SUBMITTED BY:

MRS. BEENA ALFONSA,

1st yr. M. Sc. (Nursing)

OBSTETRICS AND

GYNAECOLOGICAL NURSING,

2012-2013BATCH,

ORIENTAL COLLEGE OF NURSING.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE. PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

MRS.BEENA ALFONSA

IST YEAR MSC NURSINGORIENTAL COLLAGE OF NURSING.NO.43/52,2ND MAIN INDUSTRIAL TOWN, WEST OF CHORD ROAD, BANGALORE-560010.

2. NAME OF THE INSTITUTION Oriental College of Nursing, Bangalore.

3. COURSE OF THE STUDY AND SUBJECT IST year M.Sc.Nursing.

Obstetrics and gynecological Nursing.4. DATE OF ADMISSION OF COURSE

0

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

5. TITLE OF THE TOPIC “A Study to Assess The Knowledge And Attitude Towards Surrogacy Among the Surrogate Mothers of Selected Institutions in Bangalore With A View To Develop An Information Booklet”

6. BRIEF RESUME OF THE INTENDED WORK6.0 Introduction6.1 Need for the study6.1.1 Statement of the problem6.2 Review of related literature6.3 Objectives of the study6.3.1 Operational definitions6.3.2 Assumptions6.3.3 Hypothesis6.3.4 Sampling Criteria(Inclusion and Exclusion criteria)6.3.5 Delimitations

EnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosedEnclosed

Enclosed

7. MATERIALS AND METHODS 7.1. Sources of data: The data will be collected from the surrogate mothers from the selected institutions at Bangalore.7.2. Method of data collection: Descriptive survey approach.7.3 Does the study require any investigation or intervention to be conducted on the patients or human beings or animals? – No-7.4. Has ethical clearance being obtained from your institution? – Yes-

8 LIST OF REFERENCES Enclosed

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND

ADDRESS

MRS. BEENA ALFONSA

IST YEAR MSC NURSING

1

ORIENTAL COLLEGE OF NURSING.

NO.43/52,2ND MAIN INDUSTRIAL TOWN,

WEST OF CHORD ROAD, BANGALORE-

560010.

2. NAME OF THE INSTITUTION Oriental College of Nursing, Bangalore.

3. COURSE OF THE STUDY AND

SUBJECT

Ist year M.Sc.Nursing

OBSTETRICS AND GYNAECOLOGICAL

NURSING

4. DATE OF ADMISSION OF COURSE 28-06-2012

5. TITLE OF THE TOPIC “A Study to Assess The Knowledge

And Attitude Towards Surrogacy

Among the Surrogate Mothers of

Selected Institutions in Bangalore

With A View To Develop An

Information Booklet”

6. BRIEF RESUME ON INTENDED WORK

6.0 INTRODUCTION

“Surrogacy is the practice of a woman carrying the biological child of another

person or couple with whom the baby will be placed for adoption after the

birth”.

2

“A surrogate mother is a woman who carries a child for someone else,

usually an infertile couple. There are two different types of surrogacy.

They are traditional surrogacy and gestational surrogacy. Explanations

for both types can be found below”. Jenn Z

To be the part of creation- the most beautiful and cherishing experience that a

person ever has. Nature has bestowed this productive capacity only in the lives of the

women and every woman cherishes this experience of motherhood. To become a

mother is like a flowering process which is considered as the moments of the

fulfilment of life. Though it is counted as the most dignified moments and experience

in life, many women remain in the great depression and sorrow for not being able to

be a mother. Unfortunately, due to the physiological defects many women remain

helpless to give birth to their own off-spring. In order to survive this tragic situation,

they may opt for the available solutions. The desire for motherhood leads them to

search for the possible alternative solutions and surrogacy itself presents as the most

viable and reliable alternative.1

Surrogate mother is defined by the Collins English dictionary as, “a woman

who bears a child on behalf of a couple unable to have a child, either by artificial

insemination from the man or implantation of an embryo from the woman”. The

Oxford dictionary defines surrogate mother as, “a woman who bears a child on behalf

of another woman, either from her own egg fertilized by the other woman's partner or

from the implantation in her womb of a fertilized egg from the other woman.” 2

The ART Regulation Bill, 2010 defines the surrogate mother as, “a woman

who is a citizen of India and is resident in India, who agrees to have an embryo

generated from the sperm of a man who is not her husband and the oocyte of another

woman, implanted in her to carry the pregnancy to viability and deliver the child to

the couple/individual that had asked for surrogacy” .3

Surrogacy is a method of reproduction whereby a woman agrees to become

pregnant and deliver a child for a contracted party. The word surrogate means

“substitute”. Surrogacy arrangements do not only take place within the family, but

also within the community, the state, the country and presently even the world. 3

