Surrogacy arrangements usually focus on intended parents, egg providers, and surrogates; issues related to children are often overlooked.

Legal and Social Considerations

Intended parents are often unaware that laws in their own country may differ from laws in the country where a child is born or how these differences can affect their arrangement. Laws regarding the status of surrogacy, citizenship of children, and definitions of who is (or is not) a legal parent, for example, can affect an intended parent’s ability to establish parentage. Without proper information, intended parents may not have the documents they need to leave a foreign country and return home with their child, leading to confusion, unexpected expenses, and travel delays. In worst-case scenarios, children can be left “stateless” or forced to remain in their country of birth. While some experts do not believe a coherent approach to dealing with the risk of stateless children exists at this time, others emphasize the critical need for intended parents to seek advice from a lawyer with expertise in international law and citizenship before entering into a surrogacy arrangement.

Unresolved legal parentage in the parents’ home country can also be a problem, particularly if a couple divorces and disagrees over the custody of a child. This scenario can exacerbate related legal issues such as financial support, inheritance, and other state-granted benefits.

Health and Medical Risks

According to the United States’ Centers for Disease Control and Prevention, women who conceive through assisted reproductive technologies are at higher risk of preterm birth because they are more likely to carry multiples. Surrogates have an even higher rate of multiples because agencies and clinics want to increase the chances of live births, and some intended parents would prefer twins for financial or other reasons. Multiple embryo transfer is contrary to best medical practice; in some places, laws cap the number of embryos that can be transferred at one time. 

Medically unnecessary cesarean sections are routine in international commercial surrogacy, both for the convenience of intended parents and to increase the speed and volume of births at fertility clinics. Though they are life-saving when needed, the indiscriminate use of cesarean sections puts gestational mothers at far greater risk than vaginal delivery. For children, it can lead to both short- and long-term adverse health outcomes.

Intended parents can play an important role in minimizing some of these health risks for gestational mothers and for children by, for example, insisting that the surrogacy contract does not require the surrogate to have a scheduled cesarean section (unless otherwise indicated by her or her medical provider) and stipulates only single embryo transfer.

Questions About Identity

Very little is known about the psychological effects of international commercial surrogacy on children. Being born as a result of such an arrangement may raise questions for children about their identity, nationality, and family relationships. 

Lessons from other fields may help frame some answers. Advocates of adoption reform, for example, talk about the importance of access to birth records and birth stories. The Donor Sibling Registry was founded in 2000 to support donor-conceived children, and now includes more than 62,000 members. The organization assists individuals born as a result of sperm, egg, or embryo donation who are seeking to make mutually desired contact with others with whom they share genetic ties. More than 16,000 have found sibling and/or donor matches through the site.

See Surrogacy360’s tool Principles and Standards for Engaging in International Commercial Surrogacy for recommendations on safeguarding the rights of children born through surrogacy.