Excellent BMJ article on the problems of commercial surrogacy

[2Rebecca]

https://www.bmj.com/content/383/bmj.p2003 Not sure how much of this is visible to non members but it's a good article looking at the problems of commercial surrogacy arrangements which often exploit women and expressing concern over the UK's draft Surrogacy 2023 act

The end of the article in case it is hidden
In March 2018, the UN High Commissioner for Human Rights recommended that member states adopt clear and comprehensive legislation that prohibits the sale of children and that they create safeguards in the context of commercial surrogacy. This should include either the prohibition of commercial surrogacy until and unless properly regulated systems are put in place or strict regulation of commercial surrogacy.19
In 2015 the European Parliament similarly described surrogacy as “reproductive exploitation” that “undermines the human dignity” of women. A commission charged with advising the Swedish government on surrogacy in 2022 stated that it was “impossible to be sure a surrogate has made a truly uncoerced decision.”
Yet, so far, attempts to establish a global convention around surrogacy have come to nought. The Hague Conference on Private International Law first convened to discuss surrogacy in 2010, before establishing an experts’ group in 2015 to further study the private international law issues around surrogacy. It established a working group in 2023 to review private international law matters related to legal parentage generally, including legal parentage resulting from international surrogacy arrangements.
Wade thinks that a global agreement is impossible. “To do this [establish a convention], signatory countries would have to agree that surrogacy is permissible, when many countries ban it outright.” Failing an international convention, Mahmoud would like to see an acknowledgment of “trusted” commercial surrogacy destinations in UK law, including Canada and some US states, which have high quality healthcare, genetic origin safeguards, and safeguarding practices for surrogates. The average cost of surrogacy is about $100 000 in the US and C$85 000 in Canada, compared with $60 000 in Georgia, $90 000 in Cyprus (a popular surrogacy tourism destination where gay and single intended parents are allowed to seek commercial surrogacy), $50 000 in Laos, and $50 000 in Mexico.
“There is clearly a need for international surrogacy law reform to highlight those destinations with excellent trodden pathways around the welfare of the surrogate (and egg donors) and any child born,” says Michael Johnson-Ellis, a gay parent of two children born by surrogacy in the UK and founder of My Surrogacy Journey, a surrogacy agency for gay parents that consulted on the new draft law. It takes a liberal position on surrogacy.
Bewley fears that the UK’s Surrogacy (Regulation) Act 2023, conversely to the UN position, prioritises prospective parents’ interests, privileging a “happy family formation” trope promulgated by intended parent activists and agencies, such as BeParent and competitors World Center of Baby, which operates from Cyprus, Georgia, Mexico, and Ukraine, and Lotus Surrogacy, which operates out of Georgia, Kazakhstan, Ukraine, and the US (Los Angeles). “We shouldn’t ignore the risk in creating a global child production line in the name of some parents’ ‘fertility rights,’” obstetrician professor Susan Bewley says, adding that some voices in the debate are too quiet. “We rarely hear from surrogates in poor countries, and we can’t hear the voices of overseas surrogate-born children–mind you, they will have plenty to say on the issue in 20 years’ time.”

"...we can’t hear the voices of overseas surrogate-born children–mind you, they will have plenty to say on the issue in 20 years’ time.”

I think they will too. It's a ticking time bomb which 'commissioning parents' haven't really thought about yet.

Yes, imagine finding out your parents bought you from an impoverished Ukrainian woman, using bought eggs with no prospect of tracing your genetic origins or family health history, and left that woman to get on with the war (or earthquake in the case of the babies evacuated from Nepal after the earthquake there in 2015). Imagine finding what heartless, amoral people your parents are (if you didn't already know).
There will be a lot of very upset young adults soon.
There was a webinar with a French surrogate born woman who campaigns against surrogacy that I watched the other night. It has absolutely affected her life and caused much grief.

She is Olivia Auriol @sunshine_livi also to be found on Instagram and Tiktok. Helps if you speak French.

https://x.com/sunshinelivi/status/1707508541412495696?s=61&t=4VcB-5PAva88_x6Zp2Qr2SQ

Thanks for posting @2Rebecca
I'll get the hospital librarian to send me a version I can access.

I'm really delighted to see this raised by the BMJ. As far as I'm aware I have not seen a single statement from either the RCOG or RCM regarding the proposals which is pretty disgraceful imo.

The Law Commission has recently published the responses to their consultation and they are proving very interesting to read.

Here is an email from a NHS obstetrician. Identifying details redacted but I'll take a punt the person is male, probably specialising in fetal medicine.

