written by: Giulia, Pascal, Annina, Chantal, Pauline and Isabel
Surrogacy agency websites all have something in common: they are filled with baby pictures. It either looks at you with its beautiful blue eyes, or it is sleeping with pink roses around its head. “Making a couple a family”- the wording in those websites are very promising. Their mission is clear: a guaranteed baby at a guaranteed price. But what exactly is the price? In contrast to Canadian agency websites, where no prices are given, some (not all) US websites do present them. And yet, they are confusing.
Commercialisation in California
Currently, several states have laws in place that affirmatively permit surrogacy to take place within their borders. The state that has the most liberal market of surrogacy is California, even though it appears to be more expensive compared to other states. The courts in California have constantly advocated the enforcement of contracts regarding gestational surrogacy. Additionally, they have not limited the access to surrogacy, as opposed to the existing restrictions in other jurisdictions. California acknowledges the intentions of all the involved actors, whether the intent is to use one’s own genetic material, donated eggs or to artificially inseminate a surrogate. Surrogacy services are primarily provided by private, commercial agencies that screen, coordinate concerned parties and regulate agreements in accordance with their own criteria.
Altruism in Canada
Trade in the reproductive capabilities of women and men and the exploitation of children, women and men for commercial ends raise health and ethical concerns that justify their prohibition… (Assisted Human Reproduction Act, 2004)
Contrary to common belief, surrogacy is authorised in Canada. Altruistic surrogacy (i.e. prohibition to pay a surrogate mother for her services) is tolerated while commercial surrogacy – in which the woman is remunerated to act as a surrogate – is criminalised through legislation.
However, it is allowed to reimburse a surrogate mother to cover the expenses incurred as a result of the surrogacy.
The exact cost of surrogacy in Canada is difficult to estimate but, nonetheless, there is a popular belief among intended parents that surrogacy in Canada remains more cost-effective than in the United States.
Misleading cost structures
Today, only few attorneys display online prices to use reproductive technology, an egg donor, a surrogate, a fertility lawyer to draw up the required contracts, the court pleadings to certify that the birth certificate reports the intended parents and not the name of the surrogate, to receive the passport and security number for the babies. This renders the whole process of analysing the cost structures of surrogate agencies a lot more difficult.
In fact, regarding the costs, one must take into consideration medical treatments – that are not covered by regular health plans – fertility insurance, and the prices that surrogates and egg donors ask today. The total amount usually ranges from $100,000 to $200,000. This sum can vary according to the quality of the doctors, the experience of the attorneys, as well as the health condition, intelligence, academic background and physical attractiveness that intended parents look for in the sperm/egg donors and in the surrogate. Models and young women are being rewarded up to $60,000 to become egg donors. Surrogates habitually demand around $20,000 and attorney costs are estimated to $15,000. Obtaining a parental judgement for the hospital to state the names of the couples on the birth certificate adds another $5,000 to the final amount. Besides, agencies that pair you with egg donors and surrogate mothers have set fees. “With such costs always on the rise, the best way to estimate those costs are to look at an arm and a leg and multiply their worth by a factor of ten” (Gibson, 2010: page?).
Prices on surrogacy websites in California and Canada
This section attempts to understand the complex cost structures. We looked at three agency websites situated in California: The Surrogacy Program, the Coastal Surrogacy and the West Coast Surrogacy Centre. All of them stated their fees for their services in a structured, but not compatible manner. There is only one Canadian agency website that actually published their fees, namely, Surrogacy in Canada Online. The fees can be roughly divided into surrogate mother fees, program fees and other fees, such as legal issues. The problem lies in how they define and classify the costs. Moreover, there is usually an agency fee, but it does not state what this fee is for; finding a surrogate and proof screening her, or also IVF treatment?
It is difficult to find out what exactly the agency does and what not. The Surrogacy Program ensures that their “dedicated staff will help to facilitate your entire journey, from the vitro conception process through the birth of your baby”. And yet, if one looks at their cost estimate for their services, the disclaimer states that “All medical costs are payable to your doctor and are not included in this estimate.” (source?).
The table below is an attempt to place all the costs in a comparable manner. We decided to divide the costs into four sections: agency fee, surrogate mother fee (without any medical fees), medical fees, legal fees, and other expenses. While it is unclear what precisely the agency fee includes, the surrogate mother fees can be further divided into a one-time unconditional payment (not legal in Canada), maternity clothes, child care and housekeeping, monthly expenses (traveling to the clinic), and life insurance. Certain agencies also consider lost wages of the mother (and sometimes even the father) and other expenses. All of them will give the surrogate mother an extra premium when having the second surrogate child, or if giving birth to twins. There are various other costs that may be added depending on the circumstances, for example, if a C-section is needed, that is also an extra cost for the intended parents.
sources: https://www.westcoastsurrogacy.com/, http://www.coastalsurrogacy.com/, https://www.surrogacyprogram.com/, https://surrogacy.ca/,
For our calculations, we assumed a first-time surrogate mother, giving birth to one child in a natural manner, which considerably reduces the cost. The medical fees can also be misleading as some agencies list it as part of the agency fee, others as surrogate mother fee, and others again leave it out completely. We allocated medical treatments to that section, if not otherwise stated. The legal fees are very straightforward and seem to be consistent over the estimation of costs. In the other expenses, we added any number we could not allocate in a different section, such as the extra fee for international clients, or psychological support program that facilitates the connection between the surrogate mothers and the intended parents. All numbers are variable and tend to be within a range. This table always illustrates the highest possible number. The total costs in red are for international clients, receiving a first-time surrogate with a single child and no major medical complication.
