Image: DES Daughter, Flickr.
As a professional in child welfare, a birth, foster and adoptive mother, I have an interest in children and their well being, and attempt to keep up to date with the relevant issues, which includes surrogacy. However, for most of the general public, surrogacy is not of interest or widely understood. A surrogacy arrangement or surrogacy agreement is the carrying of a pregnancy for commissioning parent/s, or intended parent/s, usually termed IPs.
However, in the last few weeks surrogacy has been brought to our attention. The newspapers, television stations and social media are awash with the story of Gammy, a little boy who is a twin, born by surrogacy in Thailand. Sadly, Gammy was born with Down syndrome, and it is alleged that the commissioning couple from Australia, took the female twin and left him because of his disability and poor health. Gammy also has a serious heart condition. Daily more information comes to light, a complex case! People have ‘taken sides’ as the case has sparked debate on many levels: medical, ethical and legal.
This story promoted me to do some more research, and I was surprised of the extent and scope now of surrogacy. The story raised for me many questions, which include:
Should societies be concerned about the commercialisation of surrogacy? Should it intervene, or is surrogacy a ‘private’ matter between adults?
Altruistic and/or commercial surrogacy? What are the positives and negatives of both?
What happens if the surrogate dies or is severely disabled in child birth?
Is the wealth and power difference between the IPs and the surrogate important?
Who regulates and monitors the surrogate agencies? Their governments?
What is a ‘reasonable’ fee for a commercial surrogate?
Should surrogacy be open to all….single, gay, lesbian, heterosexual?
What legal rights exist for the surrogate if she changes her mind?
What happens if the IP/s refuses the child/children after birth?
Should people wishing to form a family be legally able to advertise, and pay for, a donor egg and/or sperm?
How does research inform us about the surrogate, IPs and children born from surrogacy?
The reasons are complex and varied, but include:
Singles and couples who wish to have a child that is genetically related to at least one of them
Heterosexual women who are unable to carry a child due to a range of factors. Surrogacy Australia states that the medical conditions include 33% Fibroids, 7% heart conditions, 18% cancer survivors, 18% blood or autoimmune conditions, 22% hysterectomy (medically required) and 22% MRHK (uterus doesn’t function) (1)
Single women or lesbian couples who can’t or don’t want to go through pregnancy or artificial insemination
Single or same-sex partnered men
Singles and couples for whom adoption is not an option, by choice or guidelines
Who becomes a surrogate?
Surrogates seem to come from a range of backgrounds and they become a surrogate for a wide range of reasons. Many may be in poverty and exploited, or in the case of Gammy’s mother, who felt that the fee paid (quoted as AUD 11,000 to 14,000) would allow her to pay off debts, send her two other children to school, and start a small business in the local market. There are women who want to help others who cannot have children, enjoy being pregnant or giving birth.The types of surrogacy There are two main types of surrogacy, gestational surrogacy and traditional surrogacy.Gestational surrogacyIn gestational surrogacy, the pregnancy results by the surrogate mother being implanted with an already fertilised embryo which may be produced using in vitro fertilization (IVF), via the Intended Parents egg and sperm or using a donated or purchased egg (in the case of gay males) or sperm. In this case the pregnant woman makes no genetic contribution to the child. Gestational surrogates are also referred to as gestational carriers. Gestational surrogacy is more common than traditional surrogacy and is considered less legally complex.Traditional/ Partial/ genetic contracted surrogacyThe gestational surrogate provides the egg for the child and is impregnated with the sperm of the commissioning father (this can be naturally or usually through artificial insemination). In these cases, the gestational surrogate is genetically linked to the child.Surrogacy Contracts, Arrangement or AgreementMost people are not able to locate a surrogate or are willing to enter into an altruistic arrangement, so instead choose commercial surrogacy , either in their own country or more commonly overseas.
