The Future for Surrogacy Globally Sam Everingham Director Families Through Surrogacy The Future for Surrogacy Globally

Overview Community Attitudes Changes in availability Trends in surrogacy law globally Changes in use globally & by Swedes Stabilising Factors Pressures on surrogacy Outcomes for Children

Community attitudes

Swedes Support Surrogacy

Changes in availability

New Developing Markets India closes to LGBTI Greece opens to foreigners Cambodia closes Laos & Kenya open 1990s 2000s 2010 2011 2013 2014 2015 2016 Thailand/Nepal boom Thailand, Nepal & India close Ukraine booms IPs engaging in USA

Impact of Market Closures Greater pressure on US, Canada & UK surrogacy Increasing wait times to locate surrogate Lower cost US options Growth of hybrid programs Eg Canadian surrogate + US IVF

Which Countries Allow For citizens + foreigners (legal) For foreigners (no laws) For citizens Australia, Israel, South Africa, New Zealand, Netherlands, India, Thailand, UK, Czech Republic USA, Canada, Ukraine, Greece, Georgia, Russia, Brazil Kenya, Mexico, Albania, Laos, Thailand

Trends in surrogacy law

Legal Status & Who is Eligible

Other Countries Accepting Foreigners Country Legal status General Eligibility USA Legislation specific to surrogacy in some states granting legal parentage Some states allow access to gay couples, singles, and heterosexuals of any age Ukraine Grants legal parentage Heterosexual married couples who meet general medical criteria Canada Legislation specific to surrogacy in some provinces granting legal parentage Combined age of intended parents must be <110 Greece Legislation specific to surrogacy granting legal parentage Heterosexual couples and single females

Changes in use

Five Largest User Nations USA Israel China Australia Canada

Largest European User Nations Overall France UK Spain Sweden Germany Per capita Ireland Norway Sweden

Surrogacy Usage Globally ~ 10,000 engage in agency-facilitated surrogacy globally each year ~255 Swedish engaging per year Most Swedes engaging in Ukraine, USA & Georgia.

Where Are Swedes Mostly Engaging? NOW USA Ukraine 2012 - 2014 Thailand Georgia 2011 USA India

Stabilising factors

Agency Support Surrogates who carry without agency support often find it very difficult So…. Independent Surrogacy can be tough on all parties Countries with good professional support (eg US, Ukraine) predicts far better surrogate experience

Professionals with Long Experience Producing Better Outcomes 30 years experience USA Canada Greece Small no. of agencies Large no. of agencies Ukraine Georgia Russia, Kenya No experience

Published IVF Success Rates

pressures

Lack of Options Higher demand for surrogates in fewer countries Countries with smaller populations (eg Georgia) don’t have sufficient surrogates

Difficult Laws Banning advertising - In Canada & Greece Banning payment – in Canada & Greece Excluding gay couples – in Greece, Ukraine, Georgia

Desire for Twins Increasingly surrogates will not accept double embryo transfer, as its harder on their bodies Twin pregnancies come with far higher risks

Outcomes for children

Surrogacy Outcomes for Children Academic research shows lack of a genetic or gestational link between parent and child has no negative effect on parent/child relationships or psychological well-being of mother, father or children1 no major psychological differences between 10 yr olds born via surrogacy vs children born via other ART or natural conception2 1 Golombok et al Human Reproduction 21, (7) pp. 1918–1924, 2006 2 Soderstrom-Anttila Surrogacy: outcomes for surrogate mothers, children and the resulting families—a systematic review Human Reproduction Update, 22, (2) pp. 260–276, 2016

Surrogacy Outcomes for Children Children in gay father families1 show low levels of behavioral and emotional problems significantly lower levels of internalizing problems than children in lesbian mother families 1 Golombok et al Child Development, 2017 Parenting and the Adjustment of Children Born to Gay Fathers Through Surrogacy