ISSUED JULY 2020 and UPDATED AUGUST 2021
In addition to the usual risks involved in cross-border surrogacy arrangements, the COVID-19 pandemic raises additional concerns and heightened risks for all parties involved. Given the ongoing threat of the virus around the world, we continue to urge those considering international surrogacy arrangements to avoid entering these arrangements at this time.
Surrogacy arrangements continue to be affected in a number of ways, varying by country and jurisdiction. Challenges include travel restrictions; shut-downs; and difficulties accessing full medical care for surrogates, egg providers, and babies. Some of these risks apply to domestic arrangements (within country) as well. Ongoing uncertainty and changing circumstances during this period make it difficult to predict what conditions will be like over the course of an entire surrogacy relationship. Furthermore, travel for surrogacy arrangements by any party may exacerbate inequities, as arrangements may involve travel from states or countries with high rates of COVID to those with lower rates or with little to no vaccine access, posing risk to that population.
– Egg providers may face increased difficulties accessing comprehensive health care before or after the egg retrieval procedure as medical facilities are stretched thin by COVID cases. Even before the pandemic, egg providers routinely received minimal care for health complications related to hormonal stimulation with egg retrieval.
– Some surrogates face requests to refrain from getting a COVID vaccine; reports show some intended parents are fearful of the effect of the vaccine on the fetus, even though evidence to date shows increased risk to the surrogate and fetus if they contract COVID. Surrogates also face obstacles to accessing comprehensive and timely prenatal, delivery, and post-partum care due to burdens on health systems during the pandemic; curtailment of activities that would support their own and fetal health during pregnancy; possible requirements to move away from their families to the location where they will give birth; and decreased ability to report violations. They may be asked or pressured to care for a child when the intended parents are unable to travel, resulting in potential emotional and financial stress, unexpected bonding with the baby, and possibly difficulty handing over the baby when the intended parents arrive. Some surrogates report they are not receiving payment on time.
– Babies may be stranded in their country of birth with intended parents unable to reach them due to travel restrictions and border closures. These babies could experience an emotional toll due to either the absence of a consistent caregiver with whom to bond, or challenges associated with separating from the initial caregiver and establishing a new bond with intended parents.
– International surrogacy arrangements always involve a risk of difficulty in obtaining citizenship in intended parents’ home country, and may even be barred entirely from obtaining citizenship for their child. This risk is heightened during the pandemic. Intended parents may be unable to bring babies home because of difficulties obtaining paperwork authorizing departure from the child’s country of birth or re-entry into their own country of residence. Some intended parents are incurring additional fees to care for their child while stranded, or to arrange travel to reach their child.
In addition, surrogates, egg providers, and babies continue to risk COVID-19 exposure in clinic settings, and intended parents and babies face exposure during travel.
Unexpected situations may arise for all parties as clinics are affected by economic pressures, professional recommendations, and/or new or changing regulations. Potential concerns include temporary or permanent closures of clinics or services at any time (leading to disruption of care for surrogates and women undergoing egg retrieval, whether as egg providers or to use their own eggs with a surrogate); pressures on surrogates and egg providers to take health risks to speed up the process; and pressures on intended parents to make choices they otherwise might not make (for example, multiple embryo transfer).
Jurisdictions are addressing surrogacy arrangements during the COVID-19 pandemic in different ways, some on a case-by-case basis, others prohibiting any entry into the country for extended periods. Changes are taking place all the time.
These myriad challenges, barriers, and unknowns in the current situation lead us to recommend against international surrogacy arrangements at this time.
For those who decide to go forward, we urge you to find out about the effects of the pandemic on contracts, arrangements, protocols, and regulations in countries where you are exploring surrogacy, and to know that unexpected changes are likely to arise.