In support of surrogacy: a response to the Pope's call for a universal ban

The Pope has called for a universal ban on surrogacy, condemning it as 'deplorable' and a 'violation of the dignity of the woman and child' (see BioNews 1222). This is not terribly surprising, given the Catholic Church's view on other matters relating to human reproduction, including IVF, abortion and gamete donation, although of course, it is a decision for national law-makers and not religious leaders. It also echoes the narrative being recently promoted by a small group of radical feminists that all surrogacy is exploitative. However, as professionals who work in and research the field of surrogacy, these views are difficult to reconcile with what we see on the ground.

At work there is a chasm between two alternative portraits of surrogacy. In one, surrogacy is a collaborative arrangement based on mutual trust, respect and informed consent, in which a woman volunteers to help someone else have a family. Specialist professionals (including surrogacy organisations, lawyers, counsellors, psychologists and/or medical professionals) protect those involved, ensuring informed consent and keeping everyone safe. Much wanted and loved children are brought into the world, with positive birth stories of which they are proud, and in the long term, they thrive. This is the lived experience of most surrogacy cases we see, certainly when surrogacy is practised ethically in countries like the UK and the USA.

Pope Francis seems to be referring to another, different and inaccurate picture which paints all surrogacy as inherently exploitative, as a form of human trafficking and as commodification of children. In this characterisation, surrogacy brokers facilitate wealthy intended parents to buy babies, exploiting vulnerable women and causing psychological damage to children in the process.

The examples given by those espousing this view are typically of surrogacy arrangements between Western intended parents and surrogates in countries with little or no regulation – including some countries in Africa, South America and Eastern Europe, and formerly including India (surrogacy in India having been prohibited for foreign intended parents since 2015).

Positive examples of surrogacy in places like the UK are, it is argued by some radical feminist opponents of surrogacy, an illusion: the women involved are being exploited even if they don't realise it, and it is inevitable that the children born will suffer harm.

The truth is of course that, as with almost any human endeavour, there are both good and bad examples of surrogacy. It is not disputed here that, on occasion, dubious and even criminal practices have been exposed, including last year in Crete (see BioNews 1204). The important thing is not to condemn what can be a valuable practice based on one example of exploitative surrogacy, without looking at the evidence that shows what a positive experience surrogacy can be.

Looking to the evidence on surrogacy involving UK-based intended parents, it is clear that most pregnancies do not take place in poor countries. Information from the Family Court's Child and Family Court Advisory and Support Service (CAFCASS) shows that, between 1 April 2017 and 31 October 2023, 2346 parental orders were applied for by UK parents following the births of children through surrogacy, of which a maximum of 6.4 percent involved children born in Africa (<85), South America (<41) and India (25). However, the overwhelming majority of cases (72.3 percent) involved surrogacy arrangements in the UK (<1130) and the USA (567).

There is also clear high-quality peer-reviewed research by Professor Susan Golombok demonstrating both that women acting as surrogates in such places experience positive long-term outcomes, and that children – far from suffering psychological damage – fare as well, as or better than, other children. The narrative that all children born through surrogacy are harmed is – quite simply – wrong. A recent research project, Children's Voices in Surrogacy Law, asked children born through surrogacy in the UK, or whose mothers were surrogates, about their experiences and understandings of how the process worked (including long term). Their responses were overwhelmingly positive.

Surrogacy is undoubtedly a sensitive practice, in which a careful ethical balance should be struck between the interests of the adults involved, the professionals who support them, and – most importantly – the child. Ethical surrogacy is both possible and practically achievable, especially where there is judicial or regulatory oversight. This can require all parties to undergo medical and psychological screening (to ensure suitability and to minimise risk), protections to support informed consent (such as counselling, independent legal advice and clear written agreements setting out all parties' expectations, following detailed discussion), the availability of appropriate professional support, and the retention of information for future the benefit of the child.

The UK is quite rightly moving further in this direction with the Law Commissions' recommendations for a more rigorous regulatory framework (see BioNews 1185), and such safeguards are already commonplace in the legal frameworks of many US states. In New York, for example, the Child-Parent Security Act which came into force in 2021 permits compensated surrogacy subject to significant protections including regulation of surrogacy agencies and a Surrogate Bill of Rights. Where there is a robust legal framework, the risk of exploitation and harm in surrogacy is low.

In contrast, blanket prohibitions on surrogacy are unhelpful, likely increasing the risk of exploitation by exporting surrogacy to countries where there is no law, no safeguards and a broader context of poverty, inequality and social injustice. Surrogacy is already prohibited in much of Europe, for example, and this has created a significant unmet demand which is arguably precisely what has fostered the emergence of commercial surrogacy services in less optimal ethical environments. There is no doubt that fewer intended parents would be driven to unregulated surrogacy abroad if they could access safe ethical surrogacy at home.

Surrogacy is not, as Pope Francis has suggested, inherently immoral and unethical. It is a sensitive practice involving ethical challenges, but these can be managed much more effectively through regulation than prohibition. Both in principle and in practice, seeking to ban all surrogacy is therefore not the way forward. The answer is instead to encourage policymakers around the world to grasp the nettle and manage surrogacy properly.