ISSUED JULY 2020
For an updated article (April 2021), see Ethics of Surrogacy During COVID-19 Pandemic.
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. We urge those considering international surrogacy arrangements to avoid entering these arrangements at this time.
Surrogacy arrangements are affected by travel restrictions; shelter-in-place regulations; and challenges in accessing medical care for surrogates, egg providers, and babies. Some of these risks apply to domestic arrangements (within country) as well. Uncertain and changing circumstances in this period make it difficult to predict what conditions will be like over the course of an entire surrogacy relationship.
– Egg providers may face increased difficulties accessing health care before or after the egg retrieval procedure. Even before the pandemic, they routinely received minimal care for health complications related to hormonal stimulation with egg retrieval.
– Surrogates may face obstacles to prenatal, delivery, and post-partum care; 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; decreased ability to report violations; and other challenges.
– 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. 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. (Many government offices have been closed during the pandemic.)
– 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.
In addition, surrogates, egg providers, and babies risk COVID-19 exposure in clinic settings, and intended parents and babies face exposure during travel. Some surrogates are not receiving payment on time, and some intended parents are incurring additional fees to care for their child while stranded, or to arrange travel to reach their child.
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).
Surrogates 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.
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.
Note that this advisory applies to intended parents considering surrogacy, or in surrogacy contracts where a pregnancy has not yet been initiated.