Surrogacy has emerged as a significant reproductive option for individuals and couples facing infertility or other barriers to biological conception. This practice encompasses a wide range of legal, ethical and social dimensions, which can vary considerably across different cultural, social and regional contexts. In Ghana, childbearing is highly valued for its role in personal fulfilment and social status, which may influence the eligibility criteria for surrogates. However, research on the practice of surrogacy in Ghana, particularly the experiences of surrogate mothers, is limited.
This study addresses this gap by exploring the recruitment, eligibility criteria, and personal experiences of surrogate mothers in Accra, Ghana, through qualitative narratives. By focusing on an African context, where surrogacy is predominantly unregulated and heavily stigmatised, this study contributes to global discussions on the influence of legal, ethical and cultural frameworks on reproductive practices.
For clarity and consistency, we use the term ‘surrogate mother’ to describe women who carry a pregnancy on behalf of another individual or couple, and ‘intended parents’ to describe those who seek to have a child through surrogacy.
Types of Surrogacy
Surrogacy arrangements are categorised as either commercial or altruistic.
- Traditional Surrogacy: Typically involves the surrogate mother being artificially inseminated with either the sperm of the intended father or a donor, making her the genetic mother of the child. This arrangement often gives rise to complex legal challenges regarding parental rights and custody.
- Gestational Surrogacy: Involves the creation of an embryo via in vitro fertilisation (IVF), which is then implanted in the surrogate, who has no genetic link to the child. This simplifies legal distinctions and reduces potential disputes regarding parentage.
Commercial surrogacy, which involves financial compensation beyond medical expenses, is legally permissible in certain jurisdictions but remains prohibited or heavily restricted in others due to ethical concerns. In contrast, altruistic surrogacy involves reimbursement for reasonable expenses only, aiming to reduce the risk of exploitation.
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Ethical Considerations
Ethical debates surrounding surrogacy focus on issues of autonomy, exploitation, and the welfare of the child. The welfare of children in surrogacy arrangements is also a significant area of concern, with a particular focus on the identity of the child, familial relationships, and best interests.
This study adopts Erving Goffman’s theory of social stigma as the primary theoretical framework to examine the experiences of surrogate mothers in Ghana. Goffman’s concept of ‘stigma management’ provides a useful lens through which to explore the coping strategies adopted by surrogates and surrogacy agencies. Furthermore, Goffman’s framework aids in understanding the intersection of stigma with recruitment processes and postnatal care. By integrating Goffman’s theory, this study contributes to a nuanced understanding of how stigma shapes the lived experiences of surrogate mothers in Ghana.
Global Perspectives on Surrogacy Regulations
In countries that allow altruistic surrogacy, such as Belgium, Denmark, the Czech Republic, the Netherlands, the UK, Canada and Australia, surrogates are selected based on stringent health and psychological criteria, and the recruitment process is typically facilitated by agencies that ensure informed consent and protect the rights of all parties involved. These nations impose strict regulations to ensure that surrogacy remains a charitable act and not a commercial transaction.
In the USA, surrogacy agencies typically establish specific criteria for selecting surrogates to ensure both the health of the child and the likelihood of a successful pregnancy. The following factors are typically considered: age, marital status, financial stability, medical and psychological stability, and past pregnancy experience. However, studies have noted a predominance of white, married women in surrogacy arrangements, who are often compensated for their involvement in surrogacy. Surrogacy agencies tend to select women who have already had children and are in good health, as these candidates are perceived to be more likely to experience successful pregnancies and exhibit emotional readiness for the process.
In India, the Surrogacy (Regulation) Act of 2021 outlines specific criteria for intended couples and surrogates, aiming to regulate the practice and ensure ethical standards. Intended couples must be Indian citizens, infertile and married, with specific age requirements, while surrogate mothers must meet certain criteria, including having their own children and aged 25-35 years.
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In the African context, surrogacy practices are diverse and largely unregulated in many nations, including Ghana, where infertility carries a significant social stigma.
