The wording of commercial surrogacy contracts is telling. The language reflects the economic inequality between the surrogate and the client.
“If the surrogate loses her uterus as a result of the performance of her obligations under this Agreement, she will receive $5,000.00 from the intended parents,” a contract states.
It continues: “If the intended parents jointly request that the surrogate terminate the pregnancy because of the child's medical condition(s), she shall do so immediately. If the surrogate refuses to terminate the pregnancy, the surrogate shall be in material breach of this Agreement and the intended parents' obligations under this Agreement shall immediately terminate.”
Natalia Gamble, director of Brilliant Beginnings, says the agency made an active decision “to only facilitate people going to places that we felt were ethical, safe and secure.”
Although Ms Gamble believes her approach is ethical, she helps clients go to Nigeria, Cyprus and Ukraine, where commercial surrogacy thrives.
“We made the active decision at Brilliant Beginnings to only facilitate people going to places that we felt were ethical, safe and secure – we focused primarily on the US, but through our law firm (NGA Law) we have helped people go to places like Nigeria, Cyprus and Ukraine, because our role is much more than just helping them in the first place, but helping them bring their children home and sorting out all the legal issues afterward,” she said.
In Northern Cyprus, even gender selection is allowed. Several clinics advertise this on their websites.
“The cases that occur in Nigeria or Cyprus, where it is very unregulated and there is no legal framework, are a very, very small percentage of the total international surrogacy landscape,” she said.
“We need to be very alert to the risks of exploitation and those risks are greatest in places where there is no legal framework regulating the way surrogacy is carried out. […] but the point is not to exaggerate those risks, as most people go to what you might call 'good surrogacy destinations.'”
Ms Gamble is pushing for a change in UK law that would give the intended parent(s) legal rights over the child (embryo) from the moment of conception.
“It's in the best interest of the child,” she says. “If you talk to a surrogate, they'll say, 'Look, I'm not the mother of this child, I'm always very clear that this is someone else's child that I'm carrying' — no one wants the surrogate on the birth certificate, including themselves.”
But is that true? Are surrogate mothers really that distant?
I spoke to Liane, who said her own experience with surrogacy caused “a lot of sadness and pain.”
She described the market as infected with a kind of “toxic positivity.”
She added: “It's portrayed as a wonderful thing to do, a beautiful selfless act that can only bring joy, while I felt used, manipulated and destroyed.”
Ms Gibson of Surrogacy Concern says cases of “coercion and regret” are not uncommon, even within the British surrogacy model.
“In surrogacy, the wishes of the adults are considered more important than the needs of the child. This creates a societal sense of entitlement to the woman's body,” she said.
Surrogacy Concern is concerned with the practices of single men purchasing children abroad, white couples using black surrogates, and the growing trend of using low-cost surrogacy destinations such as Mexico, Colombia, Kenya and Ghana.
Physical harm to surrogate mothers is real. Carrying a baby always carries serious risk, but for surrogate mothers it is those risks are often greatly increased.
Linda Khan, an epidemiologist in the departments of pediatrics and population health at NYU, says surrogates are “at increased risk for all kinds of pregnancy complications, which lead to adverse outcomes for women and children.”
One factor, she says, is that the embryo is not biologically related to the woman and is implanted through IVF. Another is that “many women carry multiples because it's so expensive. They want two for the price of one.”
“Twinning is not safe, even when it happens naturally. It is a huge burden on a woman’s body, and it makes all the risks of complications go through the roof.”