Surrogacy

Surrogacy may be either traditional or gestational, which are differentiated by the genetic origin of the egg. Gestational surrogacy tends to be more common than traditional surrogacy and is considered less legally complex.{{cite web |url=http://www.webmd.com/infertility-and-reproduction/guide/using-surrogate-mother|title=Using a Surrogate Mother: What You Need to Know|website=WebMD|access-date=April 6, 2014}}

A traditional surrogacy (also known as partial, natural, or straight surrogacy) is one where the surrogate's egg is fertilised by the intended father's or a donor's sperm.

Insemination of the surrogate can be either through sex (natural insemination) or artificial insemination. Using the sperm of a donor results in a child who is not genetically related to the intended parents. If the intended father's sperm is used in the insemination, the resulting child is genetically related to both him and the surrogate.{{Cite journal |last1=Bhatia |first1=Kalsang |last2=Martindale |first2=Elizabeth A.|last3=Rustamov|first3=Oybek|last4=Nysenbaum|first4=Anthony M. |date=2009 |title=Surrogate pregnancy: an essential guide for clinicians|journal=The Obstetrician & Gynaecologist |language=en|volume=11|issue=1|pages=49–54|doi=10.1576/toag.11.1.49.27468|issn=1744-4667|doi-access=free}}{{Cite web|url=https://vittoriavita.com/what-is-surrogacy/|title=Surrogacy: what is it? Different types of surrogacy|publisher=VittoriaVita}}

Some choose to inseminate privately without the intervention of a doctor or physician. In some jurisdictions, the intended parents using donor sperm need to go through an adoption process to have legal parental rights of the resulting child. Many fertility centres that provide for surrogacy assist the parties through the legal process.{{Citation needed|date=April 2025}}

Gestational surrogacy (also known as host or full surrogacy{{cite journal |last1=Imrie|first1=Susan|last2=Jadva|first2=Vasanti|date=4 July 2014|title=The long-term experiences of surrogates: relationships and contact with surrogacy families in genetic and gestational surrogacy arrangements|journal=Reproductive BioMedicine Online |volume=29 |issue=4 |pages=424–435|doi=10.1016/j.rbmo.2014.06.004|pmid=25131555|doi-access=free}}) was first achieved in April 1986.{{Cite web|url=https://people.com/archive/and-baby-makes-four-for-the-first-time-a-surrogate-bears-a-child-genetically-not-her-own-vol-27-no-18/|title=And Baby Makes Four: for the First Time a Surrogate Bears a Child Genetically Not Her Own |website=People.com |language=en|access-date=2019-07-29}} It takes place when an embryo created by in vitro fertilization (IVF) technology is implanted in a surrogate, sometimes called a gestational carrier. Gestational surrogacy has several forms, and in each form, the resulting child is genetically unrelated to the surrogate:

• The embryo is created using the intended father's sperm and the intended mother's eggs;
• The embryo is created using the intended father's sperm and a donor egg;
• The embryo is created using the intended mother's egg and donor sperm;
• A donor embryo is transferred to a surrogate. Such an embryo may be available when others undergoing IVF have embryos left over, which they donate to others. The resulting child is genetically unrelated to the surrogate.{{Cite journal|last=Brinsden|first=Peter R.|date=2003-09-01|title=Gestational surrogacy|journal=Human Reproduction Update|language=en|volume=9|issue=5|pages=483–491|doi=10.1093/humupd/dmg033|pmid=14640380|issn=1355-4786|doi-access=free}}

The embryo implanted in gestational surrogacy faces the same risks as anyone using IVF would. Preimplantation risks of the embryo include unintentional epigenetic effects, influence of media which the embryo is cultured on, and undesirable consequences of invasive manipulation of the embryo. Often, multiple embryos are transferred to increase the chance of implantation, and if multiple gestations occur, both the surrogate and the embryos face higher risks of complications.{{Cite journal|last1=Simopoulou|first1=M.|last2=Sfakianoudis|first2=K.|last3=Tsioulou|first3=P.|last4=Rapani|first4=A.|last5=Anifandis|first5=G.|last6=Pantou|first6=A.|last7=Bolaris|first7=S.|last8=Bakas|first8=P.|last9=Deligeoroglou|first9=E.|date=2018-07-17|title=Risks in Surrogacy Considering the Embryo: From the Preimplantation to the Gestational and Neonatal Period|journal=BioMed Research International|volume=2018|pages=6287507|doi=10.1155/2018/6287507|issn=2314-6133|pmc=6077588|pmid=30112409|doi-access=free}}

Children born through singleton IVF surrogacy have been shown to have no physical or mental abnormalities compared to those children born through natural conception. However, children born through multiple gestation in gestational carriers often result in preterm labor and delivery, resulting in prematurity and physical or mental anomalies.

Gestational surrogates have a smaller chance of having hypertensive disorder during pregnancy compared to mothers pregnant by oocyte donation. This is possibly because gestational carriers tend to be healthier and more fertile than women who use oocyte donation. Gestational carriers also have low rates of placenta previa / placental abruptions (1.1–7.9%).{{Cite journal |last1=Söderström-Anttila |first1=Viveca |last2=Wennerholm |first2=Ulla-Britt |last3=Loft |first3=Anne |last4=Pinborg |first4=Anja |last5=Aittomäki |first5=Kristiina |last6=Romundstad |first6=Liv Bente |last7=Bergh |first7=Christina |date=March 2016 |title=Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review |journal=Human Reproduction Update |volume=22 |issue=2 |pages=260–276 |doi=10.1093/humupd/dmv046 |issn=1460-2369 |pmid=26454266 |doi-access=free}}

In most countries, such as China, there exists a huge gap in the legal framework between the legislation and regulation for surrogacy. Due to insufficient authority supervision, surrogacy and the safety of surrogate mothers lack of professional support or reliable operation, the medical conditions cannot be achieved either. All these precarious factors increase the safety risks of artificial surgeries such as egg retrieval and insemination. Moreover, the underground contracts can inflict serious physiological harm on surrogate mothers. Surrogacy agencies ignore surrogate mothers' health risks and deaths: enforced foetal sex selection through forced abortions are very common,{{Cite journal |last=Zhao |first=Yue |date=2023-11-15 |title=Protection of rights and legal remedies for surrogate mothers in China |journal=Humanities and Social Sciences Communications |language=en |volume=10 |issue=1 |doi=10.1057/s41599-023-02370-x |issn=2662-9992|doi-access=free }} and multiple implantations and foetal reduction procedures may also be repeated on the same surrogate mother, causing health hazards such as miscarriage, infertility, and even death.

Among gestational surrogacy arrangements, between 19–33% of gestational surrogates will successfully become pregnant from an embryo transfer. Of these cases, 30–70% will result in live birth.

For surrogate pregnancies where only one child is born, the preterm birth rate in surrogacy is marginally lower than babies born from standard IVF (11.5% vs 14%). Babies born from surrogacy also have similar average gestational age as infants born through in vitro fertilization and oocyte donation; approximately 37 weeks. Preterm birth rate was higher for surrogate twin pregnancies compared to single births. There are fewer babies with low birth weight when born through surrogacy compared to those born through in vitro fertilization but both methods have similar rates of birth defects.

