UN advisor on violence against women and girls: Ban surrogacy

Reem Alsalem, the United Nations special rapporteur on violence against women and girls, has called for a global ban on surrogacy.

Her report, “The different manifestations of violence against women and girls in the context of surrogacy,” reviewed what in the practice of surrogacy prompts violence against women and girls and the human rights implications of such mistreatment. The document noted that Alsalem consulted 78 experts and reviewed reputable secondary sources. Parents, medical experts, and women who have experienced surrogacy contributed to the report.

The report stated that globally, in 2023, surrogacy was a $14.95 billion industry, and that the industry is projected to reach $99.75 billion by 2033. Most of that money goes to intermediaries, not surrogates who might receive only 10% to 27.5% of the whole payment, the report explained. Referral bonuses in the US tend to range from $1,000 to $5,000.

Surrogacy agencies outside of the US typically offer cross-border arrangements, with commissioning parents trying to find the least restrictive, least expensive places to recruit surrogate mothers. 

“This reality is challenging the assumption that regulation is sufficient to prevent abuse in surrogacy arrangements,” the report stated.

Migrant women are either “targeted” for surrogacy or brought to other countries for surrogacy “often to circumvent legal frameworks,” according to the report.

Surrogate mothers are vulnerable, especially if they are in debt or – as they usually are – from low-income backgrounds, according to the report. If they miscarry or don’t fully comply with the contract, they might not be paid, and if they can’t become pregnant, they might be required to pay for fertility medications. Contracts might stipulate that parents can constantly monitor a surrogate mother with surveillance cameras and restrict her movement.

A study in India of 50 women found that surrogate mothers are more likely than other mothers to experience depression during and after pregnancy. In another study, about 37% of surrogate mothers found it hard to give their newborns to the commissioning parents or had regrets about deciding to be surrogate mothers. In in-vitro fertilization (IVF) circumstances, 65% of women experienced a high degree of stress and post-birth trauma, as the release of oxytocin after birth is cut off with the removal of the baby.

“Surrogates are often denied time with the newborn after birth, including not being allowed to hold the baby, and may be cut off from contact with the intended parents and the child after giving birth,” the report stated. “Some surrogate mothers report feeling like ‘an object of a scientific experiment.’”

The report explained that surrogate mothers often self-administer drugs that are supposed to be only administered by health care workers. Surrogate pregnancies’ medical risks include maternal gestational diabetes, hypertension, pre-eclampsia, and placenta previa, the report found. According to reports from India, Mexico, and Nepal, caesarean section birth is often mandated, even if it’s not medically necessary or the surrogate mother doesn’t want it.

Commissioning parents might legally, financially, and psychologically pressure the surrogate mother to have an abortion. They might also require her to follow a special diet or say she can’t get medical treatment.

Egg donors are exploited too, according to the report.

“Some reports, including from China, describe scenarios of egg retrieval and embryo transfers being conducted in unregulated, underground laboratories operated by biotechnology companies, where the women undergoing the procedures were identified by codes and categorized as ‘high-end’ or ‘low-end’ products, on the basis of their appearance and health status,” the report stated, “with each egg priced accordingly.”

The International Covenant on Civil and Political Rights, the European Convention on Human Rights, and the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment are supposed to protect people, but, the report argued, current surrogacy practices flaunt those rules.

“Circumstances in which surrogate mothers are exploited, trafficked, kept in confinement, compelled to separate against their will from the children they have borne, forced to undergo abortions or subjected to invasive, unnecessary and harmful medical procedures may amount to such treatment,” the report stated.

Alsalem recommended UN member states adopt 17 measures, including the following:

1. Internationally work to eradicate surrogacy.
2. Work toward adopting international laws that prohibit surrogacy.
3. Penalize buyers, clinics, and agencies to end the interest in surrogacy; help surrogate mothers and agencies end their involvement in the industry; educate people about the harm of surrogacy; and prohibit advertising surrogacy services and agencies.
4. Increase international work to address related human rights violations and abuses.
5. Ensure human rights bodies and mechanisms address abuse and exploitation involved in surrogacy.
6. Legally recognize the birth mother of a child born through surrogacy as the legal mother and only allow the commissioning parents to have parental rights after birth “and within a defined period to allow for reconsideration,” and mandate that any parental rights transfer mirror those of adoption.
7. Refer to females involved in surrogacy with “dignified, accurate sex-specific language.”
8. Help women and children involved in surrogacy access legal aid, psychosocial support, and financial assistance.
9. Protect the child in decisions regarding care and parents and guarantee they have the nationality of the mother or where they were born.
10. Criminally sanction and take the assets of agencies that profit from surrogacy accountable.

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