Incidence of surrogacy in the USA and Israel and implications on women’s health: a quantitative comparison

Purpose. Gestational surrogacy (GS) has been researched in multiple qualitative studies. In sharp contrast, quantitative aspects of the practice are conspicuously understudied. The present article aims to assess and compare the incidence of GS in the USA and Israel, two industrialized countries that have maintained active, formally regulated surrogacy practice, for over two decades. Method. The article is a secondary analysis of official GS figures published by the USA and Israel. Each dataset is analyzed vis-à-vis the respective country's population, adult population and number of deliveries and infants born, so as to devise local Incidence Scores. These scores are the basis for an inter-country comparison. Results. The incidence of GS is rising in both countries. Though USA surrogates are contracted by both local and international, heterosexual and gay, partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, at a ratio of 2:3, even though in Israel only local heterosexual couples and single women may contract a gestational surrogate. Conclusion. GS emerges as reflective of its social surrounding, with the ratios between the countries' GS incidence resembling the ratios between their respective fertility rates. The paper ends with considering two risks facing gestational surrogates: the risk of not conceiving and not being paid, which is the outcome of most GS cycles, and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health consequences that are likely to accompany it.