Surrogacy around the world and across international boundaries

Here's a wide ranging survey of the literature on surrogacy practice around the world.

Brandão, Pedro, and Nicolás Garrido. "Commercial Surrogacy: An Overview." Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics 44, no. 12 (2022): 1141-1158.

Abstract: "Objective Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

"Methods This is a review of the literature published in the 21st century on commercial surrogacy.

"Results A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

"Conclusion Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated."

Here's the beginning of the section on "transnational" surrogacy:

"The denial of surrogacy in most countries, for all or for some (such as single people or same-sex couples), its cost or the lack of available carriers led to an important transnational search for these (and other) reproductive treatments.[155] [156] This phenomena has been called reproductive, procreative or fertility tourism, transnational reproduction or cross border reproductive care.[157] [158] [159] [160] [161] [162] In European countries alone and concerning any kind of ART, in 2010, a total of 24,000 to 30,000 cycles of cross border fertility treatment within the continent were estimated each year, involving 11,000 to 14,000 patients.[163] Transnational surrogacy is one of the fastest-growing cross-border reproductive treatments.[164] Choosing where to perform the surrogacy treatment usually entails finding the right equilibrium between legal guarantees and costs.[165] Due to the variety of legislations, costs and availability of donors and carriers between countries, patients may search for other countries to do the entire process of surrogacy, or different phases of the surrogate treatment in more than one country.[158] As an example, a male couple may get their donated oocytes from South Africa, where there are many donors available, do the IVF, recruit the surrogate and embryo transfer in Georgia (Sakartvelo), due to attractive prices, and fly the gestational carrier to the USA to deliver the baby, where children may be registered by both parents.[166] [167]" 

Birthright citizenship and birth tourism

Birthright citizenship (i.e. every child born within the country is a citizen) is (perhaps unsurprisingly) a new-world phenomenon: it occurs widely in the Americas, which were populated largely by immigrants.

The map comes from:
Birthright Citizenship in the United States--A Global Comparison

Prosperous countries that give citizenship to everyone born within their borders (regardless of their parents' citizenship) can be attractive places to give birth, particularly if they have good medical care and comfortable surroundings, and particularly for families whose home may be problematic for political or economic reasons.

Birthright citizenship has become a political issue in the U.S. under the Trump administration, as part of a larger repugnance towards immigration.
NY Times: President Wants to Use Executive Order to End Birthright Citizenship
“We’re the only country in the world where a person comes in and has a baby, and the baby is essentially a citizen of the United States for 85 years, with all of those benefits,” Mr. Trump told Axios during an interview that was released in part on Tuesday, making a false claim. “It’s ridiculous. It’s ridiculous. And it has to end.”

While some of that repugnance focuses on countries in Central and South America, there is also an expensive birth tourism market, catering e.g. to families from Russia and China.

Here's a recent story from Bloomberg:
There’s No Stopping the Russian Baby Boom in Miami
But it’s not, the new mothers insist, about the U.S. passport. “Why does Trump think everyone is dying to have one?”

"Being a birth tourist in Sunny Isles Beach isn’t cheap, with agencies charging as much as $50,000 to set up housing, hire interpreters, find doctors and deal with paperwork. Those who can’t afford that level of service buy smaller packages and rent apartments in far-flung suburbs, sometimes teaming up to share lodgings and expenses.
...
"The focus of Trump’s criticism hasn’t been the abuse of the system but the fact that it exists. One of his arguments against birthright citizenship is that when the babies born on U.S. soil become adults, they can petition for their parents to live permanently in the country.

But to many of the Russians in Sunny Isles, at least, this idea sounded unappealing. The biggest deterrent: They’d have to start paying personal income taxes that are more than double what they are in Russia."
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And a story of a different sort from Newsweek:
FEDS RAID 'MATERNITY HOTELS' WHERE TOURISTS PAID UP TO $80K TO GIVE BIRTH IN U.S.
"Though it’s not illegal to have their babies in the United States, birth tourists usually lie to immigration officials about their reasons for travel, according to an official cited by NBC. The bigger focus, however, are the organizers of websites that targeted women in China and sold the "maternity hotel" stays to them.

