Why are some countries banning surrogacy? - The Global Story podcast, BBC World Service

Hello, I'm Lucy Hockings from the BBC World Service. This is The Global Story. Today, Italy brings in some of the most stringent surrogacy laws in the world.

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. Surrogacy 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. So is surrogacy exploitative or empowering? And how easy is it to balance the desire of gay or infertile couples who want to become parents with the rights of the women who carry the children?

With me today is the BBC's Sofia Bettiza, who is the BBC's gender and identity correspondent. Sofia, before we get started, I think we need to acknowledge it's such a divisive issue globally because it raises not just legal questions, but for a lot of people, there are ethical questions as well, at the very heart of the concept of surrogacy. But I think some people maybe are not clear about the different types of surrogacy that exist at the moment.

Can you explain for us? 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.

If you look at gestational surrogacy, this is when the woman carrying the baby is not related. 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. This embryo is then transferred into the surrogates 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 the surrogate provides her own eggs. So she's genetically related to the baby and has to give up parental rights. 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. They do. And a universal crime is a crime that is so serious that it's prosecuted even when it's committed abroad.

This new ban would make surrogacy 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 €1 million.

This is a massive culture war. You know, you've got the deputy prime minister, Matteo Salvini, calling this a uterus for rent, women used as cash machines. You've got some MPs saying that this is a crime worse than paedophilia.

It's, you know, the right wing government asserting its conservative credentials. Some people have said this law has been brought about and is really targeting LGBTQ+ families. Why do they say that, Sofia?

They see this as a wider attack on the LGBT community in Italy. And I mean, 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%. 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, you know, it was very hard for gay couples to have children.

You know, in Italy you're not allowed to adopt. That is often the argument that is used, that someone doesn't necessarily have the right to have their own biological child. They can go and adopt.

But in Italy, not possible. 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. 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 Davide. 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, a boy and a girl, thanks to a surrogate from the US. So they paid a lot of money to get their 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 and accessing the health care system, which is supposed to be free for Italians.

But they were really angry about the stigma around surrogacy. You know, their kids are going to grow up in a country where their existence, the fact that they are born is a universal crime. And then Claudio and Davide, they're a much younger couple, and they had a very different experience because when I spoke to them, they had a baby on their the way and they're 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. They were getting ready to escape.

They were learning Dutch, they were learning Maltese. And in their eyes, they were being forced into exile, into political asylum for wanting to become fathers. 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? 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.

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 who sort of put herself through this to help. Is this called the altruistic model? 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.

You also have countries where there are no regulations whatsoever like Kenya, Nigeria, the Philippines, but 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, D.

C. . Surrogacy has become a lifeline for many people who have been unable to have children of their own.

For some, it's their only opportunity to become parents. But while the demand for surrogacy and the possibilities it provides to people to have their own families has grown, the opportunities are actually still scarce. And this is largely because so few countries actually allow intended parents to pay women to carry their babies.

And Sofia, there have been huge problems as well when it comes to international surrogacy. Can you explain some of those? There's lots of issues that can happen, one of them being disagreement between the surrogate and intended parents.

And those are the people who, you know, pay or commission the procedure. And those disagreements, for example, could happen if there are complications during the pregnancy. What to do, you know, do we terminate the pregnancy or do we continue?

There's also stories of women who suffer, who have a miscarriage, and then they are completely abandoned, so they feel discarded, or sometimes they don't get paid at all because they weren't able to deliver a baby. 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 girl was healthy. The boy had Down's syndrome, and she said that the couple who had commissioned the surrogacy from Australia, they took the girl back home, but they abandoned the baby. So 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 at all.

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. That's right.

It used to be one of the key destinations, especially for people coming from the UK. But obviously that's no longer the case. What about the visibility of surrogacy now?

It feels like there's much more conversation about it, because we're seeing some celebrity couples talk about their experiences. Do you think that's fuelling 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, Kim Kardashian, Nicole Kidman, but also men. Elton John, Cristiano 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.

What I found interesting is that some US companies like Walmart 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 met.

The process in the US is meticulously regulated, and the argument is that because of that, everybody is sort of more protected. There's a full background check on the surrogates. There's a psychological evaluation.

So she can't have had a significant history of mental health disorders or, you know, depression. She can't be a smoker or heavy drinker. She needs to be financially stable and independent and all the medical costs are covered.

And obviously she gets paid as well. Does she also need to have already had her own children, Sofia? In most agencies, surrogacy agencies, yes.

And that's also because I think the idea is that they don't want women signing up to do this who don't understand the full consequences of being pregnant and giving birth. The argument is that it's when it's not regulated or banned that there isn't the same level of of protection on both sides. And what does some of these women say about the experience of being a surrogate?

What 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 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.

Even the people that do it for the money, there's also an element of wanting to give back. Bluntly though, often it is just a commercial decision. It is and a very expensive one.

Just give us one example. How much can they make? The costs are astronomical in the US.

So to break it down, first of all, there's compensation for the surrogate. That varies, but once you take into account maternity clothes, loss of earnings, time off work, that is normally between $65,000 and $95,000. Then you've got the medical costs.

And, you know, a single IVF cycle can cost up to $35,000. And then if you're a gay couple, there's additional costs because you need to, 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 these 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.

But if you take other things into account, it often goes up to $250, 000. So it's really expensive. So there is this massive global market for surrogacy, Sof ia.

It's already worth almost 14 billion, but that is projected to rise to 129 billion by 2032, according to research from Global Markets Insights. 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, surrogacy is banned because of interpretations of Sharia law, which emphasises parent and child relationships. The Catholic Church has been against surrogacy since the 80s. Pope Francis called for a global ban on surrogacy.

He said that it's a violation of the dignity of the woman and the child. 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. So we've got a situation where conservative Catholics and leftwing feminists actually agree on something. And is this because they believe it is the 'womb for hire' argument?

They are commodifying a woman's body. They essentially feel that a body is rented out by rich men and then discarded. And so, you know, they see it as a struggle against the patriarchy, whereas the Catholic Church sees it as a struggle to protect the traditional family.

And what abou the concerns over these women that are potentially being exploited, particularly in the developing world. This is by far the biggest concern among you know, 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 is it this is 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 that's 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. And sort of the risk here, I think, culturally and ideological, is that for people who are who are critical of surrogacy, is that we are creating a world where poor women, women who need money and are desperate, do this for wealthy couples who commission babies. Sofia, 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, the 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.

There are more and more people who are having children later in life. They often have, unfortunately, fertility problems and they need help. And surrogacy could be a viable option.

Also, 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 want children.

I spoke to a few couples in Italy after the ban had been passed, and they had babies on the way. They were obviously very concerned about the ban, 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.

Sofia, thank you so much. Thank you. And thank you for watching.

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