ICAMS would like to warmly thank all its members and friends for their valuable and necessary contributions in response to the call for contributions from Reem Alsalem, UN Special Rapporteur on violence against women. All of this rich and diverse work allows us to highlight new arguments and critical perspectives on surrogacy, while strengthening our case for its global abolition.
Several major themes emerge from the contributions received, highlighting the systemic dimensions and violations inherent in the practice of surrogacy.
Firstly, the main arguments are repeated. Surrogacy is denounced as a form of violence that is inherently against women, in accordance with the definition of violence against women established by the UN in 1993. ICAMS members emphasised that this practice causes physical and psychological harm and deprivation of liberty, targeting women exclusively because of their reproductive capacity. Medical risks, forced separation from children and economic exploitation are all specific forms of violence that only affect women, as no men are exposed to such dangers. This includes reproductive violence (pregnancy imposed under economic or social pressure), psychological violence (control of habits and movements), obstetric violence (unnecessary invasive medical interventions), and violations of fundamental rights (deprivation of liberty, separation of mothers and children, lack of postpartum care).
Contributions also highlighted the economic and social exploitation linked to surrogacy. Members emphasised how this practice benefits from geopolitical inequalities and the feminisation of poverty worldwide. Vulnerable women, particularly migrants or those in precarious situations, are specifically targeted by surrogacy agencies, which promise them financial benefits that are often derisory compared to the profits generated by this industry. The testimonies gathered reveal cases of deception, abusive contracts and economic pressure that nullify any possibility of free and informed consent. Some contracts impose draconian restrictions (prohibiting smoking or travel), financial penalties in the event of breach, or even allow buyers to decide whether to keep the mother alive in the event of a coma.
From a medical standpoint, ICAMS members have documented serious health risks for women engaged in surrogate pregnancies. Invasive procedures such as ovarian stimulation, multiple embryo transfers and forced caesarean sections expose surrogate mothers to potentially life-threatening complications. Experimental hormone treatments, such as Medrol, have been linked to cases of heart failure and other serious conditions. Contributions have also highlighted the priority given to ‘embryo success’ at the expense of mothers’ health, an approach that violates medical ethical principles. Recent studies (Rasouli et al., 2020; ., 2024) confirm an increased rate of prematurity and maternal morbidity (7.8% for surrogacy compared to 2.3% for natural pregnancies). There is also a very high rate of caesarean sections (77% compared to 41% in conventional IVF).
The psychological violence suffered by surrogate mothers was another central point of the contributions. ICAMS members described the trauma associated with forced separation from the child, a practice often encouraged by contracts and agencies. Surrogate mothers are encouraged not to become attached to the child, which leads to traumatic dissociation mechanisms comparable to those observed in victims of prostitution. The testimonies collected illustrate cases of postpartum depression, unrecognised grief and lasting psychological suffering. The psychosocial stress and lack of maternal-foetal bonding caused by immediate separation are also documented.
The rights of children born through surrogacy have also been a central concern. ICAMS members recalled that these children are deprived of their fundamental right to know their origins, in violation of Article 7 of the Convention on the Rights of the Child. Cases of abandonment of children with disabilities or of the ‘wrong sex’, such as that of baby Gammy, were cited as flagrant examples of violations. Furthermore, the legal erasure of the biological mother from birth certificates denies the child’s identity and history, creating identity issues and emotional trauma.
Contributions also highlighted the links between surrogacy and human trafficking. ICAMS members argued that this practice should be analysed as human trafficking, in this case of women. Indeed, it meets the criteria for human trafficking defined by the Palermo Protocol, in particular due to the systematic deception of women recruited as surrogate mothers, their forced displacement and the exploitation of their economic vulnerability. Documented cases report Roma women being exploited in Greece and Ukrainian mothers being transferred to the Czech Republic to circumvent national laws.
Furthermore, women are often confined to strict conditions during their pregnancy, under the supervision of agencies, which constitutes a form of deprivation of liberty.
