My name is Clara* and I am from Argentina. I have two daughters who are studying at a university in Argentina. Since 2023, I have been fighting to regain my place in my son’s life, with the help of my solicitor. This is my story.
In 2022, a very close friend of mine, whom I will call ‘G’, whom I met in 2007 when I was studying English, called me. He works in Europe and lives with his partner. They are both very wealthy.
At the time, I had recently separated, lost a child a few years earlier, and was not feeling well. During our conversation, G asked me to become the mother of his child. He said that the three of us would form a family. I was happy to help them become parents, and to become a mother again myself. I accepted this wonderful project. He mentioned the possibility of marrying me to make it easier for them to obtain papers in France. We would be a family of three in Europe. I would live on one floor of their large house and they would live on the other; we would raise the child together.
I know it may sound strange, but it felt strange to me at first too. I won’t lie — I didn’t want to upset him. I thought to myself, ‘Well, the world is changing so much that I’m going to become a mother this way.’ They brought me to France on a tourist visa. As I was in the early stages of menopause, they arranged for in vitro fertilisation in Spain using my friend’s partner’s sperm and donor eggs. The doctor suggested a donor with dark skin, like mine. However, ‘G’ insisted on a donor with fair skin and blue eyes. I refused.
It was a high-risk pregnancy: I was 41 years old at the time and had been diagnosed with high blood pressure and hypothyroidism. During the pregnancy, I had to go to hospital four times.
From the outset of my pregnancy, I found it extremely challenging to coexist with them. They argued a lot and started behaving very coldly towards me, as if it were a job. Gradually, the idea of a happy family life together disappeared. They decided that I should live in the neighbouring town and that I would only see the baby at weekends after he was born. G took my passport, but fortunately returned it to me four months later. I no longer recognised him; he had become a completely different person.
However, I thought I had to carry on since, after all, they were the parents and I was the mother, and we were going to start a family. I told myself that I had to put up with things, which unfortunately only got worse.
The delivery was difficult and a caesarean section had to be performed. When the child was born, G presented himself to the hospital staff as my partner. They prevented me from holding my son, saying that I was tired. They told the nursing staff that I couldn’t breastfeed him because I was going back to work. That wasn’t true. They forced me to express milk. I agreed because I thought that if the baby became too dependent on me, it would cause him distress later on. There was also the €300 they sent every month for my daughters. I had no job and no connections. I didn’t speak French yet either. I had no money. They paid all my expenses, but my visa had expired, so I couldn’t go out without being very discreet. I couldn’t ask for help, and I had to keep my word.
When I dared to protest, the tension between us increased. They made me write a curriculum vitae and told me that they could no longer support me. I had not yet recovered from my caesarean section, so I asked them for a little more time as I was still finding it very difficult to walk. However, without consulting me, they organised my departure to Spain, where I knew nobody except a vague Facebook contact in Murcia. It took five car changes via BlaBlaCar and a bus journey to get there — a distance of 1,500 km. ‘G’ accompanied me to the bus in Barcelona to Murcia, then flew back immediately.
The person I stayed with helped me and put me in touch with a solicitor. By leaving my son like that, I risked being accused of child abandonment. I called ‘G’, begging him to let me return to France. I naively told him that I risked being prosecuted for child abandonment. I then learned that they had immediately filed a complaint against me for child abandonment.
While in Spain, I was put in touch with solicitors Ambroselli and Montesinos. They organised my repatriation to France and have supported me in all my efforts, including with paperwork, work and legal action to regain custody of my son.
Thanks to their efforts, I can now see my son for two hours every fortnight under social services supervision. However, for me, this is only a first step: I hope to be reunited with my son, who is now two years old, one day.
This speech was read by Clara* at FiLiA in Brighton on 11th October 2025. Clara* has used a pseudonym due to ongoing legal action.
By 2019, I had been dreaming of having a child for a long time. This desire was deep and long-standing, but I lacked the financial means to raise a child alone. It was essential to me that the future child should know their origins and never be cut off from me. As an LGBTI+ activist who cares deeply about the cause of the oppressed, I also wanted this project to align with my political beliefs. Ethical, altruistic or humanitarian surrogacy, as it is presented and ‘sold’ today, seemed to me to be the perfect solution: it would fulfil my desire for motherhood, allow a male couple to become parents, and right an injustice. At the time, I believed that the ban on surrogacy (and assisted reproductive technology) in France was unjust.
In my search for ‘intended parents’ — in other words, commissioning parents — I was contacted by people from all countries and of all sexual orientations. I systematically refused all offers of remuneration, including those from abroad and from heterosexual couples. I would never have accepted the child having any mother other than me. We envisaged ‘traditional’ and ‘artisanal’ surrogacy without the involvement of clinics, agencies or excessive costs, apart from the initial medical tests. We agreed on homemade artificial insemination, and I insisted on registering the child with the civil authorities. I refused to give birth anonymously, as I did not want my baby to have a start in life marked by abandonment. The agreement was clear: they would raise the child in their home, and I would remain close to them. The child was always to know me and consider me a member of his family. It was an underground surrogacy arrangement which, at the time, I considered to be a ‘solidarity project’ operating on the fringes of the law. There was no written contract, only a verbal agreement, a ‘contract of trust’.
The pregnancy was much more difficult than I had imagined. I went through it all alone, with no support from the couple, my family or my friends. During the last month, they began to put pressure on me by imposing their concerns and medical choices. On the day of the birth, I realised that, in their eyes, I had never had any human dignity or maternal role. I was nothing more than a body responsible for ‘delivering’ the baby. They wanted to watch the birth from the front, despite the fact that I had no intimate relationship with any of them. The biological father preferred a caesarean section to the use of a vacuum extractor. Fortunately, the obstetrician did not listen to him. He insisted that the baby be placed in the nursery for the first night and that my stay in the maternity ward be shortened, despite my repeated objections. In the delivery room, a paediatric nurse, unaware of our surrogacy plans, said, “Don’t try to separate the mother and child.” She understood better than I did what was at stake. My stay was so difficult that the staff thought I was a battered woman. They sent me a psychologist and promised me postnatal care, but ultimately, nothing was done.
I had given my word, and when I left the maternity ward, I entrusted my baby to them. I couldn’t afford to raise him, and I believed that they would keep their promise just as I had kept mine. I never asked for any money; in fact, I gave them the social security benefits I received so that the child would have everything he needed.
Very quickly, however, the initial promises evaporated. They organised a birth party without telling or inviting me. To their relatives, they maintained the pretence that they had conceived the baby alone. The regular visits they had promised me during the first year became rare and sporadic. News and photos were slow in coming. Then, in 2022, I discovered that they were planning to move to the other side of France. Whenever the local social services intervened, they moved again. The stability that I had hoped the child would have – and which had motivated my choice of them – was not forthcoming. They also hid information about the child’s health from me. I learned from a doctor that my son had been diagnosed with autism six months earlier and that they had portrayed me as absent and unstable.
Finally, they settled in the Gard region, where social services stopped investigating. Three months later, the biological father died of aggressive cancer at the age of 37. Legally, I remained the sole holder of parental authority and was entitled to regain custody of my son, as the second commissioning couple had no biological or legal connection to him. I had resisted the pressure they had put on me to give up my rights or agree to adoption.
Naively, and in the interests of the child, I suggested to the stepfather that we arrange shared custody. However, he told me that he wanted to return to the Paris region, so I moved back there and rented a one-bedroom flat for my son. Meanwhile, he was initiating several legal proceedings against me, including temporary and long-term placement, total and exclusive transfer of my parental rights and custody, and even child maintenance. The judges granted all his requests.
