International commercial surrogacy arrangements involve a person or a family in one country who travel to another country to form a family. They cross physical borders, along with cultural and language differences, to find gestational mothers who will carry and birth a child for them.

How do these complicated relationships work? One word: Go-betweens.

The Role of Go-Betweens

Go-betweens are intermediaries that handle different aspects of these arrangements. They include fertility clinics and agencies, as well as businesses related to travel, tourism, law, and immigration.

Given the distances and differences between countries, which make it hard for intended parents to travel and spend extended time where gestational mothers are located, agencies have played an important role in the growth of international commercial surrogacy.

For people considering surrogacy, agencies are a gateway — the first point of contact and information as they navigate a complex and unfamiliar practice. And as arrangements progress, agencies are solely responsible for on-the-ground coordination on behalf of intended parents. This includes:

  • Working with local recruiters to find suitable gestational mothers.
  • Arranging treatment with local fertility clinics (including IVF, embryo transfers, and the birth).
  • Identifying lawyers to iron out legalities of hiring gestational mothers and parental rights.
  • Coordinating travel and tourism deals for intended parents visiting foreign countries.

In other words, agencies provide a “concierge” style service. This service is understandably appealing to intended parents because it covers every aspect of an arrangement, from the time they enter into a surrogacy agreement to the point they exit with a child.

Whose Needs Are Met?

Many go-betweens genuinely want to help intended parents create a family and go to great lengths to protect the interests of their clients. Others prioritize their own interests over those of their clients, often making fraudulent claims and providing inaccurate information. Far too many ignore the needs of gestational mothers, beyond those that directly affect her ability to deliver a healthy child. This neglect is apparent in, for example, unfair payment schedules and unsound practices related to pregnancy and birth (as described below).

Information Gaps

The vast majority of information on international commercial surrogacy is developed and promoted by go-betweens. This information is often incomplete or misleading. It seems designed to reassure intended parents and discourage any questions, including on practices they might perceive as problematic.

A chapter by Our Bodies Ourselves, in a forthcoming book on international commercial surrogacy, details some of the issues with information provided by agencies. These range from aggressive marketing of discounted rates to “red flags” such as:

  • Mandatory cesarean sections. This is major abdominal surgery, with slow and complicated recovery for gestational mothers, most of whom have little to no medical care after the birth and in subsequent births.
  • Implantation of multiple embryos in individual gestational mothers to increase the chances of healthy live births.
  • “Reductions” (or abortions) of one or more fetuses when intended parents do not opt for multiple children.

With the focus on intended parents and children, gestational mothers are often invisible within the surrogacy relationship. Agencies almost never provide any information about the women they recruit, from their experiences before the surrogacy relationship to the payment and care they receive within one.

And because the process limits direct contact and relationships between intended parents and gestational mothers, it is difficult to get a full — and accurate — picture of what is at stake.

Surrogacy360 aims to bridge information gaps by documenting how international commercial surrogacy is practiced and how it affects everyone involved in the surrogacy relationship.

We hope all parties will join our efforts to promote best medical practices and transparency. Without collective involvement, there is no way to ensure that expanded reproductive options are available for everyone — and, at the same time, guarantee sound medical care and fair work conditions for those who make these options possible.

Top photo: Martin Addison (cc)