Surrogacy Practice Research Articles

A View of Civil Law and Islamic Law on the Practice of Surrogate Mother

IVF is one of the modern methods that can help legal couples obtain children. Both Indonesian Civil Law and Islamic Law allow this practice. Still, it must be carried out based on the provisions, namely by involving couples who are legal in the eyes of the law. IVF carried out through surrogate motherhood is prohibited by both positive law and Islamic law because its existence can disrupt lineage. Children born from this practice are not considered legitimate due to confusion and ambiguity during the process. This research is a normative juridical literature study that is processed based on primary and secondary legal sources consisting of primary, secondary, tertiary legal materials, and non-legal materials with the aim of: 1) Understand how Indonesian civil law and Islamic law view the issue of surrogate mothers; and 2) Knowing how the guardianship status of IVF children born through surrogacy practices. It was found that both Positive Law and Islamic Law prohibit the practice of IVF with surrogate mothers because it results in legal confusion for the child. This research is expected to contribute to further research, especially research that raises the theme of IVF.

The Legal Basis and Legislative Regulation of Limited Open Surrogacy in China

Chinas surrogacy market is turbulent, social public opinion has been condemned, and the attitude of regulations is unclear. This paper focuses on the legal basis of surrogacy and the countermeasures to improve the existing mechanism of surrogacy. This paper discusses the pros and cons of surrogacy from the angle of law, puts forward the point of view of limited open surrogacy, and then analyzes the current situation of the law on surrogacy, and offers some suggestions to improve surrogacy. This study may provide a new way to solve the surrogacy problem. This paper comprehensively examines surrogacys legal, ethical, and practical dimensions, advocating for a limited opening of surrogacy practices. It then delves into an in-depth analysis of surrogacys current legal landscape and proposes recommendations to refine the surrogacy process. This study holds the potential to offer a novel and constructive approach to addressing the surrogacy challenge in China.

Surrogacy in the Republic of Kazakhstan: A theoretical and legal perspective on legislative regulation improvements

A comprehensive understanding of medicine and psychology is indispensable for successful surrogacy practices. This paper aims to provide a qualitative assess-ment of modern Kazakhstan's legislative regulation of surrogacy in light of con-temporary challenges. This paper intends to highlight some aspects of surrogacy law that have not been adequately expressed in Kazakhstan contract law. The study revealed that a number of issues in this area are not regulated by law in Ka-zakhstan, creating legal gaps and potential contract law issues. Preparing a docu-ment or official commentary addressing many issues in contractual relationships pertaining to surrogacy contracts could be an essential solution. Family and healthcare lawyers will find the information in this paper useful for their practices.

The advantages and disadvantages of altruistic and commercial surrogacy in India

BackgroundComprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested.MethodsThis paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources.ResultsSurrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society.ConclusionPolicies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child.