Looking at the plane numbers, one can observe that they do not only vary between Canada and California, but also between Californian agencies themselves. The agency cost for the first two clinics are an average of $20,000 while the third one, West Coast Surrogacy, did not explicitly state a fee. The fee of matching intended parents and a surrogate is $1,800 and we interpreted that as the agency fee. A surrogate mother receives a payment ranging from $30,000 to $60,000 in California. For their expenses during the pregnancy they receive between $5,000 and $10,000, while the Canadian surrogate should receive around $28,000 for the same expenses.
The medical fees are the most dubious ones, as they are never explicitly stated. There is also the issue that we are not entirely sure whether or not these agencies do all the medical work or if they collaborate with other clinics, thus concluding why these medical costs are sometimes not part of their estimation (e.g. Surrogacy Program). The legal fees appear to be around $10,000 in both California and Canada. All the costs we were not able to allocate into a section also seem to vary significantly. While in Canada the total cost of a surrogate child is around $70,000, it can go way above $100,000 in Californian agencies. We believe that certain costs are not stated on the West Coast Surrogacy Website, as they have neither medical nor agency fees.
There are two interesting aspects of these numbers we would like to emphasise. Firstly, in Canada the surrogate mothers should only be compensated for all the extra expenses they accumulate during pregnancy, while in California they also receive an extra payment. But the compensation of $28,000 for a Canadian surrogate mother goes way beyond the compensation a Californian one receives for the same expenses. Thus, either the Californian surrogate mothers receive a significant lower amount for expenses arising from pregnancies, which they would have to pay out of their own pockets, or Canadian surrogate mothers are overcompensated for their service. One has to consider that there should not be drastic differences in lifestyle costs between the two countries. Another interesting fact we would like to point out is the still missing difference of prices between both regions, even if adding an unconditional payment of $30,000 to the surrogate mothers. If that is the case, there would still be a difference of prices between $10,000-$50,000. We suppose that is the agency fee that is not given by the Surrogacy in Canada Online website or is generally not allowed in Canada.
The Hidden Costs in Canada
Canada prohibited commercial surrogacy with the Assisted Human Reproduction Act. However, as altruistic surrogacy is legal, a surrogate mother is allowed to get back out-of-pocket expenses. They typically include travel costs, food, clothing, parental vitamins, childcare, medications, medical bills, and more. The range of payments can vary largely. E.g. surrogate mothers cannot be reimbursed “for a loss of work-related income incurred, unless a qualified medical practitioner certifies, in writing, that continuing to work may pose a risk to her health or that of the embryo or foetus.” (AHRA, point 12.3, a) – “reimbursement of expenditures”)
The current situation with the Assisted Human Reproductive Act as the legal source creates a lot of insecurity and a grey area regarding what counts as a “birth related expense” and what not. The expenses were thought to be set out in detail in other regulations. But as these regulations have not been drafted, those provisions are still not in force – even though being enacted in 2004.
To receive the money, the surrogates must submit receipts to the intended parents before being reimbursed. Only anticipated known expenses can be paid for in advance. They include prescriptions, accommodations, legal bills and so forth.
Nevertheless, many intended parents wish to give their surrogate mothers or egg donors a small gift, to show them their gratitude and appreciation. It is prohibited to give them a fee or a payment. But small personal gifts, such as flowers and restaurant gift cards are tolerated.
If someone is convicted to a violation to any article of the sections 5 to 7 or 9 of the AHRA, they are liable to a fine of up to 500,000 dollars or up to 10 years in jail, or both.
The issues around price systems in the case of altruistic surrogacy
So in the end, is Canada truly cheaper than the United States? The following two articles will further explain the issues of the prices’ system in Canada. The first one, from “The Star” allows a deeper understanding of the secret black-market of paid surrogacy in Canada. The government tries to have a strong control on prices of surrogacy in order to protect women and children from exploitation.
There, some people do not agree with the fact that prices do not include payment of the surrogate mother and consider that instead of protecting women, they were actually hurting them. That is why there is some under-the-table payment. A lot of parents are concerned about prices structure and would like to pay more things to support the surrogate mother.
“There is a vast grey area that allows plenty of money to change hands, with little enforcement from the government”. Those payments are mainly cash, jewellery and gift cards. They are considered as “difficult-to-trace gifts”. The article quotes a surrogate mother who claims that she received money from the parents to take her family to Disneyland.
The second article, from “CBC” is about the risk of those non-authorised payment. Paid surrogacy is punished by 500,000$ or 10 years in jail. This does not prevent parents from paying their surrogate mother. That is why they try to eliminate the gifts’ traceability by avoiding bank transfer and pay in cash. Nevertheless, some couples are afraid of the Canadian law. They feel constrained by the rules and penalties of paying their surrogates. Moreover, they do not agree with the price structure offered by the agency. As a result, some of them are forced to use the services of a surrogate found on the Internet, without the contract and support of an agency.
Many times, the rare clients who chose to go through the whole process without an agency acting as intermediary and a surrogacy lawyer disregard certain issues. They forget the insurance coverage for medical consequences or illness during the pregnancy (with medical care costs continuously on the rise today in the United States). They fail to provide specific insurance coverage for the surrogate mother, and do not address issues such as prenatal testing, vitamin complements.
Moreover, without the assistance of an expert lawyer, they tend to skip through procedures, such as psychological or infections testing of the surrogate and her companion, the egg/sperm donors. Finally, they fail to draft the contracts appropriately, to ensure that the intent and financial responsibilities of the parties, as well as the parental rights are correctly determined.