Women Head East for Wombs to Rent

“No drinking, no smoking, no taking drugs and eat healthily.” As she lists the rules she wants her future surrogate mother to abide by, the voice of Rumyana Nencheva, 34, a dentist from Varna, Bulgaria, gets thinner and quieter.

The ‘infertility epidemic’

According to the European Society of Human Reproduction and Embryology, ESHRE, in 2010, one in six couples in the world suffers from infertility. In up to 35 per cent of cases, ESHRE says, this is down to physiological reasons in the woman. An average of nine out of 100 women in the world aged 20 to 44 cannot have a child. “Infertility is turning into an epidemic whose peak we have yet to see,” says Georgi Stamenov, head of Nadezhda (Hope), one of the main centres for reproductive health in Sofia.

Nencheva has come to Ukraine, seeking a surrogate mother. Diagnosed with uterine cancer in June 2008, she cannot bear a child of her own.

She is a part of a growing phenomenon of women who are unable to get pregnant and - facing a ban on surrogate pregnancy at home - travel thousands of miles to Ukraine to rent another woman’s womb.

Victims of society’s stigma against childless women, especially in the Balkans, they also confront the hostility of the law in most countries to paid-for surrogacy.

They are drawn to Ukraine by the former Soviet republic’s relaxed laws on commercial surrogacy, its relatively developed medical infrastructure – and the price.

Most women heading for Ukraine come from western Europe and the Americas - only they can usually afford the fees. But a growing number, like Nencheva, are middle-class professionals from the Balkans for whom the cost is still a huge sacrifice.

The staff at the International Surrogate Motherhood Center (ISMC), in Kharkov, Ukraine, tell Nencheva that she is not the only woman with that name from Bulgaria to have travelled more than 2,000km to Kharkov.

“We have many patients from the Balkans,” the woman at the Center confides. While there, Nencheva spots another Balkan traveller, Snezhana, a rotund Macedonian in her forties.

The woman behind the desk explains in a businesslike manner that Nencheva has two options when it comes to choosing a surmama, the Russian word for surrogate mother. Doctors at the Feskov clinic – where the necessary medical procedures are performed - can select a woman to carry a child, or Nencheva can choose one herself from the ISMC’s long list.

“We have a rich database of candidates,” the woman continues, “blondes, brunettes, women with blue eyes, Slavic types, darker-skinned ones, or ones with higher education. If her medical indicators turn out to be incompatible with yours, the selection can be repeated.”

A curse in the Balkans

In Balkan societies the taboo against childnessness is especially strong. Here “the inability to conceive a child, and carry it to maturity, is regarded as abnormal,” says Bulgarian psychologist Yana Pacholova. “If people learn about it, the woman experiences shame, reproachful glances, negative attitudes, whispers behind her back, and isolation from society,” she adds. Fear of barren women in Bulgaria is handed down the generations. Folklore teaches that childlessness is a curse and a disease. If a craftsman touches a barren woman, his trade will wither. Young maidens must also avoid them. By touching a childless woman, they imperil their own fertility, for childlessness is contagious. In traditionally patriarchal cultures, the child and the production of children legitimate the position of the woman and determine her status in society, according to the Bulgarian social anthropologist, Haralan Alexandrov. “The worth of the woman depends on her carrying on the bloodline and continuing the family,” he says. “It is hard to imagine the terror that the clan feels when faced with the fact that a woman belonging to it cannot have children,” notes anthropologist Antonina Zhelyazkova, from Sofia. In some parts of the Balkans, including Kosovo, Macedonia and western Romania, the families of a childless woman would cope with this dilemma by giving her the child of a relative to bring up as her own, according to Violeta Stan, a child psychiatrist in Timisoara, western Romania. But, among the Roma, the inability of a woman to conceive can lead to the annulment of the marriage. Among the Kardash community in Bulgaria, meanwhile, a mother-in-law can even chase away an infertile daughter-in-law.

Why Ukraine?

For women who want to escape the taboo on childlessness, and who do not want to adopt, the only solution is to find a surrogate mother who will carry their egg to maturity.

For most governments, however, surrogacy raises serious ethical dilemmas, mainly concerning women being paid to carry children for someone else.

That is why no European Union country allows commercial surrogacy, and why women seeking to rent a womb have to head east to Ukraine, Russia, Georgia, Kazakhstan, or even further afield to India.

