Navigating the Ethics of International Surrogacy: Growing Families pioneering efforts for Reform and Standardisation

Embark on an enlightening journey with Sam, and his pursuit for ethical surrogacy standards and reform, as we scrutinize the complexities of international surrogacy. Through an in-depth conversation, we tackle the creation of the National Advisory Board and its  Ethical Standards document, a beacon of hope aiming to secure the well-being of surrogates and intended parents alike. Our dialogue spans the necessity of clear guidelines, the importance of direct compensation for surrogates, and the critical role of psychological support, painting a vivid picture of the moral intricacies involved in the surrogacy process.

This episode highlights the need for transparency and the importance of professional support. With Sam's expertise, we navigate through the turbulent waters of international laws, the advocacy work of organizations like SEEDS, and the potential for a unified global regulatory body to oversee these delicate arrangements. Whether you're an intended parent, a surrogate, or just someone intrigued by the evolving narrative of family creation, our conversation offers a compass through the unpredictability of surrogacy's global terrain, leaving you equipped with insights and resources, such as the Growing Families website, to guide your path.

Growing Families https://www.growingfamilies.org or call +61 02 8054 0078

Growing Families was established by Sam Everingham in 2014 (initially as Families Through Surrogacy) and has assisted over 3000 singles and couples to engage in cross-border donor and surrogacy arrangements.

As an International Advisory Board creator Growing Families specialises in education, guidance and support on surrogacy and donation globally. It provides legal, financial, psychological and practical professional industry advice as an independent third party in a complex area to providers. Growing Families helps singles, heterosexual and gay couples on their family building journeys.

Contact Growing Families today to find out more about its confidential one to one consultations, holistic concierge packages and global events with guest speakers and industry experts from around the world.

Transcript

Speaker 2: 0:22

Welcome everybody to today's podcast. We're really excited Sam and I are going to delve into ethical standards. It's a pretty juicy topic and a bit of a challenging topic, but I really wanted to talk to Sam about the things that he's doing in growing families. I just wanted to start with the vision for growing families. It actually includes making complex family building easier for all and as part of that vision, it's about becoming an advocate for change to make the industry safer and easier for all. Sam, I know you've done quite a bit of work over a number of years now to make international surrogacy easier and I understand you've got a document called Ethical Standards. So today's just about exploring that and about some ideas that you've got and some ambitions you've got in this space. So if you could tell us a bit about that, that would be wonderful. Yeah, sure, Kerry.

Speaker 3: 1:07

So, as an organisation, growing families around a year ago reached out and formed the National Advisory Board, made up of experts from a number of countries around the world who offer surrogacy programs. It consists of lawyers and doctors and surrogacy experts from places like the USA, from Canada, from Argentina, israel, salahkiya, mexico, georgia, even Greece, colombia and Ukraine. So we brought those people together because we really wanted to have a voice in the sector, given that these cross-border arrangements come with additional complexities and risks, and our aim with this stand is to try and protect the interests of vulnerable surrogates and vulnerable attending parents, and to do that by establishing guidelines which are really essential to consider before you engage in this process. So the guidelines are sort of some of them are aimed at attending parents in terms of what they should be thinking about, some are aimed at surrogates and some are aimed at agencies in terms of what they should be doing, and part of this is awareness raising to try and make people aware that there's some more important issues you need to think about here before you go ahead. So, as a starting point, if I just start by talking about what we've developed in terms of, if you like, seven key points for attending parents, and these are based on the fact that surrogates are a limited commodity globally. They're an extraordinary type of woman who can carry a baby without getting emotionally involved. So we really want attending parents to be able to demonstrate a genuine need for surrogacy related to a medical issue, psychological issue or fertility issues and that can, of course, be the absence of uterus in the case of gay guys. But I mean just wanting to engage with syrogots. He appears you know you're too busy to have a kid.

