Surrogacy agency websites all have something incommon: 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 on those websites is very promising. Their mission is clear: a guaranteed baby at a guaranteed price (Circle Surrogacy, 2017). 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. This article will look at how surrogate agencies articulate prices on their websites.
California allows the commercialisation of surrogacy, where both the agency and the surrogate mother may profit from the service (ModernFamily, n.d.). Canada takes a different stance and forbids anyone to seek profit from this action. Nevertheless, a woman may become a surrogate if she does it as an altruistic gesture (Assisted Human Reproduction Act, 2004). Wasn’t surrogacy an act of altruism in the first place? Let us guide you through our research on Californian and Canadian websites to see exactly what intended parents are paying for. First, though, we want to give some more details about the current legislation in both places.
LGBT Culture, Biotech Industry and Neoliberalism
California is well known for accepting people regardless of their sexual orientation or origins. Besides its multiculturalism, the state is also famous for its constant strive for innovation. With Silicon Valley and the Headquarters of Apple, California is a centre for technological breakthroughs. Thus, it is little surprising that they are open to the surrogacy business.
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 (Gibson, 2010).
A Tale of Supreme Sacrifice and Love
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. Parties involved in commercial surrogacy are subject to criminal penalties up to $500,000 in fines and/or 10 years in prison. The surrogate mother is not subject to criminal sanction. The main objective of the penalties, as it appears from the debates, is to target those who profit the most from arranging surrogacy arrangements. Altruistic surrogacy is analogised to organ donation, and is therefore not criminalised (Ruparelia, 2007, p. 22). As Health Canada (2017) explains:
Expenses Covered in Canada
It is permitted to reimburse surrogate mothers for out-of-pocket expenses. They typically include travel costs, food, clothing, prenatal vitamins, childcare, medication, medical bills, and more (Payment to surrogate mothers, n.d.). The range of payments can vary largely.
The current situation with the Assisted Human Reproductive Act as the legal source creates a lot of uncertainty 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 (Gruben & White, 2016).
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 (Surrogacy in Canada online, 2017).
Nevertheless, many intended parents wish to give their surrogate mothers a small gift to show them their gratitude and appreciation. Indirect and disguised payments (e.g., paying a mortgage, credit card bills or school tuition) are prohibited.
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.
Who’s Doing It Right?
“Commodification versus Altruism” is a very disputed question in the literature. Amongst the scholars, diverse issues are raised.
Certain authors criticise the effects of neoliberalism on the reproductive service labour. As a matter of fact, Zelizer advocated a separation between intimate ties and monetary transfers, to avoid the contamination and degradation of the sacred act of childbearing (2005, p. 842).
But how is commodification linked to neoliberalism?
Neoliberalism promotes the idea that infertile people should take responsibility and change their behaviours and lifestyle to maximise their chances of pregnancy, while contemporarily turning reproductive labour into a commodity (Kroløkke & Pant, 2012, p. 234). Parry also denounces the victims of neoliberalism (2015, p. 33). According to her, workers are “exploited financially, in unstable outsourced employment, working under oppressive contractual service relationships in the bioeconomy” (2015, p. 33). Parry argues that neoliberal markets have already played a significant role in crossing the line between the antagonist spheres of intimate ties and economic activity. As a consequence, reproductive labour now takes place within the space of the clinics, rather than in the intimacy of home, mainly for efficiency reasons.
She also points out the implication of corporations and institutions that are opposed to worldwide regulations. Neoliberal markets allow them to maximise profits (Parry, 2015, p. 35). Nonetheless, Spar believes that international regulations will arise because surrogacy arrangements have already stretched across borders. She claims that a global legal framework could guide transactions and prevent abuse (2005, p. 306). Below, you can find a depiction of surrogacy laws around the world.
Concerns about surrogacy generally have been limited to commercial arrangements, but many of the issues in question are opposing altruistic surrogacy as well.
So, whatwhat’s wrong with altruistic surrogacy? Isn’t promoting altruism a noble goal for a nation?
Ruparelia argues that the present framework of viewing altruistic surrogacy as disconnected from coercion or exploitation relies on western ideals of the role of women in the family” (2007, p. 11). However, this ideal is problematic in all family constructs, including western ones. But is even more pronounced where patriarchal norms dictate vulnerable women their positions and control their bodies (Baker, 1996, pp. 34-35; Ruparelia, 2007, p. 11).
But on what basis?
