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A press release from a research company focusing on emerging investment opportunities recently alerted subscribers to an exciting new market with a “staggering” compound annual growth rate of 6.25 percent. Though “dynamic growth” is predicted for Europe, the report notes that for now the United States dominates the market, a status that it will hold for the foreseeable future.
Folks who understand why a C.A.G.R. of 6.25 percent per annum is something to get excited about will no doubt be following through on opportunities within this rapidly expanding market; the rest of us might just be scratching our heads in ethical befuddlement. The commodity being discussed in the press release is not orange juice or pork belly futures or the latest derivative concocted on Wall Street—but gestational surrogacy.
The now worldwide surrogacy industry is an outgrowth of major in vitro fertility advances in recent decades that have opened up new options for couples or single parents seeking to create or expand a family. The surrogacy baby boom is being driven largely by people in the West struggling with infertility or worrying about health risks because of previously difficult pregnancies.
According to the World Health Organization, more than 17 percent of people in high-income nations now contend with infertility. Researchers blame career- or lifestyle-driven delays in family-making for some of the difficulties people are facing conceiving and bringing pregnancies to term.
Even greater I.P.—“intended parent”—demand has been created by couples in same-sex relationships. Celebrity influencers documenting their surrogacy journeys on Instagram have further stimulated demand.
The global surrogacy market, valued at $14 billion in 2022, is projected to reach $129 billion by 2032, according to another report, this one from Global Market Insights. That’s a lot of bucks and a lot of babies and a lot of young women renting their bodies to other people.
It seems one couple’s fertility problem is another person’s opportunity. But we are talking about human bodies and human life, not your typical commodity.
For the church, questions about the morality of surrogacy transcend issues of market regulation, citizenship and parental authority claims. On April 8 in its declaration “Dignitas Infinita,” the Dicastery for the Doctrine of the Faith outlined a definitive position on surrogacy, including it among a host of contemporary social and geopolitical concerns that offend the church’s understanding of human dignity.
Taking “a stand against the practice of surrogacy, through which the immensely worthy child becomes a mere object,” the discastery’s prefect, Cardinal Víctor Manuel Fernández, cited a lengthy commentary on surrogacy from Pope Francis:
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. 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. Consequently, I express my hope for an effort by the international community to prohibit this practice universally (No. 48).
That is surely a position that will frustrate couples or single people yearning for children who see in surrogacy a path to family. Unfortunately, Cardinal Fernández argues in the declaration, “acknowledging the dignity of the human person…entails recognizing every dimension of the dignity of the conjugal union and of human procreation. Considering this, 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” (No. 49).
But fans of free market solutions to, well, just about everything may not see much to be unhappy about in surrogacy arrangements. The Cato Institute charges that critics have exaggerated their problematic aspects.
In a “quest to highlight the perceived harms of surrogacy, critics systematically minimize the substantial value of creating life,” Cato argues. “For most couples, surrogacy is the last stop on their journey after a hard-fought battle with infertility. Most children produced via surrogacy would not be alive without it.”
Cato researchers say that surrogate mothers “are not exploited based on objective measures, nor do they feel exploited” and that there is “little evidence of post-surrogacy regret.”
“Evidence indicates that both gestational carriers and resulting children experience predominantly positive long-term psychological outcomes and do well in the years following birth,” Cato says.
Contemporary surrogacy comes in two forms: Some would-be parents are able to arrange “altruistic surrogacy,” when a friend or relative agrees to carry their offspring. Only associated medical costs are reimbursed in an altruistic surrogacy. This form of surrogacy is legal in the United Kingdom, which, like many other nations, has ruled out so-called commercial or for-profit surrogacy.
A “traditional surrogate” hosts the pregnancy and serves as the egg donor as well, meaning the baby under contract would also be the surrogate mother’s biological offspring. That form of surrogacy is rapidly losing ground to gestational surrogacy as I.V.F. breakthroughs have made it possible for couples and single parents to use their own embryos in surrogate wombs; in such cases, the surrogate mother has no genetic connection to her offspring.
While the total cost of a surrogacy in Canada and the United States can range between $120,000 to $250,000, costs can be substantially lower elsewhere. In Mexico, Colombia and other mid- to low-income nations, a surrogacy can be delivered for about half what it would cost in the United States, accelerating the expansion of fertility and surrogacy tourism as would-be parents from affluent nations shop around the world for the lowest costs.
Ukraine had been a top spot for intended parents to find women willing to host pregnancies, but the Russian invasion has thrown that market into turmoil, highlighting the precarious nature of international surrogacy as intended parents from affluent societies jostled to extract “their” surrogate mothers out of the war zone in 2022. Now, many intended parents have taken their business to the Czech Republic or the former Soviet republic of Georgia, where surrogacy laws are similar to those of Ukraine. That is, at least for now. Legislation currently under discussion in Georgia would outlaw for-profit surrogacy.
