Surrogacy, and escrow accounts

 Surrogacy contracts involve a long term relationship, focused on a nine month pregnancy.  So commercial surrogacy depends on secure financial arrangements, which generally require funds to be held in escrow.  The WSJ article below documents that these escrow accounts are insufficiently regulated in some states, which can cause serious problems for surrogates and intended parents when the account holders are dishonest or careless.

Surrogacy Is a Multibillion-Dollar Business. Sometimes the Money Goes Missing.  "The growing industry has little regulation and many cases of financial abuse; escrow funds taken to pay gambling debts, buy bitcoin." By Ben Foldy
 

"Escrow companies, used in the majority of surrogacies, can handle millions of client dollars with almost no oversight, according to a Wall Street Journal review of court filings and interviews with parents and surrogates.

...

"The lack of regulation means that parents and surrogates frequently have little legal recourse and dim hopes of recovering lost funds. Already-pregnant surrogates must carry through with labor that they know they may not be paid for, while potentially being on the hook for medical bills they may not be able to afford. Parents face the prospect of messy litigation from unpaid surrogates. One couple whose surrogacy funds disappeared due to fraud before they were able to successfully transfer an embryo said they gave up hope for a pregnancy.

“Holding other people’s money is usually such a highly regulated industry,” said Andrew Bluebond, an attorney in Texas who helped Gallozzi look into what happened at SEAM. The surrogacy community’s relatively small size and intimate domain, Bluebond said, fostered a false sense of financial security.

“Rather than using the safeguards other industries use, they let their trust betray them,” he said. 

...

"Surrogacy has exploded into a multibillion-dollar industry, driven by increasing rates of infertility, expanded insurance coverage, the growing prevalence of LGBTQ families and an influx of couples from countries where the practice is illegal, including China. Last week, President Trump announced a deal aimed at lowering the price of medications used in IVF. 

There were around 10,850 transfers of embryos to surrogates in the U.S. in 2023 involving clinics reporting to the Society for Assisted Reproductive Technology, which says it represents clinics that perform around 95% of all procedures. That was up from 8,461 in 2021. The group’s data and other analyses expect an annual growth rate of about 15% over the coming years. About half of those embryo transfers resulted in successful deliveries.

Despite the growth, there are no federal laws regulating the financial or other aspects of surrogate pregnancies, and the practice is subject to a patchwork of state regulations. In Louisiana, for example, compensating surrogates is outlawed entirely. In a handful of other states, the contracts that often accompany surrogacy arrangements are legally unenforceable. 

...

"Last month, the nonprofit Society for Ethics in Egg Donation and Surrogacy, which functions as a kind of industry best-practices group in lieu of regulation, passed new guidelines for escrow accounts, although they have no binding power. The suggestions recommend escrow providers have relevant credentials, are subject to audits by certified accountants and have more than $10 million in bond coverage. " 

 

Do we need to worry that surrogacy will be banned in the US? (by the UN??)

  Stat News has a call to prevent surrogacy from being banned, following a recent UN resolution to do just that.

How to keep commercial surrogacy from getting banned
An unlikely alliance working to end surrogacy is gaining power    By Arthur L. Caplan  Oct. 20, 2025
Caplan is head of the Division of Medical Ethics at the NYU Grossman School of Medicine. 

 

Caplan calls for more regulation, which might be a fine idea.  But I don't share his concern that the UN call to ban surrogacy will lead to it being banned in the US. Surrogacy in one form or another has been legalized in every US state (or maybe all but one.)   This is one of those times where it's good that the UN is toothless. 

 

HT: Martha Gershun 

Demand for surrogacy outstrips supply in England (where commercial surrogacy is illegal)

 Economics in action.

The Guardian has the story:

‘It’s overwhelming’: woman who was UK’s first surrogate closes agency as demand soars
Kim Cotton says laws, little changed since being rushed through in response to her pregnancy in 1985, are ‘dinosaur’  by Jessica Murray 

"Much has changed since Kim Cotton became the UK’s first surrogate 40 years ago, when she was forced to flee hospital on the floor of a car under a blanket, such was the level of media frenzy around her story.

...
"She has spent decades running the surrogacy agency Cots (Childlessness Overcome Through Surrogacy), facilitating more than 1,000 pregnancies. But in September she is closing its doors as soaring demand and a lack of surrogates is making the job more stressful than ever before.

...

"There are now about 400 children a year born through surrogacy to UK parents, up from about 50 a year before 2008, and more than half are now born through international surrogacy arrangements.

"Pro-surrogacy campaigners have blamed the stringent laws in the UK for pushing more people to seek surrogacy arrangements abroad, sometimes in countries with lax or nonexistent regulations. Waiting lists at many British surrogacy agencies are now years long.

“As soon as same-sex parents could go for a parental order, demand doubled, but supplies remained the same,” Cotton says. “There’s also just more infertility around.

...

"The UK’s surrogacy laws have changed little since they were first introduced in 1985, when they were rushed through parliament as a direct response to Cotton’s pregnancy.

"In 2023 the Law Commission published a report with suggested changes, including the creation of a national surrogacy register, and ensuring intended parents in domestic surrogacy arrangements can become parents from the child’s birth.

"Under current laws, intended parents have to apply for a parental order after birth, which can take months and create issues over who makes decisions about the baby’s healthcare in the first weeks of life.