In the EU, Austria, Germany, Sweden, France, Hungary and Italy prohibit all forms of surrogacy, paid-for or not. Britain, the Netherlands, Belgium, Denmark and Greece allow surrogacy, as long as no commercial element is involved.

Ukrainian law, by contrast, is the most surrogacy-friendly in Europe. Article 123.2 of Ukraine’s Family Code stipulates that women may receive financial compensation to carry someone else’s child, and the law places no limits on the amount that can be paid.

The law also guarantees the biological mother’s legal rights to the child or children born in the surrogate mother’s womb. No adoption process or court order of any kind is required. The entire process is regulated by a contract signed [Pic 1.Contract from Kharkov] between the agency or clinic, the biological mother and the surrogate mother.

By this, the surrogate mother surrenders all rights to the child carried in her womb. Only the names of the biological parents are entered on the birth certificate.

Valery Zukin, vice-president of the Ukrainian Association of Reproductive Medicine (UARM), says 150 to 200 paid-for surrogate motherhood cycles take place in the country each year.

About half of the women renting these Ukrainian women’s wombs are foreigners, usually from the US, Britain, France, Sweden and Italy, but also from Balkan countries.

Cheaper in Kiev

The law is not the only reason why women seeking wombs to rent come to Ukraine. “The main reason… is the price,” claims Marina Vasilieva, patients’ coordinator of New Life, a surrogacy centre that opened a permanent office in Kiev in March this year.

The ISMC in Kharkov initially quoted Rumyana Nencheva 21,760 euros for its services. Prices depend on the state of the biological woman’s ovaries and on whether she requires donor sperm or not.

New Life in Kiev charges in American dollars. Its price is higher, at about $35,000, [26,000 euro], including an egg donation.

This is still only about one-third of the price charged in those US states, such as Florida, Nevada, New Hampshire, Virginia and California, that permit commercial surrogacy.

For renting out their wombs, the agencies in Ukraine pay surrogate mothers from $7,000 US [5,080 euro] in Kharkov to $12,000 [around 8,700 euro] in Kiev.

Beside that, would-be parents are expected to pay the women about 200 euro per month in support fees, or a total of about 1,550 euro for the whole pregnancy. “They also pay for medical expenses during the pregnancy and for monitoring,” Vassilieva explains.

“The terms for our surrogate mothers are quite good, for  Ukraine,” she says but stresses being a surrogate mother is not an instant passport to wealth.

A single-bedroom apartment in the capital, Kiev, costs around $80,000 US [around 58,000 euro]. Vassilieva notes that is at least six times the average fee a surrogate mother earns.

However, Ukrainian law does not limit the number of surrogate pregnancies a woman may have.

If the recent financial crisis has boosted the number of potential wombs for rent, Vassilieva insists that many would-be surrogate mothers are still motivated, at least in part, by simple altruism.

Recruitment of candidate surrogate mothers is mainly done via the internet and by regional representatives of the New Life agency, who work in various parts of Ukraine.

“At any moment the candidate database of New Life comprises between 20 and 25 women, all with at least one of their own children,” Vassilieva says.

“Among them are women with secondary and vocational school diplomas, as well as students and higher education graduates,” she continues.

Beside the level of education, a candidate’s profile on the database will describe her height, weight, job and employer. The final selection is carried out by a psychologist.

Too pricey for the Balkans

While prices in Ukraine are far lower than in the US, they are well above what most people in Balkan countries can afford. It is far too costly for Ani Dimova, a frail-looking young woman from Asenovgrad in Bulgaria.

Medical reasons for turning to surrogacy

Hysterectomy Data from Eurostat, the statistical office of the European Union, show that every year an average of 120 of 100,000 women in the EU undergo hysterectomies - removal of the uterus and other reproductive organs. Mayer-Rokitansky-Kuster-Hauser [MRKH] syndrome, whereby women are born with an absent or underdeveloped uterus, is another reason why women to turn to surrogacy. Women with rare diseases, such as: - multiple sclerosis; - disease of the endometrium [uterus lining], uterus; - heart, renal or other types of organ failure; - women with transplanted organs; - some types of cancer.

She still remembers her deep shock on discovering in her teens that she would never conceive. “At first, my parents tried to hide it from me,” she says.