The legal and practical challenges that intended parents must overcome in order to secure a child through surrogacy and return the child legally to their home countries are manifold: How will the nationality of a child born overseas be determined? What if the surrogate mother declines at the last minute to turn over the infant she gives birth to? How are the surrogate’s future medical costs internalized in the market? Can a surrogate mother decide on her own to terminate a pregnancy? Can the contracting I.P.s. overrule that decision?
Many of these questions and others have not been thoroughly addressed by international and local law. How the surrogacy industry is regulated varies from nation to nation—and, within the United States, from state to state.
To some, the Vatican’s indictment of surrogacy may seem misplaced or even quaint as development in surrogacy and related fertility science and tech accelerates, but the church has not been the only transnational actor to express concern about the implications of surrogacy. According to Unicef, current international human rights law “does not provide safeguards specifically focusing on domestic surrogacy and International Surrogacy Arrangements (ISAs), which places children born through surrogacy at risk.”
Despite its growing popularity, the institution of global surrogacy exists in what a former United Nations Special Rapporteur on the sale and sexual exploitation of children calls an “international regulatory vacuum” that “leaves children born through this method vulnerable to breaches of their rights,” warning that surrogacy “may often amount to the sale of children.”
“There is no right to have a child under international law,” said Maud de Boer-Buquicchio in 2018 as she presented a report on the surrogacy phenomenon to the Human Rights Council in Geneva. “Children are not goods or services that the State can guarantee or provide. They are human beings with rights.”
“Commercial surrogacy, as currently practised in some countries, usually amounts to the sale of children,” Ms. de Boer-Buquicchio charged.
An analysis of international surrogacy arrangements from Unicef published in February 2022 points out that “children born through surrogacy…are at risk of multiple human rights violations—particularly, their right to an identity, including name, nationality, family relations and access to origins; the right to the enjoyment of the highest attainable standard of health; and the right to not be sold.”
And Unicef warns: “Decisions may be made by adults in surrogacy situations which are discriminatory based on the child’s disability and/or gender, and which are contrary to the child’s best interests as the paramount consideration.”
Other secular forces that join the church in surrogacy skepticism include contemporary feminists concerned about the potential exploitation of women in less-affluent societies. Other feminists perceive the commoditization of her womb to be a woman’s prerogative, making gestational surrogacy no different than other kinds of women’s work and a sensible economic option for women in the developing world.
In “Dignitas Infinita,” Cardinal Fernández argues that the industry “violates the dignity of the woman, whether she is coerced into it or chooses to subject herself to it freely.”
A surrogate mother, he says, “is detached from the child growing in her and becomes a mere means subservient to the arbitrary gain or desire of others. This contrasts in every way with the fundamental dignity of every human being and with each person’s right to be recognized always individually and never as an instrument for another” (No. 50).
Of course no amount of money can guarantee how a surrogate mother may feel when the child she has carried, even one she may share no genetic connection to, is born. Some women have immediately regretted their side of a surrogacy contract and have sought to keep the infant they gave birth to as confounding parental claims are hashed out in court.
Organizers of the Declaration of Casablanca, an international anti-surrogacy campaign, charge that the surrogacy industry violates U.N. conventions protecting the rights of the child and the surrogate mother. Monsignor Miloslaw Wachowski, the undersecretary for relations with states in the Vatican Secretariat of State, endorsed the campaign on April 5, calling for a broad-based civic alliance to stop the “commercialization of life.”
Monsignor Wachowski argued that surrogacy reduces human procreation to a concept of “individual will” and desire, where the powerful and wealthy prevail. “Parents find themselves,” he said, “in the role of being providers of genetic material, while the embryo appears more and more like an object: something to produce—not someone, but something.”
With reporting from The Associated Press
More from America
- New Vatican doc ‘Dignitas Infinita’: What it says on gender theory, surrogacy, poverty and more
- Podcast: New Vatican document addresses gender theory, surrogacy and more
- The right and wrong way to read the new Vatican doc on dignity
- Persons, Not Products
A Deeper Dive
- Declaration of the Dicastery for the Doctrine of the Faith “Dignitas Infinita” on Human Dignity
- Children risk being “commodities” as surrogacy spreads, UN rights expert warns
- Defending Gestational Surrogacy: Addressing Misconceptions and Criticisms
- Unicef: Key Considerations: Children’s Rights & Surrogacy
- Poverty and Commercial Surrogacy in India: An Intersectional Analytical Approach
- Surrogacy laws: why a global approach is needed to stop exploitation of women
The surrogate baby boom at a glance
$4 billion: global surrogacy market value in 2020
$14 billion: value in 2022
$129 billion: projected value in 2032
18 percent: share of the worldwide adult population who experience infertility, or roughly one in six people.
$100,000–$200,000: cost range for surrogacy in the United States, the highest in the world. A typical compensation fee for the surrogate mother accounts for roughly 50 percent of the overall surrogacy cost.
In 1999, just 1 percent of “embryo transfer cycles” in the United States—that is, a transfer of an embryo created through in vitro fertilization to a uterus—used a gestational surrogate. By 2019, surrogates were used in 5.4 percent of those transfers.
Sources: Global Market Insights, Centers for Disease Control and Prevention, World Health Organization, Fertility Clinics Abroad.
