Conor here: This topic might seem straightforward to some, but the intersection of money and power in surrogacy raises profound questions. The exchange of funds inherently introduces power dynamics that cannot be ignored.
Even if we accept the author’s claim that “The desire for a child is primal, one of the most natural urges in the world” (though some evidence suggests this is a myth), should we act on every natural impulse? Can a financially struggling woman or couple embrace this urge with the same freedom as a wealthier counterpart? Moreover, what happens to the desire to avoid exploitation—yes, even if “it’s all there in the contract”?
As Ihor Pechonoha from the Swiss-based BioTexCom, which operates baby factories in Ukraine, notes, “We are looking for women in the former Soviet republics because, logically, [the women] have to be from poorer places than our clients.”
By Ferrukh Faruqui, an Ottawa-based family physician, writer, and essayist focusing on medical ethics. She was a 2025 Fellow at the University of Toronto’s Dalla Lana Fellowship in Journalism and Health Impact. Originally published at Undark.
In 2000, a Canadian woman named Sally Rhoads-Heinrich became a surrogate for a Maryland couple, carrying and delivering twins. This rewarding experience led her to establish Surrogacy in Canada Online a year later, facilitating connections between intended parents and potential surrogates. Between 2002 and 2008, she underwent eight additional IVF cycles in her attempts to help other struggling couples become parents, but she faced significant challenges, including miscarrying four times.
Her final surrogacy attempt resulted in a life-threatening twin ectopic pregnancy that necessitated emergency surgery, during which she lost her left fallopian tube.
As an agency owner, Rhoads-Heinrich has seen the medical risks that other surrogates encounter. She shared experiences of negative outcomes, including hemorrhages during childbirth and multiple placental abnormalities. However, she noted that some risks have diminished over time, as fertility specialists have shifted from multiple embryo transfers—often resulting in twins or triplets—to single-embryo transfer protocols, which aim for a single pregnancy.
Rhoads-Heinrich assured me that surrogates understand the health risks associated with carrying genetically unrelated babies. “It’s all there in the contract,” she conveyed, emphasizing that the contract outlines various risks related to pregnancy.
Following her surgical intervention, Rhoads-Heinrich successfully had two more children of her own, describing surrogacy as “an absolutely beautiful way to create families.”
With infertility affecting nearly one in six adults worldwide, Global Market Insights reports that the global surrogacy market is valued at over $22 billion. Projections indicate that this figure could grow nearly tenfold by 2034. However, the health risks faced by surrogates introduce complex ethical dilemmas. Recently, the United Nations Special Rapporteur on Violence Against Women and Girls presented her report to the UN General Assembly, concluding that surrogacy is detrimental and exploits women and girls. She advocates for UN member states to take measures to abolish all forms of surrogacy, whether traditional (utilizing the surrogate’s own egg) or gestational (where an unrelated embryo is implanted).
The longing for a child is indeed primal, leading surrogacy advocates to question why a woman shouldn’t create a child for someone desiring one. However, this perspective overlooks a crucial inquiry: how ethical is it to value a person’s wish for parenthood above the health and well-being of a woman who may face potential harm in the process? While surrogacy might appear to be a viable solution for both biological and social infertility (which affects singles and same-sex couples), at its essence, I contend that even regulated surrogacy can exploit women’s bodies for the benefit of others.
Surrogacy practices differ significantly across the globe. It is prohibited in many European countries, such as France, Spain, and Italy. Australia and Canada allow altruistic surrogacy, meaning surrogates can only be compensated for pregnancy-related expenses. Some U.S. states, including California and New York, have legalized commercial surrogacy.
Activist Julie Bindel wrote in a commentary for Al Jazeera about the societal conditioning of women to be ‘nice’ and to prioritize the needs of others over their own. “Pregnancy is a major endeavour, and surrogacy can cause complications and carries health risks,” Bindel stated.
To prepare for pregnancy, a gestational surrogate usually takes estrogen for two to three weeks to thicken her uterine lining, along with progesterone, which enhances blood flow, preparing the womb for a lab-conceived embryo that is genetically unrelated to her. The embryo, at five days old, is then implanted into the surrogate’s womb, where it will develop into a baby.
Research findings from last year by McGill University reproductive endocrinologist Maria Velez indicate that gestational carriers (a term some critics find “dehumanizing”) face higher rates of maternal complications compared to women with spontaneous pregnancies or those carrying their own embryos created via in vitro fertilization.
