With the huge demand for surrogacy in China, the country’s underground surrogacy industry is booming. Apart from renting out their wombs, what kind of journey do they go through?
For the first 32 years of her life, Wang Yan, who was born in rural Henan, lived a normal life, marrying a fellow villager at the introduction of her parents and having a son and a daughter.
In addition to the meagre income from farming, her husband opened a kiosk at the entrance to the village to supplement the family’s income. Even so, the money earned was barely enough for the family to survive.
This life was shattered when her father-in-law fell down the stairs and was paralysed in bed; her mother-in-law had a heart attack and owed a few tens of thousands of yuan (A few thousand pounds）after a rescue operation.
While her husband farmed, took care of the children, and did odd jobs at home, she went out to work alone to pay off her debts as soon as possible.
She lives in a 10-person basement apartment, manages goods in a supermarket during the day and works as a waitress in a restaurant at night, sleeping only three or four hours a day. Even so, she could only save more than 4,000 yuan a month.
Wang Yan doesn’t know how much longer she will have to go on like this. She feels sad when she hears her little daughter crying on the phone, missing her mother.
In May 2017, a text message on her mobile clutched her heart: “A woman in Zhengzhou, Henan Province, has earned more than 100,000 yuan a year as a surrogate”.
She thought, “I can’t earn that kind of money even if I’m dead exhausted”. She read the article several times and searched the Internet for “surrogacy” to see what it was all about.
Surrogacy is a form of assisted reproduction in which a fertile woman uses assisted human reproduction techniques to carry embryos for another family until the baby is born. The resulting baby is biogenetically unrelated to the surrogate mother.
“They make the embryos and put them in your womb, you just give birth to them.” Wang Yan, who only has a junior high school education, used her limited knowledge to quickly learn about this new thing.
After determining that she would not have sex with a man and that the baby was not related to her, she decided to become a surrogate mother.
“It’s quick money and you can earn a lot “, says Wang, who doesn’t shy away from saying that this is what she values.
With the development of China, the demand for children has made the market for surrogacy increasingly large. Behind the demand you see infertile people, lone parents and sexual minorities.
In 2009, the Chinese Population Association released a set of data showing that more than 40 million people in China suffer from infertility, accounting for 12.5 per cent of the population of childbearing age, which means that on average one in eight couples is unable to have children.
And the National Office for the Aging released the China Aging Development Report (2013), which shows that in 2012, there were more than a million families without a single child (due to the one-child policy implemented in 1979, which means that a family can only have a maximum of one child, which results in families losing their only child being called a family without a single child), with 76,000 new ones added each year.
There are also couples seeking a second baby through surrogacy after the full implementation of the two-child policy in 2016, as well as the LGBT community, women who do not want to have children themselves and families who want to “have more children”, all of whom are potential clients for surrogacy.
The huge market demand has made it difficult to estimate the number of surrogate mothers like Wang Yan, but their existence remains in a legally grey area where they are neither recognized nor opposed.
Although it has been explicitly stated twice that medical personnel are not allowed to perform surrogacy techniques since 2001. According to the Chinese Ministry of Health promulgated the Measures for the Administration of Assisted Human Reproductive Technology and in 2003 promulgated the Ethical Principles for Assisted Human Reproductive Technology and Human Sperm Banks.
However, the regulations here only bind formal medical institutions and medical personnel, and there is no explicit prohibition on individuals and intermediaries engaging in surrogacy. And the type of punishment given is administrative punishment and criminal liability, but it is also not specified as to what specific offences are involved.
As can be seen from the 2013 case of China’s FuChen surrogacy agency, when the Beijing Municipal Health Bureau intended to investigate and punish the FuChen Group’s Excellence Medical Clinic for allegedly carrying out assisted reproductive technology and surrogacy in violation of the law, it refused to open its doors for inspection on the grounds that it was “not a medical institution and not under the management of the Health Bureau”.
In the end, the Health Bureau had to refer the case to industry and commerce and public security and investigate and punish the clinic for “operating beyond its scope”.