Opting for surrogacy is a choice for single men desiring to raise a child from infancy, same sex couples unable or unwilling for pregnancy, or women unable or unwilling to carry children on their own. Surrogacy is chosen by women for a number of medical reasons, such as abnormal or absent uterus, either congenitally (also known as Mayer–Rokitansky–Kuster–Hauser syndrome){{cite journal|last1=Patel|first1=Nayana Hitesh|last2=Jadeja|first2=Yuvraj Digvijaysingh|last3=Bhadarka|first3=Harsha Karsan|last4=Patel|first4=Molina Niket|last5=Patel|first5=Niket Hitesh|last6=Sodagar|first6=Nilofar Rahematkhan|date=2018|title=Insight into different aspects of surrogacy practices|journal=Journal of Human Reproductive Sciences|volume=11|issue=3|pages=212–218|doi=10.4103/jhrs.JHRS_138_17|pmc=6262674|pmid=30568349 |doi-access=free }} or post-hysterectomy.{{Cite journal|last1=Dar|first1=S.|last2=Lazer|first2=T.|last3=Swanson|first3=S.|last4=Silverman|first4=J.|last5=Wasser|first5=C.|last6=Moskovtsev|first6=S. I.|last7=Sojecki|first7=A.|last8=Librach|first8=C. L.|date=2014-12-17|title=Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program|journal=Human Reproduction|volume=30|issue=2|pages=345–352|doi=10.1093/humrep/deu333|pmid=25518975|issn=0268-1161|doi-access=free}} Women may have a hysterectomy due to complications in childbirth such as heavy bleeding or a ruptured uterus. Medical diseases such as cervical cancer or endometrial cancer can also lead to surgical removal of the uterus. Past implantation failures, history of multiple miscarriages, or concurrent severe heart or renal conditions that can make pregnancy harmful may also prompt women to consider surrogacy.{{cite journal|last1=Söderström-Anttila|first1=Viveca|last2=Wennerholm|first2=Ulla-Britt|last3=Loft|first3=Anne|last4=Pinborg|first4=Anja|last5=Aittomäki|first5=Kristiina|last6=Romundstad|first6=Liv Bente|last7=Bergh|first7=Christina|date=9 October 2015|title=Surrogacy: outcomes for surrogate mothers, children and the resulting families – a systematic review|journal=Human Reproduction Update|volume=22|issue=2|pages=260–276|doi=10.1093/humupd/dmv046|pmid=26454266|doi-access=free}} The biological impossibility of single men and same-sex couples having a baby also may indicate surrogacy as an option.

In gestational surrogacy, the child is not biologically related to the surrogate, who is often referred to as a gestational carrier. Instead, the embryo is created via in vitro fertilization (IVF), using the eggs and sperm of the intended parents or donors, and is then transferred to the surrogate.{{cite news |title=What is Surrogacy |url=https://globalstarsurrogacy.com/what-is-surrogacy/ |access-date=16 March 2021 |work=Global Star Surrogacy}} Because gestational surrogacy includes at least one round of IVF, it is always more expensive than a round of IVF alone.{{Cite web |date=2024-01-08 |title=How much does surrogacy cost? |url=https://www.today.com/parents/parents/surrogacy-costs-rcna40050 |access-date=2025-01-15 |website=TODAY.com |language=en}}

According to recommendations made by the European Society of Human Reproduction and Embryology and American Society for Reproductive Medicine, a gestational carrier is preferably between the ages of 21 and 45, has had one full-term, uncomplicated pregnancy where she successfully had at least one child, and has had no more than five deliveries or three Caesarean sections.{{Cite journal|last1=Bergh|first1=Christina|last2=Romundstad|first2=Liv Bente|last3=Aittomäki|first3=Kristiina|last4=Pinborg|first4=Anja|last5=Loft|first5=Anne|last6=Wennerholm|first6=Ulla-Britt|last7=Söderström-Anttila|first7=Viveca|date=2016-03-01|title=Surrogacy: outcomes for surrogate mothers, children and the resulting families—a systematic review|journal=Human Reproduction Update|volume=22|issue=2|pages=260–276|doi=10.1093/humupd/dmv046|pmid=26454266|issn=1355-4786|doi-access=free}}  

The International Federation of Gynaecology and Obstetrics recommends that the surrogate's autonomy should be respected throughout the pregnancy even if her wishes conflict with what the intended parents want.{{Cite journal |date=1996 |title=FIGO Committee guidelines |url=http://dx.doi.org/10.1016/0020-7292(96)02660-4 |journal=International Journal of Gynecology & Obstetrics |volume=53 |issue=3 |pages=297–302 |doi=10.1016/0020-7292(96)02660-4 |issn=0020-7292|url-access=subscription }}

The most commonly reported motivation given by gestational surrogates is an altruistic desire to help a childless couple. Other less commonly given reasons include enjoying the experience of pregnancy, and financial compensation.{{Cite journal |journal=Human Reproduction |last1=Golombok |first1=Susan |last2=MacCallum |first2=Fiona |last3=Lycett |first3=Emma |last4=Murray |first4=Clare |last5=Jadva |first5=Vasanti |date=2003-10-01 |volume=18 |issue=10 |pages=2196–2204 |language=en |doi=10.1093/humrep/deg397 |pmid=14507844 |issn=0268-1161 |title=Surrogacy: the experiences of surrogate mothers|doi-access=free }}

Having another woman bear a child for a couple to raise, usually with the male half of the couple as the genetic father, has been referenced a couple of times in historical text, but does not seem to ever have been a common practice. Babylonian law and custom allowed this practice, and a woman unable to give birth could use the practice to avoid a divorce, which would otherwise be inevitable.{{cite book |title=Early Mesopotamia Society and Economy at the Dawn of History |last=Postgate |first=J.N. |year=1992 |publisher=Routledge |isbn=978-0-415-11032-7 |page=[https://archive.org/details/earlymesopotamia00post/page/105 105] |url-access=registration |url=https://archive.org/details/earlymesopotamia00post/page/105 }}{{Cite news | url=https://www.economist.com/news/leaders/21721914-restrictive-rules-are-neither-surrogates-interests-nor-babys-carrying-child | title=Carrying a child for someone else should be celebrated – and paid| newspaper=The Economist| date=May 13, 2017}}

Many developments in medicine, social customs, and legal proceedings around the world paved the way for modern surrogacy:{{cite book|last=Merino|first=Faith|title=Adoption and Surrogate Pregnancy|year=2010|publisher=Infobase Publishing|location=New York}}

• 1936{{spaced ndash}} In the U.S., drug companies Schering-Kahlbaum and Parke-Davis started the pharmaceutical production of estrogen.
• 1944{{spaced ndash}} Harvard Medical School professor John Rock became the first person to fertilize human ovum outside the uterus.
• 1953{{spaced ndash}} Researchers successfully performed the first cryopreservation of sperm.
• 1976{{spaced ndash}} Michigan lawyer Noel Keane wrote the first surrogacy contract in the United States.{{cite news| author = Van Gelder, Lawrence |title=Noel Keane, 58, Lawyer in Surrogate Mother Cases, Is Dead|work=The New York Times|access-date=May 9, 2019|url=https://www.nytimes.com/1997/01/28/nyregion/noel-keane-58-lawyer-in-surrogate-mother-cases-is-dead.html|date= January 28, 1997|author-link=Lawrence Van Gelder}}
• 1978{{spaced ndash}} Louise Brown, the first "test-tube baby", was born in England, the product of the first successful IVF procedure.
• 1985–1986{{spaced ndash}} A woman carried the first successful gestational surrogate pregnancy.{{Cite web|url=https://people.com/archive/and-baby-makes-four-for-the-first-time-a-surrogate-bears-a-child-genetically-not-her-own-vol-27-no-18/|title=And Baby Makes Four: for the First Time a Surrogate Bears a Child Genetically Not Her Own|website=People.com|language=en|access-date=2019-05-09|last=Johnson|first=Bonnie|date=May 4, 1987}}
• 1986{{spaced ndash}} Melissa Stern, otherwise known as "Baby M," was born in the U.S. The surrogate and biological mother, Mary Beth Whitehead, refused to give up custody of Melissa to the couple with whom she made the surrogacy agreement. The courts of New Jersey found that Whitehead was the child's legal mother and declared contracts for gestational carrierhood illegal and invalid. However, the court found it in the best interest of the infant to award custody of Melissa to the child's biological father, William Stern, and his wife Elizabeth Stern, rather than to Whitehead, the gestational carrier.Levine, Judith, "Whose Baby is It? Surrogate Motherhood on Trial, Village Voice, Nov. 25, 1986; Levine, Judith, "Motherhood is Powerless," Village Voice, Apr. 14 1987.
• 1990{{spaced ndash}} In California, gestational carrier Anna Johnson refused to give up the baby to intended parents Mark and Crispina Calvert. The couple sued her for custody (Calvert v. Johnson), and the court upheld their parental rights. In doing so, it defined the legal mother as the woman who, according to the surrogacy agreement, intends to create and raise a child.{{cite news |first=Catherine |last=Gewertz |url=https://www.latimes.com/archives/la-xpm-1990-10-11-me-3119-story.html |title=Surrogate Confesses Her Secret: Trial: Anna L. Johnson admits cashing check from unborn child's intended parents after she'd decided to seek custody. She denies telling The Times she didn't feel bonded to baby. |work=Los Angeles Times | date=October 11, 1990}}
• 2009{{spaced ndash}} Ukraine, one of the most requested countries in Europe for this treatment, has its first Surrogacy Law approved.
• 2015{{spaced ndash}} India prohibits commercial surrogacy for foreigners over concerns the country has become a hub for reproductive tourism.{{cite web | url=https://www.theguardian.com/world/2015/oct/28/india-bans-foreigners-from-hiring-surrogate-mothers | title=India bans foreigners from hiring surrogate mothers | work=The Guardian | date=October 28, 2015 }}
• 2016{{spaced ndash}} A Swedish government inquiry recommends banning all surrogacy in Sweden and taking steps to prevent its citizens from doing it abroad.{{cite web | url=https://www.thelocal.se/20160224/women-in-sweden-told-they-shouldnt-become-surrogate-mums | title=Swedes told they shouldn't use surrogate mothers | date=February 24, 2016 }}
• 2021{{spaced ndash}} The Supreme Court of Mexico ruled that every individual, regardless of sexual orientation, marital status, or nationality, has the right to access assisted reproductive technology to form a family, and that the Civil Code of the state of Tabasco that restricts surrogacy to Mexican married couples is unconstitutional. It also ruled that legal parentage should be based on the presence of procreational will, not genetic or gestational relationship.{{Cite web | url=https://surrogacymiracles.mx/is-surrogacy-in-mexico-legal-a-detailed-explanation/ | title=Is Surrogacy in Mexico Legal? A Detailed Explanation | website=Surrogacy Miracles | date=April 2024 | access-date=September 9, 2024}}
• 2024{{spaced ndash}} Italy bans surrogacy both at home and abroad, making it illegal for Italian citizens to travel abroad for surrogacy.

