Transnational Surrogacy Is A Major Feminist Issue But Not Enough People Are Talking About It

By Nick Cesare

In 1977, the first in vitro fertilization procedure (IVF) was carried out in the UK. Several decades later, the phenomenon known as medical tourism began to take off throughout the United States and parts of Europe as patients sought out healthcare at lower costs. Together, these two things have led to the controversial process of transnational surrogacy.

Surrogacy is a process that many of us have probably heard about; usually it involves a couple who wants to have a baby, their genetic material, and a surrogate mother who carries that fetus to term. Western women choose to go with surrogate pregnancies for a variety of reasons: they may be unable to carry a child themselves, they concerned about losing their jobs due to pregnancy, or they may simply not want to become pregnant for personal reasons.

Those who choose surrogacy in the United States must come face to face with the nearly crippling cost: anywhere from $80,000 to $120,000. This incredible financial burden is not unwarranted, given the invasive and difficult work that a surrogate must carry out for nine whole months, but it’s enough to drive less wealthy women away from domestic surrogate mothers.

Instead, these women have turned to healthcare providers in the global south, where medical care costs less and is often of comparable quality to what you might find in the United States or Canada. However, hiring the services of a surrogate mother in a country like Thailand or Malaysia is nothing like getting cheaper knee surgery overseas. Instead, the demands of being a surrogate coupled with problems that women in the global south face create unique issues for transnational surrogacy. Let’s go over some of those together so that we can all be more informed about an important global feminist issue.

It’s Tough To Be A Surrogate Mother

Being a mother is already hard enough, but things are even tougher for surrogate mothers. Here’s why:

The work is incredibly difficult

These women must give donor couples unprecedented access to their personal lives and must carefully regulate their activities and diets. When you are carrying a child on behalf of another party, you can get in a lot of trouble for something as simple as eating contaminated ice cream, which can increase the risk of a miscarriage.

Job security is non-existent

Speaking of miscarriages, they can be incredibly difficult experiences for non-surrogate mothers who have to cope with the emotional fallout of losing a child. On top of this, however, surrogate mothers must treat a miscarriage like losing a job, especially in the global south, where there are few protections for workers and very little in the way of guarantees to keep buyers liable. Even here in the United States there is insufficient recognition of surrogacy as a legitimate line of work. Susan Markens, associate professor of sociology at Lehman College, refers to the United States as “the Wild West of reproductive medicine,” thanks to the lack of regulation surrounding reproductive work.

In fact, there are absolutely no federal laws regulating surrogacy, and supporting surrogacy contracts, in the United States. Instead, surrogates have to look to either state surrogacy laws, which not every state has, or try their luck in the courts if they feel wronged in the course of their work. This general lack of regulation is just another way in which state and federal governments undermine women’s’ rights to their own bodies.

The work is underappreciated

This lack of recognition seems to be a symptom of a general lack of respect for stereotypically feminine work. Jobs that involve housekeeping, care-giving, and child-rearing are not as well-respected as their masculine counterparts. This cultural attitude creates problems when it comes time to draw up rules and regulations for jobs that are done exclusively by women, since these lines of work aren’t able to piggyback on pro-worker attitudes in more masculine jobs.

And It’s Worse For Surrogates Overseas

What makes transnational surrogacy a unique issue of its own, and not just an issue to be lumped in with the problems that all surrogate mothers face, is the special plight of women in the global south.

Transnational surrogates face unique problems

Alison Bailey points out at least two problems that are unique to transnational surrogacy. The first is that, in many countries in the global south, surrogacy is poorly understood and seen as a form of sex work. Setting aside the fact that there should be no stigma surrounding sex work, this opens up surrogate mothers to violence and harassment based on this misunderstanding.

Second, western women (and couples) who are seeking out surrogates overseas have demonstrated a preference for lighter skinned surrogates, even when the surrogate has no genetic connection with the child that they will bear. This practice of picking lighter skinned women just serves to exacerbate the racial divide along the poverty line, as darker skinned women are left behind when western money comes to town.

That’s not all that transnational surrogates have to deal with, though. Think about why many women in poverty try to find jobs: they have children of their own they need to support. Unfortunately, the demands of surrogacy can make it difficult for these women to take care of their own children, because their full time job is to be pregnant with the child of another person. Situations like this may be why only 39% of children in the global south are breast-fed for the first six months of their lives.