To further embarrassment, the FuChen Group was only fined a maximum of 30,000 RMB in accordance with the Regulations on Human Assisted Reproductive Technology. This is a very small amount for a business.
The reality of the demand and the gap in the law has allowed surrogacy to go underground and flourish.
Wang Yan contacted an online surrogacy agency with a high reputation, “The big agencies are more guaranteed.” The customer service told her to go for a medical check-up first, “no infectious diseases, endometrial thickness of 9 or more” before she could apply for the job, and she would be reimbursed for travel and examination fees.
Despite her husband’s disapproval, Wang Yan quit her job and bought a bus ticket without her husband’s permission. It was May 13, 2017, and she dared not imagine what was waiting for her.
After a 20-hour train ride, Wang Yan arrived in an unfamiliar city at nightfall.
A logistics supervisor in charge of surrogate mother management took her from the station to her accommodation, a three-room residence with a TV, air conditioning and a refrigerator, Wang Yan had never lived in such a nice place. A surrogacy agency’s accommodation for surrogate mothers. (Photo)
She was allocated a single room, one for each of the two other surrogate mothers who had already had their embryos transferred, and the 40-plus-year-old nanny slept on the sofa. The nanny cooked noodles for Wang Yan and boiled an egg. After eating, she had a video call with her husband to show him where she was staying. Her husband instructed her, “Be careful, don’t get cheated by people.”
Early the next morning, the supervisor of logistics took her to the hospital for a check-up, gynecological, blood sampling, a full set of checks.
After passing the tests, Wang Yan signed the entry agreement and submitted her ID card – the agency told Wang Yan that this was to prevent the surrogate mother escaping.
The salary is calculated from the day she comes in, with ￥2,000 a month for living expenses and a commission of ￥170,000 distributed over time, with ￥10,000 given at three months, ￥20,000 each month from five months onwards, and the final sum paid after the birth. Add ￥20,000 if you have twins; add another ￥10,000 for a caesarean section.
When her period came ten days later, Wang Yan was blindfolded by the agency and taken to a so-called “regular hospital” for the transplant.
The head of the surrogacy agency revealed that the level of doctors, medical technology, environment and equipment directly affect the success rate of the transplant, which is the most crucial bargaining chip for the agencies. The success rate of transplantation varies from agency, from a high of 70 percent to a low of 20 percent.
In earlier times, egg pick-ups and transplants were often carried out in underground laboratories in private hospitals. Dozens of surrogacy agencies worked with hospitals, sharing a single laboratory. Then some powerful surrogacy agencies began to set up their own laboratories, buying high-end equipment from overseas and paying millions of yuan to hire medical staff from hospital fertility centers to come and operate in secret.
The labs contain expensive medical equipment and clients’ embryos, which can be costly if they are investigated. As a result, agencies often set up their laboratories in secluded suburban villas that are difficult for outsiders to access, except for medical staff, and surrogate mothers are brought in blindfolded.
But many agencies are reluctant to spend the cost, and they often seek out small clinics without a license and qualifications to work with, which also increases the risk of the surrogacy process. “Embryos are delicate and easily contaminated if the cleanliness is not up to standard, potentially leading to malformations or other congenital diseases in the baby,” said one surrogacy agent.
Before the embryo transfer, the doctor told Wang Yan to drink more water and hold her urine so that she could see clearly when the ultrasound was done. After drinking many glasses of water, her mobile phone was taken away and she changed into sterilised clothes and shoes and went into the operating theatre.
The operating theatre was the size of a bathroom and next to it was a freezing room, which Wang Yan guessed was probably for storing embryos. The equipment used for the operation looked quite professional, she couldn’t name it, and she was vaguely panicked.
After lying down, amid forties female doctor reassured her to “relax” and asked her which client’s embryo she was transferring. After Wang Yan gave her name, the doctor took out the thawed embryo, put it into a thin transfer tube and implanted it into her womb.