“I was 14 and had just had my first check-up in hospital. I went outside and waited for them in the car. When my mom came out, she was crying.” 

Though naturally smiley, Dimova says few days go by when she is not reminded that she cannot have her own child. “I’ve thought about going somewhere where surrogacy is possible but the prices are very high,” she says

“They’re not for the likes of us. In Ukraine, you’d need about 50,000 Bulgarian leva [around 25,600 euro] saved up.”

On hearing her story, Dimova says that her former boss, Dimitrina Popova, offered to carry a child for her, if the law was changed to allow surrogacy in Bulgaria.

Popova, 36, a mother of two, recalls her teenage daughter’s reaction when she shared her desire: ‘“You’re crazy!’ she said.” But Popova can do nothing for Dimova right now. Bulgaria banned all forms of surrogacy in 2007. 

Frustrated by the high costs of going abroad and the ban on surrogacy at home, Dimova went, in December 2009, to see Kalina Krumova, a Bulgarian parliamentarian, asking her to start a new debate on relaxing the current surrogacy ban.

Krumova duly raised the issue with fellow parliamentarians and in public throughout March 2010. Heightened public interest in the issue led to calls - backed by medical, ethical and legal experts - to ease the ban on surrogacy, as long as no commercial element is involved.

Currently, Krumova and a team of specialists are working on proposed changes to exising legislation concerning surrogacy.

Radina Velcheva, head of the Iskam Bebe (I Want a Baby) Foundation, supports a partial relaxation of the current law. “Those benefiting should be married women aged 18 to 43 for whom carrying a child to maturity is proven to be impossible,” she says.

Surrogate mothers would not receive a fee but the courts would approve the payment of certain expenses to carriers, such as medical costs, food, clothes and psychological assistance. These would be covered by the biological parents.

In spite of that, concerns remain in Bulgaria about any reform to the surrogacy ban. Fani Davidova, a legal expert for the non-governmental Access to Information Programme, a citizens’ advice service, warns changes must not be rushed.

Davidova, who writes on adoption issues and adopted a boy in 2006, says childless parents should look at other options first, such as adoption and fostering.

Meanwhile, Tolina Mladenova, from Sofia, says she would also be a surrogate mother, if it were legal. Financially secure in her 40s, she recalls explaining to her two children that she would like “to give her belly to another mummy who wants a child”.

“They were a little alarmed,” she adds. “They asked what would happen to it. I said that it wouldn’t be ours. ‘We’ll take care of it in mummy’s belly and then we’ll give it away.’”

Andreea Parvu explains why she wanted to rent out her womb. Interview conducted on  June 23, 2010.

Q: Tell me about yourself? A: “I'm 25, married with a little girl. I live in Brasov, graduated from vocational fabrics weaving school and went to work immediately after school. Then I was 17. I married at 22.” Q: And your husband? A: He works maintaining heating installations in Bucharest and Pitesti. He returns home once a week when he is working in Bucharest, and every night when he is in Pitesti. Q: How are you doing financially? A: The financial situation is not so good. My husband’s salary is better than mine. But I want to do this [be a surrogate mother] to help. Don't get me wrong. There are many families who can’t have children. Anyway my reasons are numerous. Q: Do you know some of these families? A: Not personally, but I have met some on the internet and seen them on TV. Q: When did you think about becoming a surrogate mother? A: Last December, or January 2010. I read about a TV star who said she’d had problems having a baby and was looking for a surrogate mother. There are numerous candidates wanting to become surrogate mothers on the internet, not only me. Q: What is your particular reason to want to become one? A: To help somebody who can’t have children. And, of course, [do it] for the money Q: Have you spoken to any lawyers to find out if this is legal? A: I learned a lot from the internet, that it [surrogacy] is legal. I bear their child; their cells are implanted in me. The child takes a certificate on my behalf and on behalf of his father, not my husband. It follows the procedure for adoption. I have to give up the child and give it to his biological mother who must adopt it. Q: What does your husband think about this? A: He agreed and supports me. I wouldn’t go over his head… I’ve consulted with him at every step. Q: What exactly did you ask for in your proposal to become a surrogate mother? A: To help me, reciprocally. I help them get a child and they help me financially. The newspapers exaggerated and said I wanted 27,000 euros, but it’s not true. Nothing like it. I'm not a woman of inflated requirements. Q: What responses did you receive toward your proposal? A: Once the article was in the Ziarul de Brasov and on TV, no one came to seek me - not for surrogacy, or for other information. I have the impression that Romania is not ready for this and it’s possible only with foreigners. Q: When did you first put your ad in? A: In March. My husband and I started to think about it in January, but time passed before we decided. I was interested in the legal aspect. Q: When you put in your ad, you received no calls from Romania? A: No. Nothing like that. Q: What was the reaction around you? A: I was criticised a lot. Some colleagues and friends supported me, but there are those who said that I was not OK. Are you sorry that you said, ‘I want to become a surrogate mother’? A: No, I'm not. Back to top of interview >>

