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This paper offers a comprehensive review of the gestational surrogacy process in the US, as well as internationally, focusing on the legal and ethical challenges that gestational carriers, intended parents, fertility providers, and OB/GYNs may face. The objective of this review article is to serve as an overview and provide information on legal, cultural, and ethical aspects of the decisions to pursue gestational surrogacy both for intended parents and gestational carriers in the US and globally. By understanding the surrogacy landscape and the obstacles, the surrogacy agencies and other involved parties can improve the surrogacy process to better serve all parties involved.

STUDY QUESTIONHow are ART and IUI regulated, funded and registered in European countries?SUMMARY ANSWEROf the 43 countries performing ART and IUI in Europe, and participating in the survey, specific legislation exists in only 39 countries, public funding (also available in the 39 countries) varies across and sometimes within countries and national registries are in place in 31 countries.WHAT IS KNOWN ALREADYSome information devoted to particular aspects of accessibility to ART and IUI is available, but most is fragmentary or out-dated. Annual reports from the European IVF-Monitoring (EIM) Consortium for ESHRE clearly mirror different approaches in European countries regarding accessibility to and efficacy of those techniques.STUDY DESIGN, SIZE, DURATIONA survey was designed using the online SurveyMonkey tool consisting of 55 questions concerning three domains—legal, funding and registry. Answers refer to the countries’ situation on 31 December 2018.PARTICIPANTS/MATERIALS, SETTINGS, METHODSAll members of EIM plus representatives of countries not yet members of the Consortium were invited to participate. Answers received were checked, and initial responders were asked to address unclear answers and to provide any additional information they considered important. Tables of individual countries resulting from the consolidated data were then sent to members of the Committee of National Representatives of ESHRE, asking for a second check. Conflicting information was clarified by direct contact.MAIN RESULTS AND THE ROLE OF CHANCEInformation was received from 43 out of the 44 European countries where ART and IUI are performed. Thirty-nine countries reported specific legislation on ART, and artificial insemination was considered an ART technique in 35 of them. Accessibility is limited to infertile couples in 11 of the 43 countries. A total of 30 countries offer treatments to single women and 18 to female couples. In five countries ART and IUI are permitted for treatment of all patient groups, being infertile couples, single women and same sex couples, male and female. Use of donated sperm is allowed in 41 countries, egg donation in 38, the simultaneous donation of sperm and egg in 32 and embryo donation in 29. Preimplantation genetic testing (PGT) for monogenic disorders or structural rearrangements is not allowed in two countries, and PGT for aneuploidy is not allowed in 11; surrogacy is accepted in 16 countries. With the exception of marital/sexual situation, female age is the most frequently reported limiting criteria for legal access to ART—minimal age is usually set at18 years and maximum ranging from 45 to 51 years with some countries not using numeric definition. Male maximum age is set in very few countries. Where permitted, age is frequently a limiting criterion for third-party donors (male maximum age 35 to 55 years; female maximum age 34 to 38 years). Other legal constraints in third-party donation are the number of children born from the same donor (in some countries, number of families with children from the same donor) and, in 10 countries, a maximum number of egg donations. How countries deal with the anonymity is diverse—strict anonymity, anonymity just for the recipients (not for children when reaching legal adulthood age), mixed system (anonymous and non-anonymous donations) and strict non-anonymity.Public funding systems are extremely variable. Four countries provide no financial assistance to patients. Limits to the provision of funding are defined in all the others i.e. age (female maximum age is the most used), existence of previous children, maximum number of treatments publicly supported and techniques not entitled for funding. In a few countries, reimbursement is linked to a clinical policy. The definition of the type of expenses covered within an IVF/ICSI cycle, up to what limit and the proportion of out-of-pocket costs for patients is also extremely dissimilar.National registries of ART and IUI are in place in 31 out of the 43 countries contributing to the survey, and a registry of donors exists in 18 of them.LIMITATIONS, REASONS FOR CAUTIONThe responses were provided by well-informed and committed individuals and submitted to double checking. Since no formal validation was in place, possible inaccuracies cannot be excluded. Also, results are a cross section in time and ART and IUI legislations within European countries undergo continuous evolution. Finally, several domains of ART activity were deliberately left out of the scope of this ESHRE survey.WIDER IMPLICATIONS OF THE FINDINGSResults of this survey offer a detailed view of the ART and IUI situation in European countries. It provides updated and extensive answers to many relevant questions related to ART usage at national level and could be used by institutions and policymakers in planning services at both national and European levels.Study funding/competing interest(s)The study has no external funding, and all costs were covered by ESHRE. There were no competing interests.ESHRE Pages are not externally peer reviewed. This article has been approved by the Executive Committee of ESHRE.

