Surrogate motherhood regulation in South Africa: Medical and ethico-legal issues in need of reform

Use of a gestational ("surrogate") carrier is increasingly common. Risk for maternal and neonatal adversity is largely unknown in this birthing population. To determine the risk for severe maternal morbidity (SMM) and severe neonatal morbidity (SNM) in gestational carriers. Population-based cohort study. All of Ontario, Canada. All singleton births at more than 20 weeks' gestation, from 2012 to 2021. Exposure was type of conception, namely, gestational carriage (main exposure), unassisted conception (comparison group 1), and in vitro fertilization (IVF) (comparison group 2). Main composite outcomes were SMM and SNM. Modified Poisson regression models generated weighted relative risks (wRRs) using propensity score-based overlap weighting. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, preterm birth, and postpartum hemorrhage. Of all eligible singleton births, 846 124 (97.6%) were by unassisted conception, 16 087 (1.8%) by IVF, and 806 (0.1%) by gestational carriage. Respective risks for SMM were 2.3%, 4.3%, and 7.8%. The wRRs were 3.30 (95% CI, 2.59 to 4.20) comparing gestational carriage with unassisted conception and 1.86 (CI, 1.36 to 2.55) comparing gestational carriage with IVF. Respective risks for SNM were 5.9%, 8.9%, and 6.6%, generating wRRs of 1.20 (CI, 0.92 to 1.55) for gestational carriage versus unassisted conception and 0.81 (CI, 0.61 to 1.08) for gestational carriage versus IVF. Hypertensive disorders, postpartum hemorrhage, and preterm birth at less than 37 weeks were also significantly higher contrasting gestational carriers to either comparison group. Absence of information about indications for choosing a gestational carrier, and oocyte or sperm donor source. Among singleton births of more than 20 weeks' gestation, a higher risk for SMM and adverse pregnancy outcomes was seen among gestational carriers compared with women who conceived with and without assistance. Although gestational carriage was associated with preterm birth, there was less clear evidence of severe neonatal morbidity. Potential mechanisms for higher maternal morbidity among gestational carriers require elucidation, alongside developing special care plans for gestational carriers. The Canadian Institutes of Health Research.