In Ruparelia’s opinion, Canada lost an opportunity to recognise that it is dangerous to condemn one form or surrogacy, while approving another one (2007, p. 53). The socialization of women to embrace their reproductive capacities and to be valued according to their motherhood, contributes to “the moral celebration of women’s altruism that may further motivate women to give of themselves through “gift” surrogacy” (Ruparelia, 2007, p. 13). Given this assumption, the differentiation that is made between commercial and non-commercial transactions needs to be revaluated (Ruparelia, 2007, p. 13). The main reasons that justify an interrogation of the present Canadian legislation include (Ruparelia, 2007, p. 26):
– Reducing women to the value of their wombs;
– Alienating women from their maternal capacities;
– Expecting women to be natural givers.
In most cultures today, selflessness is an intrinsic part of women’s identity and their value in society and within family structures, particularly regarding reproduction (Harrison, 1983; Raymond, 1990). The ideal woman should be willing to endorse the responsibilities of motherhood (Pollock 2003; Brown 2006). It is against this background that altruism with regards to reproductive labour should be viewed. Women are expected to grasp the opportunity of becoming mothers and to help other women reach this goal (Ruparelia, 2007, p. 30). This reference to the selflessness of women is present in both the surrogate mother and the intended mother. The surrogate mother may feel an obligation to help another woman due to cultural norms. The infertile woman, on the other hand, may feel compelled through her natural urge to become a mother to conform to gender standards that dictate a fundamental desire for motherhood (Raymond, 1990; Kroløkke & Pant, 2012, p. 241; Ruparelia, 2007, p. 31). This situation extends to other aspects of reproduction, as emphasised in Almeling’s research. Her results prove that the gendered norms inspire more altruistic rhetoric in egg donation than in sperm donation, producing different regimes of bodily commodification for women and men (2007, pp. 319-340).
The different points about “Commodification versus Altruism” that have just been described are not an exhaustive summary of everything that is being discussed, but we wanted you to have a glimpse at the complexity of the topic we are dealing with.
Besides, another very controversial debate arises: How is value assigned to bodies? To attempt answering that question we employed a more empirical approach.
Misleading Cost Structures
Today, only few attorneys display online prices to use reproductive technology, an egg donor, a surrogate and a fertility lawyer to draw up the required contracts to certify that the birth certificate reports the intended parents and not the name of the surrogate in order 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 USD 100,000 to USD 200,000 (Gibson, 2010). 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 (Tober, 2001, pp. 139-140). Surrogates habitually demand around USD 20,000 and attorney costs are estimated to USD 15,000. Obtaining a parental judgement for the hospital to state the names of the couples on the birth certificate adds another USD 5,000 to the final amount. Besides, agencies that pair you with egg donors and surrogate mothers have set fees (Gibson, 2010).
What are Intended Parents paying for?
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 comparable manner. There is only one Canadian website that actually published estimation of 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 “[a]ll medical costs are payable to your doctor and are not included in this estimate.” (The Surrogacy Program, 2017).
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 fees, surrogate mother fees (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, which is also an extra cost for the intended parents.
For our calculations we assumed a first-time surrogate mother, giving birth to one child naturally, 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 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 medical complication.
Looking at the plain numbers, one can observe that they do not only vary between Canada and California, but also between Californian agencies. The agency cost for the first two clinics are an average of USD 20,000 while West Coast Surrogacy did not explicitly state a fee. The fee of matching intended parents and a surrogate is USD 1,800 and we interpreted that as the agency fee. A surrogate mother receives a payment ranging from USD 30,000 to USD 60,000 in California. For their expenses during the pregnancy they receive between USD 5,000 and USD 10,000, while the Canadian surrogate should receive around USD 20,850 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 these agencies do all the medical work or if they collaborate with other clinics. This could be the reason why these medical costs are sometimes not part of their estimation (e.g. Surrogacy Program). The legal fees appear to be around USD 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 USD 70,000, it can go way above USD 100,000 in California 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 aspects about these numbers that we would like to emphasise. Firstly, in Canada the surrogate mothers may 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 USD 20,850 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 expenses linked to the surrogacy. 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 USD 30,000 to the surrogate mothers. If this is the case, there would still be a difference of prices between USD 10,000-40,000. We suppose this is the agency fee that is not given by the Surrogacy in Canada Online website or is generally not allowed in Canada.
Black Market and Imprudence in Canada
In this part, we would like to present you with a selection of newspaper articles that highlight the underground activity that has arisen in Canada.
One article denounces the mismatch between supply and demand that has led to a cut-throat competition. It has pushed intended parents to demonstrate generosity beyond what is tolerated by law. Remuneration takes the form of difficult-to-trace gifts and surreptitious payments. Surrogate mothers and the agencies have started to question the benefits of the law. Intended parents feel constrained by the rules and penalties for paying their surrogates (Cribb, 2016).