...

“The laws are so antiquated, they’ve not changed since 1985 when I was a surrogate, but it was a kneejerk law that was passed. It’s fossilised. It’s a dinosaur. And it’s just on the back burner now. It’s a damn shame.”

"Campaigners were hopeful the Law Commission report would lead to reform, but the change of government in 2024 has pushed surrogacy to the bottom of the agenda.

"There is also strong opposition from those who are concerned that relaxing the laws could lead to people being coerced into surrogacy by financial need, or wealthy people outsourcing pregnancy because they have the resources to do so.

...

"As well as parental rights from birth, Cotton said she would like to see reform of the expenses system for surrogates. As commercial surrogacy is banned in Britain, advertising for surrogates is not permitted and only “reasonable expenses” are allowed to be paid.

Cotton says this seems to have been accepted as about £15,000-£20,000, although there is no official guidance around what is permitted.

“If the surrogate baby has been living with a couple since the baby was born, how are they going to say, well, no, actually I can’t give you a parental order because you paid a bit too much to the surrogate?” Cotton says. “So we need more clarity.”

Although she is closing down Cots, Cotton is reluctant to leave the world of surrogacy behind completely, and says she will continue to offer advice to people through a surrogacy advice line."

The UN General Assembly issues a call for surrogacy to be outlawed

 A growing number of families are formed by gestational surrogacy, in which a woman bears a child for another couple.  Surrogacy is legal throughout the US, and regulated state by state.

United Nations General Assembly has issued a report saying that surrogacy in all its forms should be regarded as a crime against women, and banned outright.

Report of the Special Rapporteur on violence against  women and girls, its causes and consequences
The different manifestations of violence against women and girls  in the context of surrogacy 

Summary: In the present report, the Special Rapporteur on violence against women and  girls, its causes and consequences, Reem Alsalem, examines the different manifestations of violence against women and girls in the context of surrogacy.

...

Conclusion and recommendations :

69. The practice of surrogacy is characterized by exploitation and violence against women and children, including girls. It reinforces patriarchal norms by commodifying and objectifying women’s bodies and exposing surrogate mothers and children to serious human rights violations. 

70. Considering the above, the Special Rapporteur recommends that Member States and other relevant stakeholders: 

(a) At the international level, take steps towards eradicating surrogacy in all its forms. Pending its abolition, States must take action to prevent further  harm and strengthen the protection of the rights of women and children involved in surrogacy arrangements;

(b) Work towards adopting an international legally binding instrument prohibiting all forms of  surrogacy..." 

 

HT: Kim Krawiec

 

Informed consent and compensation for clinical trial participants (Ambuehl, Ockenfels and Stewart in REStat)

 Here's the latest in a series of papers that suggests that participants who are attracted to e.g. clinical trials by the pay may be those who have the most trouble evaluating the costs and risks. So high pay should be paired with robust procedures for informed consent.

Ambuehl, Sandro, Axel Ockenfels, and Colin Stewart. "Who opts in? Composition effects and disappointment from participation payments." Review of Economics and Statistics 107, no. 1 (2025): 78-94.

Abstract: "Participation payments are used in many transactions about which people know little but can learn more: incentives for medical trial participation, signing bonuses for job applicants, or price rebates on consumer durables. Who opts into the transaction when given such incentives? We theoretically and experimentally identify a composition effect whereby incentives disproportionately increase participation among those for whom learning is harder. Moreover, these individuals use less information to decide whether to participate, which makes disappointment more likely. The learning-based composition effect is stronger in settings in which information acquisition is more difficult. 

"we contribute to the burgeoning literature on the moral constraints on markets (Kahneman et al., 1986; Roth, 2007; Ambuehl et al., 2015; Ambuehl, 2022; Elias et al., 2019). Around the world, the principles of informed consent are fundamental to regulations concerning human research participation, as well as to transactions such as human egg donation, organ donation, and gestational surrogacy (DHEW 1978, The Belmont Report, 1978; Faden & Beauchamp, 1986). According to these principles, the decision to participate in a transaction is ethically sound if it is made not only voluntarily but also in light of all relevant information, properly comprehended.3 Our results show that payments for participation can be in conflict with participants’ understanding about the consequences of participation. They further show that the severity of this conflict grows with respect to both the amount of the payment and the difficulty of acquiring and processing information about the consequences of the transaction."

#######

Earlier:

Wednesday, September 4, 2024 Incentives matter for getting participation in clinical trials by low income households

 

Sunday, March 10, 2024 Does high pay equal "undue inducement"? An experiment by Sandro Ambuehl

 

 

Italy criminalizes surrogacy from abroad

 Italy has banned its citizens from accessing surrogacy in other countries where it is legal.  It will be interesting to see how they enforce this. (But of course gay couples will have fewer opportunities to skirt the law than couples who could pretend to have had a pregnancy..)

The NYT has the story:

Italy Criminalizes Surrogacy From Abroad, a Blow to Gay and Infertile Couples. The new law was pushed by the party of Giorgia Meloni, Italy’s conservative prime minister. by Emma Bubola

"Italy passed a law on Wednesday that criminalizes seeking surrogacy abroad, a move the country’s conservative government said would protect women’s dignity, while critics see it as yet another crackdown by the government on L.G.B.T. families, as the law will make it virtually impossible for gay fathers to have children.