P-386 The impact of cross-border surrogacy practices on the welfare of children

Abstract Study question What are the clinical characteristics and medical outcomes of cross-border surrogacy (CBS) arrangements? Summary answer CBS practices commonly involve anonymously donated oocytes and multiple embryo transfers which can adversely impact the psychological and physical welfare of the children born. What is known already Intended parents may seek CBS when surrogacy in their home country is prohibited or when access is restricted to heterosexual couples, or when they cannot find a surrogate in their home country. Standards of clinical care can differ between the parents' home country and the CBS destination. Surrogacy is generally unregulated in CBS destinations, making it difficult to monitor clinical practices and the outcomes for the children born. In Australia, where this study is set, anonymous gamete donation and multiple embryo transfers for patients engaged in surrogacy is prohibited. The rate of twin surrogacy deliveries is 2.2%. Study design, size, duration This cross-sectional study collected data through an online, anonymous survey open between April and November 2021. Participants/materials, setting, methods A survey with predominantly fixed-choice questions was developed and informed by the authors’ prior research, the literature, and one author’s experience of surrogacy and surrogacy advocacy. Questions were refined through an iterative process involving consultation with parents through surrogacy. Australian parents through surrogacy were eligible to participate and the study was advertised to personal contacts, members of a surrogacy non-profit organisation and members of a surrogacy related Facebook group. Data were analysed descriptively. Main results and the role of chance One hundred and eight Australian parents through CBS completed the survey. Surrogacy was undertaken in twelve destinations, with approximately half of respondents completing surrogacy in the United States of America (34%, n = 37) or Canada (17%, n = 18). Almost all respondents reported the pregnancy was a result of an embryo transfer (92%, n = 98) and not artificial insemination (8%, n = 10). Of those reporting embryo transfer, 41% reported the transfer of multiple embryos (n = 40) and 79% reported the use of donor oocytes (n = 77). Of the respondents that used donor oocytes, almost half were from an anonymous donor (47%, n = 36) and all but one noted their intent to disclose the use of donor oocytes to their child (97%, n = 76). Pregnancy or birth complications were reported by 29% of respondents (n = 31). There were 12 twin births (11%), 22 preterm births (20%) and 24 births requiring neonatal intensive care (22%). The median time spent in the neonatal intensive care unit was 6 days (range 1-60). All but one twin birth arose from pregnancies resulting from a multiple embryo transfer and the majority were preterm (75%, n = 9) and required neonatal intensive care (59%, n = 7). Limitations, reasons for caution It is not known if those who completed the survey are representative of all parents through CBS. However, the respondents’ sociodemographic characteristics and motivations for surrogacy were similar to those in previously conducted studies, both within Australia and internationally. Wider implications of the findings The welfare of children born through surrogacy can be protected by addressing the barriers to undertaking surrogacy domestically and thereby reducing the number of people crossing borders, and by promoting identity release or known donation and single embryo transfer as best practice in surrogacy internationally. Trial registration number Not applicable

A brief comprehensive overview of surrogacy

Statistics situates infertility as a global health issue with about 48 million couples and 186 million individuals. The rate at which IVF and surrogacy arrangement have been engaged globally has raised alarm to scholars in medicine, sociology, law, social work, psychology, and religion among other fields. Improved methods and unarguable advantages of surrogacy particularly to couples in dire need of children has left even more questions unanswered. The focus of this research is placed on the interdisciplinary factors that influences the practice of surrogacy. Due to the paucity of data on the subject, a systematic review of relevant published articles dated until 2023 were engaged within survey design. This study argues that surrogacy is not welcomed in many societies, however, it is also clearly noted that it is currently practiced in several countries. Interdisciplinary collaboration has been situated within surrogacy practice, and the findings of this study is prominent for such.

Towards a missiology of marriage and sexuality: A review of Timothy Tennent’s theology of the body

Missiologists have written little in response to many of our modern world’s newly emergent and influential sexual lifeways, ideologies, surrogacy practices, and family formations. The 2020 book written by missiologist Timothy Tennent For the Body: Recovering a Theology of Gender, Sexuality, and the Human Body represents an exception. Thus, it merits sustained attention from other missiologists wishing to consider such realities. This article reviews Tennent’s exposition of a “theology of the body,” focusing on his arguments regarding marriage and celibacy as missional icons of the gospel, and explores the relevance of the book’s topic for missiology. It commends Tennent for addressing an important and timely topic that ought to be addressed by missiologists. It suggests that Tennent might have more fully achieved his laudable goal of framing a suitable argument for the public square had he interacted more with anthropology, not just theology, and had he explicitly interacted with the writings of professional missiologists on fundamental missiological principles. The article proposes that missiology, despite its relative silence till now, has discipline-specific strengths for engaging contemporary challenges related to sex and marriage and Christian witness. It encourages missiologists to direct our future missiological conversations, research, writing, and curricular development accordingly.

