Renting wombs: the ethics of international surrogacy

PHOTO: Surrogacy in India, 18 December 2019, Manisha Rawat on Flickr

Surrogacy is “booming”. Now a multi-billion dollar industry globally, it is set to be valued at AU$187 billion by 2032. While medical advancements and social shifts have normalised this path to parenthood, there is concern that while surrogacy has the ability to bring one woman’s dream to life, it exploits another — often one more vulnerable than the buyer.

Surrogacy options in Australia can be difficult to come by, and commercial surrogacy in the West is often financially infeasible. This drives Western couples and individuals who desire a family, but cannot have one traditionally, to participate in international surrogacy. The practice is a source of hope for many, including those who are infertile or have other medical conditions, as well as individuals in same-sex male relationships.

The ethics of international surrogacy, however, continue being subject to fierce debate, with some detractors claiming it to be an inherently unethical practice. Domestic laws vary widely and significantly define the international landscape, complicating international responses and the ability to protect surrogates.

Surrogacy within Australia

The number of women offering to be a surrogate — to carry and give birth to a child on behalf of another person or couple — in Australia is significantly lower than those looking for the service. As there is more demand for surrogacy than women offering the service, most Australians find themselves compelled to search for fertility options overseas. In one year, 213 Australian babies were born through international surrogacy; contrastingly, just 131 Australian surrogate babies were born in Australia and New Zealand.

Commercial surrogacy is typically the type practiced in popular overseas destinations, which occurs when the surrogate gains a personal profit beyond “reasonable expenses”. It is illegal within Australia, and residents of New South Wales, Queensland and the Australian Capital Territory face criminal charges if they participate in overseas commercial surrogacy. Australia only permits altruistic surrogacy — where the surrogate does not receive any additional compensation or personal profit from the intended parents beyond the pregnancy’s expenses.

The true cost of fertility tourism

Despite its perceived merits, international surrogacy is a controversial road to starting a family. The US is one country in the West which has a thriving surrogacy industry, but it can cost up to AU$250,000 to have a baby through an American surrogate. In other countries, primarily those in the Global South, it can cost a fraction of the price; however, these countries face criticism for having unregulated sectors leading to exploitation and unethical medical practices. These criticis question whether international commercial surrogacy is truly an equal exchange of child and money. They make us ask: does prioritising the domestic dreams of Westerners support the exploitation of vulnerable women’s reproductive systems?

The landscape of international surrogacy is constantly shifting as states alter domestic laws. In the past, Thailand and India were hotspots for international commercial surrogacy, however both countries banned the practice for foreigners in recent years, causing business to move across borders; notably, Georgia has seen a sharp increase in fertility tourism due its permissive international surrogacy laws.

Surrogacy in India and Thailand

India and Thailand were previously incredibly popular destinations for fertility tourism before both states banned international commercial surrogacy.

Before its 2015 ban, international surrogacy in India generated up to US$2.3 billion (AU$3.3 billion) in the country annually. An estimated 25,000 children were born to surrogates in India by 2012, with 50 per cent of them born to intended parents in the West.

Surrogate mothers had no rights over the children in India, making it an attractive destination to couples who weren’t interested in a relationship with the surrogate mother, or who were concerned the surrogate would try to stake a claim against the baby. In Thailand, on the other hand, parentage law did not mention surrogacy arrangements at the time of the ban on international surrogacy, so the birth mother was considered the legal mother of the child.

Once dubbed the “womb of Asia,” Thailand’s ban of the practice followed several cases that drew negative attention to the industry, including an Australian couple who travelled to Thailand in 2014 to have twins via surrogacy. They only took one twin home, leaving the other — who had Down syndrome and a congenital heart condition — with the Thai surrogate mother.

The mother, Pattaramon Chanbua, was just 21 upon becoming a surrogate. She was offered the equivalent of an estimated AU$16,000 to be a surrogate, and hoped to pay off debts and for her two children’s education with the money. She struggled to pay for baby Gammy’s medical expenses, later raising money for him through an online campaign. She claims she never received the full compensation owed to her by the agency, which operated out of a house in Bangkok.

Though the court later ruled that the couple did not abandon baby Gammy willingly, this case displays the negative impacts, intended or otherwise, that international surrogacy can have on both surrogate mothers and the children they birth. The Australian father was also a convicted child sex offender, which raised concern for the safety of children of surrogacy arrangements.