"Surrogacy is already illegal in Italy. But the government of Prime Minister Giorgia Meloni has vowed to broaden the ban to punish Italians who seek it in countries where it is legal, like in parts of the United States."

###########

Earlier:

Thursday, August 22, 2024  Surrogacy under continued attack in Italy

Surrogacy under continued attack in Italy

The language of repugnance is strong in these latest developments.

The NYT has the story:

Has Power Moderated Italy’s Leader? Not to Same-Sex Parents.  Prime Minister Giorgia Meloni has mostly shown a pragmatic streak abroad. But at home, her government is plunging many gay families into panic. 

"Surrogacy is already illegal if conducted in Italy. But the government of Prime Minister Giorgia Meloni wants to expand the prohibition. It has promoted a bill that would also punish Italians who make use of surrogacy even in places abroad where it is legal, like in parts of the United States. Those Italians who do could face up to two years in prison and be fined the equivalent of about a million dollars.

"Italy’s lower chamber of Parliament approved the bill last summer, and the Senate’s justice committee greenlighted it last month. The Senate is expected to vote on it as soon as the fall.

...

"No one can convince me that it is an act of freedom to rent one’s womb,”  [Prime Minister Meloni] said in the spring at an event in Rome. “No one can convince me that it is an act of love to consider children as an over-the-counter product in a supermarket.”

“Uterus renting is a shameful, inhuman practice,” she said. “It will become a universal crime.”

##############

Earlier

Wednesday, April 5, 2023

Surrogacy under siege in Italy

Surrogacy in Israel

In Israel, where commercial surrogacy is legal, surrogates are more and more coming from educated and religious communities. 

Haaretz has the story:

Married, Educated, Not in It for the Money: The New Profile of Israeli Surrogate Mothers. Who are the Israeli women who wish to be pregnant and give birth for others? The answer to that question has changed dramatically over the past decade  by Ronny Linder

""I'm a little tired of women telling me how disadvantaged all surrogates are, so I thought of starting a thread just for surrogates, with: name + our occupation + town. I'll go first." This is what one moderator of an open Facebook surrogacy group wrote, about a year ago – and the responses came pouring in: a computer programmer from Tekoa, a sociolinguistics Ph.D. from Kfar Sava, a school principal from Jerusalem, a postgraduate student of gender studies from Hatzeva, a lawyer from Gush Etzion, an oncology nurse from Mevasseret Zion and so on and on.

"The post and the responses to it, written in reaction to the prevalent perception that views surrogacy as bearing the potential for exploitation of disadvantaged women who must "hire out" their uteruses for money, largely reflects the great transformation, over a few short years, in the profile of surrogate mothers and of the entire field in Israel. 

...

"Since the surrogacy law was legislated in 1996, almost 1,300 children have been born in Israel through surrogacy procedures. In recent years, the number has averaged around 80 children per year. Data collected by the Health Ministry about surrogate mothers between 2022 and 2023, reveals the changes in the profiles of women who choose to take on the task, as compared with the last study, in 2010. That study, which reviewed surrogate mothers during the years 1996-2010, was conducted by Etti Samama as part of the work for her doctoral thesis in health-system management at Ben-Gurion University. To compile recent data, Adam Ringel and Eti Dekel, for many years the national supervisor of the surrogacy law, collected information from 246 cases – 90 percent of the cases filed with committee in the last couple of years. 

...

"The data indicate a fundamental change in the socio-economic status of women who choose to become surrogates. In terms of education, while in 2010 the majority of surrogate mothers had a high school education (70 percent), nearly one fifth (18 percent) had less than 12 years of schooling, and only 7 percent had academic degrees. Less than a decade and a half later, however, the picture has been transformed: 65 percent of surrogate mothers have an academic degree, and only about one fifth have only a high school education (14 percent) or less than 12 years of schooling (8 percent). The proportion of those with academic degrees among surrogates is significantly higher than that group's share of the population, which is 38 percent.

"A similarly changed picture emerges in terms of employment: In 2023, only 2.5 percent of surrogates were unemployed, compared with 25 percent in 2010. No less interesting is the finding regarding geographical dispersal of surrogates, as compared with the general public: In recent years, almost half (45 percent) of them come from kibbutzim, moshavim and organized communities – compared with just 12 percent in 2010.

...

"An absolute majority of surrogates come from [the world of] religious Zionism, on the one hand, or are secular women from kibbutzim and other organized communities, on the other," Ringel elucidates. "These two groups are seemingly worlds apart, but in the world of surrogacy, you see the resemblance between them. These are independent, strong women, with a fully developed values-based worldview, who are looking to do something big for others, who see surrogacy as a calling, as female empowerment and as the ultimate giving."

"What happened between 2010 and 2024 that led to such dramatic change in the profile of surrogate mothers? Experts in the field ascribe the change mainly to the opening up of the option for married women to become surrogates, beginning in 2010 – a move that significantly increased the pool of potential surrogates and also changed their socio-economic backgrounds.

"This is indeed a transformation: in 2010, all surrogates were unmarried women, 75 percent of them divorced, the rest single (and a few widows). In contrast, in 2022-2023, 80 percent of surrogates were married or in relationships, and only 20 percent were divorced or single.