In Romania, surrogacy is not illegal. Andreea Parvu, after reading a tabloid article about a TV star allegedly seeking a surrogate mother, put an advert on the internet in March 2010 announcing she was willing to rent out her womb.

“I wanted to help somebody who can’t have children. And, of course, [do it] for the money,” says Parvu, who has a daughter aged three and lives in Brasov. She became the subject of press and TV interest, but, to her surprise, no one took up her offer.

“I have the impression Romania isn’t ready for this,” she says. She believes people were afraid to respond openly to her advert after it gained publicity.

Balkans crackdown

Influenced by their common interest in European integration, Balkan countries are clamping down on surrogacy. In Serbia, which aspires to EU membership, a brief debate on the regulation of surrogacy ended with the imposition of a complete ban at the start of 2010.

“There were concerns that it would become commercialised,” Mima Fazlagic, a Belgrade gynaecologist, explains. EU-candidate Croatia outlawed surrogacy under a new law on medical fertility in 2009.

Before Bulgaria banned surrogacy in 2007, there was no law on reproductive medicine in the country and several dozen procedures were carried out in the 1990s, recalls Dr Pavleta Tabakova. She oversaw several surrogate births in Sofia in her private clinic before the ban was introduced.

The first surrogate pregnancy she directed resulted in the birth of twin boys in the early 1990s. The biological mother had had her uterus removed but donated the egg, Tabakova says.

“She was a journalist,” she adds, “Although she wasn’t shy at first about speaking publicly, now she refuses to do so. I even had a case where a mother-in-law carried a child for her daughter-in-law.”

The absence of legislation on surrogacy in Macedonia, Montenegro and Bosnia means that women seeking surrogate mothers in these countries are left in an unclear legal situation.

In Romania, which joined the EU alongside Bulgaria in 2007, there is also no law regulating surrogacy. In 2005, the Romanian parliament adopted a draft law on reproductive health that would have permitted non-commercial surrogacy, but President Traian Basescu rejected it.

Surrogate births were not unheard of in Romania in the 1990s, however. The first known case of a Romanian surrogate mother bearing a child took place in 1998 at the Bega clinic in Timisoara, western Romania.

“His name is Daniel,” reveals Dr Ioan Munteanu who headed the Bega reproductive clinic at the time. Up until 2004, Dr Munteanu oversaw 15 surrogacy procedures. But he is now much older, has carried out no further cases since then, and no other official surrogacy clinic has since opened.

A few of Dr Munteanu’s clients went public. One of his first was Livia Killian, whose son, Kristian, now 12, was born to a surrogate mother at the clinic.

When Kristian was little, Killian posed with him for a photograph, published some years later in the Banateanul newspaper in 2004. But today she prefers anonymity.

According to Bulgarian social anthropologist Haralan Alexandrov, today’s more conservative climate on surrogacy - and the silence surrounding the issue - reflects the strength of patriarchal values in the region.

“Suffering is not to be talked about,” he says. “There’s no evil intent here, it’s just how our culture operates.”

In Varna, following weeks of online communication with the clinic in Ukraine, Rumyana Nencheva is back to square one.

Doctors at the Kharkov clinic have concluded that while her ovaries are not exhausted, they are almost so. Unsure whether she has a usable egg, the clinic has decided not to take her on. She finds it hard to decide on her next move.

Ani Dimova is considering moving to a country where surrogacy is permitted. Of Bulgaria’s current ban, she says: “I don’t want to think it will stay forbidden forever.”

This article was produced as part of the Balkan Fellowship for Journalistic Excellence, an initiative of the Robert Bosch Stiftung and ERSTE Foundation, in cooperation with the Balkan Investigative Reporting Network, BIRN.