Truth is often stranger than fiction, and nowhere is this more evident than when examining the real stories related to international commercial surrogacy that have occurred in the last few years. This Article utilizes these recent cases to analyze this industry using a bioethical lens. Bioethicists use stories effectively to demonstrate how theory and normative ideals apply to real world situations. By detailing examples of some of the unique scenarios that have arisen in far-flung cities of India, the United States, and the Ukraine, this Article highlights some of the bioethical dilemmas such stories raise. This Article examines these stories using the classic theoretical bioethics framework to demonstrate the need for clarification of state or national regulation and international guidelines related to international surrogacy. Global surrogacy is more popular than ever due to advances in technology allowing for gestational surrogacy, rather than traditional surrogacy. In a traditional surrogacy arrangement, a surrogate becomes pregnant via artificial insemination by sperm from the intended father or donor sperm. Because her own egg contributes to the embryo, a traditional surrogate carries her own genetically related child and agrees to give it up upon the baby’s birth. Due to well publicized cases where traditional surrogates decide they wish to raise the infant that they have carried, and due to public sympathy of these surrogates due to their genetic tie to the infant, gestational surrogacy, where there is no such genetic tie, has become vastly more popular than traditional surrogacy. Gestational surrogacy refers to the process whereby an embryo is created with an egg and sperm from the intended parents (or from donor eggs and sperm) through an in vitro fertilization procedure and is then transferred into the uterus of a genetically unrelated surrogate. Gestational surrogacy has largely replaced traditional surrogacy in the world of international surrogacy - and it is indeed a “world” of international surrogacy. The popularity of medical tourism, whereby consumers of health care travel around the world to receive cheaper medical care, has spread to reproductive tourism. International or global surrogacy is a booming business. Although some have written with concern about the potential exploitative nature of international surrogacy, the Western press has mostly positive press reports about success stories in international surrogacy. Although many countries still prohibit or restrict surrogacy arrangements, the market for international surrogacy is estimated to be six billion dollars annually worldwide. Some countries, such as India and Ukraine, wish to be seen as international surrogacy meccas by providing quality medical care for a low cost and attempting to provide the most legal protections for intended parents. In the United States and some European countries, the initial stigma associated with using a surrogate to build one’s family than existed a few decades ago seems to have dissipated as these arrangements become more commonplace. Additionally, with the ability of intended parents to research distant parts of the world as potential surrogacy destinations and with lower costs associated with a competitive global marketplace, intended parents who were previously unable to consider a surrogacy arrangement due to financial constraints, are viable fertility tourists. This Article uses cases of surrogacy in Ukraine, India, and the United States as examples. These countries have been at the forefront of the booming international surrogacy industry. The field of international surrogacy is relatively new, with participant countries competing to become known as leaders in this field. California has a long history with surrogacy. Due to its developed system of surrogacy, it is perceived as an attractive international surrogacy option for those who can afford the high cost of surrogacy in the United States. India has also emerged as a global leader in surrogacy in the developing world. Ukraine is quickly gaining traction as a destination of choice. This Article using these stories involving surrogacy in the United States, India, and Ukraine to highlight similarities and differences in the surrogacy experience in countries active in the international surrogacy market. This Article first tells the story of a recently uncovered baby-selling ring that exploited aspects of both surrogacy and adoption law and involved two countries active in international surrogacy: the United States (California specifically) and Ukraine. Then, this Article explores stories in India and Ukraine involving babies lost in legal limbo due to the inconsistencies of surrogacy law in different countries. Next, this article discusses the gestational surrogacy landscape in the United States, India, and Ukraine and examines the laws and regulations related to surrogacy that exist in each country. Finally, this Article discusses bioethical concerns raised by the stories as they relate to each of the parties involved in commercial surrogacy-the intended parents, the surrogates, and the infants. I use this bioethical framework to deconstruct the stories of commercial surrogacy to identify areas where the current global surrogacy market could stand to change.

Reconciling Surrogacy Adversaries Through the Embryo

The desire to have a children in family is the natural wish of all the spouses, but this desire is not being fulfilled in some spouses due to several reasons, so those spouses who misses the opportunity to have a child to lead their life happily do various other efforts to acquire a heir, one of which is the hiring of a surrogate mother or in other words implementing a surrogate mother in their family. Surrogate mother emerged as a result of the development of Science and Technology in the field of medicine. The fact is that a practical process is done on a surrogate mother which results as a help to the couples who are unable to breed their own offspring naturally; but as it is said that all the actions have a reaction in same way the process or the result of implementing a surrogate mother has triggered a lot of problems in the field of Law and Religion in Muslim Community. The first problem is the implementation of a surrogate mother which is not legalised by Islamic law or which is prohibited in Islamic Law. The second problem is the status of the child (Lineage) born through a surrogate mother. The Fuqaha differs from the opinions of the surrogate mother between the one that permits and the other which forbids the practice of being a surrogate mother. Looking at the problems that arises through the implementation of in vitro fertilization (IVF) or surrogate mother process so it is necessary to study a law of legal certainty on the practice of surrogate mother so a to give a clear clarity to the people who will practice the surrogate mother and to those who alwready have a offspring through a surrogate mother.

Surrogacy is a complex issue that evokes a strong moralistic response. In South Africa, commercial surrogacy is illegal and surrogacy agreements that contain financial incentives beyond expenses associated with the pregnancy and birth are unenforceable. Despite this, commercial surrogacy appears to remain a reality in South Africa. Further, given the pervasive poverty that exists in the country, the question arises, should commercial surrogacy be permitted as a means to alleviate the dire circumstances of poverty-stricken women and those dependent on them. I seek to answer this question by taking a close look at the nature of surrogacy, some of the arguments for and against it, and the Indian model of commercial surrogacy as a potential model for commercial surrogacy in South Africa.