Financial compensation for surrogate mothers in India was also inadequate, as surrogates often earned just a fraction of what the clinic was earning. At one surrogacy clinic in Gujarat, surrogates were paid US$8,000 (AU$11,600), or US$10,000 (AU$14,500) for twins. The clinic charged around US$28,000 (AU$40,600) for a successful birth following the pregnancy; the surrogate mothers therefore took home less than 30 per cent of the total price for the service.

In India, “surrogate houses” were also common, but raised concerns about women being made vulnerable during their pregnancies. The surrogate mothers lived together for the duration of their pregnancy in these houses, and while this meant that the women gained community and the opportunity to rest during their pregnancies, their confinement to the property lost them autonomy while pregnant.

PHOTO: Baby Gammy with his surrogate mother Pattaramon Chanbua and brother, Son Bui on Flickr

The rise of Georgian surrogacy

Georgia has recently taken the place of surrogacy destination hotspot. In 2025 a Georgian surrogacy clinic owner told the ABC that the clinic had 250 pregnant surrogate mothers; almost half of the clients were Australian.

The Georgian surrogacy boom began in the 2010s, and particularly took off when it became an alternative destination to Ukraine — a previous hotspot — at the onset of Russia’s 2022 invasion, highlighting the constantly evolving nature of the industry.

Georgia’s legal framework has been a key factor in establishing it as an attractive option. Intended parents are recognised as the child’s legal guardians from birth, and surrogates are granted no parental rights.

Like other popular fertility tourism destination countries, Georgia’s rise in popularity can also be attributed to its low cost; it is about a third of the price cheaper than having a child via surrogate in the US.

Georgia, like other states, has also experienced ethical issues around surrogacy. Last year, a surrogacy agency owner was arrested for embezzling money meant for surrogates, and one agency reportedly coerced a surrogate mother to get an abortion after the intended parents pulled out of the agreement, meaning she did not get paid.

The surrogate mothers are not just Georgian, as the demand is too high — women from other countries, including Central and Southeast Asia, travel to carry children as surrogates in the country. This puts women in an incredibly vulnerable situation by removing them from their families and homes.

The Georgian government announced that it would ban surrogacy for foreigners in 2023 largely due to concerns about exploitation of surrogate mothers, however the bill has not progressed. If it does, it will initiate another shift in the international surrogacy market, and the mistreatment of women will simply cross a border. Domestic exploitation has not changed between the industry moving from Thailand and India to Ukraine and to Georgia — so why expect that the next destination will be any different?

PHOTO: National Commission for Women addressing a press conference on ‘The National Consultation on Surrogacy Issues’ in New Delhi on October 15, 2015, Ministry of Women and Child Development on Wikimedia Commons

Criticisms of the practice

While surrogacy is seen as a hopeful opportunity to build a family in the West, the realities of the practice diverge sharply from this ideal around the world; in India, surrogate women have been housed in “baby farms,” a clinic in Greece which was used by Australians was raided on charges of human trafficking and women in Cambodia have been forced to keep and raise the babies they were carrying. The reality about the horrors of exploitation are consistently revealed about each surrogacy hotspot; women in each destination have been commodified, not adequately reimbursed, or had their lives forever altered.

Numerous — and sometimes conflicting — groups have staunchly advocated against surrogacy. Feminists, bioethicists and religious groups alike have argued that these international cases raise important points about the practice’s inherently unethical nature, or at least that of commercial surrogacy; it leads to the most vulnerable women being exploited, regardless of the intended parents’ intentions or reason for purchasing the service.

Those who oppose surrogacy argue that it is exploitative of women and disproportionately impacts those in the Global South. UN Women noted in a 2019 report that commercial surrogacy “is rife with the potential for the abuse of the women who work within it,” and recognised that women from lower socio-economic backgrounds in the Global South are disproportionately affected by the practice due to less comprehensive laws. Feminist journalist Suzanne Moore argues that surrogacy commodifies women, reducing them to objects for reproduction. She refers to surrogacy as “the renting of wombs,” and to the baby as “a consumer choice” within the practice. From Moore’s perspective, both surrogate mother and child are dehumanised in the process. The Office of the High Commissioner for Human Rights has similarly warned that “commercial surrogacy… usually amounts to the sale of children.” The late Pope Francis echoed these sentiments in 2024, condemning surrogacy as a “grave violation of the dignity of the woman and the child, based on the exploitation of situations of the mother’s material needs”, and called for its international ban.