Advances in assisted reproductive techniques such as donor insemination and, embryo

transfer methods, have revolutionized the reproductive environment, resulting in

surrogacy, as the most desirable option. The system of surrogacy has given hope to

many infertile couples, who long to have a child of their own. Taking advantage of

the advanced medical facilities, they seek alternative solutions like Artificial

Reproductive Technology (ART), In-Vitro Fertilization (IVF) and, Intra-Uterine

Injections (IUI), in the hope of having a child of their own.4

Currently, two types of surrogacy can be observed; “traditional” and

“gestational”. “Traditional surrogacy is done via artificial insemination, with the

surrogate using her own egg and another man's sperm. Gestational surrogacy is done

via In Vitro Fertilization (IVF), where fertilized eggs from another woman are

implanted into the surrogate's uterus. Choosing which route to take is one of the most

important and earliest decisions a surrogate and the intended parents will have to

make”.5

Mainly these kinds of situations are occurring due to the lack of proper

understanding about the duties and responsibilities of a surrogate mother. In this

context it is necessary to calculate the understanding level of the people about the

laws, pre-requisites etc of a surrogate mother. Therefore here I’m trying to throw light

upon the knowledge about the antenatal care and attitude towards surrogacy among

the surrogate mothers, mainly in Bangalore.6

6.1 NEED FOR THE STUDY

To be a mother is the dream and an ambition of every married woman.

Infertility is the situation in which the married couples are stucked with and in many

cases leading towards the problems like separation of spouses. What are the obstacles

and difficulties that are emerging out of infertility; how can it be overcome? These

kinds of substantial questions were always within me. Also I had an experience which

also happened to lead me to take this topic as the focal point of my assignment. One

of my cousins had no children even after 11 years of their marriage. They were

consulting different types of doctors, taking varieties of medicines, going for the

counselling to come out of their familial problems and even going behind so much of 4

treatment with the hope that they fill find the positive result; spent a large amount of

money, praying and awaiting for a child. Being kept in the mind this bitter experience,

I had decided to step towards this major problem which the married couples are

facing, find out its multifarious aspects and help the people in the possible ways.7

Many health issues arise for the surrogate mother.  A major issue is how much

control a physician can exercise over a surrogate mother.  For example, is she

obligated to change her current living style?  How often does she need to have vaginal

ultra-sounds or amniocentesis?  An important question to consider is if and when she

should be allowed to terminate a pregnancy.  In general, this decision would be free of

the complicating factors of STDs, as physician will ensure that the pre-embryo is free

of viruses such as human immune-deficiency virus (HIV), cytomegalovirus (CMV),

and hepatitis B&C viruses (HBC and HCV).  These viruses could compromise the

health of the surrogate mother and that of the newborn.8 

Among the different ways available, the best alternative is the surrogacy;

irrespective of whether it is traditional-where the genetic mother is involved or

gestational- where there is no involvement of a genetic mother. The surrogacy had

been taken place between the friends and relatives earlier with the pure genetic

purpose- being relieved from the pain of infertility. It was considered with a noble

intension. But a shift in attitude has been taken place in the understanding of being a

surrogate mother. A kind of commercialization had been occurred and it is the result

of the growing economic stigma in the lives of the poor and the middle class people.

