IV. Women and girls particularly affected by surrogacy
A. Surrogate mothers
12. Surrogate mothers are generally women or girls who have previously given birth to at least one child. Their motivations are often multifaceted, combining financial, empathetic and social considerations. Many express a desire to help others to experience parenthood while also emphasizing the opportunity that surrogacy provides to support them or their own families financially. 25 This is particularly relevant for single mothers, who frequently cite financial needs as a central reason for entering into surrogacy arrangements. 26 When they are described as “service providers” rather than mothers, it creates an impression that compromising their dignity and well-being could be justified by the existence of a contract.
13. Globally, most surrogate mothers come from lower-income backgrounds and have less social status compared with the commissioning parents. 27 Many lack access to effective legal remedies or advocacy mechanisms. 28 Reportedly, migrant women are either specifically targeted for surrogacy or transferred to other countries for the purpose of impregnation29 and childbirth, often to circumvent legal frameworks. 30
B. Commissioning mothers
14. Commissioning mothers are generally from higher socioeconomic backgrounds than most surrogate mothers.31 However, their experience is also frequently marked by uncertainty and emotional strain. Many commissioning mothers report anxiety regarding the outcome of the pregnancy, the nature of their relationship with the surrogate, societal stigma, legal complexities and the financial burdens involved. 32 Particularly in cross-border arrangements, they may fall victim to fraudulent practices by surrogacy agencies, resulting in substantial financial losses. 33 Some may feel exhausted by the prolonged attempts to have a child. In certain cultural contexts, infertile commissioning mothers experience additional external pressure and stigma related to expectations of fulfilling what are perceived as their primary social roles.34
C. Women and girls who provide egg cells
15. Women and girls who donate their eggs for surrogacy often come from backgrounds marked by economic vulnerability. They are typically young adults who may view egg donation as a means to meet their financial needs. 35 Agencies tend to prefer women with specific characteristics, which they promise to commissioning parents.36 The demand is frequently shaped by racist and postcolonial stereotypes, as young, white, Western women with higher education receive up to 100 times more for their egg cells than others.37
16. Recruitment is commonly driven by online advertisement that frames egg donation as both altruistic and financially rewarding while omitting vital information about the discomfort of daily hormonal injections and harmful side effects and risks, such as anaesthesia complications, 38 ovarian hyperstimulation syndrome 39 or the emotional complexities of giving up one’s genetic child. 40 Women report the absence of health services after the donation. 41 Many, particularly girls, are groomed to register as egg donors to test their tolerance for medical procedures before entering a surrogacy arrangement.42 The digital nature of this reproductive market also enables the recruitment of surrogates and egg donors from countries where such practices are formally prohibited.43
D. Infants, including girls, born through surrogacy
17. Children born through surrogacy are often pursued and cherished by commissioning parents. However, from birth, they experience immediate separation from the woman who carried them and are transferred to the commissioning parents – a process that can be emotionally and developmentally significant. 44 Individuals with disrupted development of secure attachment are at higher risk of developing mental disorders.45 In some cases, the transfer of a child is also delayed or complicated by legal uncertainties surrounding the recognition of parentage, nationality or identity, leaving the child in limbo.46 18. Studies indicate that children born through surrogacy have lower mean gestational age at delivery, higher rates of preterm birth and higher rates of low birth weight.47 Assisted reproductive technology and multifetal pregnancy have reportedly been associated with an increased risk of birth defects. 48 Breastfeeding, which is prevented in surrogacy and even contractually prohibited, 49 is essential to an infant’s healthy development. 50 While research on the long-term emotional well-being of children born through surrogacy is limited, 51 it indicates that the lack of a gestational connection places them at increased psychological risk. 52
25 Submission by Axana M. Soltan.
26 Submission by Procuraduría de Trata y Explotación de Personas Fecha of Argentina.
27 Jutharat Attawet, Ethar Alsharaydeh, and Mark Brady, “Commercial surrogacy: landscapes of empowerment or oppression explored through integrative review”, Health Care for Women International (2024).