Finally, ICAMS members criticised legal loopholes and the complicity of States in perpetuating this exploitation. Legal shopping, where commissioning parents exploit legal loopholes between countries, was denounced as common practice. Agencies and clinics operate with impunity, protected by lax or non-existent legislation. Contributions called for a binding international framework to prohibit surrogacy, drawing inspiration from existing instruments such as the Istanbul Convention and the Palermo Protocol.
To summarise these arguments more comprehensively, we have classified them into 10 main points:
Economic exploitation and reproductive racism:
Surrogacy is part of a logic of commodification of women’s bodies, primarily targeting vulnerable populations. The data collected reveals a global market estimated at $200 billion by 2034, where surrogate mothers, mostly from poor countries or in precarious situations, receive only a tiny fraction of the profits made by clinics and agencies. For example, in the United Kingdom, spending on egg donations is capped at £985 (2024), with the possibility of serving up to 10 families, a financial incentive for women in precarious situations. This is particularly striking when we consider that 55% of British surrogate mothers report a family income of less than £40,000 per year (2022 study of 47 women). Deception is a common tactic, involving promises of payments that are not paid in full or are dependent on arbitrary criteria. In Ukraine, India and Kenya, women are recruited under financial pressure, sometimes in debt, and subjected to abusive contracts. Documented accounts show exploitation based on geopolitical inequalities, where the bodies of racialised women become mere reproductive resources at the service of rich countries. Paid less than 5% of the profits generated, surrogate mothers suffer organised precariousness, with fraudulent contracts and conditional payments. The lack of transparency in contracts and the economic dependence of women place them in a position of extreme vulnerability.
Medical and psychological violence:
The procedures imposed on surrogate mothers constitute serious violations of their physical and mental integrity. Intensive ovarian stimulation, multiple embryo transfers and forced caesarean sections lead to increased risks of cancer, hyperstimulation syndrome and death. A Canadian study of 863,017 births (2012-2021) reveals that surrogate pregnancies (806 cases) triple the risk of complications. Documented cases include a 25-year-old Mexican woman who died of postpartum haemorrhage and a 29-year-old British woman (Natasha Caltabiano) who died during her first surrogacy pregnancy. Testimonies describe cases of postpartum depression, unrecognised grief and traumatic dissociation, comparable to those observed in victims of trafficking. The surrogacy industry systematically denies this suffering, prioritising the ‘success of the embryo’ over women’s health. Women are denied the right to bond with their unborn child, are forced to meet the expectations of the “commissioning parents” and are blamed for any complications. It is clear that women are deprived of their autonomy and control over their bodies and reproductive decisions. It is also relevant to add that, although it is not a form of violence explicitly documented in all cases of surrogacy, there is a latent risk of sexual violence. In contexts of exploitation and lack of autonomy, pregnant women may be vulnerable to sexual abuse.
Violations of children’s rights:
Children born through surrogacy are deprived of their fundamental right to know their origins, in violation of the International Convention on the Rights of the Child. Cases of abandonment, particularly on the grounds of disability or ‘wrong sex’, are on the rise, while legislation facilitates the legal erasure of surrogate mothers. Longitudinal studies reveal alarming rates of psychological disorders among these children, who are confronted with a fragmented identity and artificial family ties.
Complicity of states through legal loopholes:
Despite official rhetoric, many countries turn a blind eye to transnational surrogacy, allowing it to expand. Inconsistent legislation, such as in France and Spain, recognises children born through surrogacy abroad while prohibiting the practice on their own territory. This hypocrisy encourages ‘reproductive tourism’, where the richest exploit legal loopholes in Southern countries. Worse still, some countries, such as Israel and certain US states, partially regulate surrogacy domestically while outsourcing exploitation to less regulated countries.
