The day before war broke out in Ukraine, 33-year-old Tanya* was visiting a hospital in Cherkasy, a city in the centre of the country, to check on the health of her unborn twins. She was unable to return to her hometown near Kirovograd due to the ongoing violence and quickly moved to an apartment in the city with her husband and two children.
"I started getting severe pregnancy sickness (hyperemesis) just as the war started," Tanya says over the phone from Ukraine. "I’m now almost 10 weeks pregnant and I’ve struggled to eat anything or cook and care for my children properly because it’s so bad, which has made things even more difficult. I just hope I can stay where I am until I have the babies."
Being pregnant in a war zone is a terrifying prospect for anyone but Tanya’s situation is more complicated than most. She is one of approximately 1,000 surrogates in Ukraine who are currently pregnant with the biological child of another couple.
Ukraine is a global surrogacy hub. In many countries surrogacy is either illegal or only available on a voluntary basis. The law changes all the time but, right now, Ukraine is one of a few countries, including Georgia, Mexico and some US states, which allows people from abroad to engage women in surrogacy arrangements. As a result, people travel from across the world – from the UK, the United States, Ireland, Germany, Australia, Israel and China – to pay local women to carry their children.
In the UK surrogacy is legal but complex. Surrogates cannot be paid anything other than reasonable expenses and it is the surrogate, not the biological parents, who is legally the parent of the child at birth. In Ukraine the law is more straightforward, with surrogacy arrangements possible for any married, heterosexual couple who can prove they are medically unable to carry their own baby (currently surrogacy in Ukraine is not allowed for queer couples or single people). This, combined with the fact that a ban on surrogacy came into force across much of Asia in 2015, means the industry in Ukraine has boomed. Although official statistics are hard to come by, experts estimate that approximately 2,000 to 2,500 children are born in the country each year through surrogacy. In each case agencies act as intermediaries between surrogates and parents, with total costs ranging from around US$35,000 (£26,700) to US$65,000 (£49,600). For westerners the option is considerably cheaper than in America, where surrogacy packages typically start at US$120,000 (£91,600).
Here in Ukraine I don't see other ways of earning that kind of money.
This is Tanya’s second surrogate pregnancy and she will be paid US$20,000 (£15,200) for carrying the twin babies of an American couple. Despite the challenges of hyperemesis and her ongoing anxiety about the war, Tanya is grateful for the support she’s had from her agency, Repromedicine, which is not something all surrogates can rely on.
"I was panicked when the war started because I read that some agencies have started dropping surrogates but I have continued to get the support, advice and care I need. That made me feel calmer."
Tanya is also in daily contact with the twins’ parents through a translation app. "They suggested I move to Poland but I never want to leave Ukraine because it’s my home. My brother is fighting and I have my elderly parents here, too, who can’t travel. The parents of the twins are very understanding of my decision to stay here. When I feel scared they help to distract me and take my mind off the war so that I feel supported."
Although she’s afraid, Tanya is trying to stay strong for the sake of her children, her health and the babies she is carrying. "We’ve been hearing sounds of explosions and although nobody was hurt, it was very scary," she says. "Many families are sleeping in the bathroom, including my own, away from all the windows to stay safe. Mostly I'm scared for my children, because they hear the noises of the planes from the sky and they wake up afraid. The only way I can get through is by pretending that everything is okay and I’m living an ordinary life. I don’t have time to be sick or panic because my children need me, so all I can do is focus on happier things."
Sam Everingham, global director of Growing Families, a nonprofit organisation that supports parents through surrogacy and advocates best practice, says that before the war started, more couples were turning to surrogacy abroad due to the challenges they face in their home countries and the devastating impacts of infertility.
"In the past, many infertile couples would have adopted. But in recent years it's become more complicated to adopt children from other countries," he says. "As a result the waiting lists in many countries became very long, with some lasting up to eight years. Many of the parents who turn to surrogacy have been through extended periods of difficult IVF treatments and are left emotionally drained by the experience. Some women feel ashamed because they aren’t able to carry their own child."
Everingham has always advocated for the rights of surrogates as well as biological parents but it’s become more crucial than ever in recent weeks. He is in touch with around 80 parents from 12 different countries who currently have surrogates in Ukraine carrying their children, and he has been working with Ukrainian surrogate agencies to try and evacuate newborn babies and mothers who want to leave. "Many of the parents feel helpless and are unable to reach the surrogate mothers. Some agencies won’t give out numbers so they have no way of getting in touch. For babies being born now, they’re scared they will be left in a war zone."
While some surrogates are fleeing Ukraine for countries like Poland and Moldova, others, like Tanya, will stay behind. "We discourage parents from pressuring their surrogate to leave the country if they don’t want to," Everingham continues. "Surrogate mothers are exhausted by the pain and terror of war so it must be their decision. Some women don’t have passports and have never left Ukraine before. They’re worried about how they might find work in other countries, the language barriers and more."