Feminist scholars have long debated the thorny question of whether or not to call for a ban on commercial surrogacy. A Marxist-feminist approach to frame commercial surrogacy as a unique form of \"embodied labor\" (Pande, 2014, p. 104) radically shifts this debate from a moralistic understanding of surrogacy by centralizing the role of structural inequalities that shape surrogates' choices to do surrogacy work. This article argues, however, that the feminist call to frame surrogacy as work, along the lines of sex work and care work, is being co-opted by surrogacy stakeholders in powerful positions in India's fertility market. I analyze the narratives of ten fertility clinics based in India, using in-depth interviews with fourteen fertility specialists, surrogacy agents, and intended parents, as well as analyzing the content of fertility clinics' and surrogacy agencies' websites and social media. This article shows how notions of \"ethical surrogacy\" and \"compensatory surrogacy\" have emerged as ways to prioritize the interests of fertility clinics and intended parents, rather than centralizing surrogates' needs and concerns.

Surrogacy is an important method of assisted reproductive technology wherein a woman carries pregnancy for another couple. Number of couples around the world require surrogacy services for various reasons. Although this arrangement seems to be beneficial for all parties concerned, there are complex social, ethical, moral, and legal issues associated with it. It is these complexities that have made this practice unpopular in many parts of the world. Surrogacy in India has had its own journey from India becoming popular as a surrogacy center since 2002 to the Surrogacy (Regulation) Bill, 2016, which would restrict the option of surrogacy for many. Surrogacy is an important medical service for all those couples who would otherwise not have been able to produce a child. Surrogacy would be practiced harmoniously if delicate issues associated with surrogacy will be addressed properly through appropriately framed laws which would protect the rights of surrogate mothers, intended parents, and child born through surrogacy.

Members of the Czech Parliament submitted the Amendment to the Civil Code and the Criminal Code that considers surrogacy as a specific form of human trafficking addressing the prohibited commercialization of the human body. The amendment aims to protect women, whose social status is often exploited, and children, who are reduced to commodities. The proposed changes seek to prevent the abuse of international surrogacy and reproductive tourism and, as a result, prohibit surrogacy even in an altruistic form between close relatives. Current Czech legislation tolerates surrogacy. Many social and ethical questions associated with this phenomenon deserve a society-wide discussion. Foreign legislation oscillates from clearly regulated conditions for surrogacy, through regulations that tolerate surrogacy without further regulation, to the prohibition of this specific phenomenon. This paper discusses the legislative regulation of surrogate motherhood in the Czech Republic (CR), as it compares with foreign regulation, and focuses on parameters used to compare different legal systems. Detailed national legislation, but especially uniform international rules can contribute to the protection from potential abuse caused by surrogacy. While altruistic surrogacy can be morally acceptable, commercial surrogacy, especially in an international context, can lead to the aforementioned abuses.

After losing a close other, individuals usually confide in an empathic friend to receive comfort and they seem to have a heightened desire for mood-congruent, consoling music. Hence, it has been proposed that affect-congruent music acts as a social surrogate for an empathic friend. Thus, we hypothesized that listening to comforting music, as a response to a social loss experience, provides a sense of empathic company as indicated by reduced loneliness and heightened empathy. We further predicted that distracting music would have a stronger impact on the listeners’ mood in comparison to comforting pieces. To test these assumptions, an experiment with two factors was designed: (1) Sadness was induced by an approved guided imagery method where participants visualized either their father dying (social loss), losing their eyesight (non-social loss), or shopping for groceries (control condition). (2) After the mood induction, the listening task included either comforting or distracting music that participants selected themselves. Psychometric measures for mood and loneliness were collected before and after the mood induction and after the music listening. The data were analyzed with mixed model ANOVAs. The results showed a significant reduction of loneliness and a relevant rise in empathy and mood due to listening to self-selected music, irrespective of the listener’s mood or the applied listening strategy, which suggests that private musical engagement in general can provide mood-repair and a sense of connection. This beneficial effect of private musical engagement supports the notion that not only music production but also its perception engenders social cognition. Overall, the findings corroborate the idea of music as a social surrogate.

