Thursday, 21 September 2017 | News today: 10

Surrogate motherhood in Macedonia

The past 2-3 decades have the period of great development of medicine and technology in the field of reproduction. The new reproduction trends, a mix of biological and social innovations, have changed the general perception regarding parenthood and family significantly. One of the more specific treatments is the surrogate motherhood, which attracts great attention and has been a topic for a debate here, too. The Macedonian parliament recently passed the Law for changes and additions to the Law for bio-medical assisted fertilization.

According to the MPs, it is a positive and humane law which enables altruistic surrogate motherhood that is in the best interest of married couples who have exhausted all other possibilities to have a child.

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Positions and fears 

Surrogate motherhood has caused many moral and legal implications which have been the subject for debates in many scientific-expert circles and while some support it as noble, brave and unselfish act, others consider it to be unnatural.

Some of the biggest advocates for this concept are gynecologists, who have been witnessing the struggles of many childless families on a daily basis. They think that society is mature enough, but that strong caution is necessary, because it is a very ethically problematic and sensitive issue.

According to Tatjana Gurzanova, gynecology and obstetrics specialist at the Fertility center “New Born Clinic”, surrogate motherhood is something which is necessary to overcome certain problems such as cases when because of inherent malformations there is no uterus, or it has been removed because of other health issues, or because of possible life-threatening pregnancies.

“Being a parent is the basic right of a woman, if she wants it. That is the humane and medical dimension of the problem with surrogate motherhood, but there is a very important social aspect of it related to the small territory and population of just 2 million people. Many questions will arise as to who is the real parent, the emotional aspects, and another very important thing is that the woman that will carry the child for nine months may get emotionally attached to it and there is the possibility of seeing her child “on the street”. Surrogate motherhood is best when practiced on couples living out of the country, meaning that a law that will enable surrogate motherhood, but not limit it to our territory and citizens and will be possible for couples that are foreign citizens, is necessary. That is how the “proximity” issue will be overcome, the surrogate mother will be financially supported by the couple for nine months and a properly formed law will exclude the possibilities of certain illegal activities. This is a very sensitive and complicated subject, but fortunately, many European countries have already overcome these problems”, D-r. Gurzanova says.

According to psychologist Mirjana Stojanovska, surrogate motherhood contributes to new births, which is by itself a miracle of nature, and helps many people become parents, which makes it humane and of great positive importance.

“However, despite the hugely positive side of it, surrogate motherhood actualizes many problems – legal, moral, social and psychological. How to protect the new-born child from possible abuse? How to protect the future parents? How to protect the surrogate mother? How to protect society from problems caused by cases like these? Thinking about these questions as a woman, mother, professional, but first and foremost a human being, I think that this is a very humane procedure and should be legally forbidden or left out as a possibility, but that it should be put in a legal frame, which must be carefully formed, in order to reduce the danger of its abuse. I am aware that there are no ideal laws, but considering its immense positivity, I think that any possible damages should be reduced to minimum. The child should be carried by a woman that will love it and be in a positive mood. Not only she should lead a healthy life-style, but also have a mentally positive attitude towards the thing she had decided to do. Here is where the first great dilemma comes in – how will the surrogate mother get separated from the child she had been carrying and loved for nine months? Here is how I think the ideal surrogate motherhood should look like. A married couple unable to have children finds a woman (adult woman who already has children, is in a good physical and mental health and is willing to carry a child) who agrees with full awareness and responsibility to give the child to the couple once she gives birth to it. The future parents and the surrogate mother should go through all fertilization procedures, pregnancy and delivery together and they should take care of that child together as well.

Up until the delivery, legal steps that will protect both sides after the delivery must be taken, with the child’s protection being the priority. However, I think there is no law that could regulate the emotional damages that could arise in any of the participants in such an agreement. So, aside from the legal protection, there must be a well-organized psychological, psychotherapeutic care. An assessment on the personality of the surrogate mother and the future parents during the pregnancy and after the delivery must also be made, as well as psychological protection of the child for proper and painless acceptance of the reality” – Stojanovska says.

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Experiences from around the world

Macedonia is not the only European country where surrogate motherhood was forbidden until recently. It is also the case with far more developed countries with more advanced democracy such as Germany, France, Austria, Sweden and Italy where all forms of surrogate are forbidden, regardless whether it is paid or not. However, it is precisely the financial moment that initiates serious ethical dilemmas – mainly regarding women that are getting paid to be surrogate mothers.

Great Britain, The Netherlands, Belgium, Denmark and Greece allow surrogates as long as there is no commercial element involved, while it has been allowed in USA, Canada and Russia for a long time. There are some Macedonian couples that have expanded their families in this manner outside our country. There was news and photograph of a Macedonian family which had their baby from a surrogate mother with the help of the Ukrainian agency “Successful Parents”.

This principle of surrogate motherhood has been present in Ukraine for several years. This agency started working in 2003 and it has two subsidiaries, one of which is in Bulgaria. The laws in Ukraine and Bulgaria allow surrogacy and donation of egg cells, and protect the rights of the parents and the baby. The clinic offers the possibility to choose the sex of the embryo to the future parents. But, as they have pointed out several times, the clinic is working in accordance with every health legal norms in Ukraine.