...

 "There was always an altruistic element with surrogates, but ever since married and more affluent women entered the picture – the economic part became more of a bonus, rather than the main motive," Dekel points out."

Vatican statement on gender-affirming surgery and human dignity

 A new statement from the Vatican has been widely covered in the press.

Here's the story from the National Catholic Reporter:

Vatican condemns surrogacy, gender-affirming surgery, gender theory in new doctrinal note. Vatican doctrinal chief calls it 'painful' that some Catholics support gay criminalization  BY CHRISTOPHER WHITE, April 8, 2024

"Sex change operations, gender theory and surrogate motherhood pose grave threats to human dignity, according to a major new Vatican document released on April 8. 

While the highly anticipated treatise, "Dignitas Infinita: on Human Dignity," which has been the source of much speculation for months, offers a broadside against the creation of new rights motivated by sex and gender, it is largely a reiteration of long-held Catholic teaching on a number of social and moral concerns. 

The new document, however, seeks to elevate a number of social themes emphasized by Pope Francis during his decadelong papacy — such as poverty, migration and human trafficking — as being equally a part of the full panoply of potential threats to human dignity as bioethical concerns, such as abortion and euthanasia.   

...

"Among the newly identified threats to human dignity are poverty; war; the travail of migrants; human trafficking; sexual abuse; violence against women; abortion; child surrogacy; euthanasia and assisted suicide; the marginalization of people with disabilities; gender theory; sex change; and digital violence.

Gender theory, according to the document, is a subject of considerable debate among scientific experts, and risks denying "the greatest possible difference that exists between living beings: sexual difference."  

The document repeats a frequent warning of Francis against "ideological colonization," where the pope has sharply criticized western governments for allegedly imposing their sexual values on the developing world. All efforts to eliminate sexual differences between men and women must be rejected, says the document. 

At the same time, the document also begins with a caveat that all persons, regardless of their sexual orientation, must be respected, and "every sign of unjust discrimination is to be carefully avoided, particularly any form of aggression and violence."

"For this reason," the document continues, "it should be denounced as contrary to human dignity the fact that, in some places, not a few people are imprisoned, tortured, and even deprived of the good of life solely because of their sexual orientation."  

Last year, Francis became the first pope to specifically condemn the criminalization of homosexuality and said that the Catholic Church must work towards an end to what he described as "unjust" laws that criminalize being gay. At present, at least 67 countries have laws criminalizing same-sex relations. 

In its brief section on gender-affirming surgeries, the document avoids using the term "transgender" and instead offers a muted prohibition against medical interventions for such purposes.

...

"Catholic LGBTQ groups criticized the new Vatican document within hours of its publication, saying it failed to acknowledge the concrete experience of transgender and nonbinary individuals.

New Ways Ministry, an advocacy group that had an historic meeting with Francis at the Vatican last October, said in a statement that the text "fails terribly" and shows the limits of the church's understand of human dignity.

...

"The new document also goes on to repeat the pope's recent call for an international ban on the rising practice of surrogate motherhood, declaring that the "legitimate desire to have a child cannot be transformed into a 'right to a child' that fails to respect the dignity of that child as the recipient of the gift of life."  

In January, Francis used his annual "State of the World" address to ambassadors accredited to the Holy See to push for a global ban on surrogacy. 

While the pope had previously condemned the practice, the pope's sweeping remarks on the topic — where he called it a "grave violation of the dignity of the woman and the child" — marked the first time he had made such a specific policy proposal. Last month, the Vatican's ambassador to the United Nations, Archbishop Gabriele Caccia, also pressed for an international prohibition against the practice. "

Children in China

 The NYT ran an interactive story on China's change in family policy, from one child (from 1979 to 2015), to two and now to three. At the link you can see old slogans and new ones.  But it was hard to limit family sizes, and it's hard to increase them. (The relaxation of the one-child policy increased demand for surrogacy in China, where it isn't legal. But it isn't clear how much demand there is for three children families.)

OneThree Is Best: How China’s Family Planning Propaganda Has Changed, By Isabelle Qian and Pablo Robles  

"For decades, China harshly restricted the number of children couples could have, arguing that everyone would be better off with fewer mouths to feed. The government’s one-child policy was woven into the fabric of everyday life, through slogans on street banners and in popular culture and public art.

"Now, faced with a shrinking and aging population, China is using many of the same propaganda channels to send the opposite message: Have more babies.

"The government has also been offering financial incentives for couples to have two or three children. But the efforts have not been successful. The birthrate in China has fallen steeply, and last year was the lowest since the founding of the People’s Republic of China in 1949."

"Under the one-child policy, local governments levied steep “social upbringing fees” on those who had more children than allowed. For some families, these penalties brought financial devastation and fractured marriages.

"As recently as early 2021, people were still being fined heavily for having a third child, only to find out a few months later, in June, that the government passed a law allowing all married couples to have three children. It had also not only abolished these fees nationwide but also encouraged localities to provide extra welfare benefits and longer parental leave for families with three children."

