This op-ed was originally published in the Union Leader on 8/28/2025.
Does the ability to implant and grow human life in a host’s womb justify the growing use and acceptance of surrogacy? It’s a question that deserves serious study and thought as recent news events, including one of a couple with up to 21 surrogate children and another of a convicted pedophile father, have underscored.
Surrogacy is big business, estimated to generate $37.5 billion in annual revenue by 2029. Although there have been very liberal surrogacy laws in New Hampshire since 2014, there is no data available on the number of surrogacy arrangements or surrogate births in the state.
Traditionally, we think of surrogacy as a method of last resort for couples facing infertility and surrogates as selfless women willing to carry children for those who cannot. Today, it serves a host of other purposes, including its use by women who don’t want to physically bear children. Traditional surrogacy involves the use of the host mother’s own egg. Gestational surrogacy relies on implanting an egg from another donor, including a woman who is paying the surrogate to bear a child. Either path involves an agreement for the woman bearing the child to surrender him/her to the individuals contracting for her services.
What could possibly go wrong? Let me count the ways.
Let’s start with the commercialization of childbearing. An industry that yields tens of billions of dollars a year in our country needs a product and customers. A woman’s womb and the child himself become commodities to be bought and sold. The cost to prospective parents can reach up to $300,000, including up to $100,000 for the surrogate mother.
While Europe bans surrogate motherhood with few exceptions, most U.S. states are wide open with one estimate of more than 300 surrogacy agencies in the U.S. In fact, New Hampshire is considered as being among the most liberal surrogacy states. The case of possibly up to 21 “legal” surrogate children in California, a state with similar laws to ours, acquired by a single couple, 17 of whom were under three years old, begs the question of “why?” What purpose were these children created to serve?
There is also “fertility tourism” when foreign clients come to the U.S. to take advantage of our wide-open surrogacy laws, disproportionately wealthy Chinese parents, hoping to exploit our generous citizenship status for infants born on U.S. soil. When life is created outside the marital embrace for financial and personal ends, the opportunities for abuse abound.
Questions of exploitation extend to the surrogate herself. Will she be tempted to rent her body out for financial gain? We lack data and studies on surrogacy, so how can she understand the risks, medically and emotionally? Does she appreciate the potential legal implications of her surrogacy? What happens when the mother develops disease or experiences a medical emergency when carrying a child for another?
And, what of the child? Who considers the emotional and physical well-being of surrogate children? Certainly, the case in Pennsylvania, where a convicted child sex predator exploited a legal loophole to adopt a surrogate child, begs the question of creating life for the sole purpose of self-gratification. If you doubt it, consider the case of a Chicago man who court records say had already admitted abusing his own nieces and nephews excitedly messaging his graphic plans for his own surrogate infant to a friend just days before adoption.
Even absent the element of potential tragedy and abuse, surrogacy itself raises complex ethical, sociological, and human questions. Surrogate children face unique challenges, including identity and role confusion. One study found that children born through surrogacy had more adjustment issues than other children born through reproductive donation. Life is difficult enough without having to navigate through the complex genetic and psycho-social puzzle of being a child of surrogacy.
As a society, we need to take a hard look at how surrogacy is being exploited for personal ends. When it comes to the heartbreak of infertility, surrogacy is just one option, and an extremely expensive one at that. And, like many of our medical treatment protocols, it can fail to address natural root causes in favor of a man-made solution.
There are promising alternatives to surrogacy for infertile couples in emerging treatment options such as NaProTechnology. Rather than sending women and families down the expensive and exhausting path of surrogacy, NaPro providers work on the root causes of infertility with the goal of restoring women’s natural fertility and ability to bear children at a fraction of the emotional and fiscal costs of surrogacy. Notably, NaPro has been shown to be very successful in restoring women’s ability to bear children. As an alternative to the slippery ethical slope of surrogacy, promoting restorative alternatives like NaPro is something I can get behind.