Thriving Beyond

The practice of surrogacy is an emerging global market and has become a common alternative for family building. This modern reproductive practice has raised legal and ethical concerns, some of which are yet to be resolved. Is it a violation of human and children’s rights? A form of human trafficking? Should it even be legal?

What is surrogacy?

Surrogacy is when a woman (the surrogate) agrees with the intended parents (the family/individual who will receive the baby upon birth) to become pregnant and deliver the baby. There are many types of surrogacies, the main types being gestational and traditional surrogacy. Gestational surrogacy is when the child is conceived from the egg and sperm of the intended parents through in-vitro fertilization and the surrogate carries the baby to term. Traditional surrogacy is when the surrogates’ eggs are used, and therefore the child is genetically related to the surrogate. 

Let’s talk laws, ethics, and morals

Legal issues tend to arise from surrogacy legislation varying from country to country, and in the United States, laws vary from state to state and even from county to county. Countries like Italy, France, and Germany have banned all forms of surrogacy. Depending on the agreement and state laws, surrogates can be compensated for pregnancy-related medical expenses (altruistic surrogacy), or they can be paid for other services such as mental health services in addition to the pregnancy-related medical costs (commercial or compensated surrogacy). Compensated surrogacy is legal in some states, except for Nebraska, Louisiana, and Michigan. Earlier this year, compensated surrogacy was legalized in New York, reversing a long-standing ban. 

Although surrogacy can bring about many benefits and rewards for intended parents and surrogates, some serious ethical and moral considerations are involved. Not all stories of surrogacy result in happy smiles and healthy babies. The exploitation of women is a genuine concern, especially for women experiencing human trafficking and women in poorer countries seeking financial opportunities. Lack of national and international regulations also contributes to the exploitation of women. Children may be stateless or not recognized as citizens due to legislation around citizenship and birth certificate requirements. The child can be denied a relationship with their biological parents. Conflicting lifestyle choices and difference in opinions between the surrogate and the intended parents throughout the course of pregnancy can add additional challenges.

Maternal health implications & COVID-19 

Surrogates are likely to experience pregnancy-related complications like any other pregnant woman even after completing health screenings before becoming a match. A study of 124 gestational surrogates reported increases in adverse infant health outcomes, including preterm birth and low birth weight, and adverse maternal health outcomes, including gestational diabetes and placenta previa. Multiple gestations (being pregnant with more than one child at a single time) can lead to complications resulting in cesarean births which can lead to harmful effects for the surrogate and the babies. In cases of multiple pregnancies, selective reduction may be considered as an option. This is often one of the most difficult and sensitive conversations in the surrogacy process. 

The surrogacy process has been affected in numerous ways by the COVID-19 pandemic. Many families faced delays in the legal processing as courts closed, reduced hours, and/or experienced staff shortages. Surrogacy agencies may have adopted or changed their protocols to adhere to COVID-19 regulations or even paused their services. Intended parents were prevented from attending prenatal visits and separated from their children after birth due to travel restrictions. Surrogates may have incurred additional expenses in raising the chid after birth. These are just a few of the changes that have caused heightened stress and anxiety for those involved in the process. 

Some thoughts…

We have not even scratched the surface on the topic of surrogacy and have only considered few perspectives. Now, we may agree or disagree, but I urge you to consider these thoughts: 

• There can and have been exploitation and commodification of women’s bodies and reproductive rights in the process of surrogacy
• Surrogacy allows women autonomy and free will of their bodies; however, these rights can and have been violated 
• Violation of rights as it pertains to the surrogate and child may continue due to the lack of universal regulations and varying regulations from country to country 
• A surrogate is first a human being, second a mother; their needs and rights cannot be ignored or dismissed