#######

Wednesday, March 1, 2017

Surrogacy in China: available but illegal

Foreign surrogacy in Denmark is becoming less restrictive

 Above the Law has the story:

Denmark Passes New Pro-Surrogacy Regulations. The new rules in Denmark focus on two areas of surrogacy.  By ELLEN TRACHMAN  February 14, 2024

 "On February 5, 2024, the Danish government announced new surrogacy-supportive rules scheduled to come into effect on January 1, 2025. The rules address parentage for families formed by surrogacy — including commercial (compensated) surrogacy outside of Denmark — as well as for families formed by altruistic (noncompensated) surrogacy within Denmark.

...

"In Denmark, compensated surrogacy is illegal, and altruistic surrogacy has traditionally fallen into a legal gray area, pushing most hopeful parents who want to have a genetic connection to their child, but who are unable to carry a pregnancy themselves, to go abroad. The Danish government estimates that about 100 children are born to Danish parents each year by surrogacy outside of Denmark, while about five children each year are born within Denmark in altruistic surrogacy arrangements.

...

"Denmark has a history of denying parental rights to the intended parents of children born by surrogacy abroad. But on December 6, 2022, the European Court of Human Rights ruled against Denmark in K.K. and Others v. Denmark. In that case, a married heterosexual couple had twins with the assistance of a Ukrainian surrogate. Under Ukrainian law, both Danish intended parents were recognized as parents of the child, and the surrogate was not a parent of the child.

...

"The ECHR found that Denmark’s refusal to recognize the parent-child relationship between the mother and child was a human rights violation — not a violation of the mother’s human rights, but of the two children, to have a recognized legal relationship with their mother.

To its credit, Denmark is reacting to the ECHR’s definitive ruling. In the announcement by the Danish government last week, the government made it clear that the country’s new rules are intended to go beyond the minimum requirements of the ECHR to merely not violate the human rights of Danish children.  (The bare minimum requirement would be to just allow stepparent adoptions.) Instead, the Danish government’s new rules go farther to protect children and their parents.

...

"The new rules permit Danish family courts to quickly make a decision on parenthood in the case of a foreign surrogacy agreement, even permitting a court ruling to be made prior to the family’s return to Denmark. The rules also require that the court assess the best interest of the child, but with a presumption that it is, of course, in the child’s best interest to have a timely recognition of their parents.

"Moreover, the court decisions are permitted to be retroactive to the birth of the child, permitting parents to have access to parental leave work benefits, inheritance rights, and all other benefits of that legal relationship. And, in contrast to a stepparent adoption, the new rules will allow recognition of the parent-child relationship with the mother or nongenetic parent even if parents have separated, or if one parent died before they had a chance to apply for parenthood.

...

"In a stated attempt to address the risk of child trafficking, the rules require that at least one intended parent be genetically related to the child. Additionally, the surrogate is required to confirm in a notarized declaration after the birth that she wishes to transfer parenthood of the child to the intended parents."

Pope Francis calls for a ban on surrogacy

 The Catholic Church has long opposed in-vitro fertilization (IVF), one of the technological tools that allows surrogacy, on the grounds that IVF produces more embryos than are brought to term as babies, and so is comparable to abortion.*  But this week, during his annual "state of the world" foreign policy speech, Pope Francis made clear that he thinks surrogacy should additionally be banned because of the presence of "commercial contracts." 

Here's the story from the National Catholic Register:

Pope Francis Calls Surrogacy ‘Deplorable,’ Calls for Global Ban in Speech to Ambassadors

"Pope Francis called surrogacy “deplorable” and called for a global ban on the exploitative practice of “so-called surrogate motherhood” in a speech to all of the world’s ambassadors to the Vatican on Monday.

“The path to peace calls for respect for life, for every human life, starting with the life of the unborn child in the mother’s womb, which cannot be suppressed or turned into an object of trafficking,” Pope Francis said Jan. 8.

“In this regard, I deem deplorable the practice of so-called surrogate motherhood, which represents a grave violation of the dignity of the woman and the child, based on the exploitation of situations of the mother’s material needs. A child is always a gift and never the basis of a commercial contract.”

"The Pope then called on the international community to prohibit the practice of surrogacy universally."

##########

The United States Conference of Catholic Bishops reiterates the main point in this quote from its spokesperson:

Statement of USCCB on Holy Father’s Remarks on Surrogacy, January 8, 2024

“As Pope Francis stated, with surrogacy, an unborn child is turned into ‘an object of trafficking’ because it exploits the birth mother’s material needs and makes the child the product of a commercial contract. This is why the Catholic Church teaches that the practice of surrogacy is not morally permissible. Instead, we should pray for, and work towards, a world that upholds the profound dignity of every person, at every stage and in every circumstance of life.”

##########

And here's the story in the NYT:

Francis Urges Ban on Surrogacy, Calling It ‘Despicable’  The pope said that an unborn child must not be “turned into an object of trafficking,” expanding his condemnation of a practice already illegal in Italy and some other European countries.  By Jason Horowitz

"Pope Francis on Monday called surrogate motherhood a “despicable” practice that should be universally banned for its “commercialization” of pregnancy, including the practice among wars, terrorism and other threats to peace and humanity in an annual speech to ambassadors.

...

"Surrogacy is already illegal in Italy and compensated surrogacy is also illegal or restricted in much of Europe. The United Kingdom, the Netherlands, Portugal and several other nations allow surrogacy under certain conditions. Paid surrogacy is legal in some European nations, including Ukraine, Russia and Belarus.