The sphere of reproductive rights is still beyond the scope of a thorough legal analysis, and it is not given due attention in the legal literature. This may be due to the fact that the concept of reproductive rights is new to Ukrainian law and has not yet found its proper place in the general system of law. There is a lack of scientific development in the issue of protection of the rights of the child to birth, trafficking in human beings for the purpose of exploiting surrogate mothers or children born as a result of surrogate motherhood, etc. The purpose of the study is to analyze the legislative, doctrinal and moral aspects of reproductive rights and to identify effective legal measures to improve the legal regulation of surrogate motherhood in Ukraine and the proper legal protection of the child before and after birth. Experimenting with human gene material as a conception in vitro turns children into a commodity. There is an artificial situation in which wealthy men will hire women to provide contracting services to their offspring. It is difficult to disagree that in surrogate motherhood, as in any business, personal financial gain dominates. So, from this point of view, surrogacy is a kind of market and business. The conception of the child is not a right, but an opportunity that is not given to all, but surrogate motherhood turns the child into an "object of economic agreement and contract, a kind of ordering of goods." The child cannot be considered as an object of property. It is unacceptable to consider the practice of surrogacy as ethical. In addition, forced commercial surrogate motherhood falls within the definition of trafficking in human beings. The issue of reproductive technology must be addressed in such a way that the child born as a result of surrogate motherhood does not fall prey to further exploitation. The author concluded that in many countries with a licensing or altruistic regime, many aspects of the use of assisted reproductive technologies and surrogate motherhood remain unregulated. There is no clear understanding of all the principles and standards governing the use of assisted reproductive technologies and surrogacy agreements. In general, the legislation lacks sufficient standards and provisions to protect the rights of parties to surrogacy agreements. The most controversial issues are the rights of the surrogate mother, the expectant parents and the children born as a result of the surrogate motherhood. At the present stage, legal adaptation of society to the development of medicine in the field of reproductive technologies has not yet taken place in Ukraine. Cases such as the birth of several children by surrogate mothers, births of a child with developmental disabilities, birth of a dead child or miscarriage, the need for an artificial interruption of pregnancy according to the medical opinion of doctors, the termination of marriage by genetic parents, the death of one or both parents. Keywords: reproductive rights, surrogacy motherhood, legal regulation, legal protection, embryo, child rights, family, surrogacy agreement.

Prohibitions on anonymous egg and sperm donations are a growing international trend. U.S. law does not prohibit anonymous gamete donations. However, an expanding movement is advocating a shift to an open identity regime that will ban anonymity. My earlier study of three jurisdictions: Sweden, Victoria (Australia) and the United Kingdom, which adopted prohibitions on gamete donor anonymity, showed that these prohibitions played a role in creating shortages in egg and sperm supplies. Adoption of prohibitions on anonymity in the United States could result in similar shortages. This Article focuses on the potential effects of prohibitions on anonymity on the practice of surrogacy. The practice of surrogacy in the United States is highly dependent on donor eggs. Unlike most jurisdictions that prohibit gamete donor anonymity, the majority of U.S. states that permit surrogacy, distinguish between gestational and traditional surrogacy. These states provide legal certainty only to gestational surrogacy while leaving traditional surrogacy in a legal limbo. Infertility practitioners endorse the legal preference for gestational surrogacy. Donor eggs are used only in gestational surrogacy but not in traditional surrogacy. In traditional surrogacy, the surrogate uses her own eggs and is the genetic mother of the conceived baby. However, in gestational surrogacy, the eggs of the intended mother or a donor are used and the surrogate is not the genetic mother. The Article advises that a shift toward an open identity system in the United Stares should be considered with extra caution because of the potential consequences to the practice of surrogacy. Prohibitions on gamete donor anonymity causing a scarcity in donor eggs could force a return to traditional surrogacy, with the accompanying legal uncertainty. Alternatively, the legal uncertainty enveloping traditional surrogacy could deter those in need of surrogacy from seeking it altogether thereby significantly contracting the practice of surrogacy.

