A Comprehensive Review of Transnational Surrogacy: Ethical and Legal Challenges

Background and Purpose: Infertility and involuntary childlessness affects an estimated 40.2 to 120.6 million women aged 20-44, and of these women, 12 to 90.4 million are likely to seek out artificial reproductive technologies. Consequently, surrogacy has become a growing, worldwide enterprise. However, limited information exists about the ethical implications for all parties involved. The purpose of this comprehensive review is to identify the legal and ethical challenges faced by intended parents and surrogate mothers in international surrogacy arrangements.

Method: Peer-reviewed articles were identified through electronic databases including Pubmed, Academic Search Complete, CINAHL Plus with Full Text, SocINDEX  with Full Text, and PsycINFO from 2005 to 2014 using the search terms "commercial" or "tourism" or "travel" or "transnational" or "cross-border" AND "surrogate mother" AND "ethic" or "bioethic". 98 articles matched the search terms, and 11 articles were included in the final analysis through inclusion and exclusion criteria. Articles were coded thematically using the constant comparative method of qualitative data analysis.

Results: Data analysis revealed not only the legal needs of surrogate mothers and intended parents, but also the lack of ethical standards in international surrogacy arrangements. Five themes emerged from qualitative analysis: (1) informed consent, (2) custody rights, (3) surrogate care, (4) remuneration, and (5) conflicts of interest. First, findings indicate that many surrogate mothers are not provided with full informed consent before agreeing to an arrangement, and compensation for surrogates is often misleading and does not elevate their economic situations. Second, international custody battles over resulting children can harm surrogates, intended parents, and resulting children. Third, surrogacy clinics are involved in multiple conflicting roles that could be damaging to surrogates and intended parents, and as a result, the social and mental health needs of surrogates are often neglected during and after pregnancy.

Implications: The rapid growth of transnational surrogacy presents multiple legal and ethical concerns for surrogate mothers and intended parents. Results indicate that international surrogates' needs are often neglected. Findings highlight a need for universal guidelines on international surrogacy to assist each party with decision making. Furthermore, the results have implications for developing effective strategies to address the needs of surrogate mothers - physically, mentally, and socially - in a more comprehensive manner. Transnational surrogacy practices require the attention of social workers who can address and develop ethical responses to these emerging issues.