Surrogacy from a reproductive rights and justice perspective: a narrative review.

Abstract

Graphical abstract:

Abstract: Surrogacy is a form of assisted reproductive technology in which a woman carries a child on behalf of an individual or couple and relinquishes the child following birth. Since its emergence in its contemporary form in the late 1970s, surrogacy has been the subject of ongoing debate and controversy, shaped by developments in scientific research and social discourse. This work proposes a theoretical framework that directly engages with the ethical and practical paradoxes of surrogacy rather than bypassing them. The analysis is grounded in a comprehensive review of 86 scholarly articles drawn from international, cross-disciplinary literature. The aim of this research is to approach surrogacy through a non-binary, socially informed lens, placing surrogates themselves at the center of the inquiry. First, it clarifies the conceptual distinction between reproductive rights and reproductive justice, exploring their respective contributions to surrogacy debates on regulation without oversimplifying the issues or reducing them to binary frameworks. Second, it mobilizes these frameworks to diagnose how surrogates' autonomy, health, and agency are unevenly protected across national and transnational arrangements, focusing on different geographies to illustrate de diversity of surrogacy practices. Third, it critically examines institutional responses - particularly medical, legal, and associational forms of regulation - highlighting both their potential and their limitations in advancing reproductive justice for surrogates. By adopting a cross-disciplinary perspective, this work seeks to reorient the discussion toward the experiences of surrogates and to inform political decision-making concerning assisted reproductive technologies within the context of an expanding global reproductive market.

Lay summary: Surrogacy is when a woman carries a child for someone else and gives the baby to them after birth. While this practice helps people become parents, it also raises complex ethical and social questions. This review looks at 86 studies from different countries and disciplines to better understand these issues. It proposes a new way to think about surrogacy, focusing on the rights and experiences of the women involved, especially surrogates and donors. The study shows that many women, especially in the Global South, face problems such as poor access to healthcare and limited information about the process. It also highlights how medical and legal systems often fail to protect them. By combining ideas from human rights and feminist movements, the review offers a tool to identify these problems and calls for stronger protections. It encourages global rules to ensure that surrogacy respects women's health, rights, and dignity, no matter where they live.