The second commissioning person, who is legally nothing to my son, refused to return the family record book to me, with the approval of the magistrates. The public prosecutor in Nîmes described me as nothing more than a ‘procreator’. Social services were extremely accommodating, refusing to treat me as a parent for a year and explaining that they were there to ‘support the gentleman in his parenting’. The Departmental Child Welfare Services (ASE) even asked the Children’s Judge to remove my visiting and accommodation rights, which were already extremely limited, and this was ordered. Whenever this man prevented a meeting, phone call or video call between me and my son, social services covered for him.
To top it all off, the stepfather remarried another man, becoming my son’s ‘second stepfather’. This man obtained parental rights. Now, social services and magistrates are asking me to recognise this second stepfather as my child’s ‘father’. Both my son’s genetic father and my own family have been removed from his life.
Although the judge ordered visitation rights, I was unable to see my child from 31 July 2023 to 11 May 2024 – almost ten months in total. I received no updates and was reprimanded when I dared to ask for any. Social services cited being overloaded or the fact that I no longer had parental rights. Even the juvenile court judge acknowledged off the record that this should not have happened.
A complaint for incitement to child abandonment was filed against them in the Alpes de Haute Provence. All parties recognised the surrogacy, including social services and the surviving stepfather. In court, he openly admitted to this illegal surrogacy, knowing that he would not be punished, but rather that it would allow him to obtain exclusive rights and full custody of the child. The penalty in France is derisory: a €7,500 fine. If the sponsors knew this, none of them would pay for surrogacy abroad. Women’s bodies are being sold in France. Despite the evidence and confessions, the public prosecutor in Digne-les-Bains dismissed the child abandonment complaint. No judge wanted to investigate or simply apply the law. I appealed to the Attorney General in Aix-en-Provence, but he dismissed the case too.
I have now been fighting social services and judges for two years, and I am due to appear in court again on 9 October. I am fighting to be recognised as a mother and for my son to recognise me and be reunited with his maternal family. After eight months with no visiting rights, followed by supervised and semi-supervised visits where we had to ‘meet’ like strangers under the watchful eye of social services, I finally regained my visiting and accommodation rights. However, I still haven’t regained my parental rights or any prospect of custody. Social services keep telling me that their role is to ensure that the child has his father, as if the father were the child in need of protection.
For each visit and hearing, I travel 1,500 km. It requires a huge time, energy and financial commitment. Currently, I have custody of my son for half of the school holidays at my home and one and a half days per month during the school year, but I have to spend these periods in the Gard region. Needless to say, the stepfather has never moved to be closer, which makes shared custody impossible.
I had hoped this story would be one of friendship, solidarity and justice. Instead, it has become a tragedy; the biggest mistake and source of shame in my life. The state has stolen my son, as well as my dignity as a woman and a mother. Even today, I am not recognised as a parent. At school, at the doctor’s, with insurance companies or solicitors, I am nobody. I am fighting so that one day my son will truly be part of his maternal family, and so that he can forgive me — perhaps even love me. I am fighting so that no other woman will be treated as I was, and so that no other child will be torn away from their mother and maternal family. No one should have to go through what I am going through.
This speech was read by Julie* at FiLiA in Brighton on 11th October 2025. Julie* has used a pseudonym due to ongoing legal action.
My name is Marie-Anne Isabelle and the surrogacy experience that I endured here in this country nearly killed me. My mission now is to ensure that nobody goes through what I did. I have made it my cause to expose this barbaric practice for what it is and to enact change. I am not looking for glory or sympathy I just want change.
People hear about how wonderful surrogacy is, how it’s a beautiful gift and a positive experience. Then, you hear about the “terrible” surrogate who dares to ask for her child back. It’s an all-too-common depiction in our modern fairy tale world.
I believed that fairy tale when I agreed to help a family member by carrying her child. At the time, I was happy to help because I loved her and did not want or need to be paid. However, I made it clear that the child would be conceived using her egg and that I must be allowed to see and have contact with the child I would give birth to. That was the condition I would only do this under, if I could have regular contact with the child, as I could not live without seeing a child I would give birth to.
I agreed to become a surrogate mother for my cousin. She was more like a sister to me. She had been a significant presence in my life. We were a vital part of each other’s lives. I knew about her cancer. In 2009 she told me that she had created embryos and that she was researching surrogacy.
One day, she came to my house with her sister, who is also my cousin and asked if I could help her. I told her that I would only help if she let me see the child. She looked me in the eye and said, “Absolutely. There’s trust.” We’re family, you know? Not for a minute did I think I’d actually need to get a lawyer and write a contract.
I think when she asked me, she knew I had no choice but to say yes. I think she exploited our relationship. As further information came out afterwards, it appeared that they couldn’t go ahead with a surrogacy abroad as it was deemed too expensive, so they were looking for a cheaper alternative. They kind of saw me as “Oh, she’ll do it for free.” A free and cheap option.
I was told there is trust. “You will be the child’s godmother.” Those words would later come back to haunt me. I don’t believe she knows what trust means. She made all sorts of promises to brainwash and coerce me into helping her.
It was a gestational surrogacy. They used IVF with their own biological material. I remember lots of injections and visits to the clinic for very obtrusive physical examinations. It was a very procedural process, and it was quite challenging, both emotionally and physically, to go through. I’d had two normal, non-assisted pregnancies of my own and this pregnancy was nothing like those. This overmedication was purely to help these two people.
The experience was bad enough. Having somebody else try to dictate what medical procedures you should endure, how you should give birth, and what you should eat was awful. The list goes on. This affected me from the beginning of my pregnancy, yet there is still no specialized support for women going through surrogate pregnancies here in the UK.
In 2014, at the time of delivery, I made it clear that the commissioning father wouldn’t be present; it would just be her, me, and my partner. Everything went smoothly, and I felt in control. The hospital saw me as the mother. So, my wishes were taken into account; in how I wanted to do things. However, they wanted me to have an elective C-section. I refused, and my midwife backed me up by stating that C sections were not good practice. If someone doesn’t need one, they shouldn’t have one. They tried to force me and put pressure on me, saying, “Oh, it’d be better for you.”
I remember there being some confusion at the hospital. Even though the hospital had been told that it was a surrogacy, social services became involved. I thought, “This is awful. I’m trying to have a baby, and now I’ve got suspicious social services interviewing me.
The father came in after the birth because he wanted to have skin to skin contact. They had the baby. They were happy. They didn’t need me anymore so they told me to go home. However, the hospital staff did not agree. They wanted to see me walk out with the baby, carrying it according to their policy. I remember having to carry the car seat with the baby in it through the hospital in full view of the medical staff. Then, we had to do this strange exchange where I handed over the child in the hospital car park because, legally, the hospital was no longer responsible for the child once it was outside.
After the birth, I was presented with all sorts of legal documents that I was forced to sign. The timing was awful, too, right when I was trying to recover from the birth. Imagine training your body and mind for nine months to believe that you are not the mother of the child you are giving birth to. Every surrogate woman has to do that. Then, after doing that, you are presented with a document stating that you are the mother, and you are forced to sign it. I was also threatened with financial and legal consequences if I didn’t sign it. This is the dark side of surrogacy in the UK that nobody hears about because most women are given gag orders to prevent them from talking about it.
No payment was made. I was only compensated for time off work. I remember them buying me maternity clothes and reimbursing me for transportation to the clinic. They wanted to pay for food, but I politely declined. I didn’t want to feel controlled by having someone tell me what to eat. I remember my dear cousin saying, “We’d like to pay for a kitchen for you,” and I said, “No, this is me helping you I am not doing this to get anything back in return. For me to receive gifts would feel like I was being paid for a service.” I said no.