The whole process took less than 5 minutes. Wang Yan did not feel any pain and was only instructed not to exercise vigorously when she returned. She stayed in bed for 14 days.
After more than 20 days, she went to the hospital to check the fetal heartbeat and the embryo was viable. Wang Yan breathed a sigh of relief, secretly thanking herself for her good luck.
She had previously heard that some surrogate mothers had been unsuccessful for more than half a year, and some had miscarried after a successful transfer.
After the transplant, it is usually necessary to take progesterone for 75 days to keep the baby alive, and some surrogate mothers have swollen butts and even developed hard lumps.
Wang Yan escaped because of her good constitution, but she had to take progesterone every day. No one told her whether the medication and injections had any side effects.
When she was three months pregnant, Wang Yan met the mother of the baby in her womb for the first time. She looked to be in her 40s, a native of Hunan province, and accompanied her to a medical check-up and to the place where she lived, asking about her health and then asking no more questions. That was the only time they met.
She had heard that some clients who were particularly concerned about their children would self-select their surrogate mothers and take them out for individual care, even giving them various lessons in English, calligraphy and so on.
When the surrogates are selected, they are gathered together and lined up, and the clients are asked a variety of private questions, which they are expected to answer one by one, with no rhetorical questions allowed.
According to the survey, some agencies ask surrogate mothers to misrepresent their situation in terms of fertility, physical condition, age and education, and even fake ID cards and medical reports.
In some cases, when introducing third-party volunteers for egg supply to their clients, they show them those who are of good height, education and appearance, but actually use those who are not in such good condition and cost much less; some find girls in excellent condition to pose as volunteers to meet with their clients and later replace them with other people’s eggs.
Surrogacy agencies usually have detailed rules governing surrogate mothers: they can contact their families during the surrogacy period, but they are not allowed to reveal the address of their place of residence-they cannot bring outsiders to stay overnight or stay out at night, they cannot meet with anyone without permission, they cannot contact their clients alone, and in principle they are not allowed to go home; they go to bed before 22:00 every day …… violators will receive punishment.
The surrogate mothers’ activities outside are also strictly regulated. They rarely go out except for a walk downstairs after dinner. When they do go out, they avoid being recognised by people by avoiding peak traffic. When someone knocks on their door, they don’t open it easily unless they are given a ‘code’.
During her pregnancy, her husband brought the child to see Wang Yan once, at a restaurant outside, without telling her about the surrogacy. The family had a quick meal and then separated.
The life she is living now feels a bit unreal, “watching TV and listening to songs, it’s quite relaxing”. But she is constantly worried that if anything happens to the baby, all her work will be lost.
She began to avoid eating spicy food; she forced herself to eat meat and eggs every day, and listened to music, drank milk powder and took walks every day, “more than her own child”.
Wang Yan’s fears are not unfounded, because the law does not clearly regulate the interests of the surrogate, the client and the baby in the case of surrogacy.
In 2017 there was an incident in which a surrogate mother turned to the media because she was unable to receive the payment she had agreed with the agency after her client refused to accept the baby because the baby was born prematurely during the surrogacy process.
In reality, disputes over surrogacy go far beyond this category, and also involve disputes over custody, support and visitation rights, and disputes over debts arising from surrogacy, etc.
In 2015, Zhang Chunsheng, director of the legal system department of China’s National Health and Family Planning Commission, publicly expressed his desire to upgrade this work, which has been promoted for more than a decade under relevant departmental regulations, to the level of law. But to this day, this idea has not been realized.
Wang Yan hopes that the baby will be born soon, but the thought of the baby being taken away at birth makes her heart a little sad, “After all, it has been conceived for so long, there must be emotions.”
She could only console herself that the baby was going to a rich family to enjoy the blessings, “as long as the thought that he would have a good life, better than my own children who are in home, there is no complaint.”
Soon after the birth of her baby, Wang Yan was rewarded with 170,000 yuan, and after paying off her family’s debts, she took the rest of the money and built a new house in the village.