{"id":4541,"date":"2024-10-06T17:14:40","date_gmt":"2024-10-06T15:14:40","guid":{"rendered":"https:\/\/www.rivistaeco.com\/?p=4541"},"modified":"2024-10-06T17:14:40","modified_gmt":"2024-10-06T15:14:40","slug":"the-numbers-of-surrogacy","status":"publish","type":"post","link":"https:\/\/www.rivistaeco.com\/en\/2024\/10\/06\/the-numbers-of-surrogacy\/","title":{"rendered":"The Numbers of Surrogacy"},"content":{"rendered":"

Surrogacy is on the rise worldwide. Regulating it is not simple due to the ethical issues involved and the complexity of the new family relationships that need protection. For this reason legislative regimes vary from country to country. However, outright prohibition only fosters illicit practices, leaving the most vulnerable people defenseless.<\/span><\/i><\/p>\n

Surrogacy is a controversial practice due to the ethical questions it raises. Nevertheless, it is a growing phenomenon globally, linked to increasing infertility rates. How should we weigh the pros and cons? Surrogacy (GPA) involves a woman (the surrogate mother) who carries a pregnancy on behalf of another person or couple; the latter will be the parents from birth onwards with different attributions of parenthood (adoption, custody, or other) depending on the type of GPA used, the legislative regime of the country where it takes place, and the country where the surrogate family will live. Genetic surrogacy, where the surrogate mother’s eggs are used, has existed since time immemorial. It is referenced in Genesis when Sarah commissions Abraham’s son Ishmael from her servant Hagar. The practice can take an altruistic form, usually via a relative or friend, or it can be compensated, arranged through an agency, an in vitro fertilisation clinic, or privately.<\/span><\/p>\n

Two Forms of Surrogacy<\/b><\/h3>\n

Since the 1990s, thanks to in vitro fertilisation, gestational surrogacy has also been possible, where both gametes come from either the adoptive parents or donors, meaning the surrogate mother has no genetic ties to the foetus she carries. In most cases, women who request this option cannot carry a pregnancy due to congenital causes, clinical conditions, or failure in other forms of assisted reproduction. Many configurations of parental relationships to the newborn are possible, encompassing the parents involved in the conception and other existing children, as summarised in the figure proposed by Olga van den Akker in her article “Psychosocial aspects of surrogate motherhood” from 2006.<\/span><\/p>\n

Parental Relationships of the Newborn<\/b>\u00a0<\/span><\/h3>\n
\"\"
Source: Olga van den Akker, \u201cPsychosocial aspects of surrogate motherhood\u201d (2006).<\/figcaption><\/figure>\n

Where It Is Allowed and Under What Conditions<\/b><\/h3>\n

In countries where commercial surrogacy is permitted, it is highly regulated and involves a written agreement between the parties outlining intentions, obligations, reimbursements, and payments, as well as a specific decision-making process for every possible contingency. Like other forms of transactions with significant ethical implications (such as organ donation or sex work), commercial surrogacy is very controversial. It raises concerns about potential economic exploitation of surrogate mothers, who are generally in a weaker economic position than the commissioning parents. This is even more significant when it comes to fertility tourism, involving surrogates in low-income countries, who tend to be younger, less educated, and without prior obstetric and gynecological experiences. It is also controversial due to the complex parental relationships that result and the difficulty of regulating them within family law systems designed for traditional relationships and more or less patriarchal models. The tension between the view of exploitation and the view of self-determination of surrogate mothers, who can receive significant compensation and thus significantly improve their and their families’ economic conditions, is reflected in the variety of regulations. Most countries that allow GPA permit only altruistic surrogacy. In Europe, these countries include the United Kingdom, Ireland, Belgium, the Netherlands, Portugal, and Greece. Since 2018, altruistic surrogacy has also been allowed in India, Nepal, Thailand, and Vietnam, a change that aims to curb fertility tourism flows. Altruistic and, even more so, commercial GPA is banned in other states: Italy, France, Austria, Germany, Spain, Estonia, Lithuania, Norway, Sweden, Switzerland, China, Mongolia, Pakistan, and Taiwan. These countries fuel fertility tourism to states where commercial surrogacy is allowed, especially in Asia, California, and Canada. In Europe, fertility tourism destinations include Albania, Armenia, Belarus, Cyprus, the Czech Republic, Macedonia, Romania, Georgia, Russia, and Ukraine, the latter three only for heterosexual couples. The phenomenon has forced some countries that ban GPA to recognise both the nationality and affiliation of children born this way abroad, in order to protect their rights and interests: these include France, the United Kingdom, Spain, and Norway.<\/span><\/p>\n

