The practice of surrogacy is a topic of considerable interest across various fields, including media, science, social policy, and regulation. Although surrogacy is widely accepted as a form of assisted reproduction for many couples who cannot have children on their own, it often sparks strong emotions due to concerns about potential exploitation.

Consequently, there is significant debate about how it should be regulated or whether it should be permitted at all. Some countries have outright bans on surrogacy, while others have no regulations, which does not prevent people from pursuing it. There are also nations where surrogacy is regulated under either a ‘commercial’ or ‘altruistic’ model. Regardless of the model, surrogacy must be safe, ethical, and in the best interests of the child, the surrogate, and the intended parents.

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Surrogacy involves a woman carrying and giving birth to a baby with the intention of handing it over to the intended parents, based on a preconception agreement. This can be achieved through IVF performed in a fertility clinic using embryos created from the gametes of the intended parents, either fresh or frozen. Sometimes, one or both of the intended parents’ gametes may be substituted with donor eggs or sperm. In all cases, the surrogate has no genetic link to the child.

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In India, only ‘altruistic’ surrogacy is currently permitted. In this model, intermediaries are not allowed to profit from brokering or managing surrogacy arrangements, and surrogates are typically not paid beyond reimbursement for pregnancy-related expenses. However, professionals such as fertility treatment providers, lawyers, and counselors involved in the process are compensated. Critics argue that the altruistic model is unfair to surrogates who do not receive financial compensation.

Popular culture often portrays this as inherently fraught with risk and exploitation. It is essential for regulations to be based on real-life experiences rather than public perceptions. Regulators should consider successful practices from well-regulated models to develop sensible policies.

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Surrogacy is a global practice, with many intended parents seeking surrogates abroad due to long waiting times, high costs, or legal restrictions in their home countries. This includes specific groups such as same-sex or unmarried couples. Despite various efforts to establish international guidelines—such as those proposed by the International Social Service, Surrogacy 360, and draft treaties from the Hague Conference on Private International Law and the UN Convention on the Rights of the Child—there remains a lack of consensus on surrogacy regulations, reflecting diverse cultural and ethical viewpoints.

Nevertheless, the demand for continues to rise due to factors such as increasing infertility rates, advancements in medical technology, and greater social acceptance of different family structures. Many high-profile individuals, including Elton John and David Furnish, George Lucas, Cristiano Ronaldo, Sarah Jessica Parker and Matthew Broderick, Kim Kardashian and Kanye West, and more recently Rebel Wilson, Priyanka Chopra and Nick Jonas, Khloé Kardashian, Chrissy Teigen and John Legend, and Paris Hilton, have used surrogacy to build their families, often facing varying degrees of public scrutiny.

Surrogacy is likely to persist as a legitimate means of family building. To ensure its ethical implementation, a comprehensive surrogacy act is necessary. Such legislation should prioritize the rights of children, protect surrogates, and ensure that intended parents have access to ethical surrogacy services.