Anthropological studies of surrogates have shown that surrogates engage in various distancing techniques throughout the surrogate pregnancy so as to avoid becoming emotionally attached to the baby.{{cite journal|author1=Van den Akker|author2=Olga B.A.|year=2007|title=Psychological trait and state characteristics, social support and attitudes to the surrogate pregnancy and baby|journal=Human Reproduction|volume=22|issue=8|pages=2287–2295|doi=10.1093/humrep/dem155|pmid=17635845|doi-access=free}} Many surrogates intentionally try to foster the development of emotional attachment between the intended mother and the surrogate child.Ragone, Helena (1994). Surrogate Motherhood: Conception in the Heart. Westview Books.

Although gestational surrogates generally report being satisfied with their experience as surrogates, there are cases in which they are not.{{cite journal|last=Ciccarelli|first=Janice|author2=Beckman, Linda|date=March 2005|title=Navigating Rough Waters: An Overview of Psychological Aspects of Surrogacy|journal=Journal of Social Issues|volume=61|issue=1|pages=21–43|doi=10.1111/j.0022-4537.2005.00392.x|pmid=17073022}} Unmet expectations are associated with dissatisfaction. Some women did not feel a certain level of closeness with the couple and others did not feel respected by the couple. Some gestational surrogates report emotional distress during the process of surrogacy. There may be a lack of access to therapy and emotional support through the surrogate process.{{Citation needed|date=April 2025}}

Gestational surrogates may struggle with postpartum depression and issues with relinquishing the child to their intended parents.{{Cite journal|last1=Bergh|first1=Christina|last2=Romundstad|first2=Liv Bente|last3=Aittomäki|first3=Kristiina|last4=Pinborg|first4=Anja|last5=Loft|first5=Anne|last6=Wennerholm|first6=Ulla-Britt|last7=Söderström-Anttila|first7=Viveca|date=2016-03-01|title=Surrogacy: outcomes for surrogate mothers, children and the resulting families – a systematic review|journal=Human Reproduction Update|language=en|volume=22|issue=2|pages=260–276|doi=10.1093/humupd/dmv046|pmid=26454266|issn=1355-4786|doi-access=free}} Immediate postpartum depression has been observed in gestational surrogates at a rate of 0-20%. Some surrogates report negative feelings with relinquishing rights to the child immediately after birth, but most negative feelings resolve after some time.{{Cite journal |last1=Ahmari Tehran |first1=Hoda |last2=Tashi |first2=Shohreh |last3=Mehran |first3=Nahid |last4=Eskandari |first4=Narges |last5=Dadkhah Tehrani |first5=Tahmineh |date=July 2014 |title=Emotional experiences in surrogate mothers: A qualitative study |journal=Iranian Journal of Reproductive Medicine |volume=12 |issue=7 |pages=471–480 |issn=1680-6433 |pmc=4126251 |pmid=25114669}}

A systematic review of 55 studies examining the outcomes for surrogacy for surrogates and resulting families showed that there were no major psychological differences in children up to the age of 10 years old that were born from surrogacy compared to those children born from other assisted reproductive technology or those children conceived naturally.{{Citation needed|date=April 2025}}

Gay men who have become fathers using surrogacy have reported similar experiences to those of other couples who have used surrogacy, including their relationship with both their child and their surrogate.{{Cite journal|last1=Golombok|first1=Susan|last2=Ehrhardt|first2=Anke A.|last3=Raffanello|first3=Elizabeth|last4=Slutsky|first4=Jenna|last5=Carone|first5=Nicola|last6=Blake|first6=Lucy|date=2016-11-01|title=Gay father surrogacy families: relationships with surrogates and egg donors and parental disclosure of children's origins|url=https://www.fertstert.org/article/S0015-0282(16)62682-1/abstract|journal=Fertility and Sterility|language=en|volume=106|issue=6|pages=1503–1509|doi=10.1016/j.fertnstert.2016.08.013|issn=0015-0282|pmc=5090043|pmid=27565261}}

A study has followed a cohort of 32 surrogacy, 32 egg donation, and 54 natural conception families through to age seven, reporting the impact of surrogacy on the families and children at ages one,{{cite journal|author1=Golombok, S.|author2=Murray, C.|author3=Jadva, V.|author4=MacCallum, F.|author5=Lycett, E.|date=May 2004|title=Families created through surrogacy arrangements: parent-child relationships in the 1st year of life|journal=Developmental Psychology|volume=40|issue=3|pages=400–411|doi=10.1037/0012-1649.40.3.400|pmid=15122966}} two,{{Cite journal|last1=Golombok|first1=Susan|last2=MacCallum|first2=Fiona|last3=Murray|first3=Clare|last4=Lycett|first4=Emma|last5=Jadva|first5=Vasanti|date=February 2006|title=Surrogacy families: parental functioning, parent-child relationships and children's psychological development at age 2|journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines|volume=47|issue=2|pages=213–222|doi=10.1111/j.1469-7610.2005.01453.x|issn=0021-9630|pmid=16423152}} and seven.{{cite journal|author1=Golombok Susan|author2=Readings Jennifer|author3=Blake Lucy|author4=Casey Polly|author5=Marks Alex|author6=Jadva Vasanti|year=2011|title=Families created through surrogacy: Mother–child relationships and children's psychological adjustment at age 7.|journal=Developmental Psychology|volume=47|issue=6|pages=1579–1588|doi=10.1037/a0025292|pmc=3210890|pmid=21895360}} At age one, parents through surrogacy showed greater psychological well-being and adaptation to parenthood than those who conceived naturally; there were no differences in infant temperament. At age two, parents through surrogacy showed more positive mother–child relationships and less parenting stress on the part of fathers than their natural conception counterparts; there were no differences in child development between these two groups. At age seven, the surrogacy and egg donation families showed less positive mother–child interaction than the natural conception families, but there were no differences in maternal positive or negative attitudes or child adjustment. The researchers concluded that the surrogacy families continued to function well.{{Citation needed|date=April 2025}}

{{Main|Surrogacy laws by country}}

The legality of surrogacy varies around the world. Many countries do not have laws which specifically deal with surrogacy. Some countries ban surrogacy outright, while others ban commercial surrogacy but allow altruistic surrogacy (in which the surrogate is not financially compensated). Some countries allow commercial surrogacy, with few restrictions. Some jurisdictions extend a ban on surrogacy to international surrogacy. In some jurisdictions rules applicable to adoptions apply while others do not regulate the practice.