Understanding the effects of scale is essential to the understanding of natural ecosystems, particularly in marine environments where sampling is more limited and sporadic than in terrestrial environments. Despite its recognized importance, scale is rarely considered in benthic habitat mapping studies. Lack of explicit statement of scale in the literature is an impediment to better characterization of seafloor pattern and process. This review paper highlights the importance of incorporating ecological scaling and geographical theories in benthic habitat mapping. It reviews notions of ecological scale and benthic habitat mapping, in addition to the way spatial scale influences patterns and processes in benthic habitats. We address how scale is represented in geographic data, how it influences their analysis, and consequently how it influences our understanding of seafloor ecosystems. We conclude that quantification of ecological processes at multiple scales using spatial statistics is needed to gain a better characterization of species–habitat relationships. We offer recommendations on more effective practices in benthic habitat mapping, including sampling that covers multiple spatial scales and that includes as many environmental variables as possible, adopting continuum-based habitat characterization approaches, using statistical analyses that consider the spatial nature of data, and explicit statement of the scale at which the research was conducted. We recommend a set of improved standards for defining benthic habitat. With these standards benthic habitats can be defined as ‘areas of seabed that are (geo)statistically significantly different from their surroundings in terms of physical, chemical and biological characteristics, when observed at particular spatial and temporal scales’.

Background: Up until recently, adoption is the most common alternative to recommended to couples struggling to procreate. However, with the advancement in medical technology, it is now possible to procreate through assisted reproductive technology (ART). Debates continue to ensue on the contentious issues emanating from various ART procedures, for instance regarding surrogacy there are concerns that this fragments womanhood, motherhood and parenthood, and there is a dereliction of the sacredness and cultural sanctity of the family system, most especially in an African context. However, as infertility becomes more prevalent among couples trying to have children in Nigeria, it has become important that alternate mediums of reproduction be examined within the socio-cultural milieu of the country. This study set out to examine surrogacy as a panacea to infertility in Nigeria through a qualitative lens. Methods: 15 stakeholders (traditional birth attendants, medical gynaecologists and legal professionals within the social, medico-legal framework of reproductive health) in Nigeria were engaged in an in-depth interview to unravel the challenges surrogacy might or is encountering as an ART in Nigeria. Results: There are various social, traditional, cultural and religious beliefs that police the reproductive sphere of Nigeria, which has grave implications on fertility treatment. These socio-cultural and religious factors do not provide a fertile ground for surrogacy to thrive in Nigeria. Hence, it is important that the socio-cultural framing of reproducing in Nigeria become receptive to modern medical reproductive alternatives and innovations. Conclusions: For surrogacy to permeate the reproductive terrain of the country there is a need to jettison several socio-cultural and religious sentimental beliefs policing reproduction in Nigeria.

Background Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested. Methods This paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources. Results Surrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society. Conclusion Policies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child.

Assisted Reproductive technologies (ARTs) like In Vitro Fertilization (IVF) and surrogacy have made aspirations of parenthood come true for many. With quality medical services, low costs and an indifferent regulatory regime, the surrogacy industry, particularly of the commercial and trans-border variety, has boomed in India so much so that India had once been termed as the 'baby factory' of the world. Through successive administrative measures the government of India has tried to regulate surrogacy with a view to prevent exploitation of women. At least two comprehensive bills to regulate various aspects of surrogacy arrangements have been tabled in the Parliament, viz: The Assisted Reproductive Technologies Bill -2008 and the Surrogacy Regulation (2016) Bill, both of which did not see light of the day. The Government's initiative to table a new bill on this subject is a welcome move. The Surrogacy Regulation (2019) Bill brings clarity on the rights of stakeholders in surrogacy arrangements and seeks to protect the vulnerable. This is an opportune time for a comprehensive discussion on all aspects related to surrogacy arrangements in India so that the legislation becomes an effective tool for social progress. In particular, considerable thought is needed on pressing issues arising out of the provisions of this bill, such as the possibility of a flourishing grey market in cases where commercial surrogacy is completely banned and the possibility of soft coercion of women by relatives, against their own choices, for altruistic surrogacy by matrimonial families. The rights of the child in cases of arrangements in contravention with the proposed law also need deliberation. This paper discusses the lacunae in the bill on the above aspects taking into consideration the Indian experience and that of the world and attempts to propose possible alternatives that may be adopted for a more meaningful and just legislation.