Not long ago, China was where American couples looked to adopt orphaned children. Now, in a telling reversal, a growing number of Chinese couples unable to conceive or carry a baby to term are looking to the U.S. for surrogate mothers.
John Weltman, founder of Circle Surrogacy, one of the largest surrogacy agencies in the U.S., said the majority of its work is international and the Chinese have become major international clients over the past five yearas.
“I would say China is certainly one of our top three places that we have, and at one point was definitely №1,” he said,
Since 2013, Circle Surrogacy has worked with 73 Chinese intended parents (56 out of 73 sets of intended parents are heterosexual couples) with medical reasons. Ten started a second surrogacy with the agency. In the last three years alone 49 Chinese babies were born through surrogacy.
Although there is no complete data on how many Chinese have traveled to this country for surrogacy, there are agencies especially on the West Coast in this country serving Chinese clients.
In 2014, National Public Radio (NPR) interviewed surrogacy agencies in California that said the trend of Chinese coming to this country for surrogacy has taken off since 2009 and the information of surrogacy services were passed on through word of mouth.
Eva Yu, the Chinese liaison at Circle Surrogacy, travels between China and America twice a year to provide consultation to potential Chinese clients. Up to now, she has about 1,500 WeChat (a popular messaging app in China) contacts with Chinese interested in becoming intended parents.
Yu said, “Every time whoever are interested, they just add me on WeChat and then we just chat.”
For Chinese couples and their American surrogates, the partnership is much more than just legal and business arrangement.
Mrs. Ren, a 44-year-old corporate accountant (she didn’t reveal the specific name of the company) in Hangzhou, China, had a baby girl with the help of Circle Surrogacy three years ago.
Mrs. Ren said, “I felt I was really very lucky. My surrogacy experience was very smooth. ( 我就觉得我还是真的是很幸运的。还是满顺利的。)”
Unlike Mrs. Ren who is open about talking about her surrogacy experience, other Chinese women who had baby via surrogacy declined to be interviewed. Many never tell their families and friends — especially mothers-in-law — about surrogacy because of a stigma about infertility in Chinese society. In Chinese culture, there are many unfilial acts, but the worst is not to bear a child.
Mrs. Ren said some of the mothers by surrogacy even put on fake bellies at the workplace, synchronizing their sizes of the bellies with the surrogates and pretending the surrogate baby was delivered by themselves.
Mrs. Ren also considered about faking a pregnancy, but her husband dissuaded her. He told her there was nothing to be ashamed of, comparing surrogacy to having a wet nurse to breastfeed the baby if a mother has no milk.
Mrs. Ren also had less to fear about her revelation because unlike other Chinese couples who seek surrogacy because they cannot conceive, Mrs. Ren gave birth to her elder daughter, who is a primary school student now. She opted for surrogacy because she had a Cesarean section that raised the risks for a second pregnancy.
She was motivated to have a second child when, in 2014, the Chinese government ended its one-child policy.
“When the policy was abolished, I was a little bit too old for another pregnancy. Considering this aspect, I decided to do surrogacy,” she said.
In China, the demand for both domestic and international surrogacy has increased as the fertility rate has dropped during the past two decades.
According to the latest China’s Infertility Status Report issued by the China Population Association and the National Family Planning Commission, China’s infertility rate in 2016 ranged from 12.5 to 15 percent compared to 3 percent in 1995. The increase is attributed to the country’s aging population.
Although the twin factors of aging women and the end of the one-child policy have increased interest in surrogacy. A 2001 administrative order that prohibited transactions of eggs or sperms and banned medical institutions and personnel from practicing any form of surrogacy technology has made it hard for Chinese women to seek surrogacy births in their own country.
Private clinics and agencies continue to provide surrogacy services on the Chinese black market, which is unregulated and considered unsafe.
Mrs. Ren said, “I know surrogacy is legal in some states of the U.S., and legal protection is guaranteed.”
The most common practice in the U.S. is gestational surrogacy, in which an embryo is created through in vitro fertilization (IVF) using the eggs and sperms of the intended parents or donors. The surrogate receives the embryo and carries the fetus to term. So the embryo is not genetically related to the surrogate mother.