From:
Sent: 20 June 2019 13:34
To:
Subject: Re: Surrogacy consultation
Dear
There is a huge amount of information to read to understand the proposed changes but as far as i can tell on a quick glance seem to be a very good thing
i've had two situations that have caused me serious concern - both involving gestational surrogate twins and wonder how the new law might alter the interactions in these cases. Apologies for not taking the time to read it fully enough to discover whether my cases would be dealt with differently under the proposed legislation
In one case, one baby had significant abnormalities and there were discussions about whether to perform amniocentesis which of course had a small chance of causing the loss of both babies. its difficult to imagine a situation where invasive tests could not be anything other than the choice of the host, but it was difficult for the intended parents as they had no say in the decision whether to have it performed. More importantly was the issue of what to do if a serious but non lethal anomaly were identified. We faced the potential situation of one twin surviving with abnormality that the intended parents might have wished to terminate but the host might not or vice versa. Alternatively the intended parents could, in theory have chosen to only adopt the normal baby. As it happened nature took its course and the baby ( that turned out did have down's syndrome as well as physcial problems) died in utero with the survivor healthy and adopted as planned.
the second case also involved twins where one baby died in utero and the other was born prematurely. the relationship between host and intended parents broke down and although the surviving twin was adopted as planned, the host declined to let the intended parents see the post mortem result of the baby that died even though there may have been implications for the surviving baby. In addition the funeral of the stillborn baby was organised by the host as the IP's had no legal rights to become involved. The final difficulty for the IP's was even after the premature baby was well enough to move to another unit closer to their home near London ( they were spending a fortune travelling up and down for many weeks), there was difficulty in deciding who should pay for the long ambulance transfer
finally at the end of the second case, my sympathies were very much with the IP's but do know the host went on to be a surrogate for more couples. I thought there ought to be some way of any new potential IP's being made aware of any previous pregnancy difficulties.
In addition to the difficulties involving hard choices, is communication. Will the new legislation allow the IP's to be kept informed of all pregnancy complications that might affect their unborn baby?
all the best
Consultant Obstetrician NHS

I'm absolutely fuming about it. Hasn't bothered to read the proposals but thinks they are a very good thing. Refers to surrogate mother as "the host". Appears not to understand that the pregnant woman is his patient to whom he has a duty of care rather than the "intended" parents with whom his sympathies lie. Appears to have a poor grasp of consent and confidentiality.

How I wish I knew who it was as I'd be naming and shaming.

@2Rebecca we met briefly at one of the Law Commission open events in Edinburgh.
From reading through responses I have now become aware that the Scottish Law Commission offered a shortened version of the consultation with just 45 questions to answer, whilst us down south waded through 118 questions (a few n/a such as those asking for experience of surrogacy).
Can I ask, was this choice obvious? Did you use the shortened 45 question version?
I had no idea about it until I started reading replies from Scotland which nearly all use the shortened version.

I'm so cross about it. It makes a mockery of the hard work and time many people (on both sides of the debate) put in to understanding the questions and replying. The Nordic Model Now template which many responders used is the best response I have seen, really. So many others just didn't bother to engage with all the questions, for instance Mishcon de Reya simply sent a fairly short email response as have other organisations and interested parties.

Sorry if I'm derailing your thread.

Bloody hell FannyCann I wouldn't want the obs to be involved in anyone's pregnancy, misogyny all over that email, by using the term 'host' he's not seeing the pregnant woman as a human, nothing more than an incubator. Utterly depressing.

And one of his concerns seemed to be the amount of money the purchasers were spending on travel and then on transporting the infant.

“The final difficulty for the IP's was even after the premature baby was well enough to move to another unit closer to their home near London ( they were spending a fortune travelling up and down for many weeks), there was difficulty in deciding who should pay for the long ambulance transfer”

Yes LoobiJee

The NICU aspect is massively concerning. There isn't enough provision as things stand without a new cohort of mothers with high risk pregnancies, more twins, more PET, raised BP, premature births.

One of the things that came out in the Lucy Letby trial was problems around staffing and NICU cot provision. At least two babies should never have been on the unit as they were too premature for the agreed service provision, one mother had gone into labour at 25/40 and should have been transferred to somewhere like Liverpool women's hospital with a bigger NICU that could cope with such a premature baby but the nearest available cot was in Bristol and it wasn't safe to transfer her so far.
IIRC I think they were supposed to have no more than 15 babies but on occasions had as many as 18. The sickest ICU babies were meant to be nursed 1:1 but sometimes LL was in charge of 2 and I think on one occasion mentioned 2 in the ICU room and 1 in the high dependency room, going from room to room. And in some of her texts discussing staffing with her colleagues on some days there were just 5 staff on duty for 15 (?+) babies.
It was around that time that a baby from my hospital (SW) was transferred to Edinburgh as the only available cot that could be found.

The situation is unlikely to have improved. Just last week a colleague was telling me about a friend of hers who has delivered twins at 23/40 - obviously on the margins of survivability and too premature for our hospital to cope with. They have been transferred to Plymouth, 115 miles away.

I think there was a celeb couple recently having a tantrum about their surrogate born baby not being transferred from wherever they were in the NE down to London to suit their lives. Such f*ing idiots, NO idea of the issues. As far as I know you need a minimum of 1 paediatrician and 1 NICU nurse per baby for these transfers, maybe more, it's not something I'm involved with. Plus an available cot at the other end.
Damn right they should pay for the transfer.

Agree anunlikelyseahorse

And when he says "its difficult to imagine a situation where invasive tests could not be anything other than the choice of the host, but it was difficult for the intended parents as they had no say in the decision whether to have it performed." one senses he wishes it wasn't so. Those poor IPs who couldn't make the obstetric decisions for a woman they hired to breed a baby. 🙄