Study question Are gestational carriers at higher risk of severe maternal (SMM) or neonatal (SNM) morbidity, compared to patients using unassisted conception or in vitro fertilization (IVF)? Summary answer A higher risk of SMM and adverse pregnancy outcomes is seen among gestational carriers, without evident neonatal morbidity. What is known already The use of gestational carriers (GC) also known as “surrogate pregnancy” is increasing. Gestational carriage may be associated with adverse outcomes linked to both IVF techniques and exposure to foreign fetal antigens. Adverse outcomes of GC pregnancies are largely unknown. Study design, size, duration Retrospective population-based cohort study of 937,938 births, derived from existing administrative health datasets. Data were linked using unique for birthing woman and child identifiers and analyzed at ICES Ontario. The study excluded participants with untreated infertility, those utilizing ovulation induction or intrauterine insemination, and those with multifetal gestation. Participants/materials, setting, methods Singleton births at > 20 weeks gestation in Ontario, 2012-2021. Pregnancy characteristics were obtained from the Ontario Birth Registry database. Exposure groups were i) unassisted conception (comparison group 1), ii) IVF (comparison group 2), or iii) GC. Primary outcomes included validated composite outcomes of i) SMM and ii) SNM. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, preterm birth, and postpartum hemorrhage. Modified Poisson regression models generated relative risks adjusted for birthing woman’s characteristics (aRR). Main results and the role of chance Of all singleton births, 937,938 (97.7%) were from unassisted conception, 20,958 (2.2%) from IVF, and 956 (0.1%) from GC. GC were more likely to be parous, reside in a lower-income area, and have higher rates of chronic hypertension. GC were more likely than unassisted conception women to be older and be non-smokers, with some opposite trends when compared to IVF recipients. Respective rates of SMM were 2.4%, 4.6% and 7.1%. The aRR were 3.07 (95% CI 2.44-3.87) comparing GC to unassisted conception, and 1.88 (95% CI 1.46-2.42) comparing GC to IVF. Respective rates of SNM were 6.0%, 9.1% and 6.5%, generating aRR of 1.21 (95% CI 0.95-1.54) for GC vs. unassisted conception, and 0.78 (95% CI 0.60-1.00) for GC vs. IVF. Respective rates of hypertensive disorders were 6.6%, 11.6% and 13.9%. The aRR were 1.89 (1.61 - 2.21) comparing GC to unassisted conception, 1.42 (1.19 - 1.69) comparing GC to IVF. Respective rates of postpartum hemorrhage were 5.7%, 10.5% and 13.9%, generating aRR of 2.87 (2.43 - 3.38) for GC vs. unassisted conception, and 1.40 (1.17 - 1.67) for GC vs. IVF. Limitations, reasons for caution The databases did not include certain baseline details, including the reasons for opting for a GC and the sources of gametes. There is a chance that the measured association may be distorted or confounded by the unmeasured variables. Wider implications of the findings GC appear to be at an elevated risk of maternal morbidity, without evident risk of neonatal morbidity. Further studies are needed to understand the mechanisms involved. Eligibility for GC should be determined using consistent selection criteria, and consideration should be given to specialized obstetrical care to promote optimal pregnancy outcomes. Trial registration number Not applicable

