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How Canada became an international surrogacy destination

The Globe and Mail with Karen Busby 5 October 2018

Here’s an arresting statistic: Almost half of the babies born to Canadian surrogates in the province of British Columbia in 2016 and 2017 were for intended parents who lived outside the country. That’s 45 of the 102 babies born to surrogates there – 44 per cent.

What’s the national tally on such outbound babies? We don’t know. Rather, we aren’t told. The number could presumably be calculated, since individual physicians carry out the procedures and bill for them, and provinces issue birth certificates. But the information is not publicly available. Then again, we should hardly be surprised: In Canada, we don’t even know the total number of babies born to surrogates for any parent, Canadian or otherwise. I and others have been asking around for some time now.

Those B.C. numbers come to us thanks to the hard work of Pamela White, at the Kent Law School in Britain, who had to put in an access to information request with the B.C. government. She tried the province of Ontario, too, but they said they don’t collect data on residency. In the United States, such information is collected by law and published by the Centers for Disease Control and Prevention.

Prof. White, a former Statistics Canada director and data analyst, argues that Canadians deserve that level of transparency, too. She is absolutely right. Without real data, available for scrutiny, how can we make informed public policy decisions? We can’t.

Anecdotal reports and incomplete data suggest that the number of intended parents (IPs) from outside Canada has been growing in recent years. At the annual meeting of the Canadian Fertility & Andrology Society (CFAS) last month, Karen Busby, a professor in the faculty of law at the University of Manitoba, who co-authored a forthcoming paper on the topic with Prof. White, discussed why Canada is becoming an international surrogacy magnet and whether it is desirable.

The backdrop, Prof. Busby says, is that worldwide demand is huge. Many people want to be parents and can’t do so without surrogacy, but they live in countries where surrogacy is either prohibited entirely, or prohibited for them. China, Japan and many European and predominantly Muslim countries have restrictions, she says. People in such places who decide to pursue surrogacy must look beyond their own borders.

Coupled with this growing demand is shrinking supply. In the last few years, India, Nepal, Thailand and Mexico – former international surrogacy hotspots – have closed their doors to non-residents.

So why Canada? For one thing, Prof. Busby says, Canada is one of the few jurisdictions left in the world that both allows surrogacy and allows foreign participation in it. Countries such as Britain, South Africa and Israel, she says, permit surrogacy, but not for foreigners. The only other places that allow foreigners to access surrogacy within their borders, apart from a couple of completely unregulated jurisdictions, are Greece, Ukraine, Russia, Georgia and a few U.S. states.

For a number of reasons, Canada stacks up well against these others. Russia and Ukraine, for instance, only allow married heterosexual couples to participate. Canada, by contrast, does not allow discrimination on the basis of marital status or sexual orientation, Prof. Busby says.

Canada is also fairly efficient about granting legal parental rights. It varies by province, but generally speaking, IPs can be declared legal parents without a lot of hassle in just a few days, and they can be issued a birth certificate within weeks. Also, any child born in Canada has the right to citizenship, so a passport can be issued, and in short order, the families can head home and start their new lives.

Financially, Canada also compares well. Women in Canada enjoy high quality, publicly funded health care throughout the pregnancy, during the delivery and after the birth. This is as true for a woman carrying a baby for someone from France or China as it is for a woman carrying a baby for herself. Our neonatal care is also top-notch – and also publicly funded. Another perk, Prof. Busby says, is that if a Canadian surrogate has a job, then she may also qualify for employment insurance benefits following birth – to a maximum of $6,500.

Here’s another interesting twist. In Canada, it’s illegal – a criminal offence, according to the Assisted Human Reproduction Act – to pay a woman to carry a baby for you, or to pay someone else to arrange for her to do so. Since the law first passed in 2004, this prohibition has caused enormous hand-wringing for Canadian would-be parents looking to form their families with the help of a surrogate. They rightly fear that they could be prosecuted for paying a surrogate, and the penalty is steep: up to 10 years in prison and $500,000 in fines. The prohibition has reportedly driven some Canadian families to leave the country to seek surrogates elsewhere.