Methodology of the Ghana Study
A phenomenological qualitative approach was used to explore the lived experiences of surrogate mothers. This design emphasises understanding the essence of phenomena as experienced by individuals, making it ideal for addressing sensitive topics such as surrogacy. Open-ended interviews were conducted with 21 women recruited through purposive sampling. These interviews aimed to capture nuanced insights into their experiences of surrogacy, with specific reference to their recruitment, pregnancy and discharge after birth. The qualitative approach facilitated rich, detailed data collection, overcoming the criticisms of small sample sizes by emphasising the depth and authenticity of the narrratives of participants.
The Fertility Society of Ghana provided resources for identifying surrogate agencies operating in the Greater Accra Region. Data were collected between December 2020 and June 2021 from 21 surrogate mothers aged 20-40 years, who were recruited from three private surrogate agencies in the Greater Accra Region of Ghana. The agencies were identified through the Fertility Society of Ghana. They collaborate with IVF clinics to provide surrogacy-related services, including client recruitment, medical screening and counselling. Participants who were either pregnant (gestational age of 16 weeks or more) or had delivered within the past 2 years were purposefully recruited for the study.
The inclusion criteria required that participants have direct experience as surrogates, be fluent in English or a local language in which the interview could be conducted, and consent to participate. Women who had only considered surrogacy but had not yet undergone the process were excluded from the study. This was done to ensure that the participants could provide comprehensive insights into the physical, emotional and social dimensions of surrogacy. Data saturation was reached after 18 interviews, and three additional interviews were conducted to confirm saturation and enrich the data.
Data were collected through semi-structured telephone interviews by DAA, a female PhD candidate with training in qualitative research design and conduct. As part of the participant recruitment process, the first author held phone and in-person conversations with the individual participants, explaining the purpose of the study and its relevance to education in assistive reproduction. This process was a part of rapport building aimed at easing the doubts of the participant and answering any questions before actual data collection began. The telephone interview process helped accommodate the need for anonymity and privacy of the participants.
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Interviews were conducted using a semi-structured interview guide, which covered the motivations of participants for entering surrogacy, recruitment pathways, eligibility criteria, experiences of stigma and postnatal care. The interviews lasted 45-60 min and were audio-recorded with consent. Thematic content analysis was used to analyse the data. Audio recordings were transcribed verbatim and, where necessary, back translated into English. A combination of deductive and inductive coding was used. Deductive coding aligned with the existing literature, while inductive coding revealed context-specific themes. Emerging themes included recruitment and eligibility criteria, coping with societal stigma, and post-delivery and discharge experiences.
Ethical clearance was obtained from the Ethics Committee for Humanities (ECH 039/20-21). The participants provided informed consent and understood their right to withdraw at any time without penalty. Anonymity was ensured through the use of pseudonyms, and the data were securely stored.
The study involved 21 surrogate participants aged 20-40 years. Among them, six were married, and two had attained university-level education, while the majority had completed either junior or senior high school. The findings reveal the multifaceted journey of surrogates in Ghana, characterised by rigorous eligibility assessments, management of societal stigma and diverse postnatal experiences. These form the three broad themes that emerged from this research.
Recruitment Pathways into Surrogacy
This theme describes the various processes involved in selecting women to become surrogates. Surrogacy recruitment is primarily facilitated through personal referrals by friends, family or former surrogates. Prospective surrogates often encounter agencies after being informed about surrogacy opportunities by these trusted acquaintances.
The above narratives provided by participants highlight the informal pathways to surrogacy recruitment, underscoring the pivotal role of social networks and trust-based referrals. Personal connections, such as family and friends, often facilitate initial contact with surrogate agencies, reflecting the culturally embedded nature of recruitment processes in Accra.
The next step in the recruitment and selection process was medical and psychosocial screening. Participants revealed that after agreeing to be surrogates, they were required to visit the hospital to undergo a series of tests and evaluations. The ability to successfully complete these steps determines whether or not they can proceed with the surrogacy arrangement.
