Surrogacy

Surrogacy is a method of assisted reproduction whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. She may be the child's genetic mother (the more traditional form of surrogacy), or she may be implanted with an unrelated embryo. In some cases surrogacy is the only available option for parents who wish to have a child that is biologically related to them.

Terminology

A surrogate mother is the woman who is pregnant with the child and intends to relinquish it after birth. The word surrogate, from Latin subrŏgare (to substitute), means appointed to act in the place of. The intended parent(s) is the individual or couple who intends to rear the child after its birth.

In traditional surrogacy the surrogate is pregnant with her own biological child, but this child was conceived with the intention of relinquishing the child to be raised by others; often by the biological father and possibly his spouse or partner, either male or female. The child may be conceived via sexual intercourse, home artificial insemination using fresh or frozen sperm or impregnated via IUI ( intrauterine insemination) or ICI (intra cervical insemination) which is performed at a fertility clinic.

In gestational surrogacy the surrogate becomes pregnant via embryo transfer with a child of which she is not the biological mother. She may have made an arrangement to relinquish it to the biological mother or father to raise, or to a parent who is themselves unrelated to the child (e. g. because the child was conceived using egg donation, sperm donation or is a donated embryo). The surrogate mother may be called the gestational carrier.

Altruistic surrogacy is a situation where the surrogate receives no financial reward for her pregnancy or the relinquishment of the child (although usually all expenses related to the pregnancy and birth are paid by the intended parents such as medical expenses, maternity clothing, and other related expenses).

Commercial surrogacy is a form of surrogacy in which a gestational carrier is paid to carry a child to maturity in her womb and is usually resorted to by well off infertile couples who can afford the cost involved or people who save and borrow in order to complete their dream of being parents. This procedure is legal in several countries including in India where due to excellent medical infrastructure, high international demand and ready availability of poor surrogates it is reaching industry proportions. Commercial surrogacy is sometimes referred to by the emotionally charged and potentially offensive terms "wombs for rent", "outsourced pregnancies" or "baby farms".

Rationale

Intended parents may arrange a surrogate pregnancy because a woman who intends to parent is infertile in such a way that she cannot carry a pregnancy to term. Examples include a woman who has had a hysterectomy, has a uterine malformation, has had recurrent pregnancy loss or has a health condition that makes it dangerous for her to be pregnant. A female intending parent may also be fertile and healthy. but unwilling to undergo pregnancy.

Alternatively, the intended parent may be male, or multiple men (most usually a homosexual couple) who want to rear a child without a female parent.

Surrogates

Surrogates may be relatives, friends, or previous strangers. Many surrogate arrangements are made through agencies that help match up intended parents with women who want to be surrogates for a fee. The agencies often help manage the complex medical and legal aspects involved. Surrogacy arrangements can also be made independently. In compensated surrogacies the amount a surrogate receives varies widely from almost nothing above expenses to over $30,000. Careful screening is needed to assure their health as the gestational carrier incurs potential obstetrical risks. The majority of surrogates are not motivated by financial reasons, but instead want to help another individual or couple have a child.

History

Having another woman bear a child for a couple to raise, usually with the male half of the couple as the genetic father, is referred to in antiquity. For example, the book of Genesis relates the story of Sarah's servant Hagar bearing a child to Abraham for Sarah and Abraham to raise.

Attorney Noel Keane is generally recognized as the creator of the legal idea of surrogate motherhood. However, it was not until he developed an association with physician Warren J. Ringold in the city of Dearborn, Michigan that the idea became feasible. Dr. Ringold agreed to perform all of the artificial inseminations, and the clinic grew rapidly in the early part of 1981. Though Keane and Ringold were widely criticized by some members of the press and politicians, they continued and eventually advocated for the passage of laws that protected the idea of surrogate motherhood. Bill Handel, who is a partner in a Los Angeles, Surrogacy firms, also attempted to have such laws passed in California, but his attempts were struck down in the State Congress. Presently, the idea of surrogate motherhood has gained some societal acceptance and laws protecting the contractual arrangements exist in eight states.

In the United States, the issue of surrogacy was widely publicised in the case of Baby M, in which the surrogate and biological mother of Melissa Stern ("Baby M"), born in 1986, refused to cede custody of Melissa to the couple with whom she had made the surrogacy agreement. The courts of New Jersey eventually awarded custody to Melissa's biological father William Stern and his wife Elizabeth Stern, rather than to the surrogate Mary Beth Whitehead.