Speaker 3: 2:56

In our view it sort of wasn't sort of a you know part of ethical standards. Undergoing appropriate psychological counseling ahead of time is really important, because this is the process which requires a lot of sort of psychological engagement, if you like, with the syrogot, with your agency or trust involved. Unless you sort of you're ready to put that trust in other people, then that's gonna be hard, given the current landscape we've got around the world in terms of changes and disruption in the landscape. A third standard is avoiding engaging in politically unstable jurisdictions or conflict affected jurisdictions, and Ukraine, obviously, is one that comes to mind right now in that sense, obviously in Israelis too.

Speaker 3: 3:37

Fourth one second professional advice to understand the legal situation and the syrogotary regulations before we proceed. There are unethical providers who will say to you I'll look, you know you can do a syrogotary here, there's no problem. You know it's all protected, but in fact it's not. And so seeking an expert in the space who can give you reliable advice about what your legal standing is, what your syrogot standing is, what your child's standing is gonna be after the birth, are really important.

Speaker 2: 4:04

So I'm just quickly going to that one. Should they get? Well? No, growing families can help. But should they also get a lawyer in the country they're from and the destination country? Is that ideal? Certainly in the destination country.

Speaker 3: 4:14

There should be anyone in the destination country, because that's the country they're looking at in terms of where the syrogotry will be happening. So that's where they need to really be looking for getting legal advice there. Fifth one ensuring they're eligible under the destination syrogotary laws and that's what blade is the point you're just making and this is a secure pathway for the child to be granted citizenship and a travel document. Now, some of these pathways, they're not legal ones, but of courts involved. They're administrative pathways and you need to make sure that you have got a pathway to bring your baby home. And that's where growing families comes in, because we don't need to give you legal advice for administrative stuff. We can show you these are the steps to take in some jurisdictions there. The sixth one ensuring you've got agreements and advice in writing so you understand your rights, the risks and your responsibilities. It's very important that you know what you're signing up for, what you do need to do in terms of you know commitment to the process and commitment to look after that baby that's coming, because you're so not gonna care for the baby if you break up as a couple, you need to really make sure you've got an extra kin in place in a worst case scenario and make sure you've thought about all kinds of you know issues that might have been doing in pregnancy. What are your attitudes to you know, to determination, to bed rest and all kinds of issues? And the seventh one, which is really important, is paying the agreed compensation directly to your surrogate, where possible. We see two big instances where surrogates are paid through a third party. They don't get all the money it's supposed to get, so being able to pay them directly is really important. So you know where that money is going and I know a number of the good providers do mandate that.

Speaker 3: 5:48

There's also standards for surrogates that are important and there's seven of these that our consultation sort of uncovered has been really important to protect surrogates and the parents and children. The first one of those is being a citizen or a permanent resident of the country where the birth is going to occur. And that's because there's lots of arrangements now where surrogates have been brought in as foreigners from other countries to work in a country where they're not a citizen, and that's happening at the moment in places like Georgia, in North Cyprus and a few other countries like Albania, where the surrogates haven't got really good rights in that jurisdiction. Second one a deliberately one child will be raised more. Raised at child.

Speaker 3: 6:27

We want surrogates not to be, you know, have a risk of attaching them to the child they're carrying. So having finished their own family is an important point. Financial stability is important, you know, and being at least 21 years old, we think, is key criteria there. These processes do require some emotional maturity and I mean you're really not going to get any of that until you're at least 21 years old.

Speaker 3: 6:49

Medical evaluation, health screening, is really important. A surrogate being able to understand and agree to all aspects of the agreement and just try and protect surrogates from exploitation. So understanding how the birth registration will work, making sure they've got independent legal advice paid for by the attending parents, just to make sure they're fully informed before they engage. The sixth one is bodily autonomy. So making sure that the surrogates, you know, doesn't have any requirement for a mandatory C-section or a mandatory termination unless you know a life physician is saying for a medical reason. You know it's essential. But making the surrogate understand that she has got control over what she does with her pregnancy is really important to make sure she feels a power there.

Speaker 2: 7:33

I think that's a great word, sam. It's free will, empowerment, and she's doing it for the right reasons. I think that's where that screening is so important. Oh dear yeah.

