Hello, I'm Lucy Hawkins. From the BBC World Service, this is the Global Story. Carrying a child for someone else could be seen as the ultimate selfless act. It's also a booming global industry generating billions of dollars every year. I did it because I wanted to do it, because I wanted to create a family for someone who would otherwise not have one. Surgicy is growing in popularity, but while demand is rising, more and more countries are taking steps to ban surrogacy completely. Most recently, Italy, where the far-right government has passed a new law that makes surrogacy a universal crime, putting it on the same level as child abuse and human trafficking. Nobody is today's willing to accept the idea of people at the same sex to create a family. Today we're asking, is surrogacy exploitative or empowering? And how easy is it to balance the desire of gay or unfit our couples to become parents with the rights of the women who carry the children? With me today is Sophia Bettisa, the BBC's gender and identity correspondent. Good to have you with us. Hi! Before getting started, I think we need to acknowledge surrogacy is such a divisive issue globally. On lots of levels, on legal levels, on ethical questions as well Sophia. But I think some people are not clear what it actually is in that there are different types of surrogacy. Could you explain? Sure. So surrogacy is when a woman carries a baby for another couple. And there are two types of surrogacy, traditional and gestational. And the main difference is whether the surrogate, the woman carrying the baby, is biologically related to that baby. So if you look at gestational surrogacy, this is when the woman carrying the baby is not related to the baby. And so the embryo is created using IVF. And this is done using eggs from a donor or from the woman that has commissioned the surrogacy, the future mother, if you will. And using sperm again from a donor or from the future father. This embryo is then transferred into the surrogate's uterus. And this is the most common type of surrogacy because it's easier legally. And it's also easier emotionally in a way for everybody involved. The second, the other kind of surrogacy, traditional surrogacy is when to become pregnant, the surrogate provides her own egg. So she's genetically related to the baby and has to give up parental rights. And because legally it's really tricky and emotionally it can be very complicated. This has become far less common and it's actually banned in a lot of countries. Italy has a far right government now and they've introduced this new law that expands the country's existing ban on surrogacy. They call it a universal crime. It's not a symbol of modernity, but of an abominable society that composes desire with rights and replaces God with money. They do and a universal crime is a crime that is so serious that it's prosecuted even when it's committed abroad. So some examples would be, as you said, human trafficking, pitophilia, war crimes, genocide. So we're talking about really serious stuff here. And so this new ban would make surrogacy, which is legal in many countries that are Italy's allies, like the US, Canada, punishable in Italy. This is the most far-reaching ban in the world and there's no other country that does this. And the punishment would be quite severe. I mean, we're talking about up to two years in jail and a fine of up to one million euros. Wow, why has the government introduced this law or severe? I spoke to the MP who drafted the bill, Karolina Varkey, and she said that this is a law that is designed to help women, to protect women. She said to me that this is a business that is worth billions and that this is about, and I quote, "desperate women who need money that are exploited. Their bodies are rented for nine months and then the child is ripped away to be delivered to clients." This is a law that protects women from being exploited. We are not discriminating against children. This bill only targets the parents who commission the baby. But if you look at the political debate about this in Italy, this is a massive culture war. You've got the Deputy Prime Minister Mateo Salvini calling this a "userous for rent." Women used as cash machines. You've got some MP saying that this is a crime worse than Pirofilia. For some people, what this is really about is ideology. The right-wing government are setting its conservative credentials. Some people have said this law has been brought about and it's really targeting LGBTQ+ families. Why do they say that? I think they see this as a wider attack on the LGBT community in Italy. It's worth pointing out that most people that use surrogacy are heterosexual. We don't have the exact figures they don't exist. But people have told me it's about 90%. But the thing is, a heterosexual couple that goes abroad to have a baby through surrogacy and then comes back, they can hide it and they often do. They can fall under the radar. But two gay men, they can't hide because they need a third party to have children. And even before the ban, it was very hard for gay couples to have children. In Italy, you're not allowed to adopt. For example, you're not allowed to do anything. Because that is often the argument that is used, but someone doesn't necessarily have the right to have their own biological child. They can go and adopt. In Italy? Not possible. Exactly. So they're saying, "If you really want children, go and adopt." But the adopted children is difficult period, but it's actually illegal. It's not allowed. In Italy, a country where the Catholic Church is still very influential. And so surrogacy