The court case started in 2014 and lasted two years. I didn’t start the court case. It was initiated by the commissioning parents because they wanted a parental order. A parental order legally transfers parental responsibility from the surrogate to the intended parents and ends the surrogate’s rights.
I had no idea about any of this. I didn’t even know there was going to be a court case. I just thought I would hand the child over and be done with it. None of this was made clear to me beforehand. Nobody told me. I gave birth, and suddenly, all of this legal process was forced upon me. I refused to sign because they reneged on their promise of allowing me contact and everything went downhill from there.
They attempted to obtain my consent against my will at the court, exploiting my mental health, which was irreparably damaged as a result of my experience. They tried to prove that I was incapable of giving consent. However, through grit and determination—including psychiatric assessments proving I was capable of giving consent—I was permitted to remain involved in the court case and my consent was needed much to their dismay. Still, they continually tried to shut me out. Children’s Services even tried to use the case of a deceased surrogate mother. They said, “We can just use that case where someone died and pretend that’s happened here.” It was just appalling. It was made clear to me that the only way I had the best chance of having any contact was to agree to the parental order so in the end, I signed it to try and have contact with the child I gave birth to as I was promised. I have never seen the child to this day.
She was born in 2014. I haven’t seen her since I gave birth to her.
I was promised on multiple occasions during the court case that I would see her, but each time, the appointment was cancelled the day before. They were playing games with me. I believe the promises were only for the benefit of the court.
They hinted that they used me as a cheap commercial surrogate and if it hadn’t been for their legal costs they would have been granted their wish. They constantly tried to remove any trace of me from their child’s life, which is another reason why they needed my silence. I believe their behaviour stems from their resentment of me as the child’s birth mother, and that is me being generous.
I have been diagnosed with complex PTSD and underwent EMDR to alleviate some of the trauma resulting from the surrogacy. I have a deep fear of hospitals, children, and babies, which does not work well with my career in education. The damage done to me will never be repaired. Constant panic attacks and a fear and distrust of people serve as constant reminders. There are many days that I still wish I wasn’t here just to be rid of this painful world that did this to me.
The impact was not only on me, but also on my children. They took on the role of parents because I wasn’t able to take care of them. This happened ten years ago, and for the first five years, my children didn’t have a mother. They were taken away from me and sent to live with their father, which was traumatic for everyone. Then, the judge, when presented with evidence, came to the conclusion that this was not helpful to anyone and returned them to my care. Over the last five years, we have come together as a family and rebuilt our relationships, but for the first five years, we were a broken family.
In trying to help another family, they broke mine.
When did a women’s right to have a child mean that it would take away another woman’s right to have contact with a child she gave birth to? We talk about women’s rights as if they are universal but surrogacy actually means you are choosing which woman deserves more rights. That is inequality.
If leaders and law makers care so much about women’s rights why are they continuing to erode the rights of surrogate mothers?
Change needs to happen fast. Surrogacy in any form is wrong, not safe and harmful. It needs to be banned before any more women die as they already have. Listen to our voices and do not let us be silenced any more.
This speech was read by Marie Anne at FiLiA in Brighton on 11th October 2025.
The Parliamentary Office of Science and Technology (POST) is an independent service that provides impartial research, analysis, and expertise on complex science and social science issues. They share their findings with Parliament to inform policy debates and decisions. Last month POST announced a new consultation on surrogacy law reform. This follows a public consultation in 2019 from the Law Commission of England and Wales and the Scottish Law Commission, which in total has already cost £945,000.
Any individual can contribute but POST encourages submissions from researchers and experts. Whether you are in a research position, have personal experience of surrogacy or have a view on surrogacy you’d like to share, we encourage you to submit using the form and our suggested guidance. The deadline is23.55 on 5 October 2025.
After reading the Data Privacy Data Notice you will be asked for:
Your name
Your job title
Your email address
Your institution if relevant
If you are submitting as an individual or as a group – please select individual
If you are a researcher the form will ask for a link to your profile
Next, the form will show this text:
Approved work: Surrogacy: current practice and proposed reforms
What reforms have been proposed to surrogacy law, and what are the ethical, social and medical considerations?
Many stakeholders consider UK surrogacy law (Surrogacy Arrangements Act 1985) to be outdated. In 2023, the Law Commission of England and Wales/ Scottish Law Commission published a report outlining proposed reforms to surrogacy law, including a new regulatory pathway for domestic surrogacy arrangements, and new rules on payments that intended parents may make to the surrogate.
This POSTnote will describe current surrogacy practice in the UK, and suggestions for reform. It will consider research evidence and stakeholder views on surrogacy practice in the UK and internationally. It will discuss ethical, social and medical considerations, such as access to surrogacy, and the rights of surrogates, intended parents, and children.
We welcome information on issues relevant to the project. To contribute to this research, please follow our guidance for contributors.
Work will commence in September 2025, with publication expected in January 2026. The form for stakeholder contributions will close at 23.55 on 5 October 2025. We are trialing using an online form to make it easier for contributors to submit information to POST. If this form is not working, please send your submission to POST@parliament.uk
For the guidance for contributors please click here:
You will then be asked a short series of further questions:
8. Please briefly explain how your research expertise is relevant to the POSTnote topic.
E.g. if you teach a course, or if you’ve published a paper linked to the topic.
Your answer for this cannot exceed 500 characters. (If you are not a researcher you may want to state your interest in this topic.)
9. What are the key issues relevant to the POSTnote that you would like to make us aware of?
Your answer for this cannot exceed 1,500 characters.
Here you can share your concerns about surrogacy. You may want to mention a few points from the following list but please keep the word count in mind:
The UN Report from the Special Rapporteur for Violence Against Women and Girls on surrogacy, published in August. You can read the report in English and refer to the 19 recommendations. You can get a breakdown of this here.
The number of Parental Orders for surrogate-born babies has more than quadrupled in the last 12 years and commissioning parent/s living in the UK are still allowed to undertake commercial surrogacy arrangements abroad, even though commercial surrogacy is banned domestically: risking financial exploitation of women in developing countries abroad and financial exploitation of working class and lower middle class women here in the UK too,
Surrogacy agencies in the UK must be ‘not for profit’, although several employ large numbers of staff; one is attached to a law firm, and another has opened a commercial branch in Mexico City, where surrogate mothers are paid under £12,000 per pregnancy. (Incentives used by one British agency to encourage women to become surrogate mothers include meal box vouchers, trips to theme parks for the surrogate mother’s existing children and Apple watches.)
It is not a legal requirement that a woman has had her own child/ren before undertaking a surrogate pregnancy and surrogate mothers are permitted to use their own eggs in surrogacy,
There is no enforceable requirement that ensures a child has an ongoing relationship with their birth mother,
Surrogacy does not recognise the fact that babies bond in utero with their mothers, wanting her at birth, regardless of who’s egg used in the pregnancy. Surrogacy treats women as interchangeable incubators, exploiting their poverty and putting women at risk in higher-risk pregnancies. It is profoundly unethical as a way to treat a child, who recognises their mother and wants her at birth: nobody else,
The UK is an outlier in allowing any form of surrogacy to take place at all: surrogacy is much more strictly limited or completely banned in countries such as France, Germany, China, Italy, Spain, Portugal, Austria, Poland, Finland and Switzerland. Commercial surrogacy is illegal across the EU where it is defined as child trafficking. President Macron of France condemned the practice of surrogacy in May 2024, and the UN Special Rapporteur on Violence Against Women and Girls has called for UN member states to move to ban the practice entirely.