Surrogacy in Indonesia: The comparative legality and Islamic perspective

Reproductive health technology allows married couples who experience infertility to have a child through assisted reproductive technology (ART), such as the in vitro fertilisation (IVF) process. The transfer of the extracted embryo to the woman’s womb is called surrogacy technology (gestational surrogacy). The legality of the practice of surrogacy is still questionable, both on a national and international level. This research discussed the legality of surrogacy in some religious countries, focusing on Indonesia. This research used normative juridical research methods or literature review through a comparative religion-legal approach. This study indicated that most do not have a specific legal instrument regarding surrogacy practice. International law also does not have a standard legal instrument regarding the legality of surrogacy. Legality is determined by each religious country’s national laws and customs. For example, Indonesian law prohibits this practice implicitly under Law No. 36 of 2009 concerning health. The United Kingdom legalised surrogacy through the Surrogacy Agreement Act 1985, which was amended to the Human Fertilization and Embryology Act 2008, Greece through the Greek Legislation Law 3089/2002 and Law 3305/2005, and India through the 2019 Surrogacy Regulation Bill. Those countries have their limitations and characteristics that rule surrogacy. Surrogacy is indeed a technological advancement in the health sector. However, for countries that are influenced much by religion, technological advances sometimes conflict with the culture and the belief that has long been followed by most of the population. For Indonesia, the largest of Sunni Islam ruled surrogacy against the law. Next, Iran, as a Shia Islam country, ruled that surrogacy is a legal action.Contribution: The research provided information and knowledge regarding the different settings of surrogacy practice. Most religious countries bravely rejected or put strict limits on the practice of surrogacy.

Gendering Assisted Reproductive Technologies: Commercial Surrogacy and Constructions of Motherhood

Literature on commercial surrogacy argues that assisted reproduction technologies (ARTs) problematise presumed essentialist dichotomies of nature and culture. While technologies of commercial surrogacy naturalise the medicalisation of the body, these technologies in turn also produce new knowledge about the biological facts of the body. In what ways are knowledge about reproductive labour and women’s reproductive capacities embedded in these technologies? How do these technologies invite us to imagine maternal bodies? Under regimes of stratified reproduction that inflect reproductive bodies with caste, class and racial politics, how do we read the production of the gendered body within commercial gestational surrogacy practices? The paper draws on ethnographic research conducted in Mumbai to study how technologies of commercial surrogacy interact with the normative idioms of conception. I will attempt to show how assumptions about gendered bodies and gendered roles are embedded within the material teleologies of these technologies, which in turn produce newer material-semiotic significations of the reproductive body.

Theological and Ethical Reflections on Surrogacy from an African Perspective

The desire to procreate is common among couples. However, for some reasons, some couples are unable to have their own children through the traditional natural means of conception and delivery. Some of these couple give up and remain childless; others adopt children and raise them as their own and yet, some others continue to explore modern Assisted Reproductive Techniques to have “children of their own.” Surrogacy is one of such means. Though a highly patronized reproductive technique, the ethical, socio-cultural or theological/religious implications of surrogacy have been hotly debated among (Christian and non-Christian) ethicists and theologians. In Africa, where assisted reproductive technology is relatively new, the scholarly debate surrounding surrogacy is also relatively new. This literature research contributes to the ongoing debate by offering a theological and ethical reflection on surrogacy from an African Christian perspective. This paper found all surrogacy practices as immorally wrong except those that use the gametes of spouses and do not involve the deliberate killing of foetus in the procreation process.

Negotiating 'Surrogate Mothering' and Women's Freedom.

Surrogacy is one of the desired reproductive technologies for family formation, yet surrogate mothers are subjected to unethical treatments and unbalanced power relations in India. Such treatment obscures women's free decision-making and can be detrimental to their maternal self. Recently, the Surrogacy (Regulation) Act, 2021, has received thePresident's approval to regulate surrogacy practices by limiting them for the altruistic motives which have again provoked the burning debates regarding reproductive technologies, women's emancipation and procreative labour. The paper thus explores women's agency, maternal freedom and surrogate arrangements in Indian society. The complexity of the implementation of the law, vulnerability of surrogate labour, woman's bodily autonomy and reproductive choices have been analysed. This has been done through comprehensive feminist discussions on motherhood experience in terms of enforced vs. voluntary to find the way to protect women's freedom and subjectivity in the task of 'mothering as empowerment'.