"Surrogate mothers in the United States and Canada are often hired by Europeans, including same-sex couples, seeking to have children..."

##########

Earlier:

Wednesday, April 5, 2023  Surrogacy under siege in Italy

*  Monday, October 4, 2010  From repugnant transaction to Nobel Prize in Medicine

#########

Update: here's the Pope's full speech (in English) from the Vatican Press Office:

Audience with the Diplomatic Corps accredited to the Holy See for the exchange of greetings for the New Year, 08.01.2024

Interview in the Brazil Journal

 I was interviewed for the Brazil Journal by Giuliano Guandalini. The interview was conducted in English, but appears in Portuguese. We discussed controversial markets generally, including kidney exchange, which is not legal yet in Brazil.

Troca de rins. Drogas. Barriga de aluguel. Este Nobel sugere liberar tudo  (Kidney exchange. Drugs. Surrogacy...)

 Here's a snippet that comes through pretty clearly in retranslation back into English by Google Translate:

"In the US and many other countries, his work and that of other researchers has contributed to improving the waiting list for kidney transplants. In Brazil, we continue with the traditional system, with a long wait for donors. Why is it so difficult to make reforms of this kind in public services based on the teachings of modern economics?  

"A transplant always depends on an organ donation, whether from a dead person or a living individual. It is natural that family members and society in general are concerned about how this will be done in an ethical and careful manner. 

"Brazil does a lot of transplants. So there is no restriction on the medical capacity side so that more transplants can be done. But when we look at total kidney transplants in relation to population size, the number is not that big. 

"Meanwhile, there are thousands of people on dialysis because transplants have not been enough. The issue, therefore, is to allow more donations to occur in life, and changing kidneys is a way for people to help save someone they love. 

"Brazil may be one of the next countries to carry out the exchange of kidneys. Some experimental surgeries have already been performed, with legal authorization. Researchers will be able to gain support to perform more operations of this type and then, perhaps, society will be able to convince itself of the importance of changing kidneys. 

"What are the obstacles that prevent the adoption of organ exchange? Are they ethical, moral, religious issues? 

"A little bit of all those things. There are those concerned that poor and vulnerable people may have their organs stolen. Evidently, there must be complete assurance that this will not happen. But of course the poor would also like to save the lives of loved ones by giving them a kidney. "

Surrogacy in Spain is hard to suppress

 In a widely reported story, a Spanish celebrity has become the surrogate mother of her grandchild, with the help of sperm from her deceased son, and an American surrogate.  This has raised controversy in Spain, where surrogacy is illegal.

Here's the Guardian on the story:

Spanish TV star says surrogate baby is actually her grandchild. Ana Obregón, 68, says her son, Aless Lequio García, expressed desire to have a child before death in 2020

"A heated debate in Spain triggered by a 68-year-old celebrity who was reported to have used a surrogate mother in Miami to have a baby took a twist on Wednesday when the woman announced in the socialite magazine ¡Hola! that the baby was actually the daughter of her son who died of cancer in 2020.

...

"Surrogate pregnancies are banned in Spain, although children from such pregnancies in other countries can be registered.

...

"Initial reports about the baby grabbed the attention of the Spanish media and the country’s political parties, sparking criticism from the leftist coalition government. Many leading politicians and outlets of Spanish media refer to surrogacy as “womb renting”.

"The equality minister, Irene Montero of the leftist United We Can coalition partner, said surrogate pregnancies were “a form of violence against women”. The coalition’s Socialist party said legislation should be tweaked to prevent Spaniards using surrogates in other countries.

...

"The main opposition conservative People’s party has said it is open to debating legalising such pregnancies if there is no payment involved."

********

Recent related post:

Wednesday, April 5, 2023

Surrogacy under siege in Italy

Surrogacy under siege in Italy

 Opposition to surrogacy in Italy has taken aim at the babies of same sex couples.

The NYT has the story:

Surrogacy Emerges as the Wedge Issue for Italy’s Hard Right. Prime Minister Giorgia Meloni has ordered municipalities to stop certifying foreign birth certificates for same-sex couples who used surrogacy, leaving some babies in a legal limbo.  By Jason Horowitz

"the government of Prime Minister Giorgia Meloni ordered municipalities to obey a court ruling made in December and stop certifying foreign birth certificates of children born to Italian same-sex couples through surrogacy, which is illegal in Italy.

"The decision has left Martino Libero and several other children suspended in a legal limbo, depriving them of automatic Italian citizenship and residency rights like access to the country’s free health care system and nursery school.

...

"Milan, a city that has long served as a cosmopolitan haven for same-sex couples in Italy, has for now complied with the Meloni government order and suspended issuing Italian birth certificates.

"Without official recognition, Libero Martino, 2 months old this month, will have to leave and re-enter the country every few months to remain legal. A court could eventually recognize one of the men as the biological father — they decline to say which one is the sperm donor — and then they could start a separate adoption process for the other.

...

"Ms. Meloni’s government has sought to shift the issue away from the status of the children to the practice of surrogacy, which, while legal in the United States and Canada, is illegal or restricted in much of Europe outside of Greece, Ukraine and a few other countries. In Italy, home of the Vatican, it is not only illegal, but it is also widely opposed, including among Catholic corners of the center-left opposition.

...

