Outsourcing surrogacy: It takes a global village

Where do babies come from?

In our increasingly interconnected world, the answer to that question is growing more complicated. American couple hoping to become parents using an egg donated in London, a surrogate in India and a delivery planned in Nepal. Some couples have gone south of the border to find surrogates. But in an industry where the clients are desperate, the surrogates are poor and the profits for the middlemen agencies are huge, there can be heart-wrenching results.

And it’s not just U.S. couples entering the brave new world of reproductive tourism. Would-be parents from China and Europe are also coming to American shores for fertility treatments and to find surrogates who will give birth to American citizens.

Surrogacy is now a multi-billion dollar global industry, but there are only a handful of countries where it’s explicitly legal to hire a woman to bear your child. Here’s a guide to some of the international surrogacy hotspots, and how they’re handling the outsourced baby boom.

Russia

Russia is “a sort of reproductive paradise,” according to the Russian law firm specializing in surrogacy. The country has one of the most liberal surrogacy laws in the world, as well as some of the cheapest rates. Procedures cost, on average, between $15,000 to $30,000. In 2012, surrogate mothers in Russia reportedly gave birth to around 1,000 children, although there was no data on how many of those were for foreign couples.

Then, last fall, the tide shifted. Russian pop diva Alla Pugacheva, 65, and her husband had twins through a surrogate, rattling conservative corners of the country. A Russian Orthodox Church official decried surrogacy as a “mutiny against God” and “very happy fascism with a contract,” reported one Russian newspaper. Elena Mizulina, the architect of the nation’s infamous gay propaganda law declared that surrogacy was “threatening not only Russia, but humanity as a whole with extinction,” likening the practice to nuclear weapons.

As part of a conservative surge in the country, Russian parliamentarians drafted a bill in April that would ban commercial surrogacy entirely, and restrict its use to married people. The bill excludes gay couples, as same-sex marriage isn’t recognized in Russia.

Ukraine

Ukraine is one of the newest Meccas of international baby-making. For foreign couples, the price tag reportedly ranges from $30,000 to $45,000, less than half what it costs in the U.S. Only written consent is required, and Americans and Europeans don't even need a visa.

As long as parents are infertile, legally married and straight, the laws in the post-Soviet nation are stacked to protect the rights of the intended parents. Couples can select their baby’s gender and scoop up the birth certificate of their surrogate-born kid, almost as soon as he or she takes a first breath, essentially extinguishing the rights of the surrogate mother entirely.

India (and Nepal)

Three Indian surrogates, implanted with the embryos of wealthy Westerners, live together in one room in a Mumbai ghetto, rented by the clinic. In a nation with 1.2 billion people, plentiful English speakers, abundant hospitals and widespread poverty, it's little wonder that India has become a surrogacy destination for many Westerners.

Commercial surrogacy has been legal here since 2002, getting its start largely thanks to infertile couples of Indian origin in the U.S., U.K. and Middle East. Even factoring in costly plane rides, seeking help at one of India's more than 1,000 fertility centers can be a relative bargain. India's surrogacy prices of $18,000 to $30,000 are roughly one-third of the cost in America.  Sudhir Ajja, who co-founded Mumbai clinic Surrogacy India, told ABC News that nearly all of his clients are from overseas – many coming from the U.S., Australia and Sweden. The exact size of India's industry is unclear, with estimates ranging from $450 million to $3 billion a year.

But India's big business of renting wombs has raised thorny ethical concerns. Many surrogates come from crushing poverty, but stand to earn $5,000 to $7,000 in nine months – a huge sum for women who would otherwise bring in well under $1,000 annually. Some surrogates, however, are lured into contracts they don’t understand or are cheated by shady middlemen. Others are confined to sometimes crowded shelters near the fertility clinics, where their personal freedoms -like family visits - are restricted.

Some clinics have introduced more out-patient care models for surrogates, and there have been attempts to monitor and regulate the growing industry. A bill to reduce exploitative practices has gone unsigned for more than four years, but in that time, one major regulation has taken effect. In 2012, India’s Home Ministry decreed that foreigners seeking a surrogate must be a man and a woman, pushing same-sex couples and would-be single parents to look elsewhere for help. But some Westerners have gotten around the rule by hiring Indian or Nepalese women to get in vitro fertilization in India, only to deliver the babies in Nepal.

Thailand

India's new surrogacy regulations have been a boon for the industry in Thailand, where surrogacy agencies have since reported a higher number of international clients. Among this influx of clients are American same-sex couples, flocking to the country for bargain deals.

Thailand doesn't have restrictions on same-sex couples. In fact, there aren't any laws in the country regulating surrogacy at all, which has raised concerns about the exploitation of surrogates.

In 2011, Thai authorities shut down the Bangkok operations of Babe 101, an international surrogacy agency, accusing its staff of human trafficking by luring some surrogate mothers to the country with promises of unrelated jobs. The incident highlighted how the country's lack of regulations resulted in complicated legal questions around rights to children in surrogacy cases.

The country's parliament is now considering legislation that would offer protections, but could also prohibit commercial surrogacy arranged through a third party. If this legislation comes to fruition, it would complicate surrogacy for lesbian couples and transgender clients, while raising new questions about legal guardianship for gay couples.

Despite these looming changes, the country remains a popular destination for international surrogacy, particularly among Australians.

United States

Elton John and his partner David Furnish with their son Zachary Jackson Levon Furnish-John, who was born through a surrogate mother in California, in October 2011. In the United States, surrogacy is a two-way street. While Americans head all over the world to hire surrogates for a fraction of the cost at home, the U.S. also plays host to thousands of reproductive tourists. All forms of surrogacy are banned in countries such as Germany, Sweden, Italy and Norway. Others like Australia, Greece, Denmark and the Netherlands have outlawed commercial surrogacy. In a way, America's patchwork of state laws about surrogacy make it a microcosm of the rest of the world.

With its network of sperm banks, fertility clinics and laws favoring would-be parents, California is the capital of commercial surrogacy in the U.S., attracting the likes of Elton John and his partner. According to a 2012 Berkeley Journal of International Law study, a U.S. surrogacy arrangement can cost anywhere from $80,000 to $120,000. Of that, the surrogate receives between $14,000 to $18,000.

Some states that permit surrogacy require intended parents to be married, which excludes single people and many same-sex couples.

A 2013 American Society for Reproductive Medicine study estimated that one in 20 surrogacy deliveries in the U.S. are to foreigners. On the other hand, the "incidence of U.S. patients traveling abroad for care is estimated to be far lower than the rate of patients coming into the United States." To put that in context, there were only an estimated 1,400 births via surrogacy in the U.S. in 2010.

For people who live in countries such as China, where surrogacy in banned, there are some added bonuses to hiring an American surrogate or participating in so-called birth tourism. The child can get a U.S. passport, which can lead to citizenship for the parents down the road.

((http://america.aljazeera.com/))