In gestational surrogacy, the surrogate is an individual who did not provide the egg for contraception and who carries the fetus and gives birth to a child for another individual or couple. In the US, the frequency of gestational surrogacies has increased from 738 births in 2004 to 2807 births in 2015 by a gestational surrogate (1). Gestational surrogacy has provided individuals with infertility, single individuals, and LGBTQ individuals with an additional option for parenthood. However, the surrogacy process and current legal regulations in the US bring about several ethical considerations for the intended parents and the surrogate.
As there are no federal gestational surrogacy laws, regulations vary by state: 3 states deem compensated gestational surrogacy illegal, and 11 states permit gestational surrogacy for all parents, including married or unmarried heterosexual or same-sex couples and single parents (2). The remaining states have varying restrictions for the intended parent(s) based on marriage status, whether an egg/sperm donor is used, whether the intended parent is a single parent, and whether the intended parents are a same-sex couple. As evidenced by the inequity in access to gestational surrogacy, its availability is subject to political motivations and discrimination against the intended parents. In states where the law does not address gestational surrogacy entirely, biases among surrogacy agency providers may also act as a barrier to access.
In the US, the overall cost of gestational surrogacy through an agency can range from $80,000 to $150,000 (3). Particularly in light of the monetary transaction involved, opponents of gestational surrogacy state that surrogacy contracts bring unequal bargaining power and hinder accurate assessments of potential physical and psychological risk by the surrogate. In addition, concerns arise regarding a heightened lack of autonomy among those more impoverished. Meanwhile, proponents highlight the increased autonomy that gestational surrogacy provides women (4). Research profiling the demographics of surrogate mothers “[does] not support the stereotype of poor, single, young, ethnic minority women whose family, financial difficulties, or other circumstances pressure her into a surrogacy arrangement” (5). However, further qualitative research focusing on the surrogate population is needed to better understand the driving variables involved.
The current differences in the legal status of gestational surrogacy and parental rights within the US reveal ways in which discrimination in surrogacy access for intended parents and potential inequities and ethical concerns for surrogates require additional attention, research, and advocacy driven by ethics rather than politics.
Edited by: Caroline Palmer
Graphic Designed by: Libby Gough
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