Commercial surrogacy is banned in Canada and most of Europe. {{Cite web |date=2018-09-13 |title=Where in Europe is surrogacy legal? |url=https://www.euronews.com/2018/09/13/where-in-europe-is-surrogacy-legal |access-date=2025-01-15 |website=euronews |language=en}} {{Cite web |last= |first= |date=2013-07-10 |title=Prohibitions related to Surrogacy |url=https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction/prohibitions-related-surrogacy.html |access-date=2025-01-15 |website=www.canada.ca}}

The US, Ukraine, Russia and Georgia have the least restrictive laws in the world, allowing commercial surrogacy, including for foreigners.{{Cite news | url=https://www.bbc.com/news/world-europe-42845602 | title=The corner of Europe where women rent out their wombs| work=BBC News| date=February 13, 2018| last1=Ponniah| first1=Kevin}} Surrogacy is legal and common in Iran, and monetary remuneration is practiced and allowed by religious authorities.{{cite journal |last1=Aramesh |first1=K |title=Iran's experience with surrogate motherhood: an Islamic view and ethical concerns. |journal=Journal of Medical Ethics |date=May 2009 |volume=35 |issue=5 |pages=320–322 |doi=10.1136/jme.2008.027763 |pmid=19407039 |s2cid=206995988 }}{{Cite web | url=https://financialtribune.com/articles/people/63071/infertile-couples-in-iran-find-new-hope-in-surrogacy |title = Infertile Couples in Iran Find New Hope in Surrogacy|date = April 25, 2017}}

Several Asian countries used to have less restrictive laws, but the practice has since been restricted. In 2013, Thailand banned commercial surrogacy, and restricted altruistic surrogacy to Thai couples.{{Cite news | url=https://www.bbc.com/news/world-asia-43169974 |title = Thai 'baby factory' saga reaches uneasy end|work = BBC News|date = February 26, 2018|last1 = Head|first1 = Jonathan}} In 2016, Cambodia also banned commercial surrogacy. Nepal, Mexico, and India have also recently banned foreign commercial surrogacy.{{Cite news | url=https://www.bbc.com/news/world-46430250 | title='I gave birth but it's not my baby'| work=BBC News| date=December 4, 2018| last1=Perasso| first1=Valeria}}

Laws dealing with surrogacy must deal with:

• Enforceability of surrogacy agreements. In some jurisdictions, they are void or prohibited, and some jurisdictions distinguish between commercial and altruistic surrogacy.
• The different issues raised by traditional and gestational surrogacy.
• Mechanisms for the legal recognition of the intended parents as the legal parents, either by pre-birth orders or by post-birth adoption.

Although laws differ widely from one jurisdiction to another, some generalizations are possible:{{Cite web |title=Guide to State Surrogacy Laws |url=https://www.americanprogress.org/article/guide-to-state-surrogacy-laws/ |access-date=2022-10-09 |website=Center for American Progress |date=December 17, 2007 |language=en}}

The historical legal assumption has been that the woman giving birth to a child is that child's legal mother, and the only way for another woman to be recognized as the legal mother is through adoption (usually requiring the birth mother's formal abandonment of parental rights).{{Citation needed|date=April 2025}}

Even in jurisdictions that do not recognize surrogacy arrangements, if the potential adoptive parents and the birth mother proceed without any intervention from the government and do not change their mind along the way, they will likely be able to achieve the effects of surrogacy by having the gestational carrier give birth and then give the child up for private adoption to the intended parents.{{Citation needed|date=April 2025}}

If the jurisdiction specifically bans surrogacy, however, and authorities find out about the arrangement, there may be financial and legal consequences for the parties involved. One jurisdiction (Quebec) prevented the genetic mother's adoption of the child even though that left the child with no legal mother.Baudouin, Christine. [http://www.cfas.ca/index.php?option=com_content&view=article&id=772&Itemid=523 "Surrogacy in Quebec: First Legal Test"]. Canadian Fertility and Andrology Society.

Some jurisdictions specifically prohibit only commercial and not altruistic surrogacy. Even jurisdictions that do not prohibit surrogacy may rule that surrogacy contracts (commercial, altruistic, or both) are void. If the contract is either prohibited or void, then there is no recourse if one party to the agreement has a change of heart: if a surrogate changes her mind and decides to keep the child, the intended mother has no claim to the child even if it is her genetic offspring, and the couple cannot get back any money they may have paid the surrogate; if the intended parents change their mind and do not want the child after all, the surrogate cannot get any money to make up for the expenses, or any promised payment, and she will be left with legal custody of the child.{{Citation needed|date=April 2025}}

Jurisdictions that permit surrogacy sometimes offer a way for the intended mother, especially if she is also the genetic mother, to be recognized as the legal mother without going through the process of abandonment and adoption. Often this is via a birth orderBognar, Tara (November 28, 2011). [http://www.tarabognar.com/birth-orders-an-overview "Birth Orders: An Overview"] {{webarchive|url=https://web.archive.org/web/20120423065126/http://www.tarabognar.com/birth-orders-an-overview |date=April 23, 2012 }}. Retrieved December 13, 2011. in which a court rules on the legal parentage of a child. These orders usually require the consent of all parties involved, sometimes even including the husband of a married gestational surrogate. Most jurisdictions provide for only a post-birth order, often out of an unwillingness to force the gestational carrier to give up parental rights if she changes her mind after the birth.

A few jurisdictions do provide for pre-birth orders, generally only in cases when the gestational carrier is not genetically related to the expected child. Some jurisdictions impose other requirements in order to issue birth orders: for example, that the intended parents be heterosexual and married to one another. Jurisdictions that provide for pre-birth orders are also more likely to provide for some kind of enforcement of surrogacy contracts.{{Citation needed|date=April 2025}}

The citizenship and legal status of the children resulting from surrogacy arrangements can be problematic. The Hague Conference Permanent Bureau identified the question of citizenship of these children as a "pressing problem" in the Permanent Bureau 2014 Study (Hague Conference Permanent Bureau, 2014a: 84–94).{{cite web|url=http://www.hcch.net/index_en.php?act=text.display&tid=183|title=The private international law issues surrounding the status of children, including issues arising from international surrogacy arrangements – 2011–2013|publisher=hcch.net|url-status=dead|archive-url=https://web.archive.org/web/20131104003845/http://www.hcch.net/index_en.php?act=text.display&tid=183|archive-date=2013-11-04}}{{cite journal|url=http://repub.eur.nl/pub/77402|title=RePub, Erasmus University Repository: Global surrogacy practices|journal=ISS Working Paper Series / General Series|volume=601|pages=1–54|publisher=repub.eur.nl|date=December 31, 2014|last1=Beeson|first1=Diane|last2=Darnovsky|first2=Marcy}} According to U.S. Department of State, Bureau of Consular Affairs, for a child born abroad to be a U.S. citizen one or both of the child's genetic parents must be a U.S. citizen. In other words, the only way for a foreign born surrogate child to acquire U.S. citizenship automatically at birth is if they are the biological child of a U.S. citizen. Furthermore, in some countries, the child will not be a citizen of the country in which they are born because the gestational carrier is not legally the parent of said child. This could result in a child being born without citizenship.{{cite web|url=https://travel.state.gov/content/travel/english/legal-considerations/us-citizenship-laws-policies/assisted-reproductive-technology.html|title=Important Information for U.S. Citizens Considering the Use of Assisted Reproductive Technology (ART) Abroad|publisher=travel.state.gov|url-status=dead|archive-url=https://web.archive.org/web/20150907004652/http://travel.state.gov/content/travel/english/legal-considerations/us-citizenship-laws-policies/assisted-reproductive-technology.html|archive-date=September 7, 2015|df=mdy-all}}