Ironically, this prohibition, which was designed to deter commercial surrogacy, may actually be stimulating it – and may favour foreign IPs over domestic ones. Domestic IPs may be reluctant to offer money or will only offer it under the table, but because the law is not applied to acts committed outside the country, Prof. Busby says, foreign IPs can offer money openly, so long as it changes hands somewhere else. It’s conceivable that, given the choice between being paid and not being paid, Canadian surrogates – who are legally allowed to accept the money – may opt to be paid. So foreign IPs may actually be more attractive to Canadian surrogates than domestic IPs. (There’s no data on that, of course, since there’s no data.)

It is true that foreign IPs coming to Canada will still be subject to our other prohibitions, such as paying for local egg or sperm donations or performing sex selection. But, as Prof. Busby points out, most Canadians live near the U.S. border and have easy access to the services offered there. This ability to enjoy the best of both systems only adds to Canada’s appeal.

All of these factors help to explain why Canada has become a go-to place for surrogacy. I’ll add one more that Prof. Busby did not explicitly mention: There are Canadian doctors, lawyers and agencies who actively recruit IPs from around the world. If foreign parents weren’t already aware of Canada’s considerable merits, representatives of the industry are more than happy to point them out. In fact, the newly minted president of the CFAS himself, alongside the CEO of the country’s top surrogacy agency, was recently in London, promoting Canada as a premier surrogacy destination.

And they are right: For all of the above reasons, Canada is a great place to do surrogacy. Loads of people already want to come here and we can only expect that number will grow.

Not everything about this picture is rosy, however. A big question is whether Canadians need to think about recovering medical costs. Pregnancy care, even for an uneventful pregnancy, costs money. So does birth. The average uncomplicated birth in Canada rings in at between $3,000 and $6,000, depending on whether it’s a vaginal or surgical delivery. Complications can increase that figure considerably. Neonatal care can also be pricey. For instance, according to the Canadian Institute of Health Information, care for a baby born at 29 weeks weighing less than kilogram costs an average of $91,946. One baby.

“I am pretty sure that if you asked the average Canadian whether or not the Canadian health-care system should pay for any of the health-care costs incurred in order to produce a child for a non-resident IP, the answer would be no,” Prof. Busby told the CFAS meeting. “In fact, I think it would be an emphatic no.” I suspect she’s right.

As far as Prof. Busby is aware, no province has put in place laws or policies to recover the cost of surrogate pregnancy care from foreign IPs. (A few Ontario hospitals have started charging for infant care, if the infants are for out-of-province parents.) Prof. Busby says governments could consider measures such as asking IPs for money up front or not issuing a birth certificate or passport until the bill is settled.

That’s a lot of work. It would involve co-ordination across departments and even, in some scenarios, levels of government. Another option, she says, would be to follow the lead of other countries and create residency restrictions, stipulating that only people who live in Canada can work with a surrogate here. That option would, in one fell swoop, alleviate the shortage of surrogates available to work with Canadians and eliminate the cost-recovery conundrum.

That would be a tidy solution, and, all things considered, maybe the most workable one. The cost-recovery issue is challenging. Access to surrogates by Canadians is challenging, too. There are other problems. Our country is struggling under a 14-year-old law that still hasn’t rolled out the meat of its regulatory details. We are woefully lacking in transparency about surrogacy – and assisted reproduction in general. Finally, although preliminary findings are reassuring, we have not yet done nearly enough research to establish that Canadian women who act as surrogates are not exploited.

I am not hopeful, given Canada’s track record in this sphere, that we will crack these tough problems any time soon, or ever. But let’s imagine we did – no cost to the Canadian public, adequate numbers of surrogates to work with Canadian families, effective laws for and public scrutiny of the process and confidence that women were treated fairly. Then, it seems to me, Canada would be an excellent place for international surrogacy. Surely the ideal is for surrogates and babies to have quality medical care, for IPs to be free from discrimination, for parentage issues to be resolved quickly.

If we did somehow get our house in order, I’d be the first to ask: If you believe that surrogacy is a legitimate way of achieving parenthood, what would be the argument against welcoming it here?