Speaker 3: 7:40

And this is whether you know you're doing this independently or with an agency. It applies in both situations. And the seventh one, being able to live at home with their kids during the pregnancy, is really important. We see too many instances in the past where surrogates have been brought into a central city if you like to be close to a hospital but they don't think about well, where are their kids gonna live? How long are we gonna be separated from their own family? For there are some final set of standards which we've come up with for surrogate skin donor agencies and these are a bit lengthier. There's about 14 of these because these are sort of the guys who are managing the process of day in, day out for a good year year and a half for someone's journey, and because they're pulling the strings on us. But you need to really make sure that they tick the boxes when it comes to some of these things. So the first of those you need to think about is are they clearly outlining the services they're providing, like estimated costs, the billing and the refund policies? You need to know that as an IP. Are they making sure that all participants have the right independent legal advice? Are they disclosing facilitation policies regarding future contact with the surrogate. So some in some environments agencies don't allow or facilitate ongoing contact with surrogates and others they do, and it's really important for you as an IP to understand what that's gonna look like and whether you are able, if you want to, to have that kind of ongoing contact, because some people it's important to, and for some kids it might be important to facilitate any mutually desired contact between the IPs and the surrogate before and during the pregnancy. Sometimes language barriers into that. Facilitation is really important If it's agreed upon conducting thorough screening of attending parents criminal background checks, mental health evaluations, providing support and guidance to the attending parents on insurance, unnecessary arrangements during the journey, transparency in surrogate care and surrogate reimbursement. So it's very clear how much your surrogate's getting compensated and what cost is gonna be compensated for as well in terms of medical appointments and travel and all those sorts of things. Making sure they determine the match preferences what kind of a person does a surrogate wanna work with. What kind of person does the attending parent wanna work with. Make sure they are on the same page there. Making sure they're disclosing information about the background and the screening status of surrogates and donors.

Speaker 3: 9:54

Sometimes agencies sort of gloss over some of the stuff they've been. It's on the surrogates paperwork and don't disclose that and that's not on in terms of our transparency, because you need to make sure. An example of that, I suppose, is if a surrogate is living on her own and doesn't have supports around her and the agency doesn't let you know about that upfront. That's a really important sort of one. We're talking about Ensuring the surrogacy occurs in a location with access to quality medical care. Now, in some countries like the USA, we'll talk about living in any sort of town or city in the country. We're gonna make sure that she is gonna be not too far away from a good hospital in case she underbounds early, for example.

Speaker 3: 10:33

Ensure there's full consent from the surrogate, without coercion and infringement on her rights. Making sure she's got comfortable housing and safe housing allowing them to live with their families, who pointed out before. The second last one is only dealing with ethical and transparent IVF clinks which with excellent standards of care and there's a duty there to report any unethical or illegal activity to growing families and the development authorities there. So we want to make sure that if there are concerns coming up, that we hear about them and so the providers who signed up for these standards are obliged to keep us informed about this kind of stuff. And the final one is ensuring agency owners are aware of the rules and the regulations in their own jurisdiction and comply with those laws all times. This is a complicated area because there are different laws in different countries, and so a law in one country might be very different to one in another country, so that's why being aware of those laws is really key.

Speaker 2: 11:28

Does that sort of make sense to you? It does, it does. So the idea is that these have been put together by this credit.

Speaker 3: 11:35

Well, the advisory board, that's right, and this is a minimum group of standards which agencies globally should adhere to, and what we've done without a Borrubian program in growing families is said look, if you want to be a preferred provider with us, you need to make sure you sign up to these standards on a voluntary basis and, as you know, we're looking at a future process of auditing and in the future, if we can work out how we can do that cost effectively to all the providers who are doing that. When it comes to IVF clinks, they're already bound by their own In each country. They have their own regulatory bodies where they need to report to on an on an annual basis to say you know what they were doing and what their success rates for, and so for the IVF clinks that they already have those ISO type standards which are portable, not always publicly reportable. In some countries, like the UK and USA, they are publicly reportable, but in other countries they're not.