“In Canada, it is a crime to pay (in cash, goods, property or services), offer to pay or advertise to pay a woman to be a surrogate mother.” {{Cite web |last=Canada |first=Health |date=2013-07-10 |title=Prohibitions related to Surrogacy |url=https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction/prohibitions-related-surrogacy.html |access-date=2025-01-15 |website=www.canada.ca}}

In South Korea, Hong Kong, Malaysia, Thailand, and India, surrogacies are all regulated “through national laws that expressly ban it or explicitly set the parameters for its legality”.{{Citation |last=Aguiling-Pangalangan |first=Elizabeth H. |title=Surrogacy in Asia |date=2024-03-12 |work=Research Handbook on Surrogacy and the Law |pages=395–435 |url=https://www.elgaronline.com/edcollchap/book/9781802207651/book-part-9781802207651-29.xml |access-date=2024-04-10 |publisher=Edward Elgar Publishing |doi=10.4337/9781802207651.00029 |isbn=978-1-80220-765-1|url-access=subscription }}

In Korea, it is illegal to provide or use embryos. Violators are subject to imprisonment of up to three years. However, it is neither legal nor illegal to provide or use a uterus. There is no direct law on surrogacy.

• BIOETHICS AND SAFETY ACT Article 23 (Obligations regarding Production of Embryos){{Cite web |date=2025-02-01 |title=BIOETHICS AND SAFETY ACT |url=https://elaw.klri.re.kr/kor_service/jomunPrint.do?hseq=68583&cseq=2036487&lang=KOR&contentSeqKor=2848250 |url-status=live |archive-url=https://archive.today/20250201141138/https://elaw.klri.re.kr/kor_service/jomunPrint.do?hseq=68583&cseq=2036487&lang=KOR&contentSeqKor=2848250 |archive-date=2025-02-01 |access-date=2025-02-01 |website=한국법제연구원(KOREA LEGISLATION RESEARCH INSTITUTE)}}

Particularly in China, surrogacy operates within a legally gray area. Scholars mostly claim that surrogacy incites social instability both for the Chinese Government and the public, such as civil disputes, gender disproportion, crime, and the spread of disease.{{Cite journal |last1=Qi |first1=Qing |last2=Gu |first2=Xiaolei |last3=Zhao |first3=Yangyang |last4=Chen |first4=Ziqin |last5=Zhou |first5=Jing |last6=Chen |first6=Song |last7=Wang |first7=Ling |date=2023 |title=The status of surrogacy in China |url=https://www.jstage.jst.go.jp/article/bst/17/4/17_2022.01263/_article |journal=BioScience Trends |volume=17 |issue=4 |pages=302–309 |doi=10.5582/bst.2022.01263|doi-access=free |pmid=37081669 }} However, no law legislation or enforcement has been published against surrogacy, whether it is a surrogate mother or a connecting third agency, despite the state government's attitude to ban such practice.{{Cite news |title=The dangers of carrying a child for someone else in China |url=https://www.economist.com/china/2023/12/11/the-dangers-of-carrying-a-child-for-someone-else-in-china |access-date=2024-04-10 |newspaper=The Economist |issn=0013-0613}}

Any medical organization involved in surrogacy will be considered as law violation, including any institution that organizes, implements, or facilitates egg retrieval and sale of women. Statistics found more than 400 surrogacy agencies facilitate the birth of more than 10,000 surrogate children every year on average — operating underground with legal prohibitions.{{Better source needed|date=March 2025}}

Due to such blurry legal issues, surrogate mothers have become an underprivileged group facing the oppression of women's reproductive rights and the lack of formal legal restrictions. Many of the conditions they should have, such as emotional caring and social resources, are absent, as research claiming that surrogacy contracts usually blindly meet client needs while ignoring the health and well-being of the surrogate mothers. They are marginalized by society and lack the companionship of their partners and legitimate medical health checkups during the nearly one year of pregnancy.

“Australian states and territories allow altruistic surrogacy but prohibit commercial surrogacy.” https://www.surrogacy.gov.au/surrogacy-in-australia

Some countries in Europe allow altruistic surrogacy (where the surrogate is not paid), but most European countries prohibit commercial surrogacy. {{Cite web |date=2018-09-13 |title=Where in Europe is surrogacy legal? |url=https://www.euronews.com/2018/09/13/where-in-europe-is-surrogacy-legal |access-date=2025-01-15 |website=euronews |language=en}}

Numerous ethical questions have been raised with regards to surrogacy. They generally stem from concerns relating to social justice, women's rights, child welfare, bioethics,{{Cite journal |last1=Saxena |first1=Pikee |last2=Mishra |first2=Archana |last3=Malik |first3=Sonia |date=2012 |title=Surrogacy: Ethical and Legal Issues |journal=Indian Journal of Community Medicine |volume=37 |issue=4 |pages=211–213 |doi=10.4103/0970-0218.103466 |issn=0970-0218 |pmc=3531011 |pmid=23293432 |doi-access=free}} and societal traditional values.

Those who view surrogacy as a social justice issue argue that it leads to the exploitation of women whose wombs are commodified to meet the reproductive desires of the more affluent.{{Cite web |last1=Marway |first1=Herjeet |last2=Barn |first2=Gulzaar |date=July 30, 2018 |title=Surrogacy laws: why a global approach is needed to stop exploitation of women |url=http://theconversation.com/surrogacy-laws-why-a-global-approach-is-needed-to-stop-exploitation-of-women-98966 |url-status=live |archive-url=https://web.archive.org/web/20240305150422/https://theconversation.com/surrogacy-laws-why-a-global-approach-is-needed-to-stop-exploitation-of-women-98966 |archive-date=March 5, 2024 |access-date=March 27, 2019 |website=The Conversation}}{{Cite journal |last1=Saxena |first1=Pikee |last2=Mishra |first2=Archana |last3=Malik |first3=Sonia |date=2012 |title=Surrogacy: Ethical and Legal Issues |journal=Indian Journal of Community Medicine |volume=37 |issue=4 |pages=211–213 |doi=10.4103/0970-0218.103466 |issn=0970-0218 |pmc=3531011 |pmid=23293432 |doi-access=free}}{{Cite journal|last1=Anu|last2=Kumar|first2=Pawan|last3=Inder|first3=Deep|last4=Sharma|first4=Nandini|date=April 2013|title=Surrogacy and women's right to health in India: issues and perspective|journal=Indian Journal of Public Health|volume=57|issue=2|pages=65–70|doi=10.4103/0019-557X.114984|issn=0019-557X|pmid=23873191|doi-access=free}}{{Cite web|url=http://www.cbc-network.org/issues/making-life/surrogacy/|title=Surrogacy|website=The Center for Bioethics and Culture|access-date=2019-03-27}}{{Cite web|url=https://www.fairobserver.com/culture/surrogacy-legality-ethics-womens-rights-news-018210/|title=Surrogacy: Erasing the Mother|date=2019-01-09|website=Fair Observer|access-date=2019-03-27}} They argue that creating a commercial market for human bodies is inherently exploitative:

“A steady supply of women’s bodies is needed in order to meet the demands of rich couples who can afford to pay extravagant fees to agencies.” {{Cite web |date=2019-06-14 |title=Commercialized Surrogacy Exploits Women - National Organization for Women |url=https://now.org/media-center/press-release/commercialized-surrogacy-exploits-women/ |access-date=2025-01-15 |website=now.org |language=en-US}}

While some hold that any consensual process is not a human rights violation, other human rights activists argue that human rights are not just about survival but about human dignity and respect. Almost all countries ban the sale of human organs (e.g., selling a spare kidney) and renting out the use of human organs and bodily processes should be prohibited for similar reasons. https://www.dutchrapporteur.nl/binaries/dutchrapporteur/documenten/reports/2012/12/04/trafficking-in-human-beings-for-the-purpose-of-the-removal-of-organs-and-forced-commercial-surrogacy/human-trafficking-for-the-purpose-of-the-removal-of-organs-and-forced-commercial-surrogacy_tcm24-35360.pdf

