The Economist - UK (2022-04-09)

The Economist April 9th 2022 United States 37

Surrogacy

Battlegrounds of the baby business

W

henthemanwhohadpaidMelissa
Cooktobearthreeembryos,created
fromhisspermandtheeggofananony­
mousdonor,informedherthathehadrun
outofmoneyandshewouldhavetoabort
atleastone,sherefused.Herworrythathe
wouldnotbeabletolookafterthechildren
grewwhenshelearnedthatthesurrogacy
brokershehadusedinCaliforniahadnot
properlycheckedtheman’sabilitytobea
parent.Shesued,arguingthatthestatelaw
authorisingsurrogacycontracts wasun­
constitutionalbecauseit treatsbabies“asa
commodityoraschattel”.Thisandsucces­
siveattemptstoretainherparentalrights
failed.When the triplets were born Ms
Cookwasnotallowedtoseethem.
Sixyearslater,havingexhaustedallle­
galavenues,includinganattempttoget
thecase before theSupreme Court, Ms
Cookremainsconsumedbyanxietyabout
thechildren,allboys,accordingtoHarold
Cassidy,herlawyer.“Thelastweheardhe
hadlosthishouseandtheyweremoving
from motel to motel,” he says. Robert
Walmsley,theman’slawyer,saysthatis
nottrueandthatargumentsmadeincourt
filingsthatthemanwasunfittobea parent
becausehewasdeafandmuteare“grossly
offensiveanddiscriminatory”.
Thecaseillustratesthelegalandethical
messesthatcanariseina surrogacymarket
thatislargelyunregulated.Americahasno
federallawgoverningsucharrangements.
Moststates allow paid surrogacy; some
regulateit loosely.Nationaldataarescarce.
TheCentresforDiseaseControlandPre­
ventionsays18,400babieswerebornto
gestationalsurrogates(thatis,usinga do­
noregg)between 1999 and2013.Thefee
paidtoa surrogatecanrangefrom$30,000
to$60,000outofa totalcost—includingin
vitrofertilisationandfeesforbrokersand
lawyers—of$110,000­180,000.
Threeofthesixstatesthatonceprohib­
itedthebusinesshavelegalisedit:NewJer­
seyin2018,Washingtonin 2019 andNew
Yorkin2021. Poorerplaceshave shutit
down:Cambodia,India,ThailandandNe­
palhaveoutlawedcross­bordersurrogacy.
Most Europeancountries prohibitcom­
mercialsurrogacy.Ukraine,whereitisle­
galanda lotcheaperthaninAmerica,had
becomea bigmarket,beforeRussia’sinva­
sion.Butthosewhocanaffordithavelong
favouredAmerica,withitsadvancedmed­
icaltechnology,healthysupplyofeggdo­
norsandaggressivelawyering.

Demandisrisingacrosstherichworld.

Surrogacybrokerssaytheyhaveobserved

thepractice becoming moresocially  ac­

ceptable ascelebritieshavetalkedabout

usingsurrogates.Manyagenciessay  gay

couplesconstitutea growingproportion of

their clients (lesbian couples who want

childrencan mostlyusespermdonors).

Thathasinfluencedthelobbyingoffertili­

ty­rightsgroups,whichincreasinglypor­

trayaccesstopaidsurrogacyasa gay­rights

issue.Ontheothersideoftheargument, a

beliefthatnoonehasa righttopaya wom­

antocarrya babyhasunifiedsomeconser­

vativesandsomefeminists.

Motherandchildreunion

Proponents ofpaid surrogacypoint  out

thatthemarketself­regulatesinimportant

ways. Unlike the business of buying

sperm,it dependsontheuseofassisted re­

productivetechnology,whichisregulated

federally.Brokers prefer surrogates with

health insurance. Risa Levine, a lawyer

whocampaignsforbetteraccesstofertility

treatments,saysthatifhealthinsurance

covered the cost of surrogacy it would

bringnewlayersofprotectionandtranspa­

rency.Somebusinessesnowincludesome

costsassociatedwithsurrogacyinbenefits

packages.Researchsuggests15­20%of sur­

rogatesarearmywives.

Tohelpavoidsituationsinwhicha sur­

rogate,overwhelmedbymaternalfeeling,

decides  she  wants  to  keep  a  baby,  many

agencies  stipulate  she  must  already  be  a

mother.  Opponents  say  that  neither  this,

nor  the  use  of  donor  eggs,  which  is  now

what  most  surrogacy  involves,  circum­

vents a bond between mother and child.

Parental  disputes  about  what  should

happen to an unborn baby, generally amid

divorce,  are  more  common  than  conflicts

between parent and surrogate. New York’s

law allows one parent to use embryos that

both once wanted, without forcing the oth­

er  to  pay  child  support.  If  a  baby  is  born

with  a  physical  defect  that  might  have

prompted  an  abortion  had  it  been  known

about earlier, the state’s law forces parents

to accept custody.

Yet laws and contracts cannot fix every­

thing.  A  contract  may  stipulate  that  abor­

tion decisions are up to the paying parents,

but  no  court  would  force  a  woman  to  go

through with one. Health is also a concern.

More than half the babies born in America

to gestational surrogates are twins or trip­

lets, which can take a dangerous toll. “My

body,  my  choice”,  a  refrain  used  by  abor­

tion­rights  activists,  is  often  cited  by  pro­

ponents of surrogacy to counter that wor­

ry. “Why do we fight so hard to allow wom­

en to choose not to have a baby but assume

some aren’t equipped to decide to become

a surrogate?” asks Ms Levine. 

The greatest fears concern children. In

some states with little regulation, lawyers

turn  to  procedures  used  in  adoption,  in­

cluding background checks on prospective

parents.  Britain,  where  unpaid  surrogacy

is  allowed  but  contracts  cannot  be  en­

forced,  is  considering  mandatory  checks

on both surrogates and parents. That is un­

likely  to  happen  in  America.  It  could  be

“discriminatory”,  says  Mr Walmsley,  the

lawyer.  “Do  we  do  backgroundchecks  on

everyone who has a child?”n

WASHINGTON, DC
America’s childmaking market is a legal and ethical minefield

When it all works out like a dream