You may share our concerns regarding law reform proposals already suggested by the Law Commission here. You may want to mention some of the following points:
The draft Bill published in March 2023 tips the balance of power away from the surrogate mother towards the commissioning parent/s: the “certainty” lawyers and commissioning parents say they want/need only benefits them at a huge cost to working and lower middle class surrogate mothers,
The current Government have said they do not intend to make time to take forward changes to British surrogacy law in this parliament: why are POST spending public money on exploring this topic when that statement was made relatively recently?
The draft Bill reduces the time limit the surrogate mother has to change her mind to just six weeks after birth: even if she does change her mind, she is not guaranteed custody of her child but would need to apply for a parental order for her own baby, even if she has used her own egg,
The draft Bill proposes to make the commissioning couple legal parents of the child at birth, meaning the birth mother would never be recognised in law or listed on the birth certificate. This is according to the Law Commission’s preferred model,
The draft Bill proposes a minimum age of 21 for surrogate mothers, and just 18 for commissioning parents. There are no upper limits suggested for commissioning parents or surrogate mothers,
The draft Bill does not require a surrogate mother to have previously been pregnant, given birth or completed her own family. If she has not previously been pregnant or given birth, she cannot give informed consent,
‘Expenses’ would continue to be uncapped for British surrogate mothers. These potentially total thousands and this provides a real financial incentive to many women from lower socio-economic backgrounds, and disproves the myth that the UK surrogacy is genuinely ‘altruistic’. There is a categorisation proposed under reform but no upper limits. We believe the average ‘expenses’ in a British surrogacy arrangement may now significantly exceed £20,000 per pregnancy: exploiting women’s poverty in a cost of living crisis,
The draft Bill continues to allow people to bring babies to the UK who have been conceived and carried through commercial surrogacy abroad, despite significant, well-known problems of exploitation and coercion in the global commercial surrogacy market (see link below for the market value),
The draft Bill allows for open advertising to attract and recruit surrogate mothers in the UK, likely leading to an explosion in the numbers of women from lower socio-economic backgrounds agreeing to undertake the practice out of financial necessity, rather than genuine desire,
The draft Bill enables surrogacy agencies to become Regulated Surrogacy Organisations (RSOs) with power to determine which commissioning couple or individual can enter a so-called Surrogacy Pathway (with power to grant legal parentage without oversight of the Family Court or CAFCASS, as is the case now): this is a conflict of interest and gives power to organisations who have financial incentives and an ideological commitment to surrogacy and who are not experienced in meeting the ongoing burden of regulatory obligations. RSOs would be overseen by the HFEA, a role the HFEA have made clear they do not welcome and do not have necessary skills or expertise in to adequately supervise,
The Law Commission’s plans take social workers and CAFCASS out of arrangements on the new Surrogacy Pathway. The proposals remove the current practice of CAFCASS assessment for arrangements on the new Pathway, putting surrogacy on the Pathway completely at odds with UK adoption legislation and practice.
This question also asks for relevant policy documents, or statistics that relate to the topic.
These are the links to the studies you may want to share:
A 2024 study that confirms that surrogacy 3x increased risk for severe pregnancy complications – Severe Maternal and Neonatal Morbidity Among Gestational Carriers: A Cohort Study https://www.acpjournals.org/doi/10.7326/M24-0417
11. Are there other individuals or organisations you think would be interested in contributing to this POSTnote? Please only share publicly available information.
12. Please select which stakeholder group best represents you (or the organisation you are representing).
Please select No affiliation if submitting as an individual.
Finally:
13. Where did you find out about this opportunity to contribute to POST’s research?
Please answer how you found out about this consultation, we expect this to be via the X/Twitter accounts of Stop Surrogacy Now UK and Surrogacy Concern.
When all fields are completed within the character limit you can submit. Once submitted you can print your answers. Please let us know when you have submitted your response by emailing stopsurrogacynowuk@gmail.com.
If you would like to contact the POST team directly, their general enquiries email is: post@parliament.uk
Last month we received a ‘cease and desist’ letter from a law firm on behalf of their clients, My Surrogacy Journey.
This UK agency wanted us to stop talking about them and the law firm representing them issued a SLAPP – a Strategic Legislation Public Participation. Frowned on by the Solicitors Regulatory Authority, a SLAPP aims to intimidate and silence opponents. It sends a message to recipients that speaking further may land them in legal trouble.
Since I have not done anything illegal I will continue to write about this agency and their connected businesses such as their new clinic, their foundation, their agency in Mexico and the Modern Family Show which is paused as they await the birth of their third child, born to a woman in Mexico this time.
But I am not at all surprised that an agency operating under the UK model of so-called ‘altruistic’ surrogacy whilst running a commercial operation in Mexico, might not appreciate my words in this article, which inspired the letter. No, I am not surprised at all as we have seen the active silencing of women who speak up about surrogacy before.
Several surrogate mothers who were signed up with Surrogacy UK have told me they were removed from groups after raising doubts, concerns or for expressing feelings doutb, reluctance or regret. As this doesn’t align with their narrative they were ejected and blocked. These women can no longer access the social networks designed to support them, they have no one to talk to outside of their own friendships and family, and as surrogacy is presented as a unique and alternative way to have a family, many do not understand the intricate and complex emotions that come to a head in a surrogacy pregnancy and postpartum.
We supported a surrogate mother through part of her legal ordeal which was thankfully successful in ‘setting aside’ the parental order she signed under judicial encouragement. The judgment handed down prevents her from speaking publicly and she is not the first, nor will she be the last.
Another surrogate mother has been threatened more subtly, by calling her character and reputation into question and should she continue to speak out her credibility will be undermined. Others may want to speak but they don’t have the freedom to discuss their experiences and this is not a new experience. Surrogate mother’s in the USA fear being sued if they speak out. A 2015 UK court case saw a surrogate mother banned from speaking to the press after a judge’s decision saw her baby placed into the care of the genetic father, and his partner, against her wishes:
Similar gagging orders are issued in other countries that apply the so-called ‘altruistic’ surrogacy model. A 2017 case in Canada saw a rapid agreement following an online meeting and a contract that prevented her from speaking out:
“the couple offered her $500 to forego legal advice in order to speed things up….The document was also written to make the arrangement appear completely altruistic on the part of the surrogate, even though she would be paid a set amount of money whether or not she actually incurred expenses.”
Alison Motluk writes “But what bothered me most was that she was strictly forbidden from revealing any of it. The contract contained a gag order.”
Alison Motluk has written on the regularity of surrogate mothers being ‘gagged’ and shares lines from contracts detailing where surrogate mothers cannot share anything about their ‘journey’.
In some countries the threats go beyond a legal letter or a court ruling. Some surrogate mothers are threatened with the loss of their lives. An international contact of ours who wishes to remain anonymous told us:
“Mothers are afraid to speak because agencies are very powerful and there are countries where it is very easy to make a woman disappear, because their lives are worth nothing. Earlier this year a 25 year old woman acting as a surrogate mother bled to death in an illegal clinic. This happened in a country where surrogacy is legal. The mafia are threatening the family to keep silent, forcing them to delete social media posts and stay silent after the death of their loved one.”
We are often asked, why don’t these women say something, but is it any wonder as to why you don’t hear their stories when legal rulings, contracts, agencies and legal threats prevent them from sharing what happened to them?
We are one of only a handful of organisations in the UK representing the other side of surrogacy. We are not funded, we do not charge for membership and we do not receive donations. We do not have money to pay lawyers but we do have is an abundance of time to listen to surrogate mothers.
I invite all surrogate mothers with regret, doubts or concerns, to reach out to us by email (or DM us on Twitter/X) to share your stories with us in confidence. We understand why you have not been unable to speak and we are here to listen to you and what your experience of surrogacy has been.