Currently, there are no federal surrogacy laws; the laws vary from state to state. According to Columbia Law School Sexuality & Gender Law Clinic, in 2016, 14 states regulate and permit some form of surrogacy through statute.
Another attraction of a U.S. surrogacy is guaranteed U.S. citizenship for the child.
“For this reason, many people would choose to go to the United States for surrogacy,” Mrs. Ren said.
Weltman said although the majority of his Chinese clients want to get American citizenship for their children, his agency only takes on clients who have medical issues.
“I think people worry about the future in China, and that it is nice to be able to have that option for their children to have and always be able to come here,” said Weltman.
According to Circle Surrogacy, a surrogacy can last between 14 and 18 months and cost from $114,000 to $120,000, equivalent to about 6-year average salaries in Beijing and Shanghai. Surrogates receive more than $35,000. The price of surrogacy varies from state and agency.
Mrs. Ren spent $200,000 including about $70,000 paid to the surrogacy agency, including $30,000 to $40,000 for the surrogate mother and about $40,000 to the hospital. The rest went to legal fees and travel expenses.
Mrs. Ren believed the surrogate mother did something much greater than what she was paid, “She’s very loving. She did this not for the money. I was very moved by her on the day I arrived.”
Surrogates like Sarah Baker would agree.
“I wasn’t looking for anything in particular. I have a bleeding heart. And when I hear that someone else is hurting, and it’s something that I can help with, then I’m happy to help,” said Baker, who lives in Round Rock, Texas and is a mother of two.
Baker gave birth to a Chinese baby boy, Hongtao Lu, three years ago. She decided to be a surrogate because her own family is complete and her pregnancies were smooth and uncomplicated.
The Chinese baby she carried belongs to a Chinese couple in Guangzhou, who were in their fifties and waited to have their first child until they established their own business. The Chinese couple used an egg donor because the mother’s eggs were no longer viable.
Baker was connected to the Chinese couple through Extraordinary Conceptions, a California surrogacy agency. The Chinese couple didn’t speak English so their communications relied on WeChat, a widely used Chinese messaging app with a built-in translator.
Every time Baker went to the clinic for ultrasounds, she took a picture of the monitor and sent the Chinese couple pictures along with texts explaining what the doctor said.
Although surrogates can receive monetary rewards, surrogate pregnancy requires lots of effort and commitment and sometimes comes with frustrating moments.
Baker was required to have intramuscular progesterone injections after the embryo transfer. She started bleeding and had a bruise along her uterus after the embryo was transferred — subchorionic hemorrhage, which is more common with in vitro fertilization (IVF) pregnancy and can increase the risk of complications such as miscarriage, preterm labor, and placental abruption.
As the time of delivery approached, Baker experienced false labor.
While Baker’s deliveries of her biological daughters were smooth, the delivery of the Chinese baby was difficult. The baby got stuck. After 11 and half hours of induced labor, her doctor gave her epidural pain relief to numb the lower part of her body so the baby could readjust its position.
When the Chinese mother came into the delivery room after the birth, the nurse passed the baby to her. The baby that rested on her arms weighted exactly 8 pounds, and the Chinese mother couldn’t stop smiling. Eight is a lucky number in Chinese culture.
For Baker, the birth was one of the happiest moments in her life. She still remembers the Chinese baby’s birthday — December 17th, 2015.
“The one that can’t be topped for happy was when the mom came in the delivery room and saw the baby for the first time. And she just kept saying thank you over and over again. It was almost like having a high on life. It was just the most amazing thing to witness.”
While surrogacy can be a fulfilling experience for the surrogate, there are risks. According to John Petrozza, a gynecologist at Massachusetts General Hospital, the biggest risk is a multiple pregnancy.
“For most carrier situations, we’re putting back the embryos based on the age of the intended mother. So if the mother is 30 years old, and we get good embryos, we’re typically just going to put one embryo back. But if it’s an elder patient, if it’s someone who’s 42 or 43, we typically put back more embryos. And so the more embryos we put back, the higher the risk for multiple pregnancy.”
Petrozza also that if the intended parents are in their 40s, the surrogate may face higher risk of having baby with Down Syndrome and miscarrying.