Some feminists have also argued that surrogacy is an assault to a woman's dignity and right to autonomy over her body. By degrading women to purchasable "baby producers”, commercial surrogacy has been accused by feminists of commodifying women's bodies in a manner akin to prostitution. Feminist Renate Klein has argued that surrogacy is a human rights violation. In her book "Surrogacy - a Human Rights Violation", Klein examines the harms done to women who become surrogates, and how the practice breaks a number of conventions on human rights.{{cite web | url=https://www.spinifexpress.com.au/shop/p/9781925581034 | title=Surrogacy: A Human Rights Violation }} Feminist Kajsa Ekis Ekman has argued that surrogacy is akin to reproductive prostitution and baby sale. Her book "Being and Being Bought - Prostitution, Surrogacy and the Split Self" compares the two industries and how they both commodify women.{{cite web | url=https://www.spinifexpress.com.au/shop/p/9781922964205 | title=Being and Being Bought: Prostitution, Surrogacy and the Split Self }}

Some feminists also express concerns over links between surrogacy and patriarchal expressions of domination as numerous reports have been cited of women in developing countries coerced into commercial surrogacy by their husbands wanting to "earn money off of their wives' bodies". Surrogate contracts can impose restrictions on the surrogate that some say violate the surrogate mother’s rights, such as right to freedom of movement. United Nations Report of the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material https://digitallibrary.un.org/nanna/record/1473378/files/A_HRC_37_60-EN.pdf? These contracts can allow other people to legally impose requirements on the pregnant person that some argue result in “your body, my choice”. {{Cite web |date=2023-04-13 |title=Your body, my choice {{!}} Georgia L. Gilholy |url=https://thecritic.co.uk/your-body-my-choice/ |access-date=2025-01-15 |website=The Critic Magazine |language=en-GB}}

Other human rights activists express concern over the conditions under which gestational carriers are kept by surrogacy clinics which exercise much power and control over the process of surrogate pregnancy. Isolated from friends and family and required to live in separate surrogacy hostels on the pretext of ensuring consistent prenatal care, it is argued that gestational carriers may face psychological challenges that cannot be offset by the (limited) economic benefits of surrogacy. Other psychological issues are noted, such as the implications of gestational carriers emotionally detaching themselves from their babies in anticipation of birth departure.

Some argue that women in developing countries are particularly vulnerable to exploitation from surrogacy. Decisions cannot be defined as involving agency if they are driven by coercion, violence, or extreme poverty, which is often the case with women in developing countries who pursue surrogacy due to economic need or aggressive persuasion from their husbands. While opponents of this stance argue that surrogacy provides a much-needed source of revenue for women facing poverty in developing countries, others purport that the lack of legislation in such countries often leads to much of the profit accruing to middlemen and commercial agencies rather than the gestational carriers themselves. Supporters of surrogacy have argued to mandate education of gestational carriers regarding their rights and risks through the process in order to both rectify the ethical issues that arise and to enhance their autonomy.{{Cite journal|last1=Damelio|first1=Jennifer|last2=Sorensen|first2=Kelly|date=2008|title=Enhancing Autonomy in Paid Surrogacy|journal=Bioethics|language=en|volume=22|issue=5|pages=269–277|doi=10.1111/j.1467-8519.2008.00629.x|pmid=18447862|s2cid=23449395|issn=1467-8519|url=https://digitalcommons.ursinus.edu/cgi/viewcontent.cgi?article=1004&context=philrel_fac|doi-access=free}} Both opponents and supporters of surrogacy have agreed that implementing international laws on surrogacy can limit the social justice issues that gestational carriers face in transnational surrogacy.{{Cite journal|last1=Ramskold|first1=Louise Anna Helena|last2=Posner|first2=Marcus Paul|date=2013|title=Commercial surrogacy: how provisions of monetary remuneration and powers of international law can prevent exploitation of gestational surrogates|journal=Journal of Medical Ethics|volume=39|issue=6|pages=397–402|issn=0306-6800|jstor=43282765|doi=10.1136/medethics-2012-100527|pmid=23443211|s2cid=24400855}}

Some argue that commercial surrogacy strips birthmothers of their natural rights. Most countries consider the birthmother to be the legal mother unless she freely chooses to put her child up for adoption (without coercion or payment). When a woman elects to use a donor egg to become pregnant, she is not the biological mother, but is still considered the legal mother because she is the birthmother; similarly, a surrogate is still the birthmother even if she was paid to use a donor egg. United Nations Report of the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material https://digitallibrary.un.org/nanna/record/1473378/files/A_HRC_37_60-EN.pdf? Some argue that birth mothers cannot be coerced (or paid) to relinquish their custody of the child they bore (though any birthmother might need to share custody with another). It has been argued that under laws of countries where surrogacy falls under the umbrella of adoption, commercial surrogacy can be considered problematic as payment for adoption is unethical.{{Cite journal|last1=van Zyl|first1=Liezl|last2=Walker|first2=Ruth|date=2015-09-01|title=Surrogacy, Compensation, and Legal Parentage: Against the Adoption Model|journal=Journal of Bioethical Inquiry|language=en|volume=12|issue=3|pages=383–387|doi=10.1007/s11673-015-9646-4|pmid=26133892|s2cid=30324997|issn=1872-4353}}

Those concerned with the rights of the child in the context of surrogacy reference issues related to identity and parenthood, abandonment and abuse, and child trafficking.

It is argued that in commercial surrogacy, the rights of the child are often neglected as the baby becomes a mere commodity within an economic transaction of a good and a service.{{Cite journal|last1=Schurr|first1=Carolin|last2=Militz|first2=Elisabeth|date=2018-04-16|title=The affective economy of transnational surrogacy|journal=Environment and Planning A: Economy and Space|language=en|volume=50|issue=8|pages=1626–1645|doi=10.1177/0308518x18769652|bibcode=2018EnPlA..50.1626S |issn=0308-518X|doi-access=free}} Such opponents of surrogacy argue that transferring the duties of parenthood from the birthing mother to a contracting couple denies the child any claim to its birth mother and to its biological parents if the egg or sperm is not that of the contracting parents. In addition, they claim that the child has no right to information about any siblings he or she may have in the latter instance. The relevance of disclosing the use of surrogacy as an assisted reproductive technique to the child has also been argued to be important for both health risks and the rights of the child.{{Cite journal|last1=Morsan|first1=Valentina|last2=Gronchi|first2=Giorgio|last3=Zanchettin|first3=Liviana|last4=Tallandini|first4=Maria Anna|date=2016-06-01|title=Parental disclosure of assisted reproductive technology (ART) conception to their children: a systematic and meta-analytic review|journal=Human Reproduction|language=en|volume=31|issue=6|pages=1275–1287|doi=10.1093/humrep/dew068|pmid=27067509|issn=0268-1161|doi-access=free|hdl=2158/1162007|hdl-access=free}}

It has been argued that bans on surrogacy are violations of human rights under the existing laws of the Inter-American Court of Human Rights reproductive rights landmark.{{Cite journal|last=Hevia|first=Martín|date=2018-08-01|title=Surrogacy, privacy, and the American Convention on Human Rights|journal=Journal of Law and the Biosciences|language=en|volume=5|issue=2|pages=375–397|doi=10.1093/jlb/lsy013|pmc=6121059|pmid=30191070}} However, “…there is no “right to a child” under international law. United Nations Report of the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material https://digitallibrary.un.org/nanna/record/1473378/files/A_HRC_37_60-EN.pdf? The United Nations Report of the Special Rapporteur on the sale and sexual exploitation of children states, “A child is not a good or service that the State can guarantee or provide, but rather a rights-bearing human being” and argues that commercial surrogacy (where transfer of the child is a condition for payment) violates human rights as it is considered to be the sale of children (and humans cannot be bought or sold).

United Nations Report of the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material https://digitallibrary.un.org/nanna/record/1473378/files/A_HRC_37_60-EN.pdf? UNICEF says “A legally binding contractual relationship between the surrogate mother and the intending parent(s) established pre-birth, in which the transfer of the child would be made conditional upon payment, would constitute the sale of a child….The identity and family relations of a child cannot be for sale.” UNICEF KEY CONSIDERATIONS: CHILDREN’S RIGHTS & SURROGACY, Feb 2022 ,https://www.unicef.org/media/115331/file

In China, surrogacy has been argued to contradict traditional Chinese values.