And the cease and desist letter? Well, when someone wants you to stop talking about them as you’re making them look bad, that’s reason enough to carry on and perhaps shout even louder.
The Times confirmed today that this government will not proceed with law reform of the 1985 Surrogacy Act, as is proposed. We are thrilled to hear this news!
Reform proposals were first jointly shared in the 2019 public consultation from the Law Commission of England and Wales, and the Scottish Law Commission. It is why this campaign formed as we stand against surrogacy because of the harm it brings to women and children.
The legal model for surrogacy in the UK is meant to be based on ‘altruistic’ surrogacy only, but ‘reasonable expenses’ are paid like a monthly salary and the total fee averages between £16,000-20,000. These are numbers from the surrogacy agencies themselves. UK agency, Brilliant Beginnings states “In the UK, which is often described as having an ‘altruistic’ surrogacy framework, surrogates typically receive £12,000 to £35,000as expenses (which is less than in the USA, where surrogacy is commercialised and surrogates typically receive compensation of $40,000 to $90,000).”
The number of people commissioning a child in England and Wales has quadrupled. A study from Dr Kirsty Horsey, Law Professor at Loughborough University (previously a Senior research Associate at London Women’s Clinic) and My Surrogacy Journey shows that Parental Orders – where a mother transfers her parental rights to the commissioning parents or parent – rose from 117 in 2011 to 413 in 2020.
Now, approximately 500 applications for parental order go through the courts each year, and roughly half of these PO applications are for babies born abroad.
Commissioning couples or individuals living in the UK are allowed to undertake commercial surrogacy arrangements abroad and bring a child back to this country, despite commercial surrogacy being illegal here. UK Adoption laws prevent international adoption from countries due to safeguarding and exploitation risks, such as Nigeria, Cambodia, Guatemala, Nepal, Haiti, and Ethiopia – but there is no such list for surrogacy. Minimal safeguards are applied and we are aware of several examples where a convicted child sex offender obtains a child through a commercial surrogacy arrangement abroad and others who planned to obtain a child through surrogacy for the purposes of abuse.
Whilst the Law Commissions jointly acknowledge that international surrogacy “can bring a greater risk of exploitation of women and children” there were no proposed changes to the ‘old pathway’ which would continue to allow babies to be removed from their mothers abroad and brought into this country. It is worth remembering that children who are conceived and carried this way will likely never see their mothers again.
In fact, there is a section in reform that argues or Parental Orders to remain and operate alongside the ‘new pathway’ as “some surrogacy teams may still choose to make agreements outside of the new pathway. Closing off the parental order process to them would mean that a decision by the court about the legal parental status …would be unavailable.”
As a reminder, the ‘new pathway’ under reform would see:
The introduction of pre birth orders – so commissioning parents would secure parental rights a birth, as practiced in countries that apply the commercial model.
Lower age limits of 18 years for commissioning parents and just 21 years old for surrogate mothers – there were no proposed limits for the upper age for either of the adult parties and there were no limits for the number of pregnancies a woman could have for others.
There is no requirement for a woman to have previously given birth or completed her own family before embarking on a pregnancy for others and proposals would to continue to use surrogate mothers to have a baby for others, conceiving with her own egg – meaning at the point of handover the child is removed from their genetic mother who is also their birth mother.
(For more on what the proposals mean, read this blog or watch the video.)
Finally, we would like to thank everyone who sent a letter to their MP using the template from Surrogacy Concern, we truly appreciate your support. Every single email sent, every conversation, every tweet or post counts. We could not do this without your support.
Surrogacy is an inherently risky and exploitative practice which needs to end.
On Mother’s Day we celebrate our own mothers and our children celebrate us. It is a day to acknowledge the sheer hard work of raising children, how we come to have them and family units in different sizes and forms, but the focus is on mothers.
Only women can be mothers. Only women can become pregnant, give birth and breastfeed and ‘mother’ is both a social term and a legal one. The legal definition was in response to scientific developments in IVF, where egg donor conceived pregnancies created the question of what a mother is. Subsequently, two sub-categories or ‘gestational’ and ‘traditional’ surrogacy were also created. Prior to this there was no confusion about the meaning of the word ‘mother’.
The 1990 Human Fertilisation and Embryology Act (Section 27) defines ‘mother’ as
“the woman who is carrying or has carried a child as a result of the placing in her of an embryo or of sperm and eggs, and no other woman, is to be treated as the mother of the child”.
In other words, the woman who gives birth has legal rights and responsibilities and the woman who provides the egg for that embryo does not. Before this law, the word mother had one meaning which everyone understood. The only deviation and subsequent sub-subcategory was when legal rights and responsibilities were transferred from a birth mother to an adopting mother. IVF of this nature created an additional sub-category; genetic mother.
The definition of the noun ‘surrogate’ is:
a substitute, especially a person deputising for another in a specific role or office
For me, in surrogacy, the person deputising or standing in for the mother is the commissioning parent; an adult – male or female – who not only commissioned the child into being but is the social parent caring for and raising the child, as a result of an arranged pregnancy, with or without a contract. This person – as single people can obtain a child through surrogacy in the UK – or couple, later become the legal parent/s when a parental order is granted by the family court. A parental order cannot be applied for, under the current law, before the newborn reaches 6 weeks old. So these people are not the legal parents from birth and there is always (as with adoption) a birth mother, regardless of how invisible they might want her to be.
Proposed law reform would see a seismic shift with the introduction of a ‘new pathway’. This would allow for parental rights for the commissioning couple to be transferred during the pregnancy, with a pre-birth order (like that seen in commercial surrogacy arrangements, a model we are told is rejected by the Law Commission and pro-surrogacy lobbyists). That’s right, whilst the woman is still pregnant, the baby inside her doesn’t belong to her and in fact someone else has legal parental rights to the child she has not yet given birth to.
The idea that a child you have within your body belongs to someone else has lead to what I consider to be dangerous and deceptive discourse around surrogacy. Euphemistic language begins with ‘surrogate’, where the word mother doesn’t feature at all, (or worse ‘gestational carrier’) and ends with the claim that the mother is ‘giving the baby back’. Back to where, where the original order was made? The baby is not returning to the place they began. With IVF that would mean taking the child to a lab where they were conceived. No, this claim refers to handing the baby over to the strangers they may or may not be related to. (Under current UK law and reform proposals, the requirement for one commissioning parent to be genetically related to the child remains.)
The dominating theory here is that the genetics are equal to ownership and that pregnancy and birth are minor details. This denies the reality of how babies are made, with or without a Petri dish. It dismisses the mother baby bond, something agencies and proponents of surrogacy, denies exist. Academics will downplay the sharing of cells in the womb as “a mere fantasy of romanticism”.
Some supporters of surrogacy prefer to dehumanise the woman, reducing her to an electrical appliance, calling women ‘ovens’ and the baby a ‘bun’. Or they consider having a baby for others to be ‘extreme babysitting’ – like Ultra Marathons or Free Solo climbing. Something that is impressive in the danger and fraught with risk. (I’m not convinced that the medical risks are fully explained to surrogacy candidates prior to conception or implantation.) Saying a pregnant woman is simply ‘babysitting’ is an insult to motherhood and it seeks to separate the mother and baby and reduce pregnancy to a bodily function or a paid role. There may be more truth in this than was intended.
In surrogate motherhood, a genetic is unimportant, whilst the genetic link between the baby and the commissioning parent/s is paramount. In surrogacy, the natural maternal bond is dismissed as emotional and romantic and known science of maternal-foetal microchimerism is waved away, but the legal definition remains – even if a woman becomes pregnant with an embryo made from another woman’s egg, she, “and no other woman”, is the mother.
