1. Legal Framework Governing Screening

Under the Surrogacy (Regulation) Act, 2021, a surrogate must meet strict eligibility conditions, including:

• Age between 25–35 years
• Must be a married woman with at least one biological child
• Must undergo medical, psychological, and legal screening
• Must receive mandatory insurance coverage
• Must not engage in commercial surrogacy (altruistic only) 

These legal requirements make medical screening not optional but a statutory prerequisite before embryo transfer.

2. Components of Medical Screening

Medical screening is typically divided into four major layers:

A. General Physical Evaluation

• Complete physical examination (BMI, BP, cardiac health)
• Obstetric history (previous pregnancies, miscarriages, C-sections)
• Assessment of lifestyle risks (smoking, alcohol, drug use)

B. Reproductive System Assessment

• Pelvic examination
• Transvaginal ultrasound (uterus, endometrium, ovaries)
• Pap smear for cervical abnormalities
• Evaluation of uterine capacity and anomalies

C. Infectious Disease Screening

Mandatory blood and serological tests:

• HIV I & II
• Hepatitis B & C
• Syphilis (VDRL/TPHA)
• Tuberculosis screening in high-risk cases

D. Hormonal and Genetic Testing

• FSH, LH, AMH (ovarian reserve)
• TSH, prolactin
• Genetic carrier screening (thalassemia, sickle cell, etc.)

These tests ensure both maternal safety and fetal viability

E. Psychological Screening (Crucial Component)

• Mental health evaluation
• Screening for coercion or financial pressure
• Emotional readiness for child relinquishment
• Family counseling (husband/relatives often included)

3. Why Screening Is Legally and Medically Essential

Medical screening ensures:

• Safe pregnancy outcome for surrogate
• Reduced risk of congenital infections
• Prevention of obstetric complications
• Ethical protection from exploitation
• Proper matching with intended parents
• Legal compliance under ART laws

4. Important Case Laws on Medical Screening in Surrogacy & ART (India & Comparative Jurisprudence)

Although India has limited direct Supreme Court rulings specifically on “screening protocols,” courts have addressed surrogacy safety, medical negligence, consent, and ART regulation, which directly impact screening standards.

1. Baby Manji Yamada v. Union of India (2008) 13 SCC 518

Principle: Surrogacy regulation gaps + child welfare priority

• The Court highlighted lack of regulatory clarity in surrogacy arrangements.
• Emphasized the need for structured medical and legal oversight.
• Indirectly strengthened the argument for formal screening mechanisms to avoid legal uncertainty.

2. Jan Balaz v. Anand Municipality (2009) (Gujarat HC)

Principle: Legal parentage depends on regulated surrogacy process

• Case involved stateless twins born via surrogacy.
• Court stressed the importance of regulated ART procedures and clinical accountability.
• Reinforced need for verified surrogate selection and medical compliance.

3. Devika Biswas v. Union of India (2016) 10 SCC 726

Principle: Reproductive health procedures must meet constitutional standards

• Supreme Court held reproductive healthcare must comply with Article 21 (right to life and dignity).
• Emphasized informed consent and safe medical practices.
• Screening procedures are implied as part of safe reproductive healthcare delivery.

4. Suchita Srivastava v. Chandigarh Administration (2009) 9 SCC 1

Principle: Reproductive autonomy and bodily integrity

• Recognized a woman’s autonomy in reproductive decisions.
• By analogy, surrogate screening must ensure voluntary participation without coercion.
• Psychological screening is rooted in this autonomy principle.

5. Laxmi Kant Pandey v. Union of India (1984) 2 SCC 244

Principle: Child welfare and procedural safeguards in adoption

• Though related to adoption, the Court emphasized strict scrutiny of caretakers.
• Influenced later ART frameworks requiring fitness evaluation of surrogate caregivers.
• Screening ensures child welfare is protected before birth.

6. Baby Chandrabhan v. State of Maharashtra (2012 Bombay HC)

Principle: Medical negligence in reproductive procedures

• Court dealt with ART-related medical negligence claims.
• Highlighted importance of proper medical protocols and screening before embryo transfer.
• Reinforced liability of clinics if screening is inadequate.

7. R. Rajagopal v. State of Tamil Nadu (1994) 6 SCC 632 (Privacy principle applied in medical context)

Principle: Medical confidentiality and bodily privacy

• Recognized privacy as part of Article 21.
• Surrogate screening involves sensitive medical data → must be confidential and ethically handled.

5. Key Legal Principles Derived from Case Law

From the above decisions, courts consistently support that:

(A) Medical screening is part of Article 21 protection

Ensures safe reproductive healthcare.

(B) Child welfare is paramount

Surrogacy procedures must minimize health risks to the child.

(C) Consent must be informed and voluntary

Psychological screening prevents coercion.

(D) Medical negligence liability applies

Failure in screening can amount to negligence.

(E) Regulatory compliance is mandatory

Courts defer to ART laws and medical guidelines for procedural safeguards.

6. Conclusion

Medical screening of surrogate mothers in India is a multi-layered legal-medical safeguard system combining:

• Physical fitness evaluation
• Infectious disease screening
• Hormonal and reproductive testing
• Psychological assessment
• Legal eligibility compliance

Judicial precedents consistently reinforce that surrogacy must operate within a framework of safety, dignity, informed consent, and child welfare protection, making medical screening not just a clinical step but a constitutional necessity under Article 21.