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The plot of the Marathi-language film “Mala Aai Vhhaychy” (“I Want to Be a Mother”) asks a deceptively simple question: Does Yashoda, a woman turning to surrogate motherhood as an escape from poverty, have any claim on the child she is under contract to bear for Mary, an American fertility tourist? In the melodramatic world of Indian cinema, the answer is a heartwarming yes. In real life, it may not be that easy to script a happy ending.

Since 2002, when commercial surrogacy was legalized in India, the surrogacy industry has boomed, becoming a key part of the country’s lucrative medical tourism market. The cost of surrogacy for prospective parents is about $14,000 in India, compared with an estimated $70,000 in the United States. A 2008 study valued the assisted reproductive industry in India at $450 million a year.

Across India, fertility clinics attempt to replicate the success of Akanksha and other clinics in the small town of Anand in the western state of Gujarat, which was the country’s first surrogacy hub. But the boom masks growing concerns about...