Digital Encounters of Surrogacy: Nodes of a Fictional Ethnography

The article addresses the question of alternative ways to writing ethnography and more specifically, the ethnography of surrogacy. It focuses on the example of a digital ethnographic artifact that was created in order to host fictional representations of surrogacy practices. The article presents ethnographic material from a recent research project that focused on experiences of surrogate parenthood of Greek and Cypriot intended parents. The digital artifact demonstrates how multimodal anthropological narrations may represent, and simultaneously evoke, sensory experience through the temporal and spatial digital unfolding of interlocutors’ stories. Indeed, the article explains the structure of the artifact and discusses specific digital nodes which depict interlocutors’ testimonies of longing, waiting, uncertainty, vulnerability, pain, loss, joy, and safekeeping before, during, and after surrogacy procedures. In the context of the ethnographic artifact narratives and non-narratives of motherhood, fatherhood, and pregnancy refer to a variety of precarious contexts of placeness/emplacement, legality/illegality, and connectedness/disconnectedness without relying on conventional textual ethnographic writing. Drawing from selected ethnographic examples as they relate to the literature of assisted reproduction, the authors argue that digital nodal narration enables both the cultural contextualization of individual experience as well as its affective and intellectual correlation with similar and antithetical experiences of other field interlocutors.

‘Womb for work' experiences of Thai women and gestational surrogacy practice in Thailand

Risks to gestational surrogates became a concern for public health. In commercial gestational surrogacy arrangements, gestational surrogates are commonly recruited from low- to middle-income countries. Thailand is well known as a surrogacy hub in this regard. However, little is known concerning Thai surrogacy practice and the risks that Thai gestational surrogates experiences. The semi-structured interviews with fifteen Thai women who had been gestational surrogates were conducted over the telephone in Thai between March and May 2020 and lasted approximately 30 minutes. Thematic analysis was applied to analyse the translated interviews. The findings indicated that ‘womb for work’ was perceived as a surrogacy career among Thai women. ‘Womb for work’ was defined as a superordinate theme that consisted of three subthemes: (i) gestational surrogacy arrangements in Thailand; (ii) the business model of gestational surrogacy arrangements in Thailand; and (iii) risk experiences of gestational surrogates. Clear deficiencies in surrogacy practice and regulations were identified, which put gestational surrogates at risk, including those associated with embryo transfer, transnational gestational surrogacy, and unsupported pregnancies. This study shows the urgent need to introduce regulations to protect women’s health transnationally in this domain more effectively.

The practice of surrogacy as a phenomenon of ‘bare life’: An analysis of the Japanese case applying Agamben’s theory

This article elaborates the cultural and political structures that inform the belief among Japanese that surrogacy is legitimate. It argues that this belief reflects a transition from previously negative attitudes toward surrogacy practices developed in the United States. The article first elaborates the history of the Japanese recognition of surrogacy by introducing early forms of East Asian surrogacy that lasted until the first half of the 20th century. Second, it explores the recent shift in Japanese discussions about surrogacy through an analysis of cultural representations on the topic, mainly referring to a dataset of magazine articles published from 1981 to the present. The author then calls upon Giorgio Agamben’s theoretical framework to discuss the juridico-political perspective of ‘bare life’ as it relates to surrogacy, and argues that considering surrogate mothers and children conceived through surrogacy as bare life makes surrogate practice seem reasonable in modern Japanese society. To conclude, the article stresses the importance of incorporating women’s reproductive functions into law to prevent women and their conceived children from becoming bare life, and being exposed to violence, in the form of a surrogacy contract.

The nexus between self-perception and behavioural responses of gestational surrogates’ risk experiences

Despite associated risk and public concern, commercial surrogacy remains a thriving business, and opportunities for gestational surrogates continue to exist. Surrogacy arrangements have been found to place gestational surrogates at risk, with little support or guidance to help them understand or mitigate these risk factors. This study aims to investigate the self-perception of gestational surrogates through their reflection of their own risk-related behaviours throughout the surrogacy process. Data were retrieved through interviews with fifteen Thai women who had first-hand experience of commercial surrogacy, and thematic analysis was used to interpret the data. Findings showed that the perceptions of ‘trust,’ ‘commitment to obligation,’ and ‘unacceptable actions’ reflected their behaviours exposing risks to detrimental behaviours, disempowerment, and isolation. Understanding these perceptions would be advantageous for health planning programmes or policies in surrogacy practice to promote women’s heath as a whole.