We wish every mother, whether she wants to be thought as one or not, a Happy Mother’s Day.
Last month several cases in the high court came to light and we explore them here as each presents different areas of concern with international surrogacy – faceless mothers, simultaneous surrogacy and human trafficking.
Invisible Woman – a surrogate mother is faceless and nameless
A UK couple, with connections to Nigeria went there to obtain a baby. The baby was conceived with the egg of the surrogate mother and the sperm of the commissioning father but the couple never met the woman who they impregnated. Arrangements were made between their chosen clinic and agency and she remained anonymous throughout the process as this was their preference. Her face was covered during scans and appointments which were conducted remotely and only her initials were recorded in the paperwork.
When the baby was brought into the UK and a parental order was process though the court the commissioning couple’s intentions were laid bare.
“At that point we are satisfied that opting for an anonymous surrogacy will be our best option since we will not meet the surrogate mother and she will not know us. We thought this will remove all the problems people face when they do surrogacy and the stigma that surrounds it. We want safety, protection, security, and peace of mind. We didn’t want unnecessary involvement and attachment; we just want to sign the contract without owing anybody obligation. We understand someone to do this is really giving us something special we don’t want to carry this for the rest of our lives identifying the person will make us think we owe them gratitude for the rest of our life.”
This couple deliberately sought out a woman in Nigeria so they would not be required to build or maintain an ongoing relationship with the mother of their child. The burden of gratitude was too much for them and they do not know her name or what she looks like and neither will her child. The baby girl will also not know her maternal family or any other siblings she may have.
Every day we see, in private chats and on public groups, agents and brokers in Nigeria seeking women to donate their eggs and to rent their wombs. We consistently see posts from women who are clearly desperate for money and this makes them vulnerable to exploitation. Nigeria remains on the list of countries where you cannot adopt from if based in the UK, the basis for this is the risk and concerns over exploitation but this does not apply to surrogacy.
Consent was dispensed with. The full judgment is here.
Two for one – not the first case of simultaneous surrogacy for a UK couple
A UK same sex couple in their 60s and 70s paid £120,000 for two babies born to two different Ukrainian women in Northern Cyprus, though they believed the clinic to operate out of Southern Cyprus. The children were conceived from from the same woman’s eggs and the same man’s sperm so were related to each other but were not related to either of the two women, so the Parental Order was denied. Consent from the Ukrainian mothers was dispensed with. The judge for this case, Sir Andrew McFarlane, president of the family division of the High Court said:
The adoption of these children took 4 years and in the ruling the judge noted the women were “exploited for commercial gain’.
Consent was dispensed with. The full judgment is here.
Global baby – multiple international locations
This case involved a single man who paid a surrogacy agency in Israel and a fertility clinic in Northern Cyprus to implant an embryos into the womb of a surrogate mother who came from Kyrgyzstan. The mother travelled to Northern Cyprus for an embryo transfer, before returning home and later gave birth in Moldova.
The man paid Fullsuccess Medical Consulting almost £26,000 and he told the court that he believed the surrogate mother was paid £12,250. In the granting of the Parental Order, Mrs Justice Theis DBE said “what took place in this surrogacy arrangement, with the seemingly reckless disregard of the cross-jurisdiction implications of the arrangement,overseen by two essentially commercial organisations, causes the court enormous concern”.
The UK surrogacy model is meant to be altruistic and based on ‘friendship first’ but Parental Orders for international surrogacy arrangements continue to be granted by the UK courts and they appear to be on the rise.
A 2022 study shows how UK residents prefer the commercial mode as it secures parental rights and control over the surrogate mother (see our analysis) . Women are being exploited for their reproductive capability and there are no friendships being formed prior to pregancy and no ongoing relationships once the child is born. There is no basis for the child to know where they come from, they may not even be told they are born from an arranged pregnancy. Courts can dispense with ‘free, fully informed and unconditional consent’ and the mother simply disappears, returning to her home country in a puff of smoke.
These are far from the only recent cases, this month two teachers from London obtained twins from a Kazakhstani woman who gave birth in Northern Cyprus, this has resulted (at the time of writing) in an ongoing police investigation.
The Law Commission of England and Wales and the Scottish Law Commission argue that the Parental Order system that transfers parental rights should continue and work alongside the ‘new pathway’, under their reform proposals. This would continue to allow arrangements like the ones we share here, to continue.
If you have concerns over the proposals, you can write to your MP using this template from Surrogacy Concern.
In recent years the trend of celebrities buying babies has grown exponentially. We now regularly hear stories of well-known figures becoming parents ‘through surrogacy’ and see announcements on social media of their newborn’s arrival, usually accompanied with a stylized photo of the babies’ feet. Headlines like “Celebrity becomes parent” is commonplace with Paris Hilton, Amber Heard, Cameron Diaz, Rebel Wilson, adding to the trending list on Twitter. The birth mother rarely gets a mention and perhaps this is to protect her identity, but we are told by these same news stories what a wonderful thing it is to be a ‘surrogate’ so why not fully celebrate the wonderful, altruistic act a surrogate mother has done for someone less fortunate?
Most of these articles normalise surrogacy, presenting as it no different from buying a mansion or signing a business contract. We may see claims of ‘fertility issues’ as a reason to justify the practice of commercial surrogacy or – as with Priyanka Chopra and Nick Jonas – a ‘busy schedule’ is to blame for the lack of natural conception. How that same busy schedule allows time for raising a child is best left to our imaginations.
There is no room to bring ethical issues to the forefront, the glossy magazines will tell us it was the surrogate mother’s choice, so it is justified. Under the auspices of body autonomy and ‘choice feminism’ we must respect that a woman selling her child for money is to be respected and never questioned. ‘Her Body Her Choice’, a slogan once used to fight for legal abortion and further access to safe terminations has been rebranded, but this time disingenuously. If we were more honest it would be Her Body My Choice.
Choice Feminism
When a woman engages in surrogacy, we may hear talk about “free choice”, it is something a woman chooses to do. Ok, but when most surrogate mothers engage with surrogacy due to financial need, must we accept this without question? Did we ever see a celebrity renting her womb to “help” other women fulfil their desire to become mothers?
No financial need is a free choice; it is a necessity, survival. When there is a need, there is no room for free choice. There may be 100 different types of cereal on the shelves, but you can only afford the cheapest one for your children. Is that choice? If you rely upon benefits or welfare, can you use that money to buy a designer handbag if that is what you choose? We can only make free choices after our basic needs are covered. Most women engaging as surrogate mothers do not have their basic needs covered; they usually have children, a family to support – can any of these news articles tell us how a wealthy, famous woman has rented their womb out to “help” another women less fertile than herself become mother?
Celebrity Culture
This has long been held up as aspirational, for their wealth, popularity, appearance and glamourous lifestyles. Teenagers may become infatuated with a particular singer, looking to emulate them or heartbroken when their favourite band splits up. Those who once influenced fashion trends now flood the market with their own brands, from clothing and make-up brands to a shape underwear, all with a ‘name’ on them. When a Birkin bag is seen on the arm of a Oscar Winning actress, coffee cup in her other hand, the item will not only fly off the shelves but there will be a long waiting list for the next batch of bags to be delivered. The counterfeit markets are booming from cheap fakes just so those on a medium income can mimic a celebrity and, as it is with surrogacy, is not the factory workers making the big bucks.
When the of surrogacy cost is reduced and access made possible we can all have what a wealthy celebrity has, a fake designer bag can be very convincing. Kim Kardashian once paid more for a handbag than she did for a surrogate-born child. (The average cost of a surrogacy pregnancy is $90,000, depending on the US State, it is far cheaper in Ukraine, Mexico, Columbia, etc where poor women can be exploited for their eggs and womb rental.) But contrary to jokes from an Oscar Wilde play or BBC Correspondent’s tweet, babies are not handbags and not should they be carried around in one.