Fertility tourism can also create significant legal issues — while some states consider the intended parents as the legal parent from birth, others consider the surrogate mother as the legal parent. This disparity in laws can leave children stateless, citizens neither to the country they were born in or the one they are supposed to be taken to.

Children’s rights are a significant point of concern for critics of the practice. The Australian father of baby Gammy and his twin sister is a convicted sex offender. The court did not consider this pertinent to the safety of the child because they found no risk of reoffending. This raises concerns that current frameworks risk placing surrogate children in the homes of potentially dangerous individuals, violating the child’s right to safety.

Surrogacy agencies are another target of criticism. There have been reports of agencies mistreating surrogate mothers, including refusing to pay women who do not comply with strict rules or who miscarry. Surrogacy agencies also make enormous profits thanks to women’s reproductive capabilities, often little of which reaches the mother, such as in India.

The practice can also lead to health complications for surrogates — pregnant women participating in gestational surrogacy had a 7.8 per cent rate of severe maternal complications, more than three times the rate of women who became pregnant naturally (2.3 per cent). Risks include postpartum infection, pre-eclampsia and postpartum haemorrhage. Surrogacy therefore excessively disposes women to serious health complications, exacerbating the gender disparity in medical outcomes in the Global South.

Support for the practice

Those who support surrogacy, on the other hand, may believe that preventing women from participating in surrogacy undermines bodily autonomy. Surrogacy can be considered a form of labour like any other job, and therefore something that women should be compensated for. Many women choose to participate in altruistic and even commercial surrogacy of their own free will, and supporters of surrogacy believe they should have the autonomy to carry children for others if they wish to.

Surrogates can also earn a significant sum per pregnancy compared to other earning opportunities in their region. Commercial surrogacy offers key opportunities to women in the Global South, complicating the introduction of legislation opposing it, and potentially even rendering these laws unethical in themselves. One Nepalese surrogate told The Guardian, “You have to lose something to gain something and what we gain is a lot more than what we lose”.

Critics of Australia’s current surrogacy laws argue that they exacerbate international surrogacy by driving buyers overseas, as the current domestic laws make it difficult for anyone to purchase the service and discourage women from providing it. Melbourne lawyer Sarah Jefford, who specialises in surrogacy law, suggests that a greater endorsement of domestic surrogacy and less prohibitive laws would help prevent the exploitation of women in international transactions.

There are also concerns that banning surrogacy would only drive it underground, and that regulation is a more effective way forward than banning surrogacy altogether.

The legality of surrogacy around the world; dark blue is “both gainful and altruistic forms and legal”, medium blue is “no legal regulation”, light blue is “only altruistic is legal”, pink is “allowed between relatives up to second degree of consanguinity”, red is “Banned” and grey is “unregulated/uncertain situation”. PHOTO: Legal situation of surrogacy, 26 February 2018, ITPCC on Wikimedia Commons

The future of surrogacy

It has been suggested by various detractors of the practice, including ethicists and the UN Special Rapporteur on violence against women and girls, that an international response to commercial surrogacy is vital to effectively preventing exploitation in the industry; while domestic reforms to surrogacy law are important, a lack of cohesive international policy allows surrogacy agencies to simply move their resources, surrogates and customer base across borders in order to continue their business operations once one country’s national law makes it inhospitable.

A recent UN Special Rapporteur’s report which referred to surrogacy as a “modern form of slavery” called for the implementation of a legally binding international strategy to prohibit surrogacy “in all its forms”. Perspectives on surrogacy vary significantly between countries, however, and this would likely be hard to implement, with standardised rules difficult to come to a consensus on.

The Hague Conference on Private International Law is looking into developing internationally consistent surrogacy regulations, including a child’s legal parenthood when born through surrogacy.

Bioethicists’ recommendations suggest taking the surrogate mother’s wellbeing into primary concern, as it is her body which is central to the process. To minimise — and ultimately eliminate — the exploitation of surrogate mothers, it is integral that they have autonomy and the ability to provide informed consent, including awareness of potential health risks.

The root of many women’s choice to turn to surrogacy stems from economic inequality. The difficulty of structural economic reform negates it being an exclusive policy option to mitigate exploitation in the industry. This reality does highlight, however, economic inequality’s intersection with surrogacy reform and how it disproportionately impacts vulnerable groups such as women and individuals in the Global South.

The main goal for the future of surrogacy should be to prioritise human rights — the wellbeing of the surrogate mother and child foremost — and to consider a holistic, humanity-driven approach to growing families, rather than using wealth as a tool to coax consent.