The women who engage in the surrogacy are poor, normally. They accept to conceive

on the basis and only for the money. A vast majority of the surrogates consider it as

the easiest way to get a good amount of money. 9

It is also equally important to have a proper antenatal care during the

pregnancy. But in many cases the illiterate surrogates are not aware about the

different steps of antenatal care which may result in the deficiencies of the child. If

money is the only motivating force behind the surrogacy, then that also will be

leading to several severe other problems. A proper antenatal care is possible only with

a proper attitude. The commercialization will be deteriorating the attitude of the

surrogate mothers. All these can lead to a different culture. In this scenario I think it is

5

important and necessary to make study to assess the knowledge regarding the

antenatal care and the attitude towards the surrogacy among the surrogate mothers.10

A study related to infertility reveals that infertility is perceived as a problem

across virtually all cultures and societies and affects an estimated 10%-15% of

couples of reproductive age. In recent years, the number of couples seeking treatment

for infertility has dramatically increased due to factors such as postponement of

childbearing in women, development of newer and more successful techniques for

infertility treatment, and increasing awareness of available services. This increasing

participation in fertility treatment has raised awareness and inspired investigation into

the psychological ramifications of infertility. Consideration has been given to the

association between psychiatric illness and infertility. Researchers have also looked

into the psychological impact of infertility per se and of the prolonged exposure to

intrusive infertility treatments on mood and well being. There is less information

about effective psychiatric treatments for this population; however, there is some data

to support the use of psychotherapeutic interventions.11

Infertility is defined as 12 months of appropriately timed intercourse that does

not result in conception. Approximately 16% of couples in the United States will have

difficulty having a child. This appears in part because of the trend for some women to

delay childbirth until the mid- to late 30s and the associated decrease in fertility after

the age of 35. Although there is the perception that infertility is on the rise, it is

actually an artefact of the large number of women currently in the childbearing years

because of the baby boom of the 1950s and early 1960s. The base rate of infertility

among women has remained the same but the absolute number of women in the

reproductive years has increased. Approximately 40% of infertile couples have female

factor infertility, 40% male factor, and 20% a combination of both or infertility of

unknown etiology.12

Before the advances in reproductive technology clinicians believed that

infertility, particularly of unknown etiology, was caused by psychological distress.

Investigators tried to identify unconscious or other psychological variables that caused

infertility. In the mid-1980s clinicians and researchers began questioning the

hypothesis that psychological distress caused infertility. Instead, they found that

6

psychological distress was a consequence of infertility. With this understanding,

mental health professionals have become increasingly involved in the provision of

care to infertile patients. .13

A study on the infertility treatment gives amble light to solve the problem of

infertility. The importance of infertility treatment in the larger field of obstetrics and

gynaecology is related to the almost universal desire for a child among women. The

desire for a child has had different meanings throughout the history of humankind.

Before the Industrial Revolution, children were valued for their economic usefulness.

After child labour laws were enacted and children were displaced from the workforce,

they came to be valued for relational reasons, such as companionship and familial

continuity. As Griel suggested, children became economically worthless but

emotionally priceless. The shift in the value of children persists today as children are

viewed as a source of fulfilment and happiness. Therefore, children have become

something that couples work hard to obtain and feel they have a right to. From this

vantage point, the seeking of infertility treatment for years and undergoing expensive,

psychologically draining treatments can be understood as a result of the 21st century

view of the value of the child.14

While many couples presenting for infertility treatment have high levels of

psychological distress associated with infertility, the process of assisted reproduction

itself is also associated with increased levels of anxiety, depression and stress . A

growing number of research studies have examined the impact of infertility treatment

at different stages, with most focusing on the impact of failed IVF trials. Hynes and

colleagues assessed women at presentation for IVF and then following failure of IVF.

They found that women presenting for IVF were more depressed, had lower self-

esteem and were less confident than a control group of fertile women and, after a

failed IVF cycle, experienced a further lowering of self-esteem and an increase in

depression relative to pre-treatment levels (Hynes 1992). 15

The outcome of infertility treatment may also be influenced by psychological

factors. A number of studies have examined stress and mood state as predictors of

outcome in assisted reproduction. The majority of these studies support the theory that

distress is associated with lower pregnancy rates among women pursuing infertility

7

treatment (Boivin 1995, Thiering 1993, Demytenaere 1998, Smeenk 2001, Sanders

1999). The infertility treatment can be included certain psychological therapies like,

counselling, psychotherapy, relaxation technique, medications etc.16

The study about the antenatal care can be summarized as follows:

To ensure that the pregnant woman and her fetus are in the best possible

health.