“Carrying a pregnancy is tough,” Petrozza said. “These gestational carriers get paid very well. But it’s a risky proposition. These are often young women who have families of their own, they’re often married, so you don’t know the potential complications and risks that can develop and how that would impact her family.”
Surrogates also may face emotional risks. Baker had postpartum depression after the labor.
She said, “I was kind of on my own financially and emotionally at that point. I thankfully have a really strong support system here. And I found an amazing therapist who did wonders and she helped me a lot. And I also was on anti-anxiety medication for about a year.”
Although there were challenges during and after the surrogate pregnancy, Baker has no regrets.
“It was one of the good things that I thought about,” she said, laughing. “It was worth it. They sent a lot of pictures, which was really nice. So anytime I got a picture that was like sunshine on a cloudy day, especially when his hair started to grow, just poof.”
Baker, who received about $30,000 for the surrogacy, said she wanted to continue her relationship with the Chinese couple and become a part of their extended family.
“To me, it’s not a business transaction,” she said. “It shouldn’t be the main focus, because ultimately, you’re helping another family.”
Weltman at Circle Surrogacy said relationships with surrogates and their clients can be tricky, especially after the birth of the child.
“A critical aspect for most American surrogates is a relationship. And I think that has been challenging for the Chinese. Because I don’t think that’s natural culturally in China, to want a relationship with someone who is a stranger to you, and to share something so intimate with a stranger.”
Alya Guseva, a sociology professor at Boston University who studies commercial surrogacy said establishing relationships with prospective parents is important to surrogate during pregnancy because this relationship makes up the absence of relationship with the baby.
Guseva said there are other arguments against surrogacy, including fears that the industry can exploit surrogates, especially when parents from wealthy Western countries hire surrogates in developing countries. That is the reverse case when considering U.S. surrogates for Chinese couples.
In most of the world, surrogacy is in a legal vacuum, creating a global inconsistency of laws.
While countries like Russia and the Ukraine are open to commercial surrogacy regardless of where the intended parents come from, countries like the U.K., Ireland, and Denmark only allow surrogacy when the surrogate mother is not paid or only paid for reasonable expenses.
Other countries like Thailand and India that once allowed surrogacy have started limiting the practice in order to protect women.
“The concern is that women oftentimes are in situations where this is a very good offer that they cannot pass on because this is equivalent to maybe their husbands’ yearly salary. And in that sense, they’re very vulnerable when they’re making these decisions,” Guseva said.
While some critics call for banning surrogacy market, some advocate for regulating the business to give surrogates more control in the process.
“In Europe, most of the arguments against surrogacy are from the standpoint of commodifying female body or processes that are natural and confined to ideal in intimate relationship or familial relationship,” Guseva added. “There’s even arguments by moral philosophers in the U.S. about how that is an act of moral debasement. When we start valuing childbirth or babies or whatever else you think is being sold in monetary terms, we somehow debase something that should be, for all purposes, be considered sacred.”
However, Guseva said in the U.S., surrogacy is seen in a more positive light, framed as an altruistic gift that becomes the core identity of American surrogates.
“In the US, surrogates have the privilege or the luxury of actually claiming that this is a happy experience, some perceive themselves as magicians that are turning infertile couples into parents,” Guseva said. “Many feel pride in being skilled at something that comes to them naturally — the ability to have healthy babies and something for them to be proud of, but also to share almost like in a sense of sisterhood.”
Sarah Baker’s relationship with the Chinese couple in Guangzhou has continued. They send each other messages on major Chinese and American holidays. The baby is three years old now. Recently, the Chinese couple sent a video of the kid riding a scooter in a park in Guangzhou. Baker can’t stop laughing each time she watches the video.
Mrs. Ren also sends pictures of her daughter, who became kindergartener this year, to the surrogate in West Virginia. According to Mrs. Ren, the surrogate dropped out of school during college several years ago and went back after Ren’s daughter was born.
Weltman said Circle Surrogacy encourages continuing relationships between surrogates and the families.
“I don’t want the surrogate to feel like she was a baby maker, and that all you are looking forward to making this baby and then you’re leaving,” he said. “If the child wanted to meet the woman who helped bring them into the world, that’s a good thing for the child.”