"Prominent members of Ms. Meloni’s Brothers of Italy party have called surrogacy a crime “even worse than pedophilia,” in which gay couples, one of whom is usually the biological father, seek to “pass off” children as their own and mistake “children for Smurfs,” saying gay couples can uniquely afford surrogacy, even though it is overwhelmingly used more by heterosexual couples.

"The party is floating a proposal, made by Ms. Meloni when she was a member of Parliament, to make Italians’ seeking of surrogate births abroad — what she had called “procreative tourism” — illegal and “punishable with three months to two years of prison and a fine of 600,000 to a million euros.”

...

"In an interview shortly before her election, as her young daughter ran around her in a Sardinia courtyard, Ms. Meloni said she opposed gay marriage, not because she was homophobic — “I’ve got many, many homosexual friends” — but because she saw it as a step to same-sex adoption, which she opposed, and which the Roman Catholic Church successfully lobbied to exclude from a civil unions law passed in 2016.

********

Earlier:

Monday, February 20, 2023

Will Italy criminalize foreign surrogacy?

Will Italy criminalize foreign surrogacy?

 It's hard to ban something that people want and need and is legally available in other jurisdictions, but it looks like Italy might try it regarding surrogacy.  Here's a story from Britain's Sunday Times:

Italian families seeking surrogates abroad could face jail or €1 million fines by Tom Kington

"Italians travelling abroad to seek surrogate mothers to start families could face jail time and a million euro fine thanks to a new bill introduced by senators close to Giorgia Meloni, the Italian prime minister.

"The proposed law, which must be approved by the Italian parliament, describes surrogacy as “an execrable example of the commercialisation of the female body and the treatment of babies as merchandise”.

...

"An Italian law passed in 2004 banned surrogate pregnancies in Italy, forcing couples to travel to countries such as the United States and Canada to find surrogate mothers."

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]" 

Surrogacy guidelines: necessity, not convenience

 As surrogacy becomes increasingly well established in the U.S., it is regulated not only by state laws, but  also via voluntary standards put forward by trade organizations as conditions of membership.

One is  the SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY (SEEDS), which calls itself "a nonprofit organization founded by a group of egg donation and surrogacy agencies, whose purpose is to define and promote ethical behavior by all parties involved in third party reproduction." 

They have a set of guidelines published this year which member organizations are supposed to subscribe to.  One of those guidelines seems to say that surrogacy agencies should only work with intended parents who can't have children on their own. That is, they want to facilitate surrogacies that they regard as necessary rather than those that might be merely convenient.

SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY, STANDARDS of ETHICAL CONDUCT for SEEDS MEMBER AGENCIES

"24.Agency Screening of Intended Parents

"a. An Agency shall not provide service to Intended Parents unless they demonstrate a need for surrogacy associated with a disease, condition or status characterized by:

"i. the failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse;

"ii. a person’s inability to reproduce either as a single individual or with their partner without medical intervention; or

"iii. a licensed physician’s or mental health professional’s findings based on a patient’s medical, psychological, sexual, and reproductive history, age, physical findings and/or diagnostic testing. 

*******

The legal blog Above the Law has a post about this:

Should 'Social Surrogacy' Be Permitted? by Ellen Trachman

It says in part:

"What does the law say? States like Louisiana and Illinois specifically require documented medical need of intended parents in a surrogacy arrangement to comply with the state surrogacy law. Louisiana requires that a doctor “who has medically treated the intended mother … submits a signed affidavit certifying that in utero embryo transfer with a gestational carrier is medically necessary to assist in reproduction.”

"Utah previously required “medical evidence … show[ing] that the intended mother is unable to bear a child or is unable to do so without unreasonable risk.” But that provision was struck down by the State Supreme Court after determining it was unconstitutional as applied to a same-sex male couple and could not be read a in gender-neutral way. (The SEEDS standard is, by contrast, gender neutral.)

"Other states with surrogacy-specific statutes — like California, Washington, Colorado, New Jersey, and New York — are silent on medical need and, therefore, implicitly permit social surrogacy arrangements. And then those states with no surrogacy law, much of the country, permit social surrogacy by default.

"The SEEDS standard, of course, only applies to member agencies and does not prevent nonmember agencies from supporting social surrogacy arrangements or for those arrangements to occur independent of agencies."

***********

Stephanie Wang and I anticipated to some extent that this could be an issue in our paper

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798.

We surveyed populations in the U.S. and several other countries on transactions that were legal in some of them and illegal in others. We presented vignettes, and asked if they should be legal.  Because we wanted to give surrogacy a good chance of being perceived as repugnant, we made clear in the surrogacy vignette that there was no medical necessity, it was sought for convenience:

"James and Erica are a married couple in [home country]. They want to have a child, but Erica does not want to become pregnant due to the demands of her career as a model. Maria is a married mother in the Philippines. Maria’s husband is out of work, and Maria has decided to become a surrogate mother to earn additional income. James and Erica hire Maria to carry and give birth to a child from James and Erica’s sperm and egg. James and Erica pay Maria a year’s average income in the Philippines, and everyone signs a contract making it clear that James and Erica are the child’s biological parents and will have custody after the child is born."

You can see in the paper (or in this 2020 blog post) that (even) under these circumstances, clear majorities favored making this kind of voluntary surrogacy legal, not only in the U.S. and Philippines where surrogacy is legal, but also in Spain and Germany where surrogacy is illegal.

