Dr. Nayna Patel , right, a pioneer of reproductive surrogacy in India, conducts an ultrasound on 30-year-old surrogate mother Rinku Macwan, bearing twin babies, at Kaival Hospital in Anand on Oct. 31, 2011. Commercial surrogacy, made legal in India in 2002 and popular among foreign couples who are unable to conceive, has provided a large source of income for some Indian women acting as surrogate mothers despite local stigmas and ethical debates. (Sam Panthaky/AFP/GETTY IMAGES)

When 24-year-old Komal Kapoor handed over the twins she had just borne to a visiting American couple last month, she said she felt “something like sadness.”

But that lasted just a few minutes.

“In my head I kept saying, ‘These are not my children, these are not my children,’ ” recalled Kapoor, a surrogate mother who lives in a New Delhi slum. After delivering what she called two “very beautiful, fair-skinned, black-haired babies” for the couple, she signed a document relinquishing all rights to the infants in return for a little over $8,000 — more than 12 times her annual earnings as a garment worker. “With the money, I want to secure my daughter’s future,” she said.

This nation of more than 1.2 billion people has emerged as the preferred destination for a growing number of couples from around the world who are looking for a low-cost, trouble-free way of becoming parents. But a government-funded survey released this month said that in the absence of regulation, some unscrupulous agents are luring poor, uneducated women into signing surrogacy contracts that they do not fully understand.

While there are few statistics on the surrogacy industry here, India has become a hub for medical tourism because of the availability of advanced technology, the large number of medical professionals and the relatively cheap costs. “All this coupled with the huge number of poor women and lack of legal scrutiny has ensured the commercial surrogacy boom,” said Manasi Mishra, the co-author of the survey.

She said many other developing countries either do not allow commercial surrogacy or have few sophisticated hospitals.

Many of the women in her study were bearing babies for couples in the United States and Britain. The report said some couples used Skype to periodically view the surrogate mother’s belly and thus monitor the progress of the pregnancy. American couples would pay five or six times as much for a surrogate pregnancy in their own country as they do in India, according to doctors and industry officials here.

The new survey, done by the women’s advocacy group Center for Social Research, said there is “no fixed rule” for payments to surrogate mothers, which are “arbitrarily decided by the clinics.” The women, the report said, are kept in special, guarded facilities and allowed limited social interaction during pregnancy. The rights of women who miscarry are not secured, it said.

Doctors, activists and agents say the surrogacy boom began with infertile Indian-origin couples in countries such as the United States, Britain and the United Arab Emirates seeking out women in India to bear their children. At least half of the clients still belong to that group, Mishra said at a news conference.

In most cases, the clients’ sperm and egg are implanted in the surrogate’s womb, with DNA tests done after the birth to prove the genetic links to the couple and ease the issuing of a foreign passport.

Doctors say the practice is growing among Indians, too. This month, one of Bollywood’s biggest stars, Shahrukh Khan, announced that his newborn child had been carried by a surrogate, bringing social respectability and even some trendiness to the practice. But the cost is still prohibitive for most in the country..

“India is becoming a popular destination in the search for surrogate mothers, agencies are mushrooming, and now Bollywood stars are also giving the whole practice a stamp of social legitimacy. But it is frightening that all this is happening in a legal vacuum and without any monitoring,” said Ranjana Kumari, director of the Center for Social Research, which is based in New Delhi.

“Middlemen bring poor, uneducated women from the hinterland or from city slums with the lure of money. All this is being done under the facade of a noble cause of helping childless couples and supporting poor families.”

The group interviewed a total of 100 surrogate mothers in New Delhi and Mumbai for its survey, as well as parents, doctors, surrogacy agencies and others involved in the business. Most of the surrogates were married and had at least one child of their own. About half of the respondents said they had finished primary school; a little over half said they worked as housemaids, earning an average of about $50 a month.

The majority mentioned either poverty or their children’s education expenses as the reasons for agreeing to carry others’ children. Most women told interviewers that it was their decision to be surrogates, but sometimes they were also pressured by their husbands to earn money.

The Indian Council of Medical Research, a government body, introduced guidelines for accreditation, supervision and regulation of surrogacy and assisted-reproduction clinics in 2005. Later, the government formulated draft legislation that incorporates these guidelines, but the bill is yet to be introduced in Parliament. Activists, doctors and surrogacy agencies are urging lawmakers to pass it quickly. But Kumari said the measure still needs stricter punishments for violations.

Although there are no firm statistics, the new report estimates that the surrogacy industry is worth more than $450 million a year.

Many in the business defend it as helping both infertile couples and low-income Indian women. Promoters say the surrogacy agreements mandate that the women stay in special shelters during their pregnancies because the facilities are cleaner than their impoverished neighborhoods and the women’s health and nutrition can be monitored.

“Let us not forget that there are two women involved in this process,” said Hrishikesh Rai, a gynecologist and the president-elect of the Indian Society for Assisted Reproduction in Mumbai. “It is not an easy or casual decision for the infertile couple either. Surrogacy is the last extreme and a very difficult decision for couples.”

“The surrogate mothers come from very poor families, but they gain money and also self-confidence,” said Jagatjeet Singh, director of Wyzax Surrogacy Consultants in New Delhi. “They have a bank account in their names, health insurance card; they are exposed to clean, hygienic living during this period. Their aspirations for their own children begin to take shape.”

Singh added that women wanting to be surrogates come to his agency saying, “Please enroll me, please enroll me.”

“We do not even need to persuade them much now,” he said.

Kapoor said she heard about surrogacy from a neighbor who volunteered at the agency. Kapoor normally earns $54 a month gluing glitter on T-shirts, while her husband, who sorts and sells garbage, brings home about $85 a month.

She said she persuaded her husband to go along with the surrogate pregnancy but did not tell her parents. She left her home for nine months to live in the surrogate shelter with her 4-year-old daughter. Her husband visited her occasionally.

Last month, when the American couple met with Kapoor to take the twins, there was not much conversation. “They kept saying, ‘Thank you, thank you,’ the whole time,” she recalled.

In the survey, there was a question about whether the surrogate mothers experienced any doubt or difficulty about handing over the baby to the commissioning parents. A majority chose not to reply.