Speaker 2: 12:32

So, sam, what's been the success rate? So are you finding that most providers are willing to sign up to this agreement?

Speaker 3: 12:38

Yeah, I mean the ones. We already know a lot of providers who are, who are ethical and who understand these issues, and so we've have tended to single out the ones who we know are going to be okay with this model and we haven't gone out to a huge number of them at this stage, but we certainly had no barriers to the ones we've gone to so far in terms of saying, yes, this is the kind of program we think is really worthwhile.

Speaker 2: 13:01

Yeah, great, and given what's happened in Greece and for sure, a lot of people are quite concerned because things were happening allegedly very illegally and how would you know? So how do you deal with something like that? Because someone could sign an agreement and there's no, there's nothing behind it. Really.

Speaker 3: 13:19

Yeah, a little bit of a good example, because in Greece, for example, what the IVF click was doing was saying, well, look, you know you've got to pay your surrogate directly, but put it on a on a prepaid card and we'll give the card to the surrogate. And the fact that we're giving the card to the surrogate and they weren't putting the intent person touch with the surrogate. So it's really important that you are in touch with the surrogate from day one. Whichever program you engage with, are able to have direct contact with the surrogate to to avoid some of these scandals we've seen in the sector in recent years. It's important, I think, you engage with companies where there is a decent sized company with proper stands in place in terms of financial accounting. I mean, in the Greek case it seems there was one you know, boston control. He clogged all the shots. There was no board oversight of the arrangements and there's one of the key reasons we've dropped these sentences there is no accountable body, whether it's the USA or anywhere, in terms of standards. In the.

Speaker 3: 14:18

USA there were seeds, and seeds is a society for ethics and inclination and surrogacy, and they do have a voluntary system of standards which they ask their providers to sign up to. But in the rest of the world there's nothing, and so there's a big gap here. So being able to sort of you know, give people some peace of mind that you know the provider they're working with is is doing the right thing, is increasingly important, as that Greek scandal shows.

Speaker 2: 14:45

I think that's part of the reason that it is. You know, it's important to get some support through this process and not thinking it could never happen again, because it could if someone was really deceitful and setting out to do the wrong thing. But I suppose the good thing about someone like growing families and other organisations that do this work is that you're getting feedback from your clients regularly and so you're sort of hopefully mitigate those risks by knowing who's good to deal with and who's treating their sorry, getting IP really well. And yeah, it's that feedback, isn't it?

Speaker 3: 15:12

That's true, and if the Constitutional Programme we've been banning in the last year or so has really helped with that too, because we're sitting on calls between the clients and their agencies, we're getting to know how they work, we're seeing where the barriers are, where the where people tend to fall over, and that's really helping us to sort of weed out the ones who are we're doing a good job and the ones who aren't.

Speaker 2: 15:32

Yeah, great. And Sam, what does the perfect world look like, or something that's realistic that we could achieve in this space?

Speaker 3: 15:39

Well, I think it would be intimate to be able to engage in syrogacy in their own country in a legally protected and safe manner. I'm not fortunate that we're never going to get that globally, because different countries have very different attitudes to syrogacy, so we're going to see a continued use of cross-border arrangements. But that would be the ideal Not have to cross-border to do this.

Speaker 2: 16:03

And second best. I know you mentioned that Second best.

Speaker 3: 16:06

I think he's having a global body that can be a regulatory body for this. So we do see agencies having to adhere to standards to be able to operate. I think that's where there is an auditing process in place and agencies are accountable for all they do. With the ten appearance, I think that would be the second best option there. That's also a big ask, given we're talking about providers across the globe in multiple languages too.

Speaker 2: 16:33

Yeah, that's right. Yeah, such different countries to navigate, really in terms of health systems and legislation, regulations, as you said before, it's just a bit of a minefield. I applaud this agreement. I think it's a great step. It's certainly not foolproof, but it's getting people to reflect on what's important and agree to their standards.

Speaker 3: 16:51

It's a start, that's right.