The comments sections of news article on this topic may see people promoting the idea that everyone as a “right to be parents”, though no human rights law even mildly suggest this. Others argue that “adoption” is not easy for gay couples in some countries, so surrogate mothers should be provided for them to realise their dreams of a biological family. This is done in place of fighting for better adoption conditions.
Infertilityand Social or Situational ‘Infertility’
Fertility issues and advancing years mean it is difficult for many women to conceive and deliver a healthy baby, but neither are a reason to use women as a ‘proxy’ to deputise and carry the risks of pregnancy and labour to produce a child. Human beings have health problems, something inherent to the human condition. Some maybe lose their vision, a leg, an arm, teeth, or feet. Are these people entitled to a new human part to supplant their health problems? Many will agree that it is not reasonable and that organ trafficking is horrific. Nevertheless, when it comes to renting a womb it is a solution to ‘infertility’. Why did that speech change? Why is buying a healthy liver from a poor, vulnerable person abhorrent, but renting a woman’s womb and paying for a newborn is acceptable? Could it be that society normalized using women as commodities and that renting one is just not that bad?
Homosexual celebs couples with ‘situational infertility’ are well-known for renting wombs to fulfil their desire to make a family, and in cases like Nacho Palau and Miguel Bosse, who, after breaking up, separated their children, taking each one their biological boys according to the paternity. This decision left no room for sibling bonding between the four boys. In other cases, like Jeff Lewis and Gage Edwards, who’s acrimonious split after the birth of their surrogate-born daughter, now co-parent and arguments over remaining frozen embryos were tame in comparison to the law-suit from the birth mother of Monroe. Ricky Martin and his partner, Jwan Yosef, received backlash when these two men said they were “pregnant”…how many women were involved to produce their family of four? Though surrogacy scandals are not limited to homosexual couples. Actress Jamie Chung has the ‘social’ type of ‘infertility’ and claimed pregnancy would hurt her career so she outsourced it. Zheung Shaung hoped to cancel the baby order she placed with two women when she split from her boyfriend. The babies she had commissioned became inconvenient and she wanted these women, each seven months pregnant at the time, to get abortions.
Parenthood as a Human Right
From ‘fertility privilege’ of heterosexual couples and women without fertility struggles, to the claims of gay equality rights to IVF, there is a move towards a ‘right to parenthood‘. In country law and human rights in general, there is no right to become a father or a mother, it falls in the wish or dream category. To be a mother or father is a hope, a desire, not a human right.
Commodities, not humans
The discussion about surrogacy ignores a vital element—the children. Nobody addresses what biological, psychological, or developmental consequences impact these luxury babies. There is not enough research and no interest in figuring it out. However, specific facts prove that children are not the priority since, in many cases,” like in many cases in Ukraine and Thailand. In these cases, the law and contract policies with the agencies did not consider the fundamental right of the children to be protected as human beings but instead treated them as mere ‘things’. No parent in any country is entitled or has the right to abandon their children if they are born with a disability since this is a crime but babies bought as a ‘faulty product’ are rejected and abandoned for not being perfect.
As adults, knowing they were the product of surrogacy may be a traumatic discovery. Jessica Kern, a ‘product’ of commercial surrogacy asks why her mother gave her away but kept other children, she too asks why her commissioning and legal parents bought her and of decision makers, why this is permitted. Is Jessica the only surrogate-born child, who in her adulthood is asking this question? No.
Children in the surrogacy trade are not considered human beings but commodities, a social media tool, and now this celebrity ‘luxury item’ is available to the general public via the law-makers affording access and with the media usefully promoting it. There are more and more justifications for surrogacy in the media, but only a few truly explore even the most basic questions. The fact that it is already allowed demonstrates the direction we are going in. A society where money and power can buy anything, where a adult wish, realised through cold hard cash, has more weight than the rights of babies. Children are now the new Birkin. Through the popularisation of this questionable practice facilitates the increase the trade of children and the exploitation of women.
Normalising the buying and selling of babies and women as a tool to solve ‘infertility’ is not acceptable.
There has been considerable attention to a paper by a Norwegian philosopher, Dr Anna Smajdor, in the journal Theoretical Medicine and Bioethics, outlining the case for what she calls “whole body gestational donation” (WBGD) as a form of surrogacy. This astounding paper was picked up first by Reddux, and since has received attention not just on social media but also in publications such as the Daily Mail and Cosmopolitan. The reaction is, in the main, mostly one of astonished revulsion, with a few voices as shown here (see the comments under the Daily Mail article).
The gist of Dr Smajdor’s argument is as follows: In 2000, Rosalie Ber suggested that women who have been diagnosed according to the brain death criteria, or who are in a persistent vegetative state (PVS) could be used as gestational surrogates. Yet, “surprisingly”, says Smajdor, this seems not to have been implemented anywhere in the world. Smajdor makes a few adjustments to Ber’s proposal, limiting it to women diagnosed as brain dead, and argues that with prior consent of the woman, it could provide a useful means to achieve pregnancy for those unable to carry a child to term, or, indeed, as an alternative to pregnancy for any woman, given that pregnancy is not entirely risk free. The existing system of organ donation is used to justify this, hence the description of “whole body gestational donation” which sees this as analogous to donating separate organs or body parts to save life or improve health in other individuals. Much could be said in comment on this paper but here we will simply make a few remarks…
Firstly, there are many reasons why this proposal does not seem to have been implemented, one of them being the high cost of sustaining a patient on life support, which would mean that to initiate and sustain a pregnancy until viability would be likely to involve costs in the hundreds of thousands of pounds if not more.
The high costs, plus other practical problems, does mean that this form of surrogacy may never be used in practice. But this does not imply that we should be complacent. One reason for concern is that such extreme proposals are often used rhetorically in debate. A troubling scenario is suggested. There is a general outcry. Then along comes the counter response: “We are not going to do anything so terrible! We agree this is going too far. We are proposing we do something far more reasonable!” Or perhaps, often later once the fuss has died down a bit, “We will do this, but don’t worry, we’ve listened to concerns, we’ll do it only with safeguards.”
But the proposed policy may be “far more reasonable”, may have “safeguards”, but is still nonetheless full of problems. “Not so bad”, may still be not good enough.
And a second reason for concern is that even if Smajdor’s proposal is never adopted, the ways in which she argues, including her view of childbirth, and of the human body in general and women’s bodies in particular, are firmly representative of much mainstream influential thinking in bioethics. There are many commonly used ways of arguing and of thinking about ethical problems which tend to skew towards certain “rational” sounding solutions, often favouring the use of new technologies, but which frequently present only a very limited and biased view of matters. Let’s look at just a few of the problems with Smajdor’s reasoning, problems which occur again and again in the field of bioethics.
We can start by looking at the analogy with organ donation, because it will alert us to some major problems. The argument goes by analogy:
X is really the same as Y. We accept Y. So we should accept X, in order to be consistent.
We accept organ donation. So we should accept donating the whole of one’s body, not just parts. Otherwise we are being irrational. “Those who accept brain stem death as an adequate basis for organ donation, should for consistency acknowledge its acceptability for WBGD as well”, opines Smajdor.
But Smajdor has actually shot herself in the foot by using organ donation as her model, because everything we know about organ donation confirms that human beings are not simply “rational” creatures, and the body is not merely a machine to be broken into spare parts.