28 Submission by Alliance Pro Rodinu.
29 See e.g. Maria Varenikova, “Mothers, babies stranded in Ukraine surrogacy industry”, The New York Times, 15 August 2020.
30 European Network of Migrant Women and A Coalition for the Abolition of Surrogate Motherhood, Migrant Women and Reproductive Exploitation in the Surrogacy Industry: Joint Investigation (2022).
31 Christopher B. Kleinpeter, “Surrogacy: the parents’ story”, Psychology Reports, vol. 91, No. 1 (2002).
32 Mitra Zandi and others, “Nine centuries waiting: the experiences of Iranians surrogacy commissioning mothers”, Iranian Journal of Nursing and Midwifery Research, vol. 19, No. 3 (May–June 2014).
33 Submission by 4Métrica.
34 Submission by Amman Centre for Human Rights Studies.
35 Polina Vlasenko, “Worker‑mothers between legitimation and discipline: ambiguities in egg donation and surrogacy in Ukraine”, Medical Anthropology: Cross-Cultural Studies in Health and Illness, vol. 43, No. 8 (2024).
36 See https://www.donorconcierge.com/our-service. 37 Carolin Schurr, “The baby business booms: economic geographies of assisted reproduction”, Geography Compass, vol. 12, No. 8 (August 2018).
38 Carmel Shalev and others, “Ethics and regulation of inter-country medically assisted reproduction: a call for action”, Israel Journal of Health Policy Research, vol. 5, No. 59 (2016).
39 Daniella Bandelli, Sociological Debates on Gestational Surrogacy: Between Legitimation and International Abolition (Springer, 2021).
40 Eric Blyth and others, “Donor-conceived people’s views and experiences of their genetic origins: a critical analysis of the research evidence”, Journal of Law and Medicine, vol. 19, No. 4 (June 2012).
41 W. Kramer, J. Schneider and N. Schultz, “US oocyte donors: a retrospective study of medical and psychosocial issues”, Human Reproduction, vol. 24, No. 12 (December 2009).
42 Patricia Fronek, “Current perspectives on the ethics of selling international surrogacy support services”, Medicolegal and Bioethics, vol. 18 (2018).
43 Submission by Jasmine R. de los Santos.
44 Marcus Agnafors, “The harm argument against surrogacy revisited: two versions not to forget”, Medicine, Health Care and Philosophy, vol. 17 (2014).
45 Radovan Hrubý, Jozef Hašto and Peter Minárik, “Attachment in integrative neuroscientific perspective”, Neuroendocrinology Letters, vol. 32, No. 2 (2011).
46 Seema Mohapatra, “Stateless babies and adoption scams: a bioethical analysis of international commercial surrogacy”, Berkeley Journal of International Law, vol. 30, No. 2 (2012).
47 Irene Woo and others, “Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects”, Fertility and Sterility, vol. 108, No. 6 (December 2017). 48 Ruohua Yan and others, “Assisted reproductive technology and the risk of birth defects mediated by multifetal pregnancy: evidence from the China birth cohort study”, American Journal of Obstetrics and Gynaecology, vol. 232, No. 6 (June 2025).
49 Hillary L. Berk, “The legalization of emotion: managing risk by managing feelings in contracts for surrogate labour”, Law and Society Review, vol. 49, No. 1 (March 2015).
50 Bandelli, Sociological Debates.
51 While some studies indicate positive experience, the most widely cited study suffers from methodological limitations such as a relatively small original sample, which became smaller by the time of its conclusion. See Susan Golombok and others, “Families created through surrogacy arrangements: parent–child relationships in the 1st year of life”, Developmental Psychology, vol. 40, No. 3 (May 2004); and Susan Golombok and others, “A longitudinal study of families formed through reproductive donation: parent–adolescent relationships and adolescent adjustment at age 14”, Developmental Psychology, vol. 53, No. 10 (October 2017).
52 Susan Golombok and others, “Children born through reproductive donation: a longitudinal study of psychological adjustment”, Journal of Child Psychology and Psychiatry, vol. 54, No. 6 (June 2013). 53 Submissi
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