The Surrogacy Exploitation Crisis

It’s horrific, it’s disturbing, it’s damaging emotionally,” said Kayla Elliot, a young woman now fighting for custody of the baby she carried as a surrogate. What she believed was an act of generosity—helping another couple have a child—instead was part of a scheme entangling child abuse, foreign influence, and the commodification of life itself. 

That scheme burst into public view this summer when California authorities raided a sprawling mansion in Arcadia, removing fifteen children from the home of Guojun Xuan, sixty-five, a former Chinese government official, and his partner, Silvia Zhang, thirty-eight. Among the children was a two-month-old with a severe head injury. Authorities ultimately discovered twenty-one children, all with American birth certificates naming the couple as parents. Most were born to American women recruited online through “Mark Surrogacy,” an agency the couple secretly owned.

Neighbors said the mansion resembled a business, with a reception area and rows of nursery-style rooms. Investigators soon traced the couple’s network beyond surrogacy. Properties linked to Xuan were tied to narcotics, gambling, and firearms trafficking. His business partner, Haoren “Dragon” Ma, is a convicted felon who served time for orchestrating more than eight hundred fraudulent asylum applications for Chinese nationals. Xuan himself is a prominent pro–Communist party figure, part of a larger network extending Beijing’s reach abroad. For more than two decades, he also served as a senior official in Xinjiang province, where China has waged a campaign of repression and genocide against the Uyghur people.

The Arcadia story was no surprise to those familiar with the surrogacy industry. In the last year alone, a Chicago veterinarian was arrested on child pornography and abuse charges just days before he and his male partner were set to collect their surrogate-born son. In Pennsylvania, a registered sex offender was exposed online after posting videos with the child he and his partner obtained through surrogacy. YouTubers Shane Dawson and Ryland Adams welcomed a son the same way, sparking outrage after past videos surfaced of them joking about pedophilia and child rape. These cases reveal a simple truth: In much of the country, there are virtually no barriers to buying a child.

Surrogacy in the United States is governed almost entirely at the state level, and many states have adopted permissive frameworks that treat surrogacy as a private contract rather than a public concern. No states, for example, legally require intended parents to undergo background checks or home visits, which are standard practices in adoption.

It was a welcome development, then, when Reem Alsalem, the United Nations Special Rapporteur on violence against women and girls, released a report warning that “the practice of surrogacy is characterized by exploitation and violence” and urged governments to begin “tak[ing] steps towards eradicating surrogacy in all its forms.”

These cases reveal a culture willing to turn children, mothers, and even American citizenship into commodities that foreign powers can use for access and influence. In doing so, they hollow out the meaning of family, nation, and human dignity.

America’s surrogacy laws are underwritten by an absolute commitment to bodily autonomy. In practice, this commitment entails a simple syllogism: It is within a woman’s rights to do as she pleases with her body, even consent to a surrogacy contract. But that logic collapses under scrutiny. Consent is not a shield against exploitation, and an agreement on paper can conceal far deeper pressures at work.

In the United States, it is estimated that only 2 percent of contracts are altruistic, or unpaid, suggesting that lower-income women are attracted to surrogacy for financial reasons. (Surrogate-mothers can make up to $75,000 in the United States.) When New York legalized commercial surrogacy in 2021, for example, altruistic surrogacy was already legal, but very few women volunteered without pay. Legalizing commercial surrogacy was championed as “necessary” to recruit enough surrogates—an implicit admission that money, not altruism, drives supply. Across the U.S., laws prohibit the sale of organs and criminalize prostitution precisely because there are some things that should be safeguarded from market influence. Renting reproductive capacity belongs in that category.

Even if money were no factor, there is another problem. True consent requires an honest understanding of risk, and surrogacy is far riskier than the industry acknowledges or is required to disclose. A 2024 population-based study of nearly one million singleton births in Ontario found gestational carriers had the highest rates of severe maternal morbidity compared to IVF and natural births (7.1 percent vs. 4.6 percent vs. 2.4 percent). Postpartum hemorrhage and hypertensive disorders were also markedly higher among surrogates. Other analyses show surrogacy pregnancies are up to three times more likely to end in C-section and five times more likely to result in premature birth. Moreover, postpartum recovery is harder without breastfeeding or skin-to-skin bonding; oxytocin levels remain lower, with downstream effects on recovery and mental health.