"For that reason, authorities did not arrest the women staying in the buildings on Wednesday, but instead will use them as witnesses in an attempt to prosecute the "handlers."
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And here's a headline that looks like it could come from the U.S., but comes instead from Canada:

Feds studying 'birth tourism' as new data shows higher non-resident birth rates
BY THE CANADIAN PRESS
"OTTAWA — The federal government is studying the issue of “birth tourism” with a view to better understand the scope of this practice within Canada and its impacts.

"This comes as new research published by Policy Options today shows the number of non-Canadian residents giving birth in Canadian hospitals is much higher than in figures reported by Statistics Canada.
...
"Immigration Minister Ahmed Hussen ... says Canada does not collect information on whether a woman is pregnant when entering Canada, nor can a woman be denied entry solely because she is pregnant or might give birth in Canada."

Medical care as a U.S. export

Travel for medical care is sometimes viewed with some repugnance, as the names "transplant tourism" and "fertility tourism" suggest.  (In the case of transplants, particularly from deceased donors, there is sometimes the suggestion that scarce national resources shouldn't be squandered on foreign patients.)  But of course a lot of travel for medical care has to do with going where care is available, and the U.S. hosts many foreign patients. (The availability of pain medicine for palliative end of life care is apparently an issue for some.)  Here's a story from the NY Times that reflects that even travel for ordinary medical care is complex, and can be viewed with some suspicion:

International Patients, Seeking Cures in the States
Are they taking up beds that could be used for vulnerable domestic patients or are they bringing money that could be used toward other programs?


"Each year, tens of thousands of seriously ill people come to the United States hoping to access our acclaimed care. While we do not have exact figures, an economist from the United States International Trade Commission estimated in a 2015 report that between 100,000 and 200,000 international patients per year make this journey. They come with cancer, heart disease and a host of other medical conditions. Most are incredibly sick and see us as their last beacon of hope.

But these patients are not just showing up. Many of our largest and most elite health care institutions seek them out. This is a multimillion-dollar industry, and it is growing. With millions of uninsured and underinsured patients and uncertainty in the domestic health care markets, hospitals are increasingly reliant on patients from abroad to stabilize their bottom line.

...

"Is an international patient “taking up a bed” that could otherwise be used for a vulnerable domestic patient? Or is the international patient providing funds that can be used toward other clinical and research programs?

"While many international patients are wealthy, they too are a vulnerable population. They enter a foreign medical culture, which may have different standards and expectations for doctor-patient communication, especially around sensitive issues like serious illness and death.

"Furthermore, international patients, particularly those from the Middle East, are frequently members of cultural, ethnic and religious minorities. In an age of rising American xenophobia and cultural protectionism, patients and families expose themselves to considerable risk coming to the United States. On a more practical level, recent travel bans have limited families from visiting sick or dying relatives who are already here.

...

"in American hospitals, patients and their families have access to advanced palliative and end-of-life care, which may not be the case in their home countries. For instance, opioids, which can be critical to alleviating suffering in the dying process, are not widely available in some countries.

Medical tourism: cataract surgery in Britain

Britain is both an origin and a destination for medical tourism--travel to get better or cheaper medical care--and not everyone is happy to be on the receiving end.

The Telegraph has the story: Health tourists jump queue for cataract operations on NHS as British patients wait up to eight months

"Health tourists are being given cataract surgery on the NHS ahead of British patients because their conditions are considered more of a priority, it has emerged.

Hundreds of people from countries including Zimbabwe and Nigeria have been offered the eye operations before UK taxpayers, official figures show.

They have been fast-tracked by medics as their conditions are said to be "very complex and urgent", while some hospitals have waiting times of almost eight months.

Cataract surgery is the most common treatment provided on the NHS and 300,000 operations are carried out each year."
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For some medical tourism that takes British citizens abroad, see e.g. these earlier posts...

What do British fertility tourists choose in America? It's a girl!

Indian surrogates bearing British babies

Assisted suicide in England and Switzerland, continued