Incidence of surrogacy in the USA and Israel and implications on women’s health: a quantitative comparison

Birenbaum-Carmeli, Daphna and Montebruno, Piero (2019): Incidence of surrogacy in the USA and Israel and implications on women’s health: a quantitative comparison. Published in: Journal of Assisted Reproduction and Genetics , Vol. 36, No. 12 (30 October 2019): pp. 2459-2469.

Abstract

Purpose. Gestational surrogacy (GS) has been researched in multiple qualitative studies. In sharp contrast, quantitative aspects of the practice are conspicuously understudied. The present article aims to assess and compare the incidence of GS in the USA and Israel, two industrialized countries that have maintained active, formally regulated surrogacy practice, for over two decades. Method. The article is a secondary analysis of official GS figures published by the USA and Israel. Each dataset is analyzed vis-à-vis the respective country's population, adult population and number of deliveries and infants born, so as to devise local Incidence Scores. These scores are the basis for an inter-country comparison. Results. The incidence of GS is rising in both countries. Though USA surrogates are contracted by both local and international, heterosexual and gay, partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, at a ratio of 2:3, even though in Israel only local heterosexual couples and single women may contract a gestational surrogate. Conclusion. GS emerges as reflective of its social surrounding, with the ratios between the countries' GS incidence resembling the ratios between their respective fertility rates. The paper ends with considering two risks facing gestational surrogates: the risk of not conceiving and not being paid, which is the outcome of most GS cycles, and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health consequences that are likely to accompany it.

• Item Type: MPRA Paper
• Language: English
• Keywords: Gestational surrogacy; incidence; live birth; multiple birth; USA; Israel
• Subjects: H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health; H - Public Economics > H7 - State and Local Government ; Intergovernmental Relations > H75 - State and Local Government: Health ; Education ; Welfare ; Public Pensions; I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I15 - Health and Economic Development; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; K - Law and Economics > K3 - Other Substantive Areas of Law > K32 - Environmental, Health, and Safety Law

References

(1) Mitra S, Schicktanz S, Patel T. Cross-cultural comparisons on surrogacy and egg donation: Interdisciplinary perspectives from India, Germany and Israel. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 1-399.

(2) Sándor J. Transnational surrogacy: An overview of legal and ethical issues. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 35-55.

(3) Whittaker A. Merit and money: The situated ethics of transnational commercial surrogacy in Thailand. Int J Fem Approaches Bioethics 2014;7(2):100-120.

(4) Rudrappa S. Discounted Life: The Price of Global Surrogacy in India. Discounted Life: The Price of Global Surrogacy in India 2015.

(5) Whittaker A. International Surrogacy as Disruptive Industry in Southeast Asia 2018.

(6) Ferraretti AP, Pennings G, Gianaroli L, Natali F, Magli MC. Cross-border reproductive care: A phenomenon expressing the controversial aspects of reproductive technologies. Reprod BioMed Online 2010;20(2):261-266.

(7) Speier A. Reproductive travelers. Anthropol Newsl 2017;58(1):e106-e111.

(8) Whittaker A, Speier A. "Cycling overseas": Care, commodification, and stratification in cross-border reproductive travel. Med Anthr Cross Cult Stud Health Illn 2010;29(4):363-383.

(9) Birenbaum-Carmeli D. Thirty-five years of assisted reproductive technologies in Israel. Reprod Biomed Soc Online 2016;2:16-23.

(10) Gürtin ZB, Inhorn MC. Introduction: Travelling for conception and the global assisted reproduction market. Reprod BioMed Online 2011;23(5):535-537.

(11) Pande A. Commercial surrogacy in India: Manufacturing a perfect mother-worker. Signs 2010;35(4):969-992.

(12) Ragone H. Surrogate Motherhood: Conception in the Heart 1994.

(13) Vora K. Life support: Biocapital and the new history of outsourced labor. Life Support: Biocapital and the New History of Outsourced Labor; 2015. p. 1-184.

(14) Twine FW. Outsourcing the womb: Race, class and gestational surrogacy in a global market: Second edition. Outsourcing the Womb: Race, Class and Gestational Surrogacy in a Global Market: Second Edition; 2015. p. 1-103.

(15) Banerjee A. Race and a transnational reproductive caste system: Indian transnational surrogacy. Hypatia 2014;29(1):113-128.

(16) Deomampo D. Transnational Reproduction: Race, Kinship, and Commercial Surrogacy in India. Transnational Reproduction: Race, Kinship, and Commercial Surrogacy in India 2016.

(17) Pande A. "It may be her eggs but it's my blood": Surrogates and everyday forms of kinship in India. Qual Sociol 2009;32(4):379-397.

(18) Bharadwaj A. Conceptions: Infertilities and Procreative Technologies in India. Conceptions: Infertility and Procreative Technologies in India 2016.

(19) Bharadwaj A. Biosociality and biocrossings: Encounters with assisted conception and embryonic stem cells in India. Biosocialities, Genetics and the Social Sciences: Making Biologies and Identities 2008:98-116.