The Bioethics world has been abuzz lately over both the McMath (13 year-old girl in California who suffered hemorrhaging after a tonsillectomy) and Munoz (pregnant Texas woman who developed aneurism) death by neurological criteria cases—and rightly so. The specter of judicial destabilization concerning the legal determination of death is likely to be one of the hot topics of 2014. But the judicial branch of the government is not alone in attempting to reopen issues once considered fairly well settled within the bioethics literature. Consider a newly introduced bill proposed in the Kansas State Senate. Proposed by republican Senator Mary Pilcher-Cook, from Johnson County, Senate Bill 302 (SB 302) in entitled “An Act Concerning Surrogate Parenting Contracts.” SB 302 declares that “surrogate parenting contracts are hereby declared to be against public policy and such contracts shall be void and unenforceable.” Not only will the contract be unenforceable, also the parties will be subject to criminal penalties. On Monday, January 27, 2014, the Senate Public Health and Welfare Committee heard testimony on the bill. The political and ideological lines were sharp. The Bill’s sponsor argued that surrogacy potentially exploits poor women and encourages commodification of children. A pediatric nurse and president of The Center for Bioethics and Culture, an advocacy group based in California, testified that surrogacy undermines the dignity of women, children and human reproduction. Opponents of the bill, including parents of children born via surrogacy, argued that current Kansas state laws adequately protect women against exploitation. A physician who specializes in infertility, Dr. David Grainger, argued that the law would have criminalized the birth of Jesus Christ, had it existed 2,000 years ago. Reasonable people may disagree about the content, intent and potential impact of SB 302. This is not the first time the legitimacy of surrogate contracts has been challenged. The issue was first considered in the In re Baby M case. That case involved enforceability a surrogacy contract. An infertile couple from New Jersey, the Sterns, entered into a surrogacy contract with Mary Beth Whiteman, whom they located through an ad in a newspaper. Whiteman’s own egg was used with Stern’s sperm. This means that Baby M was Whiteman’s biological child, a traditional surrogacy. When the baby was born, Whiteman decided to not give up the baby and the Sterns filed suit to enforce the contract. The New Jersey Supreme Court invalidated the contract as violating public policy, but remanded the case to Family Court for determination of custody. Eventually, the Sterns were awarded custody and Whitehead was allowed visitation. A similar case in California, Calvert v. Johnson, came to a different conclusion. The Calverts were a married couple who were unable to have their own children. However, Mrs. Calvert and Mr. Calvert were capable of donating gametes, which were used to create a zygote. The zygote was implanted into Ms. Johnson for surrogacy. As was the case in the Baby M case, after the baby was born, the woman who born the child refused to relinquish the baby. In that case, the court upheld the parental rights of the biological parents, not the gestational surrogate mother. More than the debate regarding public policy, careful bioethicists should be concerned about the use of vague or ambiguous language regarding surrogacy. As in the recent death by neurological criteria cases, the imprecise use of terms such as coma, life-support, and brain injury exacerbate conflict and confuse the facts—particularly in cases relying involving dynamic, evolving medical facts. In Kansas, the failure to preserve precise definitions will muddy this debate as well. Attempting to define surrogacy (the act which she finds worthy of laws to prohibit), Pilcher-Cook said it was “creating a child that you know is purposely not going to have either a biological mother, biological father or both.” The confusion here is palpable, were it not such an important issue for many infertile couples, it would be laughable. The advent of assisted reproductive technology has increased the permutations of parentage and surrogacy. Distinctions are now made between traditional and gestational surrogacy, as well as between which parents or donors provide the gametes. The Kansas Senate bill, which is currently facing significant opposition, would criminalize all forms of surrogacy. If the Kansas State Legislature chooses to move forward with this law, it ought to provide some clarity and precision in the language, and then offer some reasonable justification. Further Reading: Kansas Senate Bill 302, available at: http://www.kslegislature.org/li/b2013_14/measures/sb302/ Hanna, John (2014) Kansas Measure Against Surrogacy Draws Opposition, San Francisco Chronicle, January 27, available at: http://www.sfgate.com/news/article/Kansas-measure-against-surrogacy-draws-opposition-5178143.php Allen, Anita L. (1988) Privacy, Surrogacy and the Baby M Case, Georgetown Law Journal, 76, 1759-1792. Epstein, Richard A. (1995) Surrogacy: The Case for Full Contract Enforcement, Virginia Law Review, 81, 2305-2342.