Everingham believes that the challenges that surrogates are currently facing as a result of the war are also eroding their sense of empowerment. "Surrogates often choose to do this to give their families a step forward," he says. "A lot of surrogates also say there is a sense of altruism, to be able to carry a baby for another couple who are struggling with infertility. The war is preventing them from being able to provide for their families."
For Tanya, the motivation to become a surrogate was financial. "When I first read about surrogacy I was afraid to try it because I’d heard of women not being paid after they went through the pregnancy. It felt like a big risk to take," she says. But three years ago she decided to do it so she could build a better life for her family. She was paid US$16,000 (£12,200) to carry her first surrogate baby, and the process ran smoothly.
"I wanted the chance to pay for things for my own children," Tanya says. "The living situation in Ukraine even before the war was far from perfect and my salary here was very low – around US$150 a week at the time. This felt like the only option to make the kind of money I needed to buy a car and a home, as well as the things my children need." Overall she was happy with her first experience, aside from the delayed payment. "I remember nobody contacted me for 10 days after the birth and I was so scared I wouldn’t be paid. I was very relieved when the money came through."
Tanya is trying to remain positive about her current situation but the war has trained an uncomfortable spotlight on the practice of international commercial surrogacy. In the past few weeks, stories of western babies being rescued from Ukraine have flooded the media yet the precarious situations of the surrogates aren’t always hitting headlines with the same force.
Emma Lamberton, a researcher in women’s rights in the post-Soviet era, believes the entire practice of commercial surrogacy throws up ethical questions. "A lot of countries, including India, have started banning the process completely," says Lamberton. "We are in a unique situation where science allows us to do this but we need to be asking ourselves whether we should and if it’s the right thing to do."
The surrogacy industry is heavily driven by demand from wealthy, western countries, which Lamberton argues is a problem in itself. "I’m not sure if commercial surrogacy can ever be truly ethical as it’s high income countries using lower powered women. Sometimes it’s hard to know where the line of choice and exploitation is drawn."
Surrogacy felt like the only option to make the kind of money I needed to buy a car and a home, as well as the things my children need.
Before the war, Lamberton says there were numerous reports of women being left uncompensated and with serious health problems as a result of surrogacy, as well as babies being abandoned if they were born with disabilities. Separation can be another big challenge for surrogates: around 25 women a year appeal to the courts to keep the child they’ve carried for nine months. Exact figures on exploitation are hard to come by but Lamberton's research shows that the care extended to surrogates can vary widely and that we lack data on the long-term risks, mental and physical health impacts of surrogacy.
Ethical challenges surrounding citizenship have also become more apparent as a result of the war. "Surrogate babies born in Ukraine aren’t Ukrainian citizens, meaning if they can’t get back to their biological parents they are effectively stateless and can’t be adopted," says Lamberton. This has been an issue in the past when couples have abandoned their babies due to disabilities but now even the most longed for babies are at risk of being left behind. "Many women are unable to leave Ukraine for family reasons but also because surrogacy is technically illegal in other countries. Some women feel they have to choose between staying in a war zone and keeping a baby that isn’t theirs."
Lamberton understands the drive behind surrogacy and says it’s impossible to judge every situation in the same way. "There are many stories about the poor families who are desperate to have a baby, we just need to ensure that we prioritise the rights of vulnerable women and children equally," she says. It’s also important to consider the financial impact that a ban on surrogacy could have on surrogates.
According to a Time article last year, research following on from India's surrogacy ban shows that preventing the practice has the potential to hurt lower income women by reducing their options to provide for their families.
For Everingham, improved global regulation of surrogacy is essential. The war in Ukraine has made it more urgent than ever. Whether the practice is voluntary – as it is in the UK – or commercial, women should be entitled to counselling and support, as well as physical and mental health checks.
"People often think that voluntary surrogacy is a safer alternative but without the right regulation that can also be damaging for surrogates, for example if they feel pushed into it by a family member," says Everingham. "Psychological support in any surrogacy situation is key. Ideally couples would be able to engage in surrogacy in their own country in a way that’s safe and regulated for couples and surrogate mothers."
For now, the safety of Ukraine's civilians takes precedence over surrogate contracts. As the war continues to rage, Tanya is unsure what will happen to the twin babies she’s carrying when the time comes to give birth. "I am really hoping that peace will be restored quickly and I can continue the pregnancy in a safe, secure environment."
Tanya admits that surrogacy has been hard on her body and it’s not a choice she’d have made in an ideal world. "Here in Ukraine I don’t see other ways of earning that kind of money. I think this will be my last [surrogate pregnancy] but if I needed the money in future I might have to do it again," she says. "It’s hard to know. In Ukraine we used to want so many nice things but now I just want to live."
*Name changed to protect identity