(20) Gibbon S, Novas C. Biosocialities, genetics and the social sciences: Making biologies and identities. Biosocialities, Genetics and the Social Sciences: Making Biologies and Identities; 2007. p. 1-198.

(21) Smietana M, Thompson C, Twine FW. Making and breaking families – reading queer reproductions, stratified reproduction and reproductive justice together. Reprod Biomed Soc Online 2018;7:112-130.

(22) Teman E, Berend Z. Surrogate non-motherhood: Israeli and US surrogates speak about kinship and parenthood. Anthropol Med 2018;25(3):296-310.

(23) Ivry T, Teman E. Pregnant Metaphors and Surrogate Meanings: Bringing the Ethnography of Pregnancy and Surrogacy into Conversation in Israel and Beyond. Med Anthropol Q 2018;32(2):254-271.

(24) Berend Z. The Online World of Surrogacy. The Online World of Surrogacy 2016.

(25) Jacobson H. Labor of love: Gestational surrogacy and the work of making babies. Labor of Love: Gestational Surrogacy and the Work of Making Babies; 2016. p. 1-206.

(26) Berend Z. Handbook of gestational surrogacy: international clinical practice and policy issues. The emotion work of a ‘labor of love 2016:62-69.

(27) Teman E. Birthing a mother: The surrogate body and the pregnant self. Birthing a Mother: The Surrogate Body and the Pregnant Self; 2010. p. 1-361.

(28) Van Den Akker O. The importance of a genetic link in mothers commissioning a surrogate baby in the UK. Hum Reprod 2000;15(8):1849-1855.

(29) Crawshaw M, Purewal S, Van Den Akker O. Working at the margins: The views and experiences of court social workers on parental orders work in surrogacy arrangements. Br J Soc Work 2013;43(6):1225-1243.

(30) MacCallum F, Lycett E, Murray C, Jadva V, Golombok S. Surrogacy: The experience of commissioning couples. Hum Reprod 2003;18(6):1334-1342.

(31) Blake L, Carone N, Raffanello E, Slutsky J, Ehrhardt AA, Golombok S. Gay fathers' motivations for and feelings about surrogacy as a path to parenthood. Hum Reprod 2017;32(4):860-867.

(32) Golombok SE, Murray CE. Fertil Steril 2003;80(S3):50.

(33) Golombok S, Readings J, Blake L, Casey P, Marks A, Jadva V. Families created through surrogacy: Mother-child relationships and children's psychological adjustment at age 7. Dev Psychol 2011;47(6):1579-1588.

(34) Jadva V, Blake L, Casey P, Golombok S. Surrogacy families 10 years on: Relationship with the surrogate, decisions over disclosure and children's understanding of their surrogacy origins. Hum Reprod 2012;27(10):3008-3014.

(35) Zadeh S, Ilioi EC, Jadva V, Golombok S. The perspectives of adolescents conceived using surrogacy, egg or sperm donation. Hum Reprod 2018;33(6):1099-1106.

(36) Gupta JA. Reproductive biocrossings: Indian egg donors and surrogates in the globalized fertility market. Int J Fem Approaches Bioethics 2012;5(1):25-51.

(37) Dickenson D. Property in the body: Feminist perspectives. Property in the Body: Feminist Perspectives; 2007. p. 1-208.

(38) Widdows H. Border disputes across bodies: Exploitation in trafficking for prostitution and egg sale for stem cell research. International Journal of Feminist Approaches to Bioethics 2009;2(1):5-24.

(39) Nahman MR. Reproductive Tourism: Through the Anthropological "reproscope". Ann Rev Anthropol 2016;45:417-432.

(40) Pande A. Wombs in Labor: Transnational Commercial Surrogacy in India. Wombs in Labor: Transnational Commercial Surrogacy in India 2014.

(41) Vora K. Potential, risk, and return in transnational indian gestational surrogacy. Curr Anthropol 2013;54(SUPPL.7):S97-S106.

(42) Majumdar A. Conceptualizing Surrogacy as Work-Labour: Domestic Labour in Commercial Gestational Surrogacy in India. J South Asia Dev 2018;13(2):210-227.

(43) Gürtin ZB. Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction. Reprod BioMed Online 2011;23(5):555-564.

(44) Norton W, Crawshaw M, Hudson N, Culley L, Law C. A survey of UK fertility clinics' approach to surrogacy arrangements. Reprod BioMed Online 2015;31(3):327-338.

(45) Smietana M. Affective de-commodifying, economic dekinning: Surrogates’ and gay fathers’ narratives in U.S. surrogacy. Sociol Res Online 2017;22(2).

(46) Gugucheva M. Surrogacy in America. Surrogacy in America 2010.

(47) Jacobson H. A limited market: the recruitment of gay men as surrogacy clients by the infertility industry in the USA. Reprod Biomed Soc Online 2018;7:14-23.

(48) Perkins KM, Boulet SL, Jamieson DJ, Kissin DM. Trends and outcomes of gestational surrogacy in the United States. Fertil Steril 2016;106(2):435-442.e2.