Speaker 2: 16:53

Yeah, what about just taking it a bit more local in Australia? I know there's probably people overseas listening, but in Australia I know there was a paper prepared years ago and I don't know much more has happened since then. But the government acknowledges there's people forced to go overseas to get a surrogate. What do you think, if anything, the Australian government caught or should do in this space?

Speaker 3: 17:13

Look, I think and I don't mean with one of the health policies today about this very issue and I think part of it is allowing children who are born by overseas so we have a shortage in this country to be recognised legally as a legal child of the parents, Australian parents.

Speaker 3: 17:29

Those kind of issues need to be fixed up in our state laws and I know we've got governments now listening to that and are aware that this is a problem for those of those people and there are an issue where children are treated equally in this space because some of them have a legal parent and others don't in their own country and that's difficult. So we're working on that and I must confess Australia is well behind the rest of the world in that area. When it comes to recognising parents who are children born overseas, it's a big issue. There's laws that have well out of date there and would put in place the knee-jerk reactions. Gradually, countries are operating their laws and making them more friendly and making big more aware that surrogacy is going to continue as a family building pathway and they need to make sure the laws protect their surrogates and their kids.

Speaker 2: 18:17

I personally would love to see. I know, when I was trying to navigate through this space I just couldn't believe how much difference it was between the states and territories. So you see some great work being done in one state, so what about the other states? So it would be fabulous if it could be sort of a federal overview and one treatment for the whole of the country, rather than being so seemingly piecemeal, I think.

Speaker 3: 18:36

That's right. We are trying to get an agreement like that in place where there's an overarching law for the whole country. But it's difficult to do that. But the second best is just getting a great template in one state to get that template adopted by the other states when they see it working well.

Speaker 2: 18:52

Yeah, absolutely. Just to finish off, sam, what do you think about the future? Any idea about timelines, or what do you think, sir, what's?

Speaker 3: 18:59

on your mind.

Speaker 3: 19:00

Look. I mean we are seeing a lot of instability in the Syrogyz landscape globally. We're seeing some prices going up in this space. I think there is, though, increasing acceptance amongst different cultures that the Syrogyz is a thing. It's not just there for sort of, for wealthy people, it is something that you know. Increasingly, women even a potential Syrogyz are more aware or they can, they can do an amazing thing to help another couple, so we are getting more aware of that, particularly in Westernized countries like Australia and the UK and Ireland, where women are putting their hands up to be Syrogyz. What I'd like to see, though, is a model here where there's more sort of potential for agencies to support Syrogyz locally. We don't have that enough here in Australia, and many countries don't have it, and that's a real gap, if you like, in terms of making it work well, because if it pens a four-row, if you don't have good support.

Speaker 2: 19:52

Yeah, absolutely, and I think every IP, everyone, wants to have a safe space. I want to mitigate the risks. I want to do this in an ethical way. That's where the Syrogyz looked after and their needs looked after and they're working with really professional providers. So any last minute thoughts? What would you recommend, sam, for anyone navigating this space?

Speaker 3: 20:09

Oh look big. In touch with other intending parents who want to send their journey to you is, I think it's really important. You know, doing a professional consultation with someone in our team, getting good advice on this kind of stuff and getting good support is really important, because you can feel very alone in this space and you can feel like you're the only one or no one understands. You know, one of the benefits of the network we do globally is we do have parents in different countries around the world who have done this journey and can help you with With peer advice peer support as well as professional support we can provide you. Unfortunately, you know, the rules are changing constantly, so you know someone who might have done something five years ago. It's probably out of date today, but it's out of the year cross that as well. So I suppose the important thing is to reach out for support if you need it.

Speaker 2: 20:56

Great, Well, well done, I've got to say. I mean, I declare I work for growing families now, but I've got to say well done on creating this advisory board, Sam, and this ethical standards. It is a fabulous first start and hopefully more great change happens because of us.

Speaker 3: 21:11

Yeah, thanks, joe, that's great.

Speaker 1: 21:15

We hope you enjoyed this episode. For further information, please head to the growing families website, wwwgrowingfamiliesorg.