Velez’s widely circulated paper evaluated maternal complications in singleton pregnancies past 20 weeks in Ontario, Canada, from 2012 to 2021. She observed that severe maternal morbidity, including conditions like hemorrhagic shock and uterine rupture, occurred 3.3 times more frequently among gestational carriers compared to spontaneous pregnancies. Increased rates of preterm births under 37 weeks gestation were also noted among surrogates.
Norbert Gleicher, medical director at The Center for Human Reproduction in New York, remarked in The Reproductive Times last year that the heightened risk of complications for gestational surrogates stems from their carrying an embryo that is genetically unrelated to them (Gleicher is also the founder and editor-in-chief of The Reproductive Times).
A study conducted in 2017 by Irene Woo and colleagues analyzed perinatal outcomes among 124 California surrogates who previously had spontaneous pregnancies. They discovered higher rates of premature birth and low birth weight among surrogate infants, alongside increased incidences of pregnancy-induced hypertension and diabetes among the surrogates. The researchers concluded that assisted reproduction techniques like IVF may elevate maternal and neonatal risks.
Critic of surrogacy, Kallie Fell, a perinatal nurse and executive director of the conservative-leaning California-based Center for Bioethics and Culture Network, spoke about her fight against what she terms “Big Fertility”—a vast coalition of pharmaceutical companies, physicians, and surrogacy agencies that exploit vulnerable, often impoverished women. (Fell addressed this topic at a Make America Healthy Again Institute event in July.)
While discussing her experiences last October, she recounted the story of Kelly Martinez, a three-time surrogate from South Dakota who nearly died due to liver failure after carrying twins for a couple from Spain. In 2017, Martinez shared her experience before the United Nations, indicating that the couple was dissatisfied when she delivered two boys instead of a boy and girl as they had anticipated. The couple left her with unpaid medical bills, marital strife, and feelings of being used and discarded.
U.S.-trained Toronto fertility specialist Prati Sharma balances surrogacy risks daily while matching surrogates with prospective parents. In Canada, where only one surrogate is available for every 100 couples seeking children, the matching process can take 18 months. In contrast, those U.S. states where surrogates are compensated may complete matches in only three to six months.
Sharma divulged the challenges of weighing maternal risks against the approval of surrogates. She noted that Canadian fertility clinics sometimes adopt a more flexible approach to accepting potentially “less than ideal” surrogates, acknowledging that the chance of complications can rise depending on how rigorously the clinics apply medical criteria, such as limiting the frequency of previous cesarean sections and premature births, while selecting surrogates of healthy weight.
Sharma’s comments raise concerns. If the pressure to provide babies for prospective parents overshadows the health and safety of women assuming these risks, what does this indicate about our societal values?
The ongoing surrogacy debate, further complicated by mounting evidence of health risks, affirms what traditional feminists have long warned about: we must not pursue a simplistic vision, ignoring potential fallout.
Ghislaine Gendron, the Canadian co-coordinator of Women’s Declaration International, expressed alarm over Velez’s findings, arguing that surrogates often sign contracts without fully comprehending the risks involved. She regards surrogacy as the “opposite” of freedom—essentially a commercial transaction for the delivery of what she reluctantly labels a “product”—a child. As Gendron posits, the woman creating that product, regardless of her conviction that she is exercising her reproductive rights, is reduced to a mere incubator.
In contrast, some view this broad perspective on surrogacy as paternalistic. Melbourne fertility lawyer and former surrogate Sarah Jefford, who used her own egg to conceive a baby girl for a grateful male couple, conceded that certain global surrogacy practices are exploitative and require improved regulation. Yet she believes it is vital to respect women’s autonomy. In Australia, expert panels assess each medical file and reject candidates deemed too high-risk, ensuring that surrogates remain “alive and well at the end” of the process.
Gleicher opposes interrogating surrogacy in itself; instead, he calls on doctors to clarify health risks for both intended parents and surrogates while tightening screening protocols to ensure that only the healthiest candidates qualify for surrogacy. Velez echoes this sentiment, hoping her findings will encourage regulation within this industry.
Creating new life is indeed a miraculous endeavor. Yet, not all progress is beneficial. Even with regulatory measures in place, the risks associated with surrogacy remain substantial. It is imperative that we pause and heed the evidence at hand. If we neglect this, we risk failing the very women who generously sacrifice their health to offer the joy of parenthood to others.