Genetic offspring in patients with vaginal agenesis: Specific medical and legal issues

What are the medical, psychosocial and legal aspects of gestational surrogacy (GS), including pregnancy outcomes and complications, in a large series? Meticulous multidisciplinary teamwork, involving medical, legal and psychosocial input for both the intended parent(s) (IP) and the gestational carrier (GC), is critical to achieve a successful GS program. Small case series have described pregnancy rates of 17-50% for GS. There are no large case series and the medical, legal and psychological aspects of GS have not been addressed in most of these studies. To our knowledge, this is the largest reported GS case series. A retrospective cohort study was performed. Data were collected from 333 consecutive GC cycles between 1998 and 2012. There were 178 pregnancies achieved out of 333 stimulation cycles, including fresh and frozen transfers. The indications for a GC were divided into two groups. Those who have 'failed to carry', included women with recurrent implantation failure (RIF), recurrent pregnancy loss (RPL) and previous poor pregnancy outcome (n = 96; 132 cycles, pregnancy rate 50.0%). The second group consisted of those who 'cannot carry' including those with severe Asherman's syndrome, uterine malformations/uterine agenesis and maternal medical diseases (n = 108, 139 cycles, pregnancy rate 54.0%). A third group, of same-sex male couples and single men, were analyzed separately (n = 52, 62 cycles, pregnancy rate 59.7%). In 49.2% of cycles, autologous oocytes were used and 50.8% of cycles involved donor oocytes. The 'failed to carry' group consisted of 96 patients who underwent 132 cycles at a mean age of 40.3 years. There were 66 pregnancies (50.0%) with 17 miscarriages (25.8%) and 46 confirmed births (34.8%). The 'cannot carry pregnancy' group consisted of 108 patients who underwent 139 cycles at a mean age of 35.9 years. There were 75 pregnancies (54.0%) with 15 miscarriages (20.0%) and 56 confirmed births (40.3%). The pregnancy, miscarriage and live birth rates between the two groups were not significantly different (P = 0.54; 0.43; 0.38, respectively). Of the 178 pregnancies, 142 pregnancies were ongoing (surpassed 20 weeks) or had ended with a live birth and the other 36 pregnancies resulted in miscarriage (25.4%). Maternal (GS) complication rates were low, occurring in only 9.8% of pregnancies. Fetal anomalies occurred in only 1.8% of the babies born. Although it is a large series, the data are retrospective and conclusions must be drawn accordingly while considering bias, confounding and power. Due to the retrospective nature of this study, follow-up data on 6.3% of birth outcomes were incomplete. In addition, long-term follow-up data on GCs and IPs were not available to us at the time of publication. To our knowledge, this is the largest GS series published. We have included many details regarding not only the medical protocol but also the counseling and legal considerations, which are an inseparable part of the process. Data from this study can be included in discussions with future intended parents and gestational carriers regarding success rates and complications of GS.