Traditional Chinese values focus on blood ties and family ties. The physical connection between parents and children and the process by which parents give birth to children are considered virtuous ("生恩 shēng'ēn"). There is also an ancient Chinese saying that believes that "the body, hair, and skin come from the parents who gave birth to one", and blood relatives should be respected, and one should not harm oneself at will ("身体发肤受之父母 shēntǐ fà fū shòu zhī fùmǔ"). When Chinese people regard blood relations as an important pathway to demonstrate filial piety and family intimacy, these traditional concepts are rooted in the cognitive norm of society. Such emphasis on biological parents and blood relations undoubtedly resulted in conflicts with the practice of surrogacy, which regards childbirth as only a physiological process.

Correspondingly, this value of kinship relations strongly affects the social status of surrogate mothers. They are easily considered "heartless" or "don't care about their own children" in Chinese society because they are only responsible for the birth process and hand over the children to others and do not participate in the upbringing process. However, there are also opinions that this separation from the children is not voluntary for surrogate mothers, but is forced by third-party agencies or restricted by unfair contracts. They can only give up the right to raise their children and send them away despite suffering great psychological and emotional trauma.

According to the Assisted Human Reproduction Act adopted in 2004, it is prohibited in Canada to compensate a female for acting as a surrogate mother or to advertise the payment of such compensation.{{Cite web |last=Canada |first=Santé |date=2017-07-12 |title=Vers une Loi sur la procréation assistée renforcée |url=https://www.canada.ca/fr/sante-canada/programmes/consultation-procreation-assistee/document.html |access-date=2023-10-29 |website=www.canada.ca}} However, on October 1, 2016, Health Canada announced its intention to update and strengthen the Assisted Human Reproduction Act to regulate the financial aspects of contracts between intended parents and surrogate mothers. According to research, surrogate mothers are mostly motivated by their low socioeconomic status or family debt; they are more likely to be forced into surrogacy due to financial pressures. In 2020, Section 12 of the Assisted Human Reproduction Act provides for the reimbursement of expenses and monetary compensation to the surrogate mother to alleviate the financial burden associated with surrogacy. According to this proposed regulation, the reimbursement of eligible expenses is not obligatory. Aiming at emphasizing the voluntary nature of the gesture. The proposed regulation provides a non-exhaustive list of different categories of eligible expenses, such as parking fees, travel expenses, caregiver expenses, meals, psychological consultations, etc. Additionally, the surrogate mother can be reimbursed for any lost wages during pregnancy if she obtains written confirmation from a qualified physician that the work posed a risk to the pregnancy.

In the US, the total costs for gestational surrogacy usually exceed US$100,000 per pregnancy. This includes hiring an agency to find a woman willing to carry the baby, the medical and health insurance costs for the pregnancy, legal fees, and IVF to create the embryos.  Additionally, some people have additional fees for egg or sperm donations, travel, money paid to the surrogate for lost work, maternity clothes, or other expenses.

{{see also|Religious response to assisted reproductive technology}}

Different religions take different approaches to surrogacy, often related to their stances on assisted reproductive technology in general.

Buddhist thought is inconclusive on the matter of surrogacy. The prominent belief is that Buddhism totally accepts surrogacy since there are no Buddhist teachings suggesting that infertility treatments or surrogacy are immoral. This stance is further supported by the common conception that serving as a gestational carrier is an expression of compassion and therefore automatically aligns with Buddhist values.{{Cite web|url=https://classroom.synonym.com/buddhist-beliefs-about-surrogate-mothers-12087675.html|title=Buddhist Beliefs About Surrogate Mothers {{!}} Synonym|website=classroom.synonym.com|access-date=2019-03-16}}

However, numerous Buddhist thinkers have expressed concerns with certain aspects of surrogacy.{{Cite journal |last=Damnoen |first=Somchai |title=Buddhist Ethics and Surrogacy Problem of Thai Society |ssrn=3013964|doi=10.31940/soshum.v9i1.1267|url=https://ojs.pnb.ac.id/index.php/SOSHUM/article/view/1267|journal=Soshum: Jurnal Sosial dan Humaniora|date=August 4, 2017 |doi-broken-date=November 1, 2024 }} One Buddhist perspective on surrogacy arises from the Buddhist belief in reincarnation as a manifestation of karma. According to this view, gestational carrierhood circumvents the workings of karma by interfering with the natural cycle of rebirth.

Others reference the Buddha directly who purportedly taught that trade in sentient beings, including human beings, is not a righteous practice as it almost always involves exploitation that causes suffering. Susumu Shimazono, professor of Religious Studies at the University of Tokyo, contends in the magazine Dharma World that surrogacy places the childbearing surrogate in a position of subservience, in which her body becomes a "tool" for another. Simultaneously, other Buddhist thinkers argue that as long as the primary purpose of being a gestational carrier is out of compassion instead of profit, it is not exploitative and is therefore morally permissible.{{Cite web|url=https://thedailyenlightenment.com/2015/01/is-surrogacy-right-in-buddhism/|title=The Daily Enlightenment » Is Surrogacy Right In Buddhism?|access-date=2019-03-16}} This further highlights the lack of consensus on surrogacy within the Buddhist community.

The Roman Catholic Church is opposed to surrogacy, which it views as immoral and incompatible with Biblical texts surrounding topics of birth, marriage, and life.{{Citation needed|date=March 2019}} Paragraph 2376 of the Catechism of the Catholic Church states that: "Techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uterus), are gravely immoral."[http://www.scborromeo.org/ccc/para/2376.htm "Paragraph 2376"]. Catechism of the Catholic Church.. Paragraph 2378 states, “A child is not something owed to one, but is a gift. the "supreme gift of marriage" is a human person. A child may not be considered a piece of property, an idea to which an alleged "right to a child" would lead. In this area, only the child possesses genuine rights: the right "to be the fruit of the specific act of the conjugal love of his parents," and "the right to be respected as a person from the moment of his conception.”"Cathecism of the Catholic Church, https://www.vatican.va/archive/ENG0015/__P86.HTM Many proponents of this stance express concern that the sanctity of marriage may be compromised by the insertion of a third party into the marriage contract.{{Cite web|url=http://blog.adw.org/2013/06/why-the-church-opposes-surrogate-motherhood-and-attempts-to-legalize-in-the-district-of-columbia/|title=Why the Church Opposes Surrogate Motherhood and attempts to legalize it in The District of Columbia|last=Pope|first=Msgr Charles|date=2013-06-19|website=Community in Mission|access-date=2019-03-14}} Additionally, the practice of in vitro fertilisation involved in gestational surrogacy is generally viewed as morally impermissible due to its removal of human conception from the act of sexual intercourse. Roman Catholics also condemn in vitro fertilisation due to the destruction of embryos that accompanies the frequent practice of discarding, freezing, or donating non-implanted eggs to stem cell research. As such, the Roman Catholic Church deems all practices involving in vitro fertilisation, including gestational surrogacy, as morally problematic.{{Citation needed|date=March 2019}}

Surrogacy does not conflict with the Hindu religion.{{Cite web|url=https://herencyclopedia.com/2016/06/06/surrogacy-and-hindu-mythology/|title=Surrogacy and Hindu mythology|last=keyadutta|date=2016-06-06|website=herencyclopedia|access-date=2019-03-15|url-status=usurped|archive-url=https://web.archive.org/web/20160607122542/https://herencyclopedia.com/2016/06/06/surrogacy-and-hindu-mythology/|archive-date=2016-06-07}} Surrogacy and other scientific methods of assisted reproduction are generally supported within the Hindu community.