for years was the only option for gay couples to have children. And that's why they see this new ban as a personal attack against them. The legal consequences are big. You've mentioned the size of the fine, but also the fact that the parents could go to jail. What would then happen to the child's affair? That is unknown, because this hasn't happened yet. This ban has just come into effect. It's a legal grey area. We don't know what will happen, but that is a big worry. I spoke to a couple in Italy who had a baby on their way through Saragas. And they were absolutely terrified about going to jail for two years. That was their question. What will happen to our baby? What I do know is that the climate at the moment in Italy is difficult for these couples. The ministry for family and equal opportunities said recently in an interview that if a couple shows up, if so two men with a child show up at a doctor's appointment, that doctors should report them to the police. So I spoke to people who said that they've got a baby on their way, and they're scared of going to the hospital. And you managed to earn the trust of some gay couples in Italy to speak to them about their experiences and what they were going through. Maurizio and Mauro and Claudio and Devide, can you tell us a little bit more about their stories and what they've been experiencing? So Maurizio and Mauro are a gay couple from Milan. They have twins. They're born a girl. Thanks to a surrogate from the US. So they paid lots of money together babies. When I interviewed them because of the political climate in Italy, their babies had not been granted Italian citizenship, which means that they could have problems accessing nurseries, accessing the healthcare system, which is supposed to be free for Italians. But they were really angry about the stigma around surrogacy. Their kids are going to grow up in a country where their existence, the fact that they are born, is a universal crime. So what does that mean? At school with their friends. If something happened and we have to go to the hospital, we legally cannot take the decision for them. We should call a judge under the eye of Italian law. Before we have no relatives whatsoever with this children. The ideological battle of the government actually is damaging the children. And then Claudio and Davide, they're much younger couple. And they had a very different experience because when I spoke to them, they had a baby on their way. And they really scared. It took me a long time to convince them to talk to me. We ended up doing the interview anonymously because they were scared that somebody from the government would see the report on the BBC and target them. I'm afraid that our child won't have his appearance because of their parents are in jail. They were basically, as you said earlier, Lucy, they were scared about going to jail and what would happen to their baby. And so they were getting ready to escape. They were learning Dutch, they were learning maltees. And in their eyes, they were being forced into exile, into political asylum for wanting to become fathers. Syracuse isn't particularly a new phenomenon for thousands of years. Couples have asked women to have children on their behalf. But the first Syracuse procedure using IVF, and that's now the most common form of Syracuse. Happened only in 1986 and has only become widely available in the last two decades. So this concept of the law is a very important thing.
medical surrogacy that you've been talking about, Sophia, is relatively new. So can we look now at some of the different laws around surrogacy and the different models that exist in different countries? What's happening elsewhere? So in terms of legal frameworks, they really vary around the world. You've got countries that have a full ban on surrogacy like China, like lots of European countries, Italy, of course, but also Germany, France, Spain. And Spain's interesting because it's a left-wing government in power and Spain at the moment. It is, but what's interesting about surrogacy is that there's left-wing groups, feminist organisations that are very much against surrogacy. So as we were saying earlier, a very divisive issue across the board. You've got countries that have a partial ban on surrogacy. And examples of that are the UK and Canada. So they allow surrogacy, but only if it's not for money. So a woman would sort of put herself through this to help. Is this called the altruistic models? It is. And so the clue is in the name. There's a woman that feels like she wants to give back. She wants to give the gift of life. Yeah, I have heard some women describe this. They say it's actually a really empowering experience. Yeah, and they also say that people do it for different reasons, but they tend to say that this really gives them a purpose. You also have countries where there are no regulations whatsoever, like Kenya, Nigeria, the Philippines, that can be complicated because that's where we see examples of things that go wrong, exploitations, things not done by the book. And then finally, you've got countries where surrogacy is fully legal. And the US is a really good example. So legal and commercial. Legal and commercial. So that means a woman carrying a baby for another couple gets paid and gets paid quite a lot of money depending on the state. So states that allow this are, for example, California, Illinois and Washington, DC. So we've looked at how surrogacy laws work around the world. Next I want to explore how and why surrogacy has become a truly global phenomenon and find out the reasons that many countries oppose it. This is