(49) Perkins KM, Boulet SL, Levine AD, Jamieson DJ, Kissin DM. Differences in the utilization of gestational surrogacy between states in the U.S. Reprod Biomed Soc Online 2018;5:1-4.

(50) König A. Parents on the move: German intended parents’ experiences with transnational surrogacy. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 277-299.

(51) Samama E. The Embryo Carrying Agreements (Surrogacy) Law: Vision, Policy and Reality 2012.

(52) Shalev C. In the throes of revolution: Birthing pangs of medical reproduction in Israel and beyond. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 327-349.

(53) Nahman M. Repro-migration: Lessons from the early days of cross-border migration between Israel and Romania. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 351-370.

(54) Rimon-Zarfaty N. Parochial altruism: A religion-sensitive analysis of the israeli surrogacy and egg donation legislation. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 371-393.

(55) Dar S, Lazer T, Swanson S, Silverman J, Wasser C, Moskovtsev SI, et al. Assisted reproduction involving gestational surrogacy: An analysis of the medical, psychosocial and legal issues: Experience from a large surrogacy program. Hum Reprod 2015;30(2):345-352.

(56) White PM. “One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients. J Assisted Reprod Genet 2017;34(4):431-443.

(57) Söderström-Anttila V, Wennerholm U-, Loft A, Pinborg A, Aittomäki K, Romundstad LB, et al. Surrogacy: Outcomes for surrogate mothers, children and the resulting families-a systematic review. Hum Reprod Update 2016;22(2):260-276.

(58) Birenbaum-Carmeli D. The politics of 'The Natural Family' in Israel: State policy and kinship ideologies. Soc Sci Med 2009;69(7):1018-1024.

(59) Teman E. A case for restrictive regulation of surrogacy? An indo-israeli comparison of ethnographic studies. Cross-Cultural Comparisons on Surrogacy and Egg Donation: Interdisciplinary Perspectives from India, Germany and Israel; 2018. p. 57-81.

(60) Teman E. The Power of the Single Story: Surrogacy and Social Media in Israel. Med Anthr Cross Cult Stud Health Illn 2019;38(3):282-294.

(61) Teman E. Surrogacy in Israel: State-controlled surrogacy as a mechanism of symbolic control. Handbook of gestational surrogacy 2016:165-173.

(62) Almassi O. Surrogacy in Israel and abroad and its state funded cost components 2018.

(63) Levine AD, Boulet SL, Berry RM, Jamieson DJ, Alberta-Sherer HB, Kissin DM. Assessing the use of assisted reproductive technology in the United States by non–United States residents. Fertil Steril 2017;108(5):815-821.

(64) Montebruno P. Essays in economic geography: School vouchers, student riots and maternal surrogacy. London School of Economics. PhD Thesis. 2016.

(65) Brinsden PR. Surrogacy’s past, present, and future. Handbook of gestational surrogacy: international clinical practice and policy issues 2016:1-8.

(66) Spar DL. The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception. The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception 2006.

(67) Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2011 Assisted Reproductive Technology National Summary Report. 2011 Assisted Reproductive Technology National Summary Report 2013.

(68) Israel Central Bureau of Statistics. Monthly Bulletin of Statistics—March 2019. Population Estimates, Based on 2008 Census 2012.

(69) U.N. Nations Department of Economic and Social Affairs. Demographic Yearbook.ST/ESA/STAT/SER.R/47 2017.

(70) Perkins KM, Boulet SL, Levine AD, Jamieson DJ, Kissin DM. State differences in gestational surrogacy, United States, 2009–2013 [13G]. Obstet Gynecol 2016;127:62S.

(71) U.S. Census Bureau Population Division. Population estimates. Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios 2012.

(72) Agay-Shay K, Rudolf M, Rubin L, Haklai Z, Grotto I. Trends in Fetal Growth between 2000 to 2014 in Singleton Live Births from Israel. Sci Rep 2018;8(1).

(73) Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Mathews TJ. Births: Final data for 2011. Natl Vital Stat Rep 2013;62(1).

(74) U.N. Nations Department of Economic and Social Affairs. Demographic Yearbook. Live Births by Age of Mother and Sex of Child, General and Age-Specific Fertility Rates: Latest Available Year, 2004-2013 2013.

(75) U.N. Nations Department of Economic and Social Affairs. Demographic Yearbook. Table 4. Vital Statistics Summary and Life Expectancy at Birth: 2009-2013 Aperçu Des Statistiques De l’état Civil Et De l’espérance De Vie à La Naissance 2013:2014.

(76) The American College of Obstetricians and Gynecologists. Women’s Health Care Physicians. Multiple Pregnancy.[Online]. 2019.

(77) Stanford Children’s Health. Complications of multiple pregnancy. [Online]. Complications of Multiple Pregnancy.

(78) Neiger R. Long-term effects of pregnancy complications on maternal health: a review. J Clin Med 2017;6(8).

(79) White PM. Commercialization, Altruism, Clinical Practice: Seeking Explanation for Similarities and Differences in Californian and Canadian Gestational Surrogacy Outcomes. Women's Health Issues 2018;28(3):239-250.