While Hindu scholars have not debated the issue extensively, T. C. Anand Kumar, an Indian reproductive biologist, argues that there is no conflict between Hinduism and assisted reproduction.{{cite journal|doi=10.1016/S1472-6483(10)60748-1|title=Ethical aspects of assisted reproduction – an Indian viewpoint|first=TC Anand |last=Kumar|journal=Reproductive BioMedicine Online|volume=14|issue=Suppl 1|pages=140–142|year=2007}} Others have supported this stance with reference to Hindu faith, including a story in the Bhagavata Purana which suggests the practice of gestational carrier-hood:

Kamsa, the wicked king of Mathura, had imprisoned his sister Devaki and her husband Vasudeva because oracles had informed him that her child would be his killer. Every time she delivered a child, he smashed its head on the floor. He killed six children. When the seventh child was conceived, the gods intervened. They summoned the goddess Yogamaya and had her transfer the fetus from the womb of Devaki to the womb of Rohini (Vasudeva's other wife who lived with her sister Yashoda across the river Yamuna, in the village of cowherds at Gokulam). Thus the child conceived in one womb was incubated in and delivered through another womb.

Additionally, infertility is often associated with karma in the Hindu tradition and consequently treated as a pathology to be treated.{{Cite web|url=https://www.beliefnet.com/faiths/hinduism/articles/hinduisms-view-on-infertility.aspx|title=Hinduism's View on Infertility|website=www.beliefnet.com|access-date=2019-03-15}} This has led to general acceptance of medical intervention for addressing infertility amongst Hindus. As such, surrogacy and other scientific methods of assisted reproduction are generally supported within the Hindu community. Nonetheless, Hindu women do not commonly use surrogacy as an option to treat infertility, despite often serving as surrogates for Western commissioning couples. When surrogacy is practiced by Hindus, it is more likely to be used within the family circle as opposed to involving anonymous donors.

For Muslims, the Qur'anic injunction that "their mothers are only those who conceived them and gave birth to them (waladna hum)" denies the distinction between genetic and gestational mothers, hence complicating notions of lineage within the context of surrogacy, which are central to the Muslim faith.{{Citation|chapter=Religion, Culture and Religious Discrimination|pages=46–78|publisher=Cambridge University Press|isbn=9781108394871|doi=10.1017/9781108394871.003|title=Religious Discrimination and Cultural Context|year=2017}}

File:HarinegameshinTransfersEmbryoKalpasutra1300.jpg

Jain scholars have not debated the issue of surrogacy extensively. Nonetheless, the practice of surrogacy is referenced in the Śvētāmbara tradition of Jainism according to which the embryo of Lord Mahavira was transferred from a Brahmin woman Devananada to the womb of Trishala, the queen of Kshatriya ruler Siddharth, by a divinity named Harinegameshin.{{cite web|url=http://www.philamuseum.org/collections/permanent/131608.html?mulR=6275|title=Harinegameshin Transfers Mahavira's Embryo|website=Philadelphia Museum of Art}} This account is not present in Digambara Jain texts, however.

Other sources state that surrogacy is not objectionable in the Jain view as it is seen as a physical operation akin to any other medical treatment used to treat a bodily deficiency.{{Cite journal|last=Kachhara|first=N.L.|date=Feb 2017|title=Some Bioethical Issues in Jain Perspective|url=http://spiritualsciencesg.com/poems-lectures/prog4.pdf|journal=National Seminar on Engaging Jainism on Modern Issues|location=Ladnun}} However, some religious concerns related to surrogacy have been raised within the Jain community including the loss of non-implanted embryos, destruction of traditional marriage relationships, and adulterous implications of gestational surrogacy.

In general, there is a lack of consensus within the Jewish community on the matter of surrogacy. Jewish scholars and rabbis have long debated this topic, expressing conflicting views on both sides of the debate.

Those supportive of surrogacy within the Jewish religion generally view it as a morally permissible way for Jewish women who cannot conceive to fulfill their religious obligations of procreation.{{Cite web | author = Spikebrennan |url=http://www.jewishindependent.ca/jewish-ethics-and-surrogacy/|title=Jewish ethics and surrogacy – Jewish Independent|date=January 20, 2017 |access-date=2019-03-14}}{{Cite web|url=http://www.schechter.edu/what-does-jewish-law-have-to-say-about-surrogacy/|title=What does Jewish Law Have to Say about Surrogacy?|last=Golinkin|first=David|date=2012-12-18|website=The Schechter Institutes|access-date=2019-03-14}} Rabbis who favour this stance often cite Genesis 9:1 which commands all Jews to "be fruitful and multiply". In 1988, the Committee on Jewish Law and Standards associated with the Conservative Jewish movement issued formal approval for surrogacy, concluding that "the mitzvah of parenthood is so great that ovum surrogacy is permissible".

Jewish scholars and rabbis which hold an anti-surrogacy stance often see it as a form of modern slavery wherein women's bodies are exploited and children are commodified. As Jews possess the religious obligation to "actively engage in the redemption of those who are enslaved", practices seen as involving human exploitation are morally condemned. This thinking aligns with concerns brought forth by other groups regarding the relation between surrogacy practices and forms of human trafficking in certain countries with large fertility tourism industries. Several Jewish scholars and rabbis also cite ethical concerns surrounding the "broken relationship" between the child and its surrogate birth mother. Rabbi Immanuel Jacovits, chief rabbi of the United Hebrew Congregation from 1976 to 1991, reported in his 1975 publication Jewish Medical Ethics that "to use another person as an incubator and then take from her the child that she carried and delivered for a fee is a revolting degradation of maternity and an affront to human dignity."

Another point of contention surrounding surrogacy within the Jewish community is the issue of defining motherhood. There are generally three conflicting views on this topic: 1) the ovum donor is the mother, 2) the gestational carrier is the mother, and 3) the child has two mothers—both the ovum donor and the gestational carrier. While most contend that parenthood is determined by the woman giving birth, a minority opt to consider the genetic parents the legal parents, citing the well-known passage in Sanhedrin 91b of the Talmud which states that life begins at conception. Also controversial is the issue of defining Judaism in the context of surrogacy. Jewish Law states that if a Jewish woman is the surrogate, then the child is Jewish. However, this often raises issues when the child is raised by a non-Jewish family and approaches for addressing this issue are also widely debated within the Jewish community.

{{main|Fertility tourism}}

Some countries, such as the United States, Canada, Greece, Georgia and Mexico are popular surrogacy destinations for foreign intended parents.{{cite web | url=https://english.elpais.com/society/2023-04-03/surrogacy-parenthood-as-a-global-industry.html | title=Surrogacy: Parenthood as a global industry | date=April 3, 2023 }} Ukraine, Belarus and Russia were also destinations before the Russian invasion of Ukraine. Eligibility, processes and costs differ from country to country. Fertility tourism for surrogacy is driven by legal restrictions in the home country or the incentive of lower prices abroad. Previously popular destinations, India, Nepal and Thailand have all recently implemented bans on commercial surrogacy for non-residents.{{Cite news |url=https://www.theglobeandmail.com/opinion/article-how-canada-became-an-international-surrogacy-destination/|title=How Canada became an international surrogacy destination|work=The Globe and Mail|access-date=2019-03-27}} China is also a famous destination, even though surrogacy is legally banned.

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• Adoption
• Artificial insemination
• Bioethics
• Commercial animal cloning
• Egg donation
• Embryo transfer
• Fertility
• Infertility
• Sexual surrogate
• Sperm donation
• Surrogacy laws by country
• Third-party reproduction
• Mitochondrial replacement therapy

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{{Reflist}}

• Berend, Zsuzsa (2016). [https://www.berghahnbooks.com/title/berendonline "The Online World of Surrogacy"]. Berghahn Books.
• Siegel-Itzkovich, Judy (April 3, 2010). [http://www.jpost.com/LandedPages/PrintArticle.aspx?id=172370 "Womb to Let"]. The Jerusalem Post.
• Li, Shan (February 18, 2012). [http://www.latimes.com/business/la-fi-china-surrogate-20120219%2c0%2c6405320.story "Chinese Couples Come to U.S. to Have Children Through Surrogacy"]. Los Angeles Times.

• [https://web.archive.org/web/20050726080830/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Surrogacy_the_issues?OpenDocument "Surrogacy"], Better Health Channel, State Government of Victoria, Australia

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