Altruistic contracted surrogacy arrangements are those where the surrogate agrees to receive no payment or reward, although it is as expected that the IP/s are to pay all reasonable medical and associated expenses associated with the pregnancy and birth. (2)
Image: Cesar Astudillo, Flickr
In most Australian states, altruistic surrogacy is legal, but needs to be carried out under the auspices of an accredited Australian IVF clinic. Intending parents are not permitted to advertise for a surrogate and most commonly utilize a family member or close friend. In all cases, gestational surrogacy arrangements are implemented and all parties agree to psychological testing and counseling. The surrogate mother must already have had children of her own, is permitted to change her mind within 6 months of the birth, and is considered the birth mother on the birth certificate. Commercial contracted surrogacy arrangements are those in which the party seeking a child agrees to pay a fee to the surrogate beyond the cost of her medical needs
The International Nature of Surrogacy
The world is truly a ‘global village’. For instance, a couple may live in the USA, have a donor egg from Russia, undergo the procedure in the USA, the surrogate may live in Thailand, India or Mexico and the baby is born in another country!
According to Grether and May, in China there are around 40 million infertile citizens – about 12.5 percent of people of childbearing age. That number has quadrupled over the past 20 years. While surrogacy in the U.S averages between USD120,000-170,000- including legal and agency fees, payments to the surrogate and medical and travel costs - it seems that many Chinese are traveling to the US to form a family. Although there are no official statistics on the number of Chinese parents, in fact in most countries overall, there are a growing number of American surrogacy clinics and agencies that are hiring Mandarin speakers and developing websites in Chinese. (3)
Gugan writes that the number of babies registered in Britain after being born to a surrogate parent has risen by 255 per cent in the past six years, amid mounting concerns. In Britain, only altruistic surrogacy is legal and the only acceptable payment is “reasonable expenses”. However, most prospective parents turn to foreign surrogacy agencies in the USA, India, Ukraine, Thailand, Russia and Georgia.
Experts believe that hundreds, possibly thousands, of babies are brought back to the UK without an official parental order. Officially, all British children born through surrogacy should be subject to a parental order, but in some countries, such as India, parents who give the embryo automatically appear on a baby’s birth certificate without the need for an order. Accordingly, there are rising numbers of people encountering trouble using surrogacy. Issues include IPs not researching and understanding the complicated international laws, fraudulent documents, the length of the process, lack of regulations in the surrogate’s country, risk of exploitation of the surrogate etc. (4)
In Australia, couples are paying huge amounts to overseas surrogates to fulfill their dreams of forming a family. New figures indicate the number of Australian couples travelling to India, the United States, Thailand and Canada - has tripled in three years. But the figure may be even higher. Most of the couples enter commercial surrogacy deals - typically worth between $50,000 and $150,000 - that would be illegal in Australia. The average cost of surrogacy in India, according to a survey of 214 Australian parents, was $77,000. Official figures show only 19 children were born in Australia last year under regulated altruistic surrogacy arrangements.
In Thailand, there are reported to be an estimated 20 surrogacy agencies, most said to be foreign owned drawing in an estimated 4 billion baht ($A133 million) annually.
To conclude, the case of Gammy has spurred widespread debate across the world, putting surrogacy, especially in Thailand, under the spotlight. Regardless of this case, there have been many concerns: commercial surrogacy is not generally acceptable in Thai society (predominantly Buddhist), the Thai Medical Council does not condone gender selection (allegedly this is occurring in some cases), cases of foreign parents not accepting disabled children born through surrogacy, exploitation of vulnerable surrogates and intended parents, some Thai clinics are not certified by the Royal College of Obstetricians and under Thai medical guidelines it is not legal for IVF clinics to supply both surrogates and egg donors (allegedly occurring). Accordingly, Thailand’s military government on 22 July 2014 announced a review of all Thai IVF clinics involved in surrogacy cases.
The Booming International Surrogacy Business: Forming Loving Families or Unregulated Fertility Tourism? You decide!
Grether, N., & May, A. “The billion-dollar international surrogacy industry is growing quickly – reaching unexpected places”, May 13, 2014
Dugan, E., The Independent on Sunday, 2nd March 2014.
Author: Janette Pepall