The Numbers of GPA<\/b><\/h3>\n

Due to rising infertility and stricter adoption rules, GPA is growing worldwide, following the trajectory of other assisted reproduction practices that initially met strong resistance\u2014from donor insemination in the 1940s to IVF in the 1970s to egg donation in the 1980s. It is estimated that more than 20,000 births occur annually through this method, which has very high success rates: in the United States, where it is allowed, though with different legislative regimes across states, 75% of fertilisations succeed and 95% of pregnancies reach term once started. Other estimates for the United States indicated that already in the first ten years of this century, 2% of IVF cycles resulted in surrogacy. International GPA agencies report a business worth several million dollars and a 6000% growth in the 2010-2020 decade. In the United States in 2012, it was a $6 billion business with an average cost per pregnancy of about $200,000, including medical and legal expenses and surrogate compensation (between $20,000 and $50,000). Before commercial GPA was banned, the health ministries of Thailand and India reported a business worth nearly $600 million for the two countries, with surrogate mothers’ compensation averaging about one-tenth of that of American surrogates.<\/span><\/p>\n

Effects on Physical and Psychological Health<\/b><\/h3>\n

As with other transactions characterised by ethical issues, an economic approach to GPA requires considering the well-being of all parties involved to determine the best organisational structure for optimal outcomes. Together with Nicola Lacetera and Mario Macis, I analysed the topic in an article published in the daily <\/span>Domani<\/span><\/i> in June 2023. Various studies consider the physical and psychological health of surrogate mothers, commissioning parents, children, and extended families. Olga van den Akker, who has conducted research in the UK, notes that mothers are essentially required to change their perspective on the definition of motherhood. In surrogacy, commissioning mothers describe themselves as “real” mothers, and surrogate mothers do not consider themselves as such despite being biological and often genetic mothers. Studies useful in understanding the effects of GPA are those that allow comparisons with the health of mothers, children, and families who used other forms of assisted reproduction or conceived naturally. Several such studies have been conducted and published in scientific journals, with the main results summarised in two systematic literature reviews: one in 2022 by Pedro Brand\u00e3o and Nicol\u00e1s Garrido (“Commercial Surrogacy: An Overview”) and another in 2016 by Viveca S\u00f6derstr\u00f6m-Anttila, Ulla-Britt Wennerholm, Anne Loft, Anja Pinborg, Kristiina Aittom\u00e4ki, Liv Bente Romundstad, and Christina Bergh C. (“Surrogacy: Outcomes for Surrogate Mothers, Children, and the Resulting Families\u2014A systematic review”). In both studies, the physical and psychological health of surrogate mothers and conceived children (in some cases followed up to 15 years of age) is comparable to that of similar samples of women and children born through natural conception. However, there is a lack of in-depth studies on international GPA and gay fathers, limiting the overall validity of the assessments. The vast majority of surrogate mothers report no difficulty in separating from the children at birth. The few cases where separation is difficult often receive disproportionate media attention relative to the actual extent of the phenomenon, influencing the public debate on the issue. Concerns about child transfers include financial exploitation, genetic ties, and contacts between families after children are adopted by commissioning parents. Investigations also highlight concerns about emotional and social stigma related to GPA indicated by both surrogate mothers and commissioning parents, reflecting the prevailing opinions of the societies in which they live. Overall, despite difficulties, the psychological well-being of surrogates, parents, and children reported in the studies is generally good. Therefore, there is no basis to argue that it is an always and inherently harmful practice.<\/span><\/p>\n

The Position of Feminist Groups<\/b><\/h3>\n

Regarding social norms, as early as 2009, Elizabeth Scott noted that in the United States, the opinion of feminist groups had changed. Initially opposed to GPA for fear it involved the sale of children and exploitation of poor women, feminists’ position gradually diverged from that of anti-abortion groups. Court rulings have also evolved as GPA regulation has become more protective of all parties’ rights and has promoted a more altruistic view. Legislation has become more restrictive, particularly in protecting children’s rights, following the 2022 UNICEF convention’s guidelines. Where surrogacy has been banned\u2014such as in China\u2014a vast underground market has emerged where no rights are guaranteed or protected. Thus, considerations of public welfare must take into account what happens to vulnerable parties in the transaction, even in countries like ours which prefer superficially protective positions.<\/span><\/p>\n

Bio<\/b><\/em><\/p>\n

Marina Della Giusta is a professor of economics at the University of Turin, an IZA fellow, visiting professor at the University of Reading, visiting senior fellow at LSE’s WISPPRH, and affiliated with the Collegio Carlo Alberto.<\/span><\/em><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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