Commercial surrogacy: Landscapes of empowerment or oppression explored through integrative review.

The surge in demand for surrogacy treatments, combined with regulatory loopholes, has spurred the widespread adoption of global commercial surrogacy. This phenomenon poses potential risks to all involved parties, including surrogates and children, encompassing ethical, legal, physical, and psychological concerns. Although commercial surrogacy is under discussion in various jurisdictions, some countries may reintroduce legislation on the matter. In addressing this intricate landscape, the researchers performed an integrative review of existing literature with the intention of providing guidance to researchers and policymakers. The researchers emphasized notable legal and ethical challenges linked to commercial surrogacy. Surrogates often experience disempowerment and oppression, exacerbated by the contractual nature of these arrangements, perpetuating structural inequalities. Children born through commercial surrogacy, especially internationally, risk losing cultural heritage and future benefits. Banning commercial surrogacy may drive it underground, harming surrogates. Reconsidering prohibitions without penalizing surrogates could mitigate downstream issues and safeguard them from exploitation.

Reconsidering Surrogacy Legislation in Thailand.

This report focuses on surrogacy in Thailand which is increasingly popular with infertile and childless couples, gay couples, individuals, and even celebrities who want children later in life. However, the debate regarding surrogacy continues. It is not widely accepted in various cases, particularly in its commercial form which is banned in many countries. However, such arrangements are still reported to be active irrespective of the ban, and in Thailand in particular. This article proposes that surrogacy legislation needs revision to enforce the current ban on commercial surrogacy.

Cumulative live birth rates among gestational surrogates in altruistic surrogacy arrangements.

Understanding the likelihood of a live birth is important for fertility treatment planning, particularly when one cycle fails and further treatment may be contemplated. This study aims to estimate the chance of live birth among gestational surrogates undergoing altruistic surrogacy arrangements between 2009 and 2016 in Victoria, Australia. A total of 81 gestational surrogates with 170 embryo transfer cycles were included. Of the 170 embryo transfer cycles, the majority were single embryo transfers (SETs; 97.1%), using frozen/thawed embryos (97.6%) which had been fertilized by intracytoplasmic sperm injection (77.6%). The cumulative live birth rate was 23.5% (95% CI, 15.6-33.8%) after the first cycle and increased to 50.6% (95% CI, 40.0-61.2%) after the sixth cycle. Of the 41 deliveries, 40 were singletons and one was a twin delivery. Two of the 42 deliveries were preterm, two were low birthweight and one was small for gestational age. The findings imply that surrogacy treatment can be offered up to six consecutive embryo transfer cycles to gestational surrogates. SET is encouraged in surrogacy practice to improve perinatal outcomes. These estimates can be used in counselling and decision-making for intended parents and gestational surrogates to continue a surrogacy treatment and informing public policy on assisted reproductive technology treatment.

Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis.

Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06-1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10-1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58-69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.

The nexus between self-perception and behavioural responses of gestational surrogates' risk experiences.

Despite associated risk and public concern, commercial surrogacy remains a thriving business, and opportunities for gestational surrogates continue to exist. Surrogacy arrangements have been found to place gestational surrogates at risk, with little support or guidance to help them understand or mitigate these risk factors. This study aims to investigate the self-perception of gestational surrogates through their reflection of their own risk-related behaviours throughout the surrogacy process. Data were retrieved through interviews with fifteen Thai women who had first-hand experience of commercial surrogacy, and thematic analysis was used to interpret the data. Findings showed that the perceptions of 'trust,' 'commitment to obligation,' and 'unacceptable actions' reflected their behaviours exposing risks to detrimental behaviours, disempowerment, and isolation. Understanding these perceptions would be advantageous for health planning programmes or policies in surrogacy practice to promote women's heath as a whole.

'Womb for work' experiences of Thai women and gestational surrogacy practice in Thailand.

Risks to gestational surrogates became a concern for public health. In commercial gestational surrogacy arrangements, gestational surrogates are commonly recruited from low- to middle-income countries. Thailand is well known as a surrogacy hub in this regard. However, little is known concerning Thai surrogacy practice and the risks that Thai gestational surrogates experiences. The semi-structured interviews with fifteen Thai women who had been gestational surrogates were conducted over the telephone in Thai between March and May 2020 and lasted approximately 30 minutes. Thematic analysis was applied to analyse the translated interviews. The findings indicated that 'womb for work' was perceived as a surrogacy career among Thai women. 'Womb for work' was defined as a superordinate theme that consisted of three subthemes: (i) gestational surrogacy arrangements in Thailand; (ii) the business model of gestational surrogacy arrangements in Thailand; and (iii) risk experiences of gestational surrogates. Clear deficiencies in surrogacy practice and regulations were identified, which put gestational surrogates at risk, including those associated with embryo transfer, transnational gestational surrogacy, and unsupported pregnancies. This study shows the urgent need to introduce regulations to protect women's health transnationally in this domain more effectively.

Mapping transnational commercial surrogacy arrangements in South and Southeast Asia.

Transnational commercial surrogacy is a form of medical tourism undertaken by intended parents in an attempt to seek surrogates in other countries. Most intended parents are from developed countries and seek their surrogates from developing countries, predominantly from South and Southeast Asia. This arrangement led to the establishment of surrogacy businesses in South and Southeast Asia, in countries such as India and Thailand. Subsequently, the business was banned in these countries, which led to a trend of moving it to neighbouring countries where there were no regulations or restrictions. This paper maps the movement of the industry and calls for attention to re-consider or re-frame commercial surrogacy in an international framework.

Nursing and midwifery use, perceptions and barriers to evidence-based practice: a cross-sectional survey.

AIM: The study aimed to explore how nurses and midwives obtain, use and embed evidence in everyday practice. METHODS: The study design was cross-sectional survey method. The setting was one local health district in metropolitan Sydney, Australia. All nurses and midwives working within the local health district, with access to an email account, were invited to participate in the study. An online survey questionnaire was distributed to explore how evidence is obtained, used and embedded within the clinical setting. The data were analysed using descriptive statistics (frequency and percentages). Pearson's Chi-square tests were used for comparison between groups. RESULTS: There were 204 survey respondents. The findings identified that the majority (n = 157; 76.96%) of respondents obtained evidence primarily from clinical practice guidelines. The majority (n = 149; 73.04%) of respondents reportedly searched databases and used evidence related to general clinical practice. There was a statistical difference (χ = 17.069; df = 8; P = 0.029) when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence. Most respondents (n = 138; 67.65%) were confident in their ability to change practice on the basis of available evidence. Thematic analysis identified four barriers to sustaining evidence-based practice, which included: the need for time; the need for organizational and management support; the need for educational opportunities and challenges to accessing evidence. CONCLUSION: The study provided an understanding of how nurses and midwives obtain, use and embed evidence into everyday practice. More importantly, the role of leadership is significant to support a process of knowledge generation, research translation and the implementation of evidence into clinical settings.