Editor's Note: This is the first part in a series on surrogacy, titled "Renting a Womb." Read Parts 2 and 3.
Surrogacy, an arrangement in which a woman carries and births the biological child of another individual or couple who will raise the child, is a complex issue from a medical, legal and moral standpoint, though the few statistics available about the practice suggest it is on the rise.
There are two types of surrogacy, traditional and gestational. In traditional surrogacy, the surrogate is artificially inseminated and becomes the genetic mother of the child. In gestational surrogacy a fertilized egg is implanted in the surrogate, who then carries the child until birth but has no genetic relation to the child.
A 2010 report from the Council for Responsible Genetics says there are hardly any statistics available on the prevalence of surrogacy in America. Based on information from the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology, however, the report states that the number of children born as a result of gestational surrogacy nearly doubled between 2004 and 2008, from 738 births to almost 1,400.
"These numbers, while only skimming the surface of the entire surrogacy market, will surely continue to rise," the report states.
But who is using this nontraditional method of building a family? Dr. Samantha Pfeifer, chair of the American Society for Reproductive Medicine's Practice Committee, says those who use surrogates are typically couples who cannot have children naturally.
"[The women] desire to have a biological child with their partner or spouse but they're unable to because they lack a uterus or a competent uterus," Pfeifer told The Christian Post. Issues such as repeated miscarriages or the removal of the woman's uterus due to cancer are among the reasons she says some couples turn to surrogacy.
On the surrogate's end, there isn't much to be gained financially, said Pfeifer, except in some high-profile cases.
"They are basically reimbursed for expenses," she said. "Typically, with the majority of surrogates, there is not a huge amount of monetary advantage to being a surrogate."
She later added: "The intention is not to coerce women to do this. The intention is to pay for expenses, loss of time from work and things like that, but it's not intended to be a huge amount of money that could potentially be viewed as a coercion."
An ideal surrogate is, among other things, a woman who has already successfully given birth to a child, said Pfeifer. In some cases she is a family member or friend of those who want a child, while in others she is someone who is found through a surrogacy agency.
In addition to medical exams, psychological evaluations are also recommended for both the surrogate and the would-be parents before proceeding.
"It's a very important part of evaluation," Pfeifer noted. "Again, do no harm. We don't want to do anything to potentially harm the person carrying the pregnancy or the baby."
A couple will typically undergo the in vitro fertilization (IVF) process of collecting eggs and fertilizing them in a lab. Those that become embryos are either placed in the uterus of the surrogate or are frozen for later use. Sometimes, based on the age of the eggs, several embryos are inserted into the surrogate at once to increase the likelihood of successfully impregnating the surrogate.
In addition to couples whose childbearing has been hindered by medical issues, many surrogacy agencies also promote their services to gay couples. The website for Modern Family Surrogacy Center in El Cajon, Calif., for example, points out that "California provides one of the most favorable legal climates" for gay couples to use a surrogate because both partners can be listed as parents on the child's birth certificate without having to go through a second-parent adoption process.
Surrogacy laws vary from state to state, however. California, Illinois and Nevada have statutes permitting surrogacy and also provide regulatory structure for the practice, according to the website for Creative Family Connections, a Maryland-based surrogacy company. Washington, D.C., by contrast, has made it illegal to enter into or help form a contract for surrogate parenting.
A bill that would have also banned surrogate parenting contracts in Kansas was withdrawn by its sponsor, Sen. Mary Pilcher-Cook, following a hearing last week, according to ASRM. Opponents of the bill argued that surrogacy should remain an option for women who cannot have children naturally, The Associated Press reports, and socially conservative Republicans were divided on the issue.
The Kansas Catholic Conference and other supporters of the bill said they were concerned about the health of surrogates and the children born to them because there is no state law pertaining to surrogacy contracts. They also said allowing surrogacy could result in the exploitation of poor women and the commodification of children.
"Surrogacy undermines the dignity of women, children and human reproduction," said Jennifer Lahl, president of the California-based Center for Bioethics and Culture, according to AP. "Consider deeply what is at stake for the dignity of women and what is in truly the best interest of the children."