Finally, women in the global south are not always well-educated about reproductive medicine and the contracts that they are entering into. They may not fully understand what is involved in pregnancy before signing on to be surrogates or, even worse, find themselves abandoned and unable to find medical care for complications that arise after the child has been delivered. Given that they lack access to powerful regulatory agencies that can defend their interests, it is not uncommon for these women to be abandoned by contracting couples or the agencies that represent them. Sometimes they don’t even receive payment after the child has been born.

And these problems aren’t properly recognized

People in the west taking advantage of questionable working conditions in the global south is nothing new. One popular argument goes like this: people in the global south, especially women, wouldn’t be able to get jobs at all if not for opportunities created by western consumers. Therefore poor working conditions, while unfortunate, are acceptable because they are preferable to the alternative.

I don’t want to turn this piece into a rant on the problems with western industry in the global south at large, so I’ll try to stay focused on the issue as it pertains to transnational surrogacy. Tuned specifically to surrogacy, the argument is basically that western women do women in the global south a service by hiring them as surrogates, excusing the poor working conditions.

The suggestion here is that we shouldn’t be too bothered by awful conditions for transnational surrogates because these women seem to have chosen this work. However, to say this is to ignore the realities of life for women in the global south. A “choice” between attaining basic standards of living or not attaining them is no choice at all, so transnational surrogates cannot be saddled with the blame for the conditions of the work.

What’s The Right Way Forward?

It’s easy to point out problems and cry foul whenever we see an instance of exploitation, but this alone doesn’t achieve much. While transnational surrogacy places women in the global south in difficult conditions, pulling all surrogacy work back to the United States isn’t necessarily the solution. After all, surrogacy, well-regulated and well-understood, can be a promising line of work for some women.

It seems to me that reform must start at home. Here in the United States we have very little in the way of legal protections or cultural respect for surrogate mothers. In an era where some government officials seem so concerned with controlling women’s bodies, legislation that identifies the work of surrogates as legitimate would be a huge step forward. In my mind, such laws would raise the legal standing of the work that a woman does with her own body to that of any other sort of work. If a woman can use her body to build a skyscraper and be recognized, but not be recognized when she uses that same body to carry a child, that is not right.

Hopefully, respect for surrogates at home backed by the full force of the law will make it harder for contract parents to fail transnational surrogacy and a make it harder for predatory agencies to find western clients.

The responsibility for reform lies with western women and couples who seek out the services of transnational surrogacy. It is up to us to make ourselves aware of the challenges that transnational surrogates face and to use our power as consumers to shop responsibly, as it were. This means interacting with potential surrogates openly and honestly, to make sure that they understand what they are getting into and that they get the fairest treatment from western consumers.




Nick Cesare is a writer from Boise, Idaho. After completing his Masters in medical ethics at the University of Colorado at Boulder, he enjoys writing on difficult subjects in healthcare, especially as they disproportionately affect women. You can follow him on Twitter @cesare_nick



  1. Nick, please check out our international campaign We are feminist/activist/academics from all over the world very much involved in this issue – the only right/ethical way forward is for a global ban on surrogacy, which is exploitative of women and children.

    • Thanks for reading the piece and commenting, Jennifer. It’s wonderful that you and many others are engaging with this issue. We agree that surrogacy is presently being used to exploit women in some awful ways, but I’m not sure that regulating women’s bodies by blocking them from entering into contract pregnancies under conditions of informed consent is the right way forward. Do you think that it’s possible for surrogacy work to be structured in a way that allows women to enter into that work of their own free will and under conditions that they find acceptable?

  2. Rachel Owen says:

    I read a book by one Indian woman. She is sociologist if I remember correctly. But not this is important. She wrote a book about surrogacy. In particular it concerns Indian surrogacy. And in that book she proposed to make surrogacy as a job. She also writes about unions of surrogate mothers. The author opens a new side of this procedure. And it is right I think. Surrogacy is extremely popular today. It is impossible to stop it. Thus, maybe it will be better not to ban. It’s better to regulate this issue properly. Needed conditions and rules can be created. It will help to conduct the procedure on the high level. And all will be happy and satisfied.

  3. Mia Mackenzie says:

    Why some people consider surrogacy to be woman’s exploitation? You know a great number of woman want to become surrogates. One makes it for altruistic purposes. They are happy to help infertile. Others can make it for money. It is a great possibility for poor woman who has own children and family to earn some money. It can be done in a great way. In case, when it’s a civilized procedure it can be. There are countries where surrogacy is legal. I know Ukraine for example. All rights are protected by the law. And no one suffers. All procedure parties are happy. And all are satisfied. These are not only infertile couples but surrogates as well. They come to the clinic by own wish. And they realize what they do. No one force them to become a surrogate.

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