To detect early and treat properly complications

Offering education for parenthood

To prepare the woman for labor, lactation and care of her infant

ANC also provides women and their families with appropriate information and

advice for a healthy pregnancy, safe childbirth, and postnatal recovery, including care

of the newborn, promotion of early, exclusive breastfeeding, and assistance with

deciding on future pregnancies in order to improve pregnancy outcomes. An effective

ANC package depends on competent health care providers in a functioning health

system with referral services and adequate supplies and laboratory support.

ANC improves the survival and health of babies directly by reducing

stillbirths and neonatal deaths and indirectly by providing an entry point for health

contacts with the woman at a key point in the continuum of care. 17

ANC indirectly saves the lives of mothers and babies by promoting and

establishing good health before childbirth and the early postnatal period – the time

periods of highest risk. ANC often presents the first contact opportunity for a woman

to connect with health services, thus offering an entry point for integrated care,

promoting healthy home practices, influencing care seeking behaviours, and linking

women with pregnancy complications to a referral system. Women are more likely to

give birth with a skilled attendant if they have had at least one ANC visit.18

The study on the statistics explains the following data. Some agencies are

reporting that the statistics on children born through Surrogacy is reaching 35,000 in

total as of 2011.  This is largely due to increased societal acceptance.

8

Surrogacy is the practice of a woman carrying the biological child of another

person or couple with whom the baby will be placed for adoption after the birth. In

traditional cases, the child will be related to the surrogate. In gestational surrogacy,

the woman is carrying the couple's fertilized egg, or embryo. Just over 5,000 children

were thought to be born and adopted through surrogacy between 2004 and 2008.19

Based on a report from the Council for Responsible Genetics, as of 2008, there

are no surrogacy statistics that are available to the public. Yet, while it is known that

the use of a surrogate has become quite popular over the years, it is not known exactly

how many children have been carried in such a manner. However, between the years

2004 and 2008, it is approximated that the number of children is over 5,000. Another

estimate is that there is an average of nine children that are born to surrogates in each

state every year.20

It is also known that there have been differing rates of success for the various

types of surrogacy procedures. For instance, when using in vitro fertilization with

mothers who are under the age of 35, success can be as high as 60 percent or more.

The success rate tends to decrease, though, as the surrogate and/or the biological

mother.increase .21

The study on the advantages of surrogacy can be summarized as follows: This

may be the only way to achieve parenthood for couples or persons suffering from

infertility or other medical conditions that render them incapable of having a child on

their own. For gay men and single men who aspire to be fathers (without getting

involved in a relationship with a woman), surrogacy is the only way to have

genetically-linked children. Children born through surrogacy may be completely

connected to the intending parents (gestational surrogacy with own eggs) or only

partly (gestational surrogacy with egg donor or traditional surrogacy).22

The act of becoming a mother (surrogate mother), is not only a self-sacrificing

but truly a brave decision. The act of giving life, a reason to live, making dreams

possible for childless couples, is more than a benefit for you. Only the mothers

understand the feeling of what it takes to carry a baby for nine months. At the end of

9

nine months, you feel, its “YOU”, who can gave happiness & smiles to the other

couple. 23

Surrogacy offer hope for various infertile couples and gives a chance for

enjoying cherishing feeling of parenthood to several couples who are unable to

conceive naturally and seeks another woman who carries pregnancy to its full term.

On the other hand, it gives financial security to those women who are coming

forward to become a surrogate mother. Comparing with the foreign countries, though

India is having very limited expenses within the existing legal framework, it is an

income generating source to those poor and illiterate women.24

6.2 REVIEW OF LITERATURE

A literature review discusses published information in a particular subject

area, and sometimes information in a particular subject area within a certain time

period. Literature reviews provide you with a handy guide to a particular topic.

Literature reviews can give you an overview or act as a stepping stone. Literature is a

broad, comprehensive in depth, systematic and critical review of scholarly

publications, unpublished scholarly print material, audio-visual materials and personal

communications. The major goal of literature review is to develop a strong knowledge

base to carry out research. Thus, literature review in many ways, starting from the

selection and formulation of problems, providing conceptual framework for the study,

assess feasibility, providing methodology, for comparison and replication, avoiding

obstacles and making generalization.25

Review of literature was collected on the following aspects:

1. Review related to knowledge of surrogate mothers towards surrogacy

2. Review related to attitude of surrogate mothers towards surrogacy

3. Review related to antenatal care among the surrogate mothers

Review related to knowledge of surrogate mothers towards surrogacy

Surrogacy is the process to become a delegated mother for someone else. To

become a surrogate mother is not simply a biological process but something superior

10

which demands a high personal commitment. It’s something above a commercial

contract. Due to the increasing stressful lifestyle, number of people is coming under

the psychological tensions which can lead to the infertility. The surrogacy is said to be

the best alternative to those infertile couples. India is considered to be the best hub of

surrogacy due to the many reasons.26

Commercial surrogacy is legal in India, as recognized by the Supreme Court

of India in 2002. India has emerged as a leader in international surrogacy and a

destination in surrogacy-related fertility tourism. Indian surrogates have been

increasingly popular with fertile couples and singles from Canada, USA, Australia,

Ireland, France and UK.27

To address issues and to regulate surrogacy arrangements, the Government of

India has taken certain steps including the introduction and implementation of

National Guidelines for Accreditation, Supervision, and Regulation of Assisted

Reproductive Technology (ART) Clinics in 2006, and guidelines have been issued by

the Indian Council of Medical Research (ICMR) under the Ministry of Health and

Family Welfare, Government of India.28

However, till now there is no legal provision dealing directly with surrogacy laws

to protect the rights and interests of the surrogate mother, the child, or the

commissioning parents. The Union health ministry of India has finalized the Assisted

Reproductive Technologies (ART) Regulation Bill 2010. Here’s a quick look at some

of the revolutionary stipulations

If a surrogate mother is married, the consent of her spouse is mandatory.

No ART bank or clinic can send an Indian citizen for surrogacy abroad.

The donor’s identity cannot be revealed and both parties will have to sign

legally-binding surrogacy agreements.

It allows surrogacy for individuals as well as couples. A couple is defined

under the Indian law as two people living together and having a sexual

relationship that is legal in the country.29

11

Even though it may take some time before the surrogacy laws are actually put

into practice, surrogacy clinics in India continue to attract thousands of visitors to the

country every year who visit the country in the hope of achieving parenthood. If you

too are keen to start your India surrogacy journey, please fill out the quote request

form on the right (www.surrogacyclinics.com/india-surrogacy-journey/30

Review related to attitude of surrogate mothers towards surrogacy

In the modern time one can observe the inculcation of commercialization in

the field of surrogacy. Due to this increasing commercialization, there has been a shift

in the attitude towards the surrogacy even in the surrogate mothers.

Commercial surrogacy is a form of surrogacy in which a gestational carrier is

paid to carry a child in her womb and is usually resorted to by higher income infertile

couples who can afford the cost involved or people who save and borrow in order to

complete their dream of being parents. This procedure is done in a large scale in

several countries including India due to the high international demand and ready

availability of poor surrogates it is reaching industry proportions.

Commercial surrogacy is sometimes referred to by the emotionally charged

and potentially offensive terms “wombs for rent”, “outsourced pregnancies”, or “baby

farms”. India is foremost in surrogacy because of the low cost treatment and ready

availability of women opting to be surrogate for childless foreigners. By some

estimates surrogacy in India is already $ 445 million business. In India surrogacy

costs about $ 12,000 compared to US where it is $ 70,000. Moreover laws in US and

UK do not allow the surrogate women to charge the childless couple; whereas in India

there are no laws preventing surrogate women in accepting compensation for renting

her womb.

All these show the attitude of the surrogate mothers towards the surrogacy.

And it is also to be accepted that this change in attitude is mainly because of the poor

economic situation and the increasing demand of life.

Review related to antenatal care among the surrogate mothers

12

Antenatal care can be said as comprehensive health supervision of a pregnant

woman before delivery or it is a planned examination, observation and guidance given

to the pregnant woman from conception till the time of labour. Antenatal care during

the pregnancy is an important step because the health of both mother and inside baby

is mutually related. The health of the mother decides the health of the child. The goals

of the antenatal care are said to be to reduce maternal and perinatal mortality and

morbidity rates and to improve the physical and mental health of women and

children.31

Antenatal care increases awareness of maternal and newborn health needs and self

care during pregnancy and the postnatal period, including the need for social support

during and after pregnancy. It also promotes healthy behaviors in the home, including