PROCREATION BEGETS LITIGATION: IT IS AN OLD STORY.STILL,THE authors of this book, Susan Crockin and Howard Jones, point to assisted reproduction as a fertile field for new and interesting legal questions. The approach they have chosen to those questions—obtainingcasereportswrittencontemporaneously withthedevelopmentsdescribedandorganizingthembytopic and then chronologically—has its advantages and disadvantages. On one hand, this approach delivers on the promise of the subtitle, giving the reader a sense of the evolution of law and policy over time and within and across jurisdictions. On the other hand, the reader misses the power of an overarching narrative weaving together cases and conceptual analysis, althoughtheauthorshave tried tocompensatewithmedical and legalcommentaries foreachtopicareaandastrongconclusion. The coverage of topics is comprehensive: embryos (includingquestionsof statusanddisposition), access tocare (includinglitigationoverthecharacterizationofinfertility),professional liability issues,various formsofcollaborativereproduction(including a large number of cases addressing same-sex parenting and posthumous reproduction), developing technologies (the intersection of assisted reproduction and genetics as well as cases related to embryonic stem cell research), and salient adoption and abortion litigation. However, not all topics are coveredcomprehensively.Theauthors’ overall strategyplaces the greatest emphasis on areas of law in which judges rather than legislators have been the key players. The conclusion, especially a lengthy essay by Crockin, provides a synthesis and suggests resolutions to certain ongoing debates. Crockin highlights areas in which consensus has developed over time, such as widespread adoption of an intermediate “special respect” position vis-a-vis embryos created during in vitro fertilization (IVF). She likewise attends to areas in which she believes more progress is possible, such as the careful drafting, completion, and implementation of comprehensive directives for the disposition of embryos left over following IVF. It is worth noting that Crockin and Jones are eminent in the world of reproductive law and medicine. This is truly an insider account, with the strengths and weaknesses usually associated with being on the inside: complete mastery of the material and interesting “behind the scenes” insights into major developments but also an occasional lack of critical distance. An illustration would be the treatment of gestational surrogates (also termed gestational carriers)—women who, following an agreement with an intended parent or parents, become pregnant via IVF involving embryos to which they have not contributed genetically. Crockin suggests that once judges grasp the medical distinction between gestational and traditional surrogates, they will translate that knowledge into legal rulings that treat gestational surrogates as nonmothers. Decisions along these lines are obviously in line with the interests of individuals seeking assistance with reproduction and the fertility industry. Such decisions also can be defended in ethical and policy terms. Still, I take issue with the implication that treating gestational surrogates as mothers is a consequence of medical naivete. In its 1998 report on assisted reproductive technologies, the New York State Task Force on Life and the Law concluded that gestational surrogates should be treated as mothers. On this issue, a full consideration of the arguments pro and con might have been beneficial. I would not expect the authors, in this type of book, to engage more radical critiques of assisted reproductive technologies and associated legal structures. The target audience for Legal Conceptions: The Evolving Law and Policy of Assisted Reproductive Technologies is professionals involved in assisted reproductive technologies. Although the focus is on law, the writing is clear and accessible, and background information is supplied for nonlawyers. For most readers, this will not be a book to read cover-to-cover; I suggest reading the commentaries and conclusions and then sampling the case reports according to interest or jurisdiction. The book is not intended as a substitute for legal advice that reflects the most up-to-date case and other developments in the relevant jurisdiction, and it should not be treated as such.

Nowadays, technology is getting more advanced. For example, IVF or "In Vitro Fertilization (IVF)" with a surrogate mother. A surrogate mother is a woman who has no relationship at all with a spouse who owns the seed then makes an agreement with them to rent out her uterus in exchange for material things. This study aims to determine the Surrogate Mother validity in Indonesia and in Ukraine on born children's civil status. This study employed normative juridical methods. The findings revealed Surrogate mothers is not allowed as it against the existing law in Indonesia. This is stated in Article 127 of Law Number 36 the Year 2009, the prohibition of the surrogate mother agreement. However, if a child is born from a Surrogate Mother, his civil status will be of surrogate mother's child. In Ukraine, on the other hand, the surrogate mother is legal. This is stated in Article 123 of the Family Code of Ukraine 2002, the children’s civil status is a genetic child of a spouse who owns the seed

Surrogation arises as a result of the development of reproductive technology science with techniques embryo transfer and in vitro fertilization (IVF) techniques. The existence of a surrogate mother both for altruistic and transactional motives have implications for the problem law. Some countries provide different regulations on surrogation. This writing is the Reform-oriented research, which confirms that surrogation does not meet the rules humanitarian values, so the need for reconstruction of health laws against the rules concerning the institutionalization of human organs, reproduction outside of natural pregnancy, the provision of sufficient spare embryos and criminalization policies against advocates, perpetrators and surrogate mother in order to achieve justice and legal certainty. Keywords: surrogation, medicolegal, humanitarian paradigmatic law.

Cross-border reproductive care: an Ethics Committee opinion.