Rates of organ donation are critically dependent upon sensitivity to the feelings not just of the donor but crucially of their families. Critical accounts in the media can greatly impact rates of donation, and sensitivity and empathy in explaining the situation and requesting consent of relatives is vital. Spain is often held up as having a particularly successful organ donation and transplantation system. This may be credited to its “soft opt out” system where the default position is that of consent, but critical to this is the extensive training in communication and sensitivity for those involved in requesting permission from families. Critical too, is widespread public understanding and acceptance, respect for those who opt out, and widespread agreement on the good that is being done by successful transplantation. (Remember the controversy that George Best had a liver transplant, only to continue drinking.)
How we treat the dead, including those who donate bodies, tissues or organs, is a deeply ingrained part of human culture. The very earliest signs of human civilisation show elaborate concern for proper burial. Disrespectful treatment of the dead has been used to mark disdain for enemies and criminals. But this, we now find abhorrent, showing how strong our respect for the dead is even in our “rational” and “scientific” age. We are moved to find that elephants also show respect for their dead. We cannot wave away these concerns with a few so-called “rational” arguments.
But this is precisely what Smajdor seems to do in her paper.
Smajdor acknowledges that in WBGD, the focus will move from caring for the patient, to using the patient’s body as a “repository of tissues that can be used to benefit others”. But, she says, this is just what happens anyway in organ donation.
Yes, it is. This is precisely why extreme sensitivity is needed. This is precisely why a different medical team deal with donation, not the team caring for the patient. This is precisely why, ideally, trained staff communicate with and care for the family. All this is overlooked in the name of “rational consistency”.
In the world of pure reason, truths are universal and eternal. Smajdor has no sense of time as for her it makes no difference. She recognises that in organ donation, we have to extend ventilation after brain death is diagnosed to keep the organs in a healthy state before they are removed for transplantation, and that in whole body gestational donation, this time would be extended. “But ventilating someone for two days, two weeks, or two years makes little difference except insofar as it forces us to acknowledge what we are doing before we hasten onto the next stage,” she writes.
But we are creatures who live in time, not in the abstract world of reason. Our experience of time is, well, an essential part of our lives, is woven into our entire embodied existence and development, our lives, our birth, our death.
Indeed, for families of those who donate organs, the time their relative spends on ventilation, and the harvesting of organs, does make a significant difference. The manner in which the family can say goodbye changes. This is not to be dismissed, and the generosity of families who willingly agree to this for the sake of others should be acknowledged. Smajdor seems to think that the issue can be resolved into overcoming our “distaste” for sustaining brain-dead patients for long periods. The “discomfort” here, she suggests, “relates to the liminal state between life and death that brain-dead patients occupy”, as if overcoming this discomfort is akin to, say, overcoming squeamishness at having to pull a splinter out of someone else’s fingernail.
For the rest of the human race, these “liminal states” are the stages of transition between life and death which form critical points of significance and meaning. The recognition of their significance is an integral part of our humanity. Neither at the start, nor at the end of life, does Smajdor understand the importance of how we respond to our embodied existence.
Furthermore, Smajdor has a pick and mix approach to evidence. She bends over backwards to examine the minutiae of the scarce empirical evidence regarding gestation in women who are diagnosed as brain dead while pregnant, speculating optimistically about what might be possible, and observing for example that “there is no known upper physiological limit to the prolongation of somatic function in the absence of brainstem function”. But this simply means we have virtually no evidence, because it’s never been done. Yet Smajdor uses it to imply we could carry on keeping the body going indefinitely. She seems to grasp at any shred of evidence that WBGD can be done. Yet at the same time, any arguments against it are dismissed as mere “distaste”.
The body is seen as a robotic resource, as a machine. The use of reason in this paper shows an instrumental rationality which understands the human body as simply part of the material universe, one more resource to be exploited and used, and as in need of improvement. The fact that even normal pregnancies are not risk free is used as an argument to justify using WBGD for any pregnancy, not simply in cases where an individual or couple cannot otherwise carry and birth a baby. But this is one place where Smajdor’s “rationality”, her mathematical calculation approach to ethics, comes apart – mysteriously, she never explains how eggs are extracted from a woman’s body, because that would remind us of the not inconsiderable risks of egg donation. Oddly as I have often noticed in much bioethics and discussions of technology ethics, it so often seems to be risks that occur in the natural course of life which are counted; risks caused by technology itself are either ignored, or it is assumed that improvements in technology can eliminate them.
Pregnancy, no; injecting a woman with massive amounts of hormones and other drugs to induce ovulation and egg extraction, yes.
The last comment for now concerns the child. Smajdor’s arguments address the physical health and safety of the foetus as it may develop within the womb of a woman who is brain-dead. Naturally physical health is extremely important. But again, she reduces the human being to nothing more than a biological, material creature. If a woman has become simply a “bio” version of a gestation machine, if she is brain dead, the baby born in such circumstances emerges from a static, unconscious and unfeeling mother. What emotional and psychological issues might this bring?
Children now often see their own ultrasounds from when they were in the womb. Recent celebrity same-sex male couples have shown off such ultrasounds, strangely isolated images, the mother entirely absent. The woman who bore a child in its first months from conception to birth is notable by her absence. What lack might such children grow to feel when they finally understand their origins? And what lack might a child feel who is born of a brain-dead donor, kept alive on ventilation for the entire period of gestation?
In surrogacy from WBGD, this is not parallel with those thankfully rare cases where a pregnant woman suffers some calamity and the pregnancy is sustained after a diagnosis of brain death to produce a child that she had wanted as her own. For in cases of WBGD surrogacy, under this scheme of technical rationality, a scheme which treats bodies as bits and pieces, and as machines to be exploited, the brain-dead woman is used as if she simply as an incubator or useful storage unit.
Of course she is never that. There are intimate biological links between a woman and the child she carries, even in the absence of any genetic relatedness. Fine-tuned adjustments to the mother’s physiology occur. Communication between mother and child takes place on many different levels. Free foetal DNA enters the maternal bloodstream. Stem cells from the foetus can help repair the mother. The growing child will recognise sounds, the mother’s voice, different tastes, the pace of the mother’s gait.
The consent of the woman to WBGD does nothing to remove these facts of human development or their significance. To focus on consent as a means of resolving ethical problems is again to see the question in terms of an abstract rationality, not in terms of the grounded biological reality and connectedness to each other which forms the underpinning of our mortal existence, which frames our moral compass.
In some jurisdictions, the families of those who donate organs may be sent anonymous “thank you” cards, or be updated anonymously about the welfare of those who received their relative’s organs. This is often a source of comfort, but must be handled with sympathy and sensitivity as families may feel their loved one “lives on” in others. With whole body gestational donation, these relatives will have waited months and months to bury their relative. What of their feelings about the child?
At birth, the child will be removed from the womb, and, presumably, the ventilation will be switched off. Will Smajdor and her bioethical colleagues tell us that concern for this is based on “irrational” feelings about the “liminal” states at the start of life, on “disgust” which we must overcome?
Arguments are sometimes presented as more rational, the more they abstract from reality they become; the more “emotional” the response the more it is dismissed or belittled. Good luck bringing up a baby on such a regime of pure reason.
Will it be left to the rest of us to explain that, no, human beings are not simply biological creatures to be manufactured to order; the dead are not simply vessels to be used to satisfy the desires of others for children. We need to explain to these “bioethicists” that, as significant as a child’s birth day is, so is their journey from inside the womb of great significance, and not just to the child but to the mother; just as the journey we all take out of this life is significant, and not just to the individual, but to all who love and care for us.
~ Paula Boddington is a moral philosopher. Paula has published on a wide variety of topics including the ethics of organ donation and transplantation, clinical genetics and genomics, and the ethics of new technologies.