Finally, when things go awry, surrogacy contracts can reveal mismatched expectations between the purchasing parents and the surrogate-mothers. Take Melissa Cook, who conceived triplets after signing a surrogacy contract. She was horrified to discover that the purchasing father—a single man who was deaf—was unable to care for three children and wanted her to abort one or two. When she refused, he threatened her legally. 

Similarly, Brittney Pearson was diagnosed with an aggressive form of cancer a few months into her surrogacy pregnancy. She delayed her treatment until the child was twenty-five weeks old, to give him a chance at life. When the intended parents, a male same-sex couple, found out the child may have health complications, they asked her to have an abortion. She refused, but in the end, they denied the child life-saving care at birth. Bodily autonomy may give surrogate-mothers absolute control over the baby during pregnancy; but they lose all rights over the child the moment he is born. 

Surrogacy contracts are written by and for adults, yet the one most affected has no voice. Indeed, the only distinction between a legal commercial surrogacy agreement and an illegal baby-selling arrangement is the timing of the contract. It’s a difference of degree, not kind, and doesn’t change the underlying reality: Money is exchanged, and a child is transferred.

Defenders of surrogacy often claim that surrogate-born children experience no psychological harm. That conclusion rests entirely on a single longitudinal study led by Professor Susan Golombok. The U.K.-based study began in 2003 with forty-two surrogate-born children and ended at age fourteen with only twenty-eight children left in the study. Golombok’s study relied mostly on mothers’ self-reports, combined traditional and gestational surrogacy, and operated in an altruistic-only regime unlike U.S. commercial practice. 

At age seven—often when children learn of their origins—surrogate-born and donor-conceived children did worse than naturally-conceived peers, echoing adoption literature’s age of realization. Despite the clear methodological limitations, this single study is repeatedly cited by lawmakers and researchers to justify surrogacy. But there is a crucial difference between no harm and no known harm. Ultimately, such children have no legal representation and bear the greatest risk. 

While appeals to bodily autonomy have overshadowed legal efforts to regulate or reduce commercial surrogacy as a moral issue, a different set of concerns has begun to capture the public’s attention: international cross-border surrogacy, citizenship fraud, and national security concerns. 

When I began researching international commercial surrogacy—a practice banned in most developed nations—I was struck by how little oversight exists in the United States. Foreign citizens can contract with American surrogates, and under the current reading of the Fourteenth Amendment, surrogate-born children gain and maintain the full rights of U.S. citizenship, including a birth certificate, Social Security number, and passport, even if the intended parents are foreign nationals who plan to raise the child abroad. Worse still, authorities do not know who these children are, where they live, or how many exist.

A 2024 report in the American Society for Reproductive Medicine’s journal Fertility and Sterility found that U.S. international surrogacy cycles nearly doubled from 2,758 cycles in 2014 to 4,905 cycles in 2019. (A single cycle refers to the process of implanting an embryo(s) into a surrogate-mother in hopes of conceiving a child.) Of all foreign nationals purchasing surrogate-born children, 41 percent are from mainland China, with France (9.2 percent) and Spain (8.5 percent) next in line. The study noted that the most common demographic taking advantage of this industry are Asian men over the age of forty-two. This isn’t exactly the crowd you picture knitting booties and singing lullabies.

“As long as you know what you want and you have money, having children in the U.S. will always bring advantages,” one Chinese case worker at a surrogacy agency told NPR. Those advantages are substantial. Once these U.S.-citizen children turn twenty-one and meet residency requirements, they can sponsor their parents and siblings for immigration. Some agencies even advertise surrogacy as a “cheaper alternative” to investor visas.

The surrogacy industry itself openly markets this outcome. As one  admits, “For international intended parents, the certainty of their child obtaining U.S. citizenship at birth is a significant factor in choosing the U.S. for surrogacy.” In plain terms, citizenship has become a product for sale alongside the child.

The scandals that opened this essay show what happens when a nation turns reproduction into a marketplace and reduces women to their wombs. That is why the U.N. Special Rapporteur has urged an end to surrogacy altogether, and why the United States must act to stop cross-border arrangements before we keep selling children for citizenship, or something worse.

California, where many of these surrogacy abuses took place, has some of the most detailed state laws regulating the industry. It’s not a question of more or better regulations. What we need are courageous leaders who boldly declare that some human goods—mothers, children, citizenship, and the bonds between them—are too precious to sell.