What approaches were adopted by the Indian vaccine manufacturers to produce COVID-19 vaccines?

Linkage: This question is important for UPSC as it tests both the scientific principle of vaccine development and India’s capacity to innovate during crises like COVID-19. The article links by showing how vaccines, once developed, were scaled through UIP, Mission Indradhanush, and digital tools like U-WIN, reflecting the bridge between science and governance. It also highlights India’s global role via Vaccine Maitri and WHO recognition, making it a holistic case study for GS 3: Science & Technology and Public Health.

Value Addition

Universal Immunisation Programme (UIP) Definition: World’s largest immunisation programme, launched in 1985, providing free vaccines against 12 vaccine-preventable diseases. Coverage: Annually vaccinates 2.6 crore infants and 2.9 crore pregnant women. Relevance: Illustrates inclusive public health coverage, state capacity, and preventive healthcare. Mission Indradhanush (MI) / Intensified Mission Indradhanush (IMI) MI (2014): Launched to increase full immunisation coverage from 62% (NFHS-4, 2015–16) to 90%. IMI (2017): Focused on low-coverage areas and “left-out” children/women. Outcome: By 2023, 5.46 crore children and 1.32 crore pregnant women vaccinated under 12 phases. Relevance: Example of targeted governance and convergence with Gram Swaraj Abhiyan. Zero-dose Outreach Definition: Identifying and reaching children who have received no vaccines at all (first contact point for immunisation). Importance: Critical for equity in healthcare since such children often belong to marginalised, remote, or migratory populations. Relevance: Reflects SDG-3 (Good Health and Well-being) and commitment to leaving no one behind. U-WIN / eVIN / SAFE-VAC U-WIN: Successor to Co-WIN, a digital platform for real-time tracking of vaccination for pregnant women and children up to 16 years; enables portability for migrants. eVIN (Electronic Vaccine Intelligence Network): Ensures real-time monitoring of vaccine stocks. SAFE-VAC: Module for adverse events reporting and ensuring vaccine safety. Relevance: Showcases digital governance in health → transparent, accountable, efficient delivery. One-Health Approach Concept: Integrates surveillance of human, animal, and environmental health systems. Need: 75% of emerging infectious diseases are zoonotic (e.g., COVID-19). Application: Strengthens pandemic preparedness and ties immunisation with wider health surveillance. Relevance: A forward-looking framework for epidemic resilience and sustainable public health. Vaccine Maitri Definition: India’s global vaccine diplomacy initiative during COVID-19, supplying vaccines to 100+ countries. Impact: Cemented India’s role as “Pharmacy of the World”; strengthened ties with developing countries. Relevance: Example of health diplomacy, South-South cooperation, and global public good. Reports & Data NFHS-4 (2015–16) Report Name: National Family Health Survey – Round 4. Finding: India’s full immunisation coverage was 62% in 2014. Significance: Provided the baseline for Mission Indradhanush. Relevance: Evidence-based policymaking; highlights gaps in equity and access. Sample Registration System (SRS) 2021 Significance: Clear evidence of immunisation’s role in improving child survival. Relevance: Shows how preventive healthcare directly impacts SDG-3 (Health & Well-being). Measles-Rubella (MR) Campaign (2017–19) Coverage: 34.8 crore children aged 9 months–15 years vaccinated. Significance: Largest catch-up campaign globally. Relevance: Example of mass public mobilisation and vaccine diplomacy readiness. Key Concepts: Zero-dose Outreach Definition: Identifying and immunising children who have not received a single vaccine. Importance: They represent the most vulnerable clusters (remote, migratory, socio-economically deprived). UPSC Link: Equity in health, SDG-3, “Leaving no one behind”. One-Health Lens Definition: Integrated surveillance of human, animal, and environmental health. Why: 75% of emerging infectious diseases are zoonotic (e.g., COVID-19, Nipah). Application: Prevents epidemics by connecting immunisation with disease surveillance across ecosystems. UPSC Link: Pandemic preparedness, sustainable health governance.