Eligibility is determined through rigorous medical evaluations, including tests for sexually transmitted infections, pelvic ultrasounds and overall health assessments. Psychological readiness also emerged as a critical consideration for surrogacy candidates, emphasising the importance of emotional stability and the ability to detach from the child after delivery. Agencies sought to ensure that surrogates were prepared for the emotional complexities of the process, although formal assessments were not conducted prior to the surrogacy. Instead, readiness was gauged through conversations with agency workers who questioned candidates about their emotional resilience and motivations.
Surrogacy agencies often prioritise women with prior childbirth experience, a critical criterion that ensures familiarity with pregnancies and deliveries. This prior experience reassures agencies and intended parents that the surrogate understands the demands and expectations associated with carrying a pregnancy, which can help mitigate unforeseen complications during surrogacy.
The Debate on Commercial Surrogacy
Should commercial surrogacy be legal?
A few months ago, Nigerian media personality Ifedayo Agoro sparked debate online when she stated that, despite having no fertility challenges, she would still choose surrogacy as her preferred means of reproduction. While some netizens agreed with her perspective, many others criticised her. Interestingly, in South Africa, this is completely outlawed by section 295 of the Children’s Act, 2005 (Act 38 of 2005). The section is to the effect that a court may not confirm a surrogate motherhood agreement unless the commissioning parent or parents are not able to give birth to a child and that the condition is permanent and irreversible, among other requirements. Ms. It is within this broader discourse that the present article is situated.
Prompted by Ms. Agoro’s remarks and by Ghana’s own rising engagement with surrogacy as evidenced by TV3’s 2024 documentary, the article examines the ethics of commercial surrogacy, a practice on which Ghanaian law remains silent. Globally, the practice is expanding. In 2024, the surrogacy market was valued at USD 194.0 million and is projected to grow to USD 321.4 million by 2033. The article compares legal approaches in the United Kingdom, South Africa, Brazil and India, and concludes with a call for clear and comprehensive legislation on surrogacy in Ghana.
Section 48 of Act 1027 defines surrogacy as an arrangement where (a) an embryo formed from an egg and sperm of persons other than a surrogate mother and the partner or husband of that surrogate mother is implanted into the surrogate mother, or (b) a gamete from a person other than the partner or husband of a surrogate mother is introduced into the surrogate mother to fertilise the egg of that surrogate mother, to enable the surrogate mother carry the foetus for the period of the pregnancy and give birth at the end of the period on behalf of another woman or the intended parent.
Building on this definition, section 22 of Act 1027 outlines procedures for recognising parentage in surrogacy arrangements, both before and after birth. Van Zyl and Walker (2013) explain that surrogacy is generally categorised into “commercial” and “altruistic” forms. Altruistic surrogacy is based on a “gift relationship,” motivated by love or altruism, in which a woman-often a close friend or relative-agrees to have a child for an infertile couple.
Commercial surrogacy offers infertile couples and individuals a practical route to parenthood. It creates opportunity for those unable to conceive naturally to have a biological child, providing both hope and fulfilment. Women should have the right to make autonomous decisions about their bodies, including the choice to act as surrogates and being compensated for surrogacy. Commercialisation, when properly regulated, not only upholds women’s freedom of choice but also ensures fair compensation for the physical, emotional, and health risks involved in surrogacy.
Commercialising surrogacy within a transparent legal framework would protect the rights of all parties-the surrogate, the intended parents, and the child. When regulated, it may contribute to economic development by creating opportunities for medical tourism and specialised reproductive health services.
Criticisms of Commercial Surrogacy
Critics argue that surrogacy risks turning women’s bodies and children into commodities. This concern is particularly acute in commercial arrangements, where surrogates may be valued primarily for their reproductive capacity. A key ethical issue is whether surrogates-who are often women from poorer backgrounds-are exploited by wealthier commissioning parents. Critics ask whether it is right to bring a child into circumstances where parentage may be contested.