A Revolution by Stealth: A Legal-Ethical Analysis of the Rise of Pre-Conception Authorization of Surrogacy Agreements

This article offers a legal-ethical analysis of recent UK and Dutch proposals to regulate surrogacy proactively through a national system of pre-conception authorization of surrogacy agreements. Within such a system, authorities are already before conception called upon to examine and assess contractual arrangements between the intending parents and the prospective surrogate mother. This regulatory approach is presented by its advocates as a win-win for all parties involved; as bringing family law in line with the changed social reality of creating families; and as maintaining a non-permissive approach toward commercial surrogacy. In this article, we critically examine these claims. Our analysis suggests that the proposed systems may result in the facilitation of surrogacy practices with commercial, commodifying and exploitative dimensions. Moreover, although these frameworks are presented as merely regulating something that is already taking place, they silently introduce a radically new and, as we shall argue, highly problematic legal-ethical approach to surrogacy.

Cumulative live birth rates among gestational surrogates in altruistic surrogacy arrangements

Understanding the likelihood of a live birth is important for fertility treatment planning, particularly when one cycle fails and further treatment may be contemplated. This study aims to estimate the chance of live birth among gestational surrogates undergoing altruistic surrogacy arrangements between 2009 and 2016 in Victoria, Australia. A total of 81 gestational surrogates with 170 embryo transfer cycles were included. Of the 170 embryo transfer cycles, the majority were single embryo transfers (SETs; 97.1%), using frozen/thawed embryos (97.6%) which had been fertilized by intracytoplasmic sperm injection (77.6%). The cumulative live birth rate was 23.5% (95% CI, 15.6–33.8%) after the first cycle and increased to 50.6% (95% CI, 40.0–61.2%) after the sixth cycle. Of the 41 deliveries, 40 were singletons and one was a twin delivery. Two of the 42 deliveries were preterm, two were low birthweight and one was small for gestational age. The findings imply that surrogacy treatment can be offered up to six consecutive embryo transfer cycles to gestational surrogates. SET is encouraged in surrogacy practice to improve perinatal outcomes. These estimates can be used in counselling and decision-making for intended parents and gestational surrogates to continue a surrogacy treatment and informing public policy on assisted reproductive technology treatment.

Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis

Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06–1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10–1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58–69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.

Reconstructing feminist perspectives of women's bodies using a globalized view: The changing surrogacy market in Japan.

This paper aims to evoke an alternative viewpoint on surrogacy, moving beyond popular Western feminist beliefs on the practice, by introducing the history and current context of East Asian surrogacy. To elaborate a different cultural perspective on surrogacy, this paper first introduces the East Asian history of contract pregnancy systems, prior to the emergence of the American invention of 'modern' surrogacy practice. Then, it examines Japanese mass media portrayals of cross-border surrogacy in which white women have become 'convenient' entities. The results of the analysis show how Japanese culture has adopted a rhetoric about the use of white women as convenient surrogate mothers in the global commercial surrogacy market. An essential aspect of surrogacy is the premise that a woman's reproductive function should be accessible to others. Past discussions among feminists have neglected this important point. Moreover, they share the assumption that white surrogacy clients are exploiters, who take advantage of women of colour as surrogate mothers. The current situation in Asia flips this perspective-with white women regarded as easier targets for exploitation by wealthy people of colour. For Asian clients, Westerners can be easily regarded as 'others' whom they can use for their reproductive needs. In today's globalized era, the surrogacy industry is no longer for affluent Westerners only. Considering this change, it is crucial to discuss surrogacy issues by reconstructing feminist perspectives with a globalized view, to help protect women's bodies, regardless of nationality, ethnicity, skin colour, or religion.

Process and problems of the international adoption in surrogacy cross-border practices in India

To identify the problems associated with the international adoption process of the cross-border surrogacy practice and to describe its problems. The research employed secondary data, which was related to cross border surrogacy industry, international adoption data and regulation, and baby trade data. The data collected was related to Indian countries. The time period for the data collected started from 2010-2017. There are many problems in each phase of the international adoption process in the practice of cross border surrogacy. They are adoption goals, adoption procedures, the role of national adoption institutions, as well as general rules of adoption regulations. There are also many problems experienced by the resultant child in the future. The international adoption in the practice of cross border surrogacy occurs in the overall procedure of adoption and that the biggest threat faced by the resultant child is being stateless.