the global story. We bring you one big international story in detail five days a week. Follow or subscribe wherever you listen. With me is Sophia Bettisa and Sophia surrogacy is a lifeline for so many infertile and gay couples, even single people who are not able to have a child of their own. And for many it's their only opportunity to become parents. But while the demand for surrogacy and the possibilities it provides for people to have their own families is growing, the opportunities are still scarce. And this is largely because so few countries allow intended parents to pay women to carry their babies. What are the some of the big problems that we're seeing with international surrogacy? I mean there's lots of issues that can happen. One of them being disagreement between the surrogate and intended parents and those other people who you pay or commission the procedure. And those disagreements, for example, could happen if there are complications during the pregnancy, what to do, do we terminate the pregnancy or do we continue? There's also stories of women who have a miscarriage and then they are completely abandoned so they feel discarded. I found out there was another surrogate used later on in the pregnancy that I had no idea about. And I think that was the hardest thing for me because I would not have put my body through what I did if I had known that she was already getting ready to have a child. I think that was very important. One of the reasons that I did the surrogacy was to be part of a bigger picture, to be part of somebody's legacy or to help them, help them with something that they just could not have and wanted so badly. And then there's also accusations of babies being abandoned. There was this case that became quite well known a few years ago in Thailand where a surrogate gave birth to twins, a boy and a girl. The boy had Down syndrome and she said that the couple who had commissioned the surrogacy from Australia took the girl back home but the abandoned the baby. When he was conceived two years ago, baby Gamy was destined for a comfortable life in suburban Australia. Today he's growing up in a provincial Thai town with Patronmon who gave birth to him but is not his biological mother. I have no regrets she says, I don't blame anyone. I see Gamy as a blessing. Obviously that's really difficult legally, emotionally and also there can be significant health risks. So there's this new study that looked at data from women in Canada showing that a pregnancy through surrogacy can have higher risks including severe bleeding after giving birth or the risk of babies being born prematurely. So this is not a straightforward procedure. And even geopolitics and war and conflict can get in the way because I think Ukraine was a major hub for commercial surrogacy in Europe and then when the war broke out that led to all sorts of complications. It's very scary here. She says looking after these defenseless babies we can only hope it's over soon. That's right it used to be one of the key destinations especially for people coming from the UK but obviously there's no longer the case. What about the visibility of surrogacy? Now it feels like there's much more of conversation about it because we're seeing some celebrity couples talk about their experiences. Do you think that's fueling some of the demand too? I think so because we have seen in the last few years a number of celebrities having babies through surrogacy especially in the US. Paris Hilton. You and your husband became parents for the first time. Congratulations. Thank you. Baby Phoenix. Yes. Because you've talked openly about your fear of giving birth. I'm so terrified of anything to do with that needles and it all I'm just so scared. How is motherhood? I love it. I feel that this is what I was born to be. I'm so obsessed with him. He does melt my heart and he's just my world. King Kardashian, Nicole Kidman but also men, you know, Elton John, a Christian Ronaldo and so I think that has made surrogacy which is something that a few years ago we weren't really talking about more known, more visible in the public eye and especially in the US is becoming popular. I mean what I found interesting is that some US companies like Walmert or Starbucks now as part of their benefits package they cover the costs of surrogacy. Do you think the commercial element of it in the US is one of the reasons why more women are willing to become surrogates because they know that these additional costs are going to be made. It's difficult to say but I think the process in the US is meticulously regulated and the argument is that because of that everybody is sort of more protected legally. Just to give you an example of the procedure in the US there's a full background check on the surrogate. There's a psychological evaluation so she can't have had a significant history of mental health disorders or depression. She can't be a smoker or a heavy drinker. She needs to be financially stable and independent and all the medical costs are covered and obviously she gets paid as well. And what does some of these women say about the experience of being a surrogate? A lot of women have said is that this gives them a purpose. It may be that they actually want to help a friend or a family member get pregnant. It may be that they already have children and this has changed their life and they want to be able to help others so there's also an element of wanting to give back. And so for some women also it is quite transactional. They're doing this for the money and it costs a lot. I mean how much does the surrogate just give us one example? How