Reproductive tourism, also referred to as cross-border reproductive care, presents complex legal, ethical, and risk-management challenges. In 2024, Pope Francis, while addressing ambassadors at the Vatican, strongly condemned surrogacy as a grave violation of the dignity of women and children, stressing that it exploits women’s financial vulnerability and reduces children to commodities. He called for a universal ban on the practice, insisting that human life, including that of the unborn, must always be respected and protected. His remarks reflect broader religious and cultural perspectives that shape ethical debates on surrogacy.
Critics of commercial surrogacy argue that pregnancy is a complex physical and emotional journey that cannot be reduced to a simple transaction. Women endure months of physical strain, including nausea, fatigue, hormonal changes, and the risks of complications such as gestational diabetes or preeclampsia. Beyond childbirth, post-pregnancy recovery could bring further challenges-pain, hormonal imbalances, emotional vulnerability, and in some cases, postnatal depression.
Commercial surrogacy could create a market where children and women are exploited for profit. In unregulated environments, the practice may blur the line between legitimate reproductive arrangements and child trafficking. Women, particularly those in vulnerable economic positions, risk being coerced into surrogacy.
Legal Frameworks in Other Countries
In South Africa, surrogacy is purely altruistic. Furthermore, under section 301 of Act 38 of 2005, paying or receiving money for surrogacy is generally prohibited. The only payments allowed are for the surrogate mother’s direct medical and pregnancy-related expenses, loss of earnings due to the pregnancy, insurance covering risks of disability or death, and reasonable fees for professional legal or medical services linked to the surrogacy agreement.
In Brazil, commercial surrogacy is prohibited under both the Constitution, 1988, as amended (by inference) and medical regulations. Article 199(4) of the Constitution, 1998, forbids the commercialisation of human organs, tissues, and substances, and by extension, paid surrogacy is deemed unconstitutional and unethical. In accordance with CFM Resolution No.
According to section 2 of the Surrogacy Arrangements Act 1985 (UK), surrogacy is only permitted on an altruistic basis, as the law strictly prohibits commercial surrogacy. This means that no one is allowed to profit from negotiating, arranging, or compiling information for surrogacy arrangements. However, the law does make important exceptions. A woman who wishes to become a surrogate is free to take steps to do so, and intended parents may also lawfully make arrangements with a surrogate to carry a child for them. Payments directly to surrogates are allowed, but only to cover reasonable expenses, such as medical costs, maternity clothing, or loss of earnings.
For many years, India was a major hub for commercial surrogacy, attracting clients from around the world due to lower costs, advanced medical facilities, and the availability of surrogate mothers. The country’s limited regulation at the time made it a leading destination for international surrogacy. Landmark cases such as Baby Manji Yamada v. Union of India(2008) and Jan Balaz v. Anand Municipality (2009) illustrate how foreign nationals, including Japanese and German citizens, engaged in surrogacy arrangements in India. The Act was enacted to curb unethical practices and safeguard the rights of surrogate mothers and children born through surrogacy (Vyas, 2025). Only altruistic surrogacy is permitted under the Act.
This article assesses the ethics of surrogacy and calls for clearer, more comprehensive legislation on the subject. While legalities may not fully resolve the ethical dilemmas surrounding surrogacy, they represent an important step forward.Ethical scrutiny must therefore move beyond compliance with legal rules to address deeper questions of justice and humanity.
Ethical Issues and Weak Legal System
Surrogacy has recently emerged as a crucial fertility treatment solution due to the development of in-vitro fertilization (IVF). There are however a number of socio-ethical and legal issues, including parental rights, children’s basic human rights, and abuse of women, most notably surrogate exploitation. In Ghana, these socio-ethical issues have not been well studied.
The results suggest that couples will resort to surrogacy when all treatments have failed. This decision is however influenced by age, economic status, family and societal pressure. Surrogates are both altruistically and monetarily motivated to enter into surrogacy arrangements. However, surrogacy practice in Ghana is marred with numerous ethical issues including lack of informed consent, exploitation, abuse, issues of compensation and maltreatment of surrogates. These issues are compounded by a weak legal and regulatory framework which is unable to address uncertainties and abuse.
Even though surrogacy has come to address infertility issues in infertile couple, it is faced with ethical issues and weak legal system.
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