Child of our time?

PUBLISHED : Friday, 24 June, 2005, 12:00am
UPDATED : Friday, 24 June, 2005, 12:00am

Congratulations must go to Christine Loh Kung-wai. That is not only for taking on the toughest job of all - parenthood - but also for publicly airing a particular choice about parenthood that we rather avoid discussing in Hong Kong: surrogacy.

The complex ethical issues surrounding making babies have been debated for the past 20 years. But surrogate motherhood - deliberately becoming pregnant with, and giving birth to, a baby for other people - is one we have avoided. Hong Kong's human reproduction legislation is often described as a grey area, even though it does not allow commercial surrogacy. Some rare types of surrogacy, however, are allowed.

For instance, if a woman is unable to carry a baby because her reproductive organs are damaged, but she has fertile eggs, her eggs can be fertilised by her partner's sperm in the laboratory. The resulting embryos can then be implanted in somebody else. This is often called altruistic surrogacy, where a friend or relative agrees to have a baby to help out a couple who cannot.

Technology to help make babies in the laboratory has been available in Hong Kong since the 1970s, when artificial insemination was first used to overcome male infertility. The city's first test-tube baby was born in 1985. Around that time, the government became concerned that technology was outpacing legislation and that it was time to regulate the whole area of artificial reproduction.

In 1987, a committee of doctors, social workers, academics and lawyers investigated the issue and, after a decade, came up with legislation. But they were careful not to be too proscriptive - for instance, they did not ban all forms of surrogacy. Instead, they established the Council on Assisted Reproductive Technology, to oversee the burgeoning field.

Surrogate motherhood is as much about evolving human relationships as technology, so it is not surprising that legal practices vary widely from society to society. In Australia, for instance, most states ban commercial surrogacy but permit altruistic surrogacy when it can be proved that no money, beyond medical expenses, changed hands.

In such private, unofficial arrangements, however, if the surrogate mother decides she wants to keep the baby, the parents with whom she has the arrangement cannot enforce the agreement. Equally, if the altruistic surrogate mother decides she does not want to continue the pregnancy, she can be subjected to great emotional or even physical pressure to continue. One Mexican woman was confined by relatives until she gave birth for her cousin.

Most developed nations draw a distinction between altruistic and commercial surrogacy, preferring to leave the altruistic relationship in the murky legal grey area but not allowing commercial surrogacy. This is probably a fairly natural reaction - most people see commercial surrogacy as a form of baby-trading.

But a number of academics who have studied surrogacy point out that of the two types, the commercial relationship is fairer for the biological mother. This is because her choice is made on pragmatic rather than emotional grounds, and she usually has a clearer idea of her commitment and obligations.

In the US, where commercial surrogacy has officially been in existence since the 1970s, the rules vary significantly from state to state, but a number do permit commercial surrogacy. Couples from all over the world now travel to America to organise surrogate pregnancies - as did Ms Loh and her partner, Craig Erhlich. An estimated 35,000 babies have been born through commercial surrogacy.

Hong Kong has had a negative fertility rate - we do not have enough babies to replace our losses through death and emigration - for some time now. Those who do choose to become parents are older and less likely to be fertile. So perhaps it is time we thought a little harder about how we have our children.

Congratulations once more to Ms Loh.

Margaret Cheng is a Hong Kong-based medical writer