Surrogacy Debate Reaches Moral Crossroads as Abolitionist Calls Grow

Gestational surrogacy has moved from the margins of reproductive medicine to the center of an intensifying ethical and political fight, and a new narrative review argues that the debate has reached a genuine moral crossroads. Writing in Frontiers in Global Women’s Health, Yaakov Bentov and Joseph Schenker of Hadassah Medical Centre and the Hebrew University of Jerusalem synthesize a decade of scholarship on the practice, in which a woman carries a pregnancy created through in vitro fertilization and has no genetic relationship to the child. Their central claim is provocative: the old question of whether surrogacy should be commercial or altruistic has been overtaken by a harder one — whether exploitation is intrinsic to gestational surrogacy itself, or contingent on the conditions under which it is practiced.

The scale of the practice is difficult to pin down because no international registry systematically records surrogacy births. The most recent international review cited in the paper estimates roughly 5,000 to 15,000 births annually while stressing that reliable contemporary global figures are unavailable. In the United States, gestational carriers were involved in 4.4 percent of assisted reproduction births in 2021, underscoring how clinically routine the practice has become. Originally developed for women with absolute uterine-factor infertility, including congenital absence of the uterus, or for whom pregnancy would pose unacceptable medical risks, surrogacy is now also sought by male same-sex couples, single men, and women who simply do not wish to undergo pregnancy — an expansion that has shifted part of the debate from infertility treatment toward broader questions of reproductive liberty.

The review’s methodology is itself notable. The authors built their evidence base through eight parallel keyword searches of a single academic index, restricted to publications from 2015 onward, yielding 400 records corresponding to 293 distinct publications. After automated screening and extraction, 127 distinct publications formed the evidence table. The authors are candid about the limitations: no independent second screener was used, inter-rater reliability was not assessed, and the corpus constitutes an abstract-level map of the field rather than a registered systematic review. Much of the literature, they note, is normative rather than empirical.

Three developments dominate the post-2015 scholarship. First, the debate has moved beyond a simple opposition between autonomy and commodification toward more sophisticated accounts of structural vulnerability and relational autonomy — the idea that formally voluntary agreements may still be shaped by poverty, gender inequality, and restricted alternatives. Second, the interests of the child, including secure legal parentage, citizenship, knowledge of origins, and recognition of the gestational relationship, have moved closer to the center of ethical analysis. Third, while much academic and professional literature remains regulationist, rejecting both blanket prohibition and unregulated markets, recent political initiatives have pushed public discourse toward an explicitly abolitionist vocabulary.

The clearest expression of that abolitionist turn is the Casablanca Declaration, published on 3 March 2023. Though not legally binding, it rejects all the conventional distinctions — commercial versus altruistic, traditional versus gestational, domestic versus cross-border — and argues that surrogacy itself is incompatible with human dignity because it instrumentalizes pregnancy and commodifies women and children. It calls for prohibiting surrogacy agreements and agencies, sanctioning facilitators, and applying extraterritorial measures against citizens who commission surrogacy abroad. The European Parliament’s non-binding resolution of 13 November 2025 condemning surrogacy in terms of reproductive exploitation has reinforced this framing, though the authors caution that it neither formally endorses the Declaration nor creates binding law. Directive (EU) 2024/1712 likewise includes exploitation of surrogacy within its trafficking framework, but only where the constitutive elements of trafficking are met; it does not equate surrogacy itself with trafficking.

The authors trace abolitionism’s deeper roots to radical feminist critiques of the 1980s, particularly the network FINRRAGE and the Baby M controversy in the United States. What is new, they argue, is not the ideas but the organizational form: the Stop Surrogacy Now campaign launched in 2015, the International Coalition for the Abolition of Surrogate Motherhood established in 2018, and, in 2025, a report by the UN Special Rapporteur on violence against women and girls calling for global abolition. The authors urge caution in interpreting this history, noting that much of it rests on scholarly analyses that are themselves critical of abolitionism, and that an expert mandate’s recommendations are not binding international law.

Perhaps the review’s most consequential argument targets the commercial-altruistic binary. A substantial literature now holds that exploitation can arise in either model: familial obligation, emotional indebtedness, and gendered expectations may constrain autonomy in altruistic arrangements just as economic inequality does in commercial ones. Reimbursement practices blur the line further — Canadian rules permit reimbursement of dependants’ care, extra food costs, and even household assistance, while the Nuffield Council on Bioethics has flagged concerns that uncertainty over reasonable expenses creates scope for hidden commercialization in the United Kingdom. Conversely, some scholars argue that refusing payment for demanding reproductive labor may itself be exploitative, and that regulated compensation with independent legal representation and insurance may better recognize the carrier’s contribution than an altruistic-only regime.

Medical evidence adds another layer of complexity. A retrospective within-woman comparison found higher rates of preterm birth, low birth weight, and several obstetric complications in gestational-carrier pregnancies than in the same women’s spontaneously conceived pregnancies, though this design cannot isolate the contributions of IVF, oocyte source, or embryo-transfer protocols. Donor-oocyte pregnancies, an indirect proxy for genetic unrelatedness, show higher adjusted odds of hypertensive disorders, cesarean delivery, and postpartum hemorrhage, and greater maternal-fetal HLA mismatch has been associated with preeclampsia — suggesting immunogenetic factors may contribute, without establishing that genetic unrelatedness alone causes the complications. The authors stress that these risks remain ethically significant precisely because their causal attribution is uncertain.

On regulation, the authors examine the Israeli model, in which a state-appointed multidisciplinary committee must approve every surrogacy agreement before treatment begins, reviewing consent, suitability, and compensation. They characterize it as one potentially defensible compromise rather than a demonstrably superior model, noting that greater oversight may also introduce delay and restrict access, and that its safeguards do not extend to arrangements Israeli citizens pursue abroad. Qualitative research found Israeli carriers generally supported governmental regulation, but the authors emphasize this does not demonstrate a causal reduction in harm. Comparable reform efforts in New York, the United Kingdom, and Australia illustrate different regulatory architectures, though their protective effects cannot be assumed before implementation and evaluation.

The review’s conclusion is deliberately balanced. Prohibition removes what is, for some people, the only pathway to genetically related parenthood, and national bans may simply displace surrogacy across borders toward jurisdictions with weaker protections, restricting access to those with sufficient resources. Yet regulation cannot eliminate every ethical concern, and poorly designed rules may legitimize exploitative practices. The authors argue that where harms arise principally from unequal bargaining power, inadequate consent, and weak legal protections, enforceable regulation may be more proportionate than categorical prohibition — while acknowledging that whether any framework can reconcile the competing moral positions remains uncertain. What is increasingly clear, they write, is that the ethical future of surrogacy will be determined less by the commercial or altruistic label attached to an arrangement than by the distribution of power, risk, responsibility, and protection among everyone involved.

Subject of Research: Ethical and regulatory debates over gestational surrogacy

Article Title: Gestational surrogacy at a moral crossroads: autonomy, exploitation, and abolitionism

Article References: Bentov, Y., & Schenker, J. (2026). Gestational surrogacy at a moral crossroads: autonomy, exploitation, and abolitionism. Frontiers in Global Women's Health, 7, 1973804. https://doi.org/10.3389/fgwh.2026.1973804

Image Credits: AI Generated

DOI: 10.3389/fgwh.2026.1973804

Keywords: gestational surrogacy, reproductive autonomy, exploitation, Casablanca Declaration, abolitionism, IVF, commercial surrogacy, altruistic surrogacy, child welfare, cross-border surrogacy, regulation, bioethics