The agency promotes its program for surrogate mothers on their website and according to their calculations couples that are in need of a surrogate mother would have to pay around 40.000 dollars. The package includes preparations and transfer of the embryo from the biological parents into the surrogate mother at one of the agency’s clinics. The full package costs 34.950 dollars and it includes consulting and coordination for the entire program. It means that biological parents look through the agency’s database to find a surrogate mother, who is between the age of 20 and 30, according to the agency’s standards, even though the law in Ukraine states that any woman between the age of 18 and 35, who is physically and mentally healthy, can be a surrogate mother.

Every surrogate mother must have had born at least one biological child of her own. The price includes medical tests for the surrogate mother and medication for her pregnancy preparation. During these procedures, future parents meet the surrogate mother and maintain contact with her. The price also includes the fertilization of the egg cell, one transfer of an embryo into the surrogate mother’s uterus, care during the pregnancy, every medical examinations and the delivery. The biological parents are also helped with the registration of the new-born baby, as well as preparation of all necessary documents that have to be submitted to their parent embassy. The agency states that it takes one month from the day of the signing of the agreement until the fertilization of the surrogate mother and two weeks after the fertilization to confirm the pregnancy through blood analyses.

The reason that most couples go to Ukraine and Georgia to look for a surrogate mother, aside from the price, is that Ukrainian law is the most open to surrogacy in Europe. In Ukraine, women can get paid to carry someone else’s child and the law doesn’t limit the amount of money that can be paid. The law also guarantees the biological mother’s rights and the rights of the children born by the surrogate mother. An adoption process or any kind of court warrant is not necessary. The entire process is arranged by an agreement signed between the agency or the clinic, the biological mother and the surrogate mother. This agreement transfers all of the surrogate mother’s rights regarding the child onto the biological parents, whose names are the only ones listed on the birth certificate. Nearly half of the women using the Ukrainian women’s services come from abroad (usually USA, Great Britain, France, Sweden, and Italy, but also some of the Balkan countries). The Ukrainian law doesn’t limit the number of surrogate pregnancies a woman can have either.

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Macedonian regulations

According to the law, a “gestational carrier” is a woman carrying an embryo or a fetus that was conceived through a procedure of bio-medical assisted fertilization (BAF), which was the result of the merge of an egg cell and spermatozoon of a woman and a man and the child will be given to the married couple after its birth. The woman must be between the age of 25 and 50, she must have at least one child of her own, must be in good physical and mental health, must be a Macedonian citizen, must not have been previously criminally charged and sentenced to jail more than six months, must not be a drug or alcohol addict and must not have a heavy chronic illness or an incurable infectious disease.

The “gestational carrier” can only give birth to one living child for somebody else and not get paid for it outside the cost necessary for proper pregnancy period. The “gestational carrier” can give to a child only for citizens of Republic of Macedonia. The material costs are covered by the married couple and they must not surpass the amount of an average salary in Macedonia over the previous year on a monthly level. The couple notifies the Ministry of health about the expenditures by submitting original proof for the material cost. In order to avoid commercialization of the surrogate motherhood, the proposed law provides a criminal act punishable by jail sentence ranging from 6 months to 5 years for those who will demand or offer money, securities, chattel or real estate, or other material goods. The married couple must not provide the gestational carrier with gifts with value of more than 100 euros in denar counter value for the entire course of the procedure and after the delivery. The revealing of the identity of the gestational carrier, the married couple and child is also considered a criminal act punishable by a prison sentence from 3 months to 1 year, for those revealing the personal, medical and genetic data. If the offense is done through the press, radio, television or other public informing means or at a public gathering, the offender will be charged with
a fine or sentenced to prison for up to three years.

Only a married couple that are citizens of Republic of Macedonia have the right to start a BAF procedure via gestational carrier. The reason for that request can be that the woman doesn’t have a uterus, has a congenital anomaly that can’t be fixed with the help of the modern surgical procedures, has irreparable damage to the uterus as a consequence from inadequately treated infections and poorly executed surgical procedures, at least three unsuccessful pregnancies or any other reason other than uterus damage.

One couple has the right to start two BAF procedures via gestational carrier that would result with the birth of a living child from each procedure. The couple is bound to take care of the child even if it is born with some disability that requires special care and wasn’t discovered during the pregnancy.

The Ministry of health will keep record of the women that fulfill the conditions to be a gestational carrier, as well as of the couples that are looking for a surrogate mother. However, it will not determine which gestational carrier would suit which couple, but will leave that to both sides to agree.

According to Nikola Todorov, Minister of Health, one of the reasons for the proposal of this law are the arguments from previously held public debates where it was concluded that families that don’t have children and have no other way of having them, but this, need additional help. The law forbids advertisement and recruitment of surrogate mothers and those actions are subject to fines and criminal sanctions of up to, or more than 10 years. The sanctions primarily refer to those that organize, mediate or perform an illegal surrogate motherhood.

The law strictly forbids that surrogate motherhood is used as a profession and there will be no companies that would go looking for women interested in this. According to Minister Todorov, the experiences from other countries have been taken into consideration, such as women giving birth for their sisters or friends.

Regardless of how perfect this looks in theory, it is ultimately up to practice to see how surrogate motherhood will work here in Macedonia. _____________________________________________________________________________________________________

Dragica Hristova, MIA