much can they make? Yeah I mean the costs are astronomical in the US so if you're to break it down, you know first of all there's compensation for the surrogates and you know once you know that varies but once you take into account maternity clothes, loss of earnings, time off work, there is normally between 65 and 95,000 US dollars. Then you've got the medical costs and you know a single IVF cycle can cost up to 35,000 dollars and then if you're a gay couple there's additional costs because you need to, they obviously gay men can't provide eggs so they need to find a donor that's expensive. Then you've got really high agency fees so you've got the surrogacy agencies that act as facilitators so they match the surrogate with the intended parents and then you've got legal fees. So overall in 2024 the average cost of commercial surrogacy in the US can be up to 140,000 dollars but if you take other things into account it often goes up to 250,000 dollars so it's really expensive. So there is this massive global market for surrogacy, it's a fee it's already
worth almost 14 billion, but that is projected to rise to 129 billion by 2032, according to research from global markets and sites. That's a huge figure. So we're seeing this growth. We're also seeing opposition grow, not just in countries like Italy. Can you tell me about some of the other opponents to surrogacy? So religious opposition is an obvious one. In some Muslim countries, for example, like Dubai, surrogacy is banned because of interpretations of Sharia law, which emphasizes power and child relationships. The Catholic Church has been against surrogacy since the 80s, Pope Francis earlier this year called for a global ban on surrogacy. He said it's a violation of the dignity of the woman and the child. Now, you know, the fact that the Catholic Church is against this, I think it's not that surprising, right? But what surprised me when I was looking into this is that a lot of feminist groups around the world are also against surrogacy. It's deeply harmful to normalise the commodification of the female body. They essentially feel that body is rented out by rich men and then discarded. Problem is, even when we're talking about altruistic surrogacy, where no cash changes hands at all. She's making a disjointed choice. She's making a choice as a woman who, in our society and every society, has been raised to be a pleaser, to do things for others, to see her womb and her reproductive system as separate from herself in many ways. And so, you know, they see it as a struggle against a patriarchy. And what about the concerns over these women that are potentially being exploited, particularly in the developing world? I would say that this is by far the biggest concern among, if you're not necessarily religious or an activist, this is what a lot of people are worried about. You know, it raises ethical questions too, because are we treating women as objects? Is the dignity of pregnancy diminished? And especially when it comes to commercial surrogacy, that's a problem because in countries where this is not regulated, there have been examples of women who are promised a few thousand dollars, and then if they have a miscarriage, for example, they're abandoned, they don't get paid. There are some horrible stories. And is it this kind of concern that's led to surrogacy being made illegal in some countries where it was popular, I'm thinking, like Thailand and India? Exactly. So, this exactly what's happening in India, for example, India had started to become a key destination for people who wanted to go through surrogacy, but then they had a few bad experiences and they decided to impose a complete ban. What else can I do? What else can I do? Should I sell my kidney to get money? There aren't enough jobs for women. It's not easy to work anywhere also. At least as a surrogate, you can live anywhere at home or a hostel and look after yourself and your family. So, if you, what do you think the future is when it comes to surrogacy? Because we're seeing this massive growth, obviously, that we've mentioned already. And money involved, the numbers are so huge. And yet there's different laws in different countries. Is there the possibility that some international legal framework could come into place? I think that's unlikely for now, but I do think that there is growing recognition that the regulation around surrogacy is inadequate, right? And I also think that social attitudes towards surrogacy are evolving in many parts of the world. Fortunately, fertility problems and they need help and surrogacy could be a viable option. In some parts of the world, it's become perfectly acceptable for gay couples to get married, have children. And I think our idea of what a family should look like, the idea of a traditional family is changing. And I think also we shouldn't underestimate how much some people, one children, I spoke to a few couples in Italy after the barn had been passed. And they had babies on the way. They were obviously very concerned about the barn. But when I asked them, what are you going to do? Are you going to stop this? Are you going to try and get out of it? Every single one of them said to me, there's no way that's my baby. So I think because of all of those elements, I think there will be a point where governments across the world might feel pushed to reconsider their stance on surrogacy or to at least introduce some sort of regulation. Sophia, thank you so much. Thank you. Thanks so much to you for listening. If you want to get in touch, email us at the
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