Sally Rhoads-Heinrich is so passionate about surrogacy, the mother of four has been a surrogate herself several times and runs her own surrogacy business.
“I absolutely love surrogacy,” said Rhoads-Heinrich, owner of Surrogacy in Canada Online, a surrogacy agency north of London, Ont. “It’s creating life. It’s creating families.”
In 2000, Rhoads-Heinrich successfully carried twins for a Maryland couple. She underwent eight more in vitro fertilization (IVF) cycles for other would-be parents, but was unable to carry another pregnancy to term. One pregnancy that ended in miscarriage required Rhoads-Heinrich to undergo emergency surgery, where she lost her left fallopian tube.
Today, Rhoads-Heinrich no longer serves as a surrogate. But her agency coordinates services for fertile women who agree to carry and deliver babies for third-party clients without being compensated.
Her agency is bolstered by a sophisticated network of fertility specialists practising under Canada’s 2004 Assisted Human Reproduction Act, legislation that prohibits compensated surrogacy.
Many players involved in Canada’s surrogacy industry call surrogacy a beautiful act of altruism that helps prospective parents — domestic and international — build their families in novel ways. But many also say surrogates should be compensated for their services, given the hardships and risks they take on.
Others say surrogacy — either paid or altruistic — exploits women and children and should be banned altogether.
“Of course, the industry will say that everything is fine, everything is perfect,” said Ghislaine Gendron, who leads the Canadian arm of the global feminist group Women’s Declaration International.
But surrogacy harms both the surrogates and the babies themselves, Gendron says, noting babies are separated from their birth mothers without their consent.
A booming business
Surrogacy is a booming business in Canada, where one in every six couples are unable to conceive naturally. According to a 2024 report, surrogacy increased by 300 per cent from 2013 to 2023, when 962 such births were recorded.
Some provincial governments now actively support the practice.
Ontario, for example, recently announced $150 million in new fertility funding to cover one IVF cycle per patient per lifetime. The province has said it will cover an additional IVF cycle for any patient who acts as a surrogate. One IVF cycle — which yields between zero and multiple embryos — costs about $20,000.
Gendron, who lives in Quebec City, says she did not always have a strong stance on surrogacy. But the more she learned about it, the more alarmed she became.
In her view, surrogacy is a commercial transaction that uses women’s bodies to produce babies for clients. Her position aligns with the stance of the International Coalition for the Abolition of Surrogate Motherhood, a network of 50 human-rights organizations that spans 14 countries, including Canada.
Gendron filed briefs opposing Bill 12, legislation that updated Quebec’s surrogacy laws in 2023. The updated legislation makes surrogacy contracts enforceable in Quebec courts. It also simplifies the process for surrogates to revoke their legal claims to the babies they deliver. The law does, however, grant surrogates a 30-day period to decide whether they will keep their babies or hand them over to the commissioning parents.
Gendron says her briefs were ignored by lawmakers. She cites the United Nations Convention on the Rights of the Child, which says, “[A] child shall not be separated from his or her parents against their will.”
A child is entitled to parents, she says, but international law does not grant a corresponding right for adults to have a child.
Surrogacy advocates disagree with her claim.
“Is it moral to tell a person that you have no right to a child because you were born without a uterus? Would you tell a male couple they can’t have a baby?” says Dr. Prati Sharma, a fertility doctor who has treated 200 surrogates at Toronto’s CReATe fertility clinic.
Toronto-based fertility lawyer Sara Cohen calls perspectives like Gendron’s outdated and paternalistic. Cohen has been involved with more than 1,000 surrogacy cases since 2014, representing both surrogates and prospective parents. Surrogacy, she says, is really about the “reproductive rights and freedoms” of women.
Cohen says Canadian surