Baby whisperer Ms. Rachel—the YouTuber-turned-Netflix-star who built a multi-million dollar empire entertaining the youngest of viewers—now has an infant of her own. The new mom, who also shares a 7-year-old son with her husband Aron, took to Instagram on Tuesday to make the announcement—and to thank her surrogate.
“I was unable to carry this pregnancy for medical reasons and we were blessed to have a surrogate who gave us the most precious gift possible,” wrote Rachel Griffin Accurso, aka Ms. Rachel. “We are now all family forever. We have immense gratitude and a deep bond. It’s been a truly beautiful experience. I’m in awe of her.”
Many other high-profile parents have also had babies via surrogate—Sarah Jessica Parker, Elton John, Nicole Kidman, Kim Kardashian, Khloe Kardashian, Gabrielle Union, Tyra Banks, and Andy Cohen, just for starters.
And plenty of regular folks have, too. The number of embryo transfer procedures using a gestational surrogate more than tripled to 9,195 between 2010 and 2019, according to a Fortune story that used Centers for Disease Control and Prevention fertility clinic data (no longer available on the CDC site).
While the exact current numbers are difficult to pinpoint, it’s safe to say the business is booming: The global surrogacy market was valued at $175.79 million in 2022 and is projected to reach $303.35 million by 2031, growing at a compound annual growth rate of 6.25% during that time. North America is the highest contributor to the market, expected to grow during the same period by 6.3%.
Still, many people don’t know much about the process. Below, experts walk readers through the surrogacy basics.
What is surrogacy?
In the simplest terms, surrogacy is when another person carries and delivers a child for another couple or person, known as the intended parents or parent.
In the past, this was done via traditional surrogacy—essentially doing an artificial insemination in the surrogate mother who then gave birth to, and relinquished (or not, in the infamous Baby M custody case), a baby of her genetic makeup, created from her own egg.
And while a mistaken belief persists that all surrogacies are still traditional surrogacies, with folks thinking it’s “just a mom giving up her baby,” explains Rachael Jones, a nurse practitioner and VP of Clinical Client Strategy at the family-building company WIN, “it’s more complicated than that, and more nuanced.”
It’s also a completely different process, called gestational surrogacy, meaning that the surrogate is in no way directly related to the offspring. “So essentially, the egg and the sperm are fertilized via IVF outside of the body in the lab, and then an embryo is placed, through an embryo transfer, into the uterus of the gestational carrier,” Jones says. “And so when she gives birth, it’s not biologically her child,” making the arrangement much clearer from a legal standpoint.
How does commercial surrogacy work?
In the U.S., most surrogacies are arranged through an agency, which matches surrogates with intended parents. Those are commercial surrogate arrangements—meaning the surrogate is financially compensated—although there are sometimes what’s known as altruistic arrangements, whereby a woman carries the baby of a friend or a loved one for other reasons, and is not paid.
Those who are paid typically make about $30,000, says Jones—although the total cost for the intended parent or parents is much greater, usually ranging from $100,000 to $200,000.
“It’s quite, quite significant, and that’s largely because you’re paying a lot of different people,” explains Jones. “So generally, you’re potentially compensating the surrogate. Then the agency that matches you and does all the work behind the scenes is getting compensated. You have to have an attorney for both parties—the intended parents as well as the surrogate—and then you’re paying for the medical services.” That sometimes includes getting a separate medical policy to cover the surrogate’s labor and delivery costs.
“And this is a completely cash market,” she adds. “There’s not any coverage. There’s reimbursement often, through companies like ours that work with big employers, but it’s nothing compared to what the cost is.”
In fact, it’s what drives some intended parents to find surrogates in other countries, where the process is much cheaper. But that comes with risks, warns Jones, as it’s hard to know if the process is exploitative, particularly in countries like India and Turkey, “basically taking advantage of somebody who is destitute and has no options.” Tricky situations can also arise, such as war in the surrogacy hub of Ukraine.
Is surrogacy legal?
Commercial surrogacy is not federally regulated but left to the states, creating a patchwork of laws by which it’s allowed without restriction in 15 states, with various conditions or legal hurdles in 32, while three states (Arizona, Indiana, Nebraska) prohibit surrogacy contracts and Louisiana prohibits surrogacy altogether.
“More and more people do actually travel for surrogacy within the U.S., because there are just a lot of states with gray areas,” Jones says.
Globally, at least 10 countries ban commercial surrogacy, including Cambodia, Italy, Germany, and Spain.
Reasons behind illegality, believes surrogacy attorney Judith Hoechst—board member of Resolve: The National Infertility Association, past chair of the American Society of Reproductive Medicines, and mother to a 21-year-old son had through surrogacy—range from extreme judgment of parents who use surrogates to a “paternalistic” attitude.
“I think there’s a judgment that people just want to pay somebody to carry their baby because they don’t feel like being pregnant,” she says. “I’m going into my 15th year practicing reproductive law, I have never had one single case where somebody doesn’t want to carry their pregnancy.”
Her clients, she says, have often gone through dangerous pregnancies and are told not to try it again, or they’ve had hysterectomies—or breast cancer that makes it too risky to be exposed to the estrogen needed for IVF procedures. And about 15% of her clients are same-sex dads.
“I just came back from the third International Surrogacy Forum in Cape Town, Africa, and so much of the world is against surrogacy because they think it’s the commodification of women,” she tells Fortune. “So I think there is paternalism involved, where men think they know what’s best for women, instead of women saying, ‘I know what’s best for me.’”
Still, there is a feminist angle opposing surrogacy, including through the International Coalition for the Abolition of Surrogate Motherhood, and, in the U.S., the Coalition Against Trafficking in Women, which pushed back against New York when the state moved to legalize the practice in 2020 with executive director Taina Bien-Aimé warning, “As with all organized exploitation of women for profit, this is also a follow-the-money game.”
Some research, meanwhile, points to surrogate pregnancies being higher risk than others—something some surrogates may not always understand going in.
Why more and more people are using surrogates
“I think the only reason, honestly, is because one in six people struggle with infertility, and they are at the end of the road to try to have a child,” says Hoechst. And unlike adoption, she says, it’s a way to have genetic offspring. But also, “adoption isn’t so easy, and international adoptions have pretty much shut down.”
Jones concurs, noting, ”There certainly are less countries, from an international perspective, that are open to adoption from the U.S. And nationally, there’s also really long wait times for domestic infant adoption. And if you want to have a baby of your own, genetically speaking, then this is sometimes the way to do it.” Especially, she says, since so many women are deciding to try pregnancy later in life, when it can be more difficult.
But Jones also sees the rise being a result of a shift in belief systems. “I think in general, we’re becoming more open and liberal to fertility in general,” Jones says. “Everybody’s in for family building. It doesn’t matter which side of the aisle that you’re on… And so I think that we’ve all become a little bit more open to knowing that there are different paths to parenthood.”
For Hoechst, that path altered her life’s trajectory—giving her renewed purpose in her career as an attorney and, of course, her son. To this day, she maintains a relationship with the surrogate, just as Ms. Rachel appears to plan on when she says they are now “all family forever.”
“I still keep in touch with her,” Hoechst shares. “I text her on his birthday, on Mother’s Day, over the holidays, to say, ‘thank you for our son’s life. Here are pictures.’ He wouldn’t exist on this earth but for her.”
This story was originally featured on Fortune.com
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