As a matter of fact, there has only been one conviction under the nine-year old law. In 2013, a fertility agency owner pleaded guilty to purchasing eggs, paying surrogates and taking money for arranging surrogacies. Her agency (Canadian Fertility Consultants) also pleaded guilty. Their fine amounted to CAD 60,000 (roughly USD 45,000) (Canadian Medical Association Journal, 2014).
Another risk of the increasing competition is the use of the internet to find a surrogate, without a contract and support of an agency. Many times, the clients who choose to go through the whole process without intermediaries disregard certain issues. They forget the insurance coverage for medical consequences or illness during the pregnancy. They fail to provide specific insurance coverage for the surrogate mother, and do not address issues such as prenatal testing or 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. (Gibson, 2010).
The Perfect Destination
Looking back at our research, we are still not able to provide an answer to where one might best go for a surrogate child. Is giving birth to somebody else’s child a noble service? And how much should the surrogate mother be paid for? Is she being exploited? Those are questions that we leave unanswered but we have exposed the necessary arguments to allow everyone to make up their own mind about the topic. As a matter of fact, the five of us have diverging opinions on this matter.
Want to share yours with us? Leave us a comment below!
ABC news. (2014). Woman Sets Out to Ban Surrogacy. Retrieved from http://abcnews.go.com/Health/woman-sets-ban-surrogacy/story?id=24262290
Almeling, R. (2007). Selling Genes, Selling Gender: Egg Agencies, Sperm Banks, and the Medical Market in Genetic Material. American Sociology Review, 72, 319-340.
Baker, B. M. (1996). A Case for Permitting Altruistic Surrogacy. Hypatia, 11(2), 34-48.
Brown, W. (2006). American nightmare: Neoliberalism, neoconservatism, and de-democratization. Political Theory, 34(6), 690–714.
Canadian Medical Association Journal. (2014). First prosecution under Assisted Human Reproduction Act ends in conviction. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3903755/
Circle Surrogacy Centre. (n.d.). Full Service, Worldwide Surrogate Parenting Agency. Retrieved from: http://www.circlesurrogacy.com/
Creative Family Connections (n.d.). Gestational Surrogacy Law Across The United States. Retrieved from: http://www.creativefamilyconnections.com
Cribb, R. (2016). Canada’s vague surrogacy laws may be doing more harm than good. Retrieved from: https://www.thestar.com/news/canada/2016/09/18/canadas-vague-surrogacy-laws-may-be-doing-more-harm-than-good.html
Gibson, R. S. (May 22, 2010). California Surrogacy and Fertility Law – Assisted Reproductive Births and Motherhood. Retrieved from: https://www.avvo.com/legal-guides/ugc/california-surrogacy-and-fertility-law—assisted-reproductive-births-and-motherhood
Gruben, V. & White, P. (2016). Surrogacy in Canada should give us cause for concern. Retrieved from: https://www.theglobeandmail.com/opinion/surrogacy-in-canada-should-give-us-cause-for-concern/article32091525/
Harrison, B. W. (1983). Our Right to Choose: Toward a New Ethic of Abortion. Boston, MA: Beacon Press.
Health Canada. (n.d.). Prohibitions related to surrogacy. Retrieved from: http://www.hc-sc.gc.ca/dhp-mps/brgtherap/legislation/reprod/surrogacy-substitution-eng.php
Kroløkke, C. H. & Pant, S. (2012). “I only need her uterus”: neo-liberal discourses on transnational surrogacy. Nordic Journal of Feminist and Gender Research, 20(4), 233-248.
Modern Family Surrogacy Centre. (n.d.). What are the State laws in California for Surrogacy?. Retrieved from: http://www.modernfamilysurrogacy.com/page/state_laws_in_california_for_surrogacy
Parry, B. (2015). Narratives of neoliberalism: ‘clinical labour’ in context. Medical Humanities, 41(1), 32-37.
Pollock, A. (2003). Complicating power in high-tech reproduction: Narratives of anonymous egg donors. Journal of Medical Humanities, 24, 241–263.
Raymond, J. G. (1990). Reproductive gifts and gift giving: The altruistic woman. Hastings Center Report, Nov/Dec, 7-11.
Ruparelia, R. (2007). Giving Away the ‚Gift of Life‘: Surrogacy and the Canadian Assisted Human Reproduction Act. Canadian Journal of Family Law, 23, 11-54.
Spar, D. (2005). For love and money: the political economy of commercial surrogacy. Review of International Political Economy, 12(2), 287-309.
Tober, D. M. (2001). Semen as Gift, Semen as Goods: Reproductive Workers and the Market in Altruism. Body & Society, 7, 137-160.
Zelizer, V. A. (2005). The Purchase of Intimacy. Law and Social Inquiry, 25(3), 817-848.