Legality

There is a default legal assumption in most countries that the woman giving birth to a child is that child's legal mother. In some jurisdictions the possibility of surrogacy has been allowed and the intended parents may be recognized as the legal parents from birth. Many states now issue pre-birth orders through the courts placing the name(s) of the intended parent(s) on the birth certificate from the start. In others the possibility of surrogacy is either not recognized (all contracts specifying different legal parents are void), or is prohibited.

Australia

In all states in Australia, the surrogate mother is deemed by the law to be the legal mother of the child as well, and any surrogacy agreement giving custody to others is void. In addition in many states arranging commercial surrogacy is a criminal offence, although New South Wales has no legislation governing surrogacy at all.

In 2006 Australian senator Stephen Conroy and his wife Paula Benson announced that they had arranged for a child to be born through egg donation and gestational surrogacy. Unusually, Conroy was put on the birth certificate as the father of the child. Usually couples who make surrogacy arrangements in Australia must adopt the child rather than being recognised as birth parents, particularly if the surrogate mother is married. After the announcement, Conroy's home state of Victoria announced that they were reconsidering the Victorian laws that make surrogacy within the state almost impossible.

France

Commercial surrogacy arrangements are illegal in France.

India

Commercial surrogacy has been legal in India since 2002. India is emerging as a leader making it into what can be called a viable industry rather than a rare fertility treatment.

Japan

In March 2008, the Science Council of Japan proposed a ban on surrogacy and said that doctors, agents and their clients should be punished for commercial surrogacy arrangements.

United Kingdom

Commercial surrogacy arrangements are illegal in the United Kingdom.

United States

Compensated surrogacy arrangements are illegal in Washington, Michigan, Utah, Arizona, New Mexico and New York. Additionally, four states in the US have held that such contracts, while not illegal, are unenforceable. California is widely recognized as one of the most friendly jurisdictions for parties desiring to enter into a surrogacy arrangement. There are many states at the present time that issue pre-birth orders placing the correct parent names on the baby's birth certificate.

Compensated surrogacy is legal in Oregon, Texas and Arkansas. Texas requires the surrogate mother to be a resident of Texas. Arkansas does not require surrogates to be residents. Intended parents and surrogates resident in any state of the USA can enter into a legal surrogacy arrangement in Arkansas. Provided the child is born in Arkansas and that financial considerations are dispensed from Arkansas the contract will be recogized by Arkansas courts and upheld.

Fertility treatment in Texas and Arkansas is a fraction of the cost in California. California is the US state closest for infertile couples from Europe and Australia who wish to enter into third party reproduction arrangements to travel.

Ethical issues

A study by the Family and Child Psychology Research Centre at City University, London, UK in 2002 concluded that surrogate mothers rarely had difficulty relinquishing rights to a surrogate child and that the intended mothers showed greater warmth to the child than mothers conceiving naturally.

Compensated surrogacy

Bioethicists are concerned that Indian surrogates are being badly paid for their surrogacy and that in addition they are working as surrogates in a country with a comparatively high maternal death rate. However high maternal death rate is found in the poorest of the poor section of the population in India who may not get access to proper medical facilities in time or from amongst many who opt not to access them because of superstition and illiteracy. Surrogate mothers in India under commercial surrogacy programs on the other hand usually are cared for with amongst the best highly advanced medical, nutritional and overall care available in the field anywhere in the world.

Fictional representation

• In Robert A. Heinlein's 1961 science fiction novel Stranger in a Strange Land, TV reporters exult that socialite Cynthia Duchess has decided to have the Perfect Baby, with the use of a sperm donor, an egg donor, and a surrogate mother.
• The character Phoebe Buffay in US sitcom Friends was a gestational surrogate mother for her brother.
• The character Fertility in Chuck Palahniuk's novel Survivor works as a commercial surrogate, although she is infertile herself.

See also

• In-vitro fertilization
• Embryo transfer
• Infertility
• Fertility
• Reproduction
• Artificial insemination
• Third party reproduction
• Repugnant market

External links

• ‘Knowing’ the Surrogate Body in Israel by Dr. Elly Teman
• French High Court Rules Surogacy Illegal
• Surrogacy - the issues
• Indian women carrying babies for well-off buyers, 'Wombs for rent' pleases women and customers, but raises ethical questions; Monday, December 31, 2007; The Associated Press; CBC News; Canadian Broadcasting Corporation
• Paid surrogacy driven underground in Canada: CBC report; Wednesday, May 2, 2007; CBC News; Canadian Broadcasting Corporation