healthy lifestyles and diet, safety and injury prevention, and support and care in the

home, such as advice and adherence support for preventive interventions like iron

supplementation, condom use, and use of ITN Support care seeking behavior,

including recognition of danger signs for the woman and the newborn as well as

transport and funding plans in case of emergencies. Antenatal care helps the pregnant

woman and her partner prepare emotionally and physically for birth and care of their

baby, particularly preparing for early and exclusive breastfeeding and essential

newborn care and considering the role of a supportive companion at birth.32

For antenatal care to work properly, you will be required to give in your

family history, your own medical history and that of your partner and also all record

of previous pregnancies, complications during pregnancy and also any cases of

abortion or miscarriage. Be open with your doctor and make your list exhaustive.

Include even the minute details so that your doctor understands your case thoroughly.

Provide all the necessary details regarding your partner and his medical history. You

can also discuss any issues that you have regarding labour and delivery so as to avoid

any stress and depression. Stress can lead to preterm labour and delivery.

Antenatal care is so essential for a pregnant woman for getting a healthy child.

It is having a special place in surrogacy. Since the surrogate mother conceives for a

commissioning parent, there can be some laxities in the antenatal care which can lead

to birth-defected problems in the child. In many cases these carelessness is occurred

13

due to the ignorance of the surrogate mother as they are very poor and illiterate. So, it

is essential to increase the understanding level of the surrogate mothers regarding the

antenatal care.33

6.2.1 STATEMENT OF THE PROBLEM

“A study to assess the knowledge and attitude towards surrogacy among the

surrogate mothers of selected institutions in Bangalore with a view to develop an

information booklet”.

6.3 OBJECTIVES OF THE STUDY

The following are the objectives:

1. To assess the level of knowledge regarding antenatal care among the

surrogate mothers.

2. To assess the attitude towards the surrogacy among the surrogate

mothers.

3. To the association between the level of knowledge and selected

demographic variables.

4. To find out the knowledge and attitude regarding the antenatal care

among the surrogate mothers.

5. To develop an information booklet regarding antenatal care among the

surrogate mothers.

6.3.1 OPERATIONAL DEFINITIONS

Knowledge: It is the awareness of surrogate mothers regarding surrogacy as

measured by their response to the structured knowledge questionnaire.

Attitude: It is the opinion of surrogate mothers towards surrogacy as measured by

attitude scale.

14

Surrogacy: Surrogacy is an arrangement in which a woman agrees to a pregnancy,

achieved through assisted reproductive technology, in which neither of the gametes

belong to her or her husband, with the intention of carrying it to term and handing

over the child to the person or persons for whom she is acting as surrogate.

Infertility: Female Infertility may be defined as the inability to conceive a child on

the part of the woman even after a year’s time period, of having sex without any

contraceptives. Interestingly, medical definition of infertility also encapsulates the

inability to carry through a pregnancy to its natural conclusion resulting in

miscarriages.

Information booklet: Educational materials which contains all information

regarding surrogacy,antenatal,intranatal,and postnatal care.

6.3.2 ASSUMPTION

1. Surrogate mothers may have some knowledge regarding surrogacy and antenatal

care.

2. Surrogate mothers may have varying knowledge towards surrogacy and antenatal

care

6.3.3 HYPOTHESIS

H1: there is significant relationship between knowledge and attitude of surrogate

mothers towards surrogacy.

H2: There is a significant association between level of knowledge and collected socio-

demographic variables.

H3: There is a significant association between attitude and selected socio-

demographic variables.

6.3.4 SAMPLING CRITERIA

INCLUSION CRITERIA

15

Surrogate mothers who are,

i. Willing to participate

ii. Read and understand Kannada and English

EXCLUSION CRITERIA

Surrogate mothers who are health professionals.

6.3.5 DELIMITATIONS

Studies delimited to

Four weeks of data collection period

Studies are conducted only with female patients who are above 35 years in

selected hospitals

Data based on written responses of 100 surrogated mothers

7. MATERIALS & METHODS

7.1 SOURCE OF DATA:-

The data will be collected from the surrogate mothers from the selected institutions at

Bangalore.

7.2 METHODS OF DATA COLLECTION:-

(A). Research Approach - Descriptive survey approach.

(B).Research Design -Non-experimental descriptive design

(C). Setting -Selected institutions at Bangalore.

