Trends in Access to Cross-border Surrogacy in Europe and Globally

Background: Demand for cross-border surrogacy has increased among intended parents in high-income countries, driven by delayed family formation, changing family structures, limited domestic surrogate availability and restrictions on access to assisted reproductive technologies. However, access to legally sanctioned cross-border surrogacy is increasingly constrained, with many former destination countries introducing restrictions on foreign intended parents. Methods: This descriptive study reviewed country-specific legislation and medico-legal literature published over the past 15 years concerning cross-border surrogacy. Legislative and policy developments in both source countries, from which intended parents travel, and destination countries providing surrogacy services to foreigners were examined, with particular attention to measures expanding or restricting access. Results: An accelerating trend towards restricting foreign access to surrogacy was identified among destination countries. Legislative restrictions on foreign intended parents have been attempted in nearly all surrogacy destinations, with bans on foreign access implemented in nine jurisdictions. Concurrently, several source countries have reviewed domestic surrogacy laws, with some introducing or strengthening restrictions on citizens undertaking surrogacy abroad. Reduced access to established destinations, combined with continuing demand, has contributed to engagement in less regulated jurisdictions and the cross-border recruitment of women to act as surrogates, including movement of Central Asian women into Georgia and other lower-cost European programs. Conclusions: Access to legally sanctioned cross-border surrogacy destinations is likely to continue to contract. Restricting domestic surrogacy without addressing underlying demand may displace intended parents towards less regulated cross-border arrangements, potentially increasing risks for surrogates, intended parents and children. Policy responses should prioritise improved access to appropriately regulated domestic family-building options alongside minimum safeguards for surrogacy practice, including informed consent, screening, counselling, ongoing support and protection of all participants.