Surrogacy during wartime in Ukraine

 Surrogacy goes on amidst the war in Ukraine. The NYT has the story:

How Ukraine’s Surrogate Mothers Have Survived the War. When Russia invaded, Ukraine’s once-booming surrogacy industry seemed at risk of collapsing. But surrogate mothers and agencies have managed to continue deliveries, and clients are arriving again to pick up their children. By Maria Varenikova and Andrew E. Kramer

"Before Russia invaded in February, Ukraine was a major provider of surrogacy, one of the few countries that allows it for foreign clients. After a pause in the spring, surrogacy agencies are resuming their work, reviving an industry that many childless people rely on but that critics have called exploitative and that, in peacetime, was already ethically and logistically complex.

...

"Agencies are also adapting to the war. Besides helping surrogate mothers and their families relocate to safer cities, some have had to come up with ways to care for children as their biological parents struggled to overcome wartime and pandemic hurdles to reach Ukraine. Svitlana Burkovska, the owner of one small agency, Ferta, took infants into her own home for months.

...

"“We did not lose a single one,” said Ihor Pechenoha, the medical director at BioTexCom, Ukraine’s largest surrogacy agency and clinic. “We managed to bring all our surrogate mothers out from under occupation and shelling.”

...

"In the first month of the war, 19 babies born to surrogate mothers for one agency were marooned in a basement nursery in Kyiv. For weeks and months, it was difficult or impossible for biological parents to reach their children in Ukraine, but by August, all of the babies had gone home.

"The war has not diminished the appeal of surrogacy for couples desperate to have children, said Albert Tochylovsky, the director of BioTexCom.

...

"Before the war, the business thrived in Ukraine, where surrogate mothers typically earn about $20,000 per child they deliver. The war has made financial security even more urgent.

One 30-year-old surrogate mother, who spoke on the condition of anonymity because she had evacuated from Melitopol in Russia-occupied southern Ukraine and feared she could be targeted for reprisal, said she credited the job with getting her family out. “With the help of surrogacy,” she said, “I saved my family.”

"Owing to the nine-month lead time, agencies cannot make snap decisions about continuing or halting the business after developments like last week’s flurry of missile strikes, and pregnant mothers cannot be moved to jurisdictions outside Ukraine that do not recognize custody for biological parents in surrogate births.

Gay couples, surrogacy, IVF and health insurance

 The Guardian has a story about the obstacles consulting a married gay couple in New York. They have an ongoing lawsuit regarding discrimination in health insurance for IVF. (Much of the article is also about the debate over whether surrogacy is ethical or exploitative):

‘We are expected to be OK with not having children’: how gay parenthood through surrogacy became a battleground  by Jenny Kleeman

"That’s when they first became aware of the eye-watering cost of biological parenthood for gay men. Maggipinto reels off the price list in a way that only someone who has pored over every item could. There’s compensation for the egg donor: no less than $8,000 (£6,600). The egg-donor agency fee: $8,000-10,000. The fertility clinic’s bill (including genetic testing, blood tests, STD screening and a psychiatric evaluation for all parties, sperm testing, egg extraction, insemination, the growing, selecting, freezing and implantation of the resulting embryos): up to $70,000. And that’s if it all goes well: if no embryos are created during a cycle, or if the embryos that are don’t lead to a successful pregnancy, they would have to start again.

"Then there’s the cost of a surrogate (called a “gestational carrier” when they carry embryos created from another woman’s eggs). Maggipinto and Briskin were told agency fees alone could stretch to $25,000, and the surrogates themselves should be paid a minimum of $60,000 (it is illegal for surrogates to be paid in the UK, but their expenses are covered by the intended parents). “That payment doesn’t include reimbursement for things like maternity clothing; lost wages if she misses work for doctors’ appointments or is put on bed rest; transportation; childcare for her own children; [or] lodging.” It takes 15 minutes for Maggipinto to run me through all the expenses they could incur if they tried to have a child genetically related to one of them. The bottom line? “Two hundred thousand dollars, minimum,” he says.

...

"Briskin used to work for the City of New York as an assistant district attorney, earning about $60,000 a year. His employment benefits had included generous health insurance. But when they read the policy, they discovered they were the only class of people to be excluded from IVF coverage. Infertility was defined as an inability to have a child through heterosexual sex or intrauterine insemination. That meant straight people and lesbians working for the City of New York would have the costs of IVF covered, but gay male couples could never be eligible.

...

"There’s a stark contrast between American and Ukrainian surrogates, Maggipinto says. “Here you have to be a woman who has already had children, who is over a certain age, who can prove that she is independently financially capable of sustaining herself without her surrogate compensation. You effectively cannot be a poor surrogate.” He is referring to the American Society for Reproductive Medicine’s guidelines, but with no official regulation in the US, there’s no compulsion for anyone to follow them.

...

"The EEOC will rule on whether the terms of Briskin’s health insurance were discriminatory within a few weeks. The City of New York has so far defended its policy. The couple’s attorney, Peter Romer-Friedman, tells me: “They say their healthcare plan doesn’t provide surrogacy for anyone, so it’s not discrimination to deny it to Corey and Nicholas.” Just like everyone else, the city’s first response was to assume this was all about access to surrogacy."