(D). Population -Selected institutions at Bangalore.

(E).Sample -Surrogate mothers who meet inclusion criteria

16

(F).Sample size -100 surrogate mothers

(G). Sampling technique -Purposive sampling technique

(H). Method of Data collection -Self administered structures knowledge

questionnaire and attitude rating scale

(I). Tool of Data collection:

Structured knowledge questionnaire to assess the knowledge on surrogacy

Attitude rating scale to assess the attitude towards surrogacy

(J). Method of analysis -The researcher will use appropriate statistical

techniques for data analysis and present in

the form of tables and diagrams.

Data will be analysed using g descriptive and inferential statistics

Descriptive statistics: Frequency and percentage distribution to describe the socio-

demographic variables

Inferential statistics: Mean, mean percentage and standard deviation to assess the level

of knowledge and quality of attitude – co-relation, co-efficient to find the relationship

between the knowledge and attitude – chi-squire test to find association between

findings and the selected demographic variables.

(K). Duration of study - 4 weeks.

(L). Research Variables -knowledge regarding surrogacy

Attitude towards surrogacy

(i). Demographic Variables - Age, place of residence, dietary pattern,

infertility, infertility treatment, education status, occupation, income, area of

residence, previous source of information.

17

(M). Projected outcome -The study will be successful in improving the

knowledge and attitude of the surrogate mothers

regarding surrogacy.

7.3 Does the study require any investigation or intervention to be conducted on the

patients or human beings or animals?

No investigation or invention will be done on human beings or animals.

7.4 Has ethical clearance being obtained from your institution?

Yes, ethical clearance has been enclosed

.

8. LIST OF REFERENCES

1. Surrogacy in India(www.surrogacy clinics.com/India surrogacy journey.

18

2. Surrogate mother | Define Surrogate mother at Dictionary.com

http://dictionary.reference.com/browse/surrogate+mothe

3. Art regulation bill 2010http://www.scribd.com/doc/33533932/Art-Regulation-

Draft-Bill1-India?

4. http://dictionary.reverso.net/english-definition/surrogate%20family

5. http://childbirthsolutions.com/articles/traditional-versus-gestational-surrogacy/

6. http://ivftreatmentindia.wordpress.com/

7. http://www.mentalhelp.net/poc/view_doc.php?id=3732&type=book&cn=5

8. http://www.unicef.org/about/history/files/Child-First-CH-03-p063-090-unravel-

nutrition-com...

9. http://www.reproductive-heal

10. http://www.unicef.org/about/history/files/Child-First-CH-03-p063-090-unravel-

nutrition-com...

11. http://www.bjmp.org/content/psychological-aspects-infertility

th-journal.com/content/5/1/9

12. FEMALE INFERTILITY: Implications and Treatments - Surrogacy India

http://www.kiranivfgenetic.com/article-15.html

13. http://www.glowm.com/?p=glowm.cml/section_view&articleid=412

14. http://www.glowm.com/?p=glowm.cml/section_view&articleid=412

15. http://www.bjmp.org/content/psychological-aspects-infertility

16. http://www.womensmentalhealth.org/resource/patient-support-services/

infertility-assisted-r...

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17. Antenatal Care - World Health Organization

http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf

18. http://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf

19. FertilityAuthority

http://www.fertilityauthority.com/treatment/surrogacy

20. Statistics on Surrogacy | Modern Family Surrogacy

http://www.modernfamilysurrogacy.com/page/surrogacy_statistics

21. http://www.modernfamilysurrogacy.com/page/surrogacy_statistics

22. http://www.euro.who.int/document/e79235.pdf

23. http://www.womenleadership.in/csr/surrogacyreport/pdf

24. http://www.iwannaget pregnant.com/surrogacy.asp

25.http://www. surrogacy clinics.com/ India-surrogacy-journey

26. http://www.encyclopedia.com/topic/Motherhood.aspx

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9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11. NAME & DESIGNATION IN

BLOCK LETTERS :

11.1 GUIDE :

11.2 SIGNATURE :

11.3 HEAD OF THE DEPARTMENT :

11.4 SIGNATURE :

12.1 REMARKS OF CHAIRMAN /

PRINCIPAL :

12.2 SIGNATURE :

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