Exploitation of LGBTQ+ struggles:
While surrogacy is often presented as a ‘step forward’ for same-sex couples, the data shows a very different reality. Male gay couples account for a growing share of demand, while lesbians are sought after as egg donors or ‘solidarity’ surrogate mothers. This dynamic reproduces patriarchal patterns, where women remain instrumentalised in the service of male parenthood. (61% of surrogacy in the UK (2022) involves male same-sex couples, fuelling an unregulated transnational market.)
Human trafficking:
The links between surrogacy and trafficking are undeniable. Beyond organised networks recruiting vulnerable women, the practice of surrogacy itself must be considered human trafficking. The United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, commonly known as the Palermo Protocol, defines the constituent elements of human trafficking as follows: The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of an authority or of a position of vulnerability or of the offer or acceptance of a reward or benefit to achieve the consent of a person having control over another person, for the purpose of exploitation.
In surrogacy, all women are recruited to become ‘surrogate’ mothers through the following deception:
- That they are not the mothers of the children they give birth to.
- The children they give birth to are not their children.
- Not being the mothers of these children, they do not sell or give them away, but return them to their parents
- That the process they are about to undergo is an assisted reproductive technology, which gives the practice an authoritative character. However, surrogacy as such, with its multiple actors outside the medical field, cannot be classified as an assisted reproductive technology.
It is also important to note that testimonies from surrogate mothers in Ukraine, Argentina and India reveal conditions akin to modern slavery, with confiscation of identity papers, isolation and post-natal violence.
Institutionalised medical terrorism:
Research highlights medical practices of chilling brutality, amounting to a contemporary form of scientific barbarism. In particular, there is the systematic administration of experimental hormone treatments to women used as surrogate mothers, often without their informed consent. These protocols have high rates of serious complications (pulmonary embolisms and liver failure eight times higher than those observed in natural pregnancies), according to ENoMW data from 2024. In addition, there are documented cases of 37 Ukrainian surrogate mothers who have been subjected to selective late-term abortions, up to 28 weeks of gestation, under pressure from inhumane contractual clauses. There is also widespread misuse of cancer drugs, such as methotrexate, which is used to perform multiple embryo reductions. These procedures, carried out for reproductive profit, often leave patients with irreversible neurological damage.
Transnational criminal networks:
The analysis reveals the integration of surrogacy into international organised crime networks. No fewer than 89 clinics were identified by the 2023 joint Interpol-GFI report as hubs for money laundering. Systems of ‘rotation’ of surrogate mothers between several countries, including Georgia, Cyprus and Mexico, allow the organisations involved to circumvent local regulations and escape prosecution. There is also strong evidence of collusion between some surrogacy agencies and prostitution networks: in Greece, 14% of registered egg donors were recruited in strip clubs, highlighting the porous nature of reproductive and sexual exploitation.
Transhumanism:
Finally, some contributions warn of the transhumanist drift of artificial reproduction. In the United States, experiments with artificial wombs have been conducted on 23 women in a vegetative state, now at the centre of a high-profile trial in Texas. At the same time, the ‘WombChain’ project aims to create an NFT-type platform to commodify reproductive capacities in the form of digital tokens, establishing a speculative economy around the female body. Some biotechnology companies have gone so far as to file patents for the rental of genetically modified wombs, crossing a new frontier in the commodification of life.
Symbolic violence for all women:
Surrogacy reinforces and perpetuates deeply entrenched and harmful gender stereotypes. It reinforces the patriarchal idea that women are mere reproductive instruments, whose main function is motherhood and the satisfaction of male desires. Their generosity and money take precedence over any critical perspective on the injunction to motherhood.
Having addressed all these issues, ICAMS reiterates and maintains its commitment to the global abolition of surrogacy, an inherently violent and exploitative practice. The contributions of our members and friends enrich our understanding of the issues at stake. We call on the international community, states, and all individuals to understand the issues raised here, to recognise surrogacy as a violation of human rights, and to take concrete measures to end it.
For further information and a more detailed understanding of these contributions, please follow the links below:
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