Responsible Surrogacy

Information regarding the ethical aspects of the process

In some countries that do not prohibit surrogacy directly, there is a relatively common phenomenon in which women from neighboring countries conduct part or all of the process in another country. For example, Nepalese women sometimes act as surrogates in a process conducted in India (and recently, Indian women act as surrogates in Nepal). Even in America, there are similar interchanges between the United States and Canada. This seemingly technical issue might have implications for the surrogacy as experienced by the surrogate and might even involve some risks.

  • First, surrogates that carry out the process (or part of it) in another country are usually housed remotely from their support sources, which usually do not join them. In other cases, the surrogate could remain living at home and travel for long hours frequently for testing and medical procedures. Both of these options, of course, have major drawbacks.
  • Second, the surrogate is more exposed to legal and health related problems in a country in which she is not considered a citizen or resident. The laws on surrogacy may differ in the neighboring country and surrogacy might even be considered as illegal employment. Not all surrogates know the local law and the limits that are imposed on surrogacy in the neighboring country. In case of legal entanglement, the surrogate may also encounter trouble due to lack of social support and sometimes due to the fact that she does not speak the native language.

If the surrogate is indeed a resident of a country other than that in which the process (or parts of it) is carried out, we recommend paying special attention to these issues – and making sure that the surrogate understands the complexities and risks involved in this particular situation and knowingly agrees to perform the procedures in a foreign country. In particular, it is recommended to make sure that the signed surrogacy agreement will state the details of the exact process (including the country in which treatments will take place, the country in which the birth will take place and the financial compensation the surrogate will receive for travels). We also recommend considering ways in which the surrogate would still have access to their support circles (for example, allowing one person to accompany her).

So far, we considered only cases in which the transition between countries was preplanned. However, we have encountered cases in which the medical circumstances called for procedures which were not available in the country in which the surrogacy took place. For example, some countries prohibit the execution of selective reduction. It is not trivial to take such cases into account beforehand because they can hardly be anticipated. However, it is worth considering that they might put the surrogate in a difficult position in which she feels she cannot refuse the request, despite the fact that she would not have willfully agreed to have any medical procedure abroad when entering the process. We suggest checking in advance if there are any medical treatments that are not available in the country in which the surrogacy takes place – and if so, raising the issue with the surrogate when writing the contract. If there are still unexpected treatments that are deemed necessary during the course of the pregnancy, we recommend being attentive and trying to see the issue from the surrogate’s point of view before making any choice.

Some of the issues raised in this section are relevant not only when considering different countries, but also when considering different states within the US or Canada. Specifically, this is the case when considering the surrogate’s lack of social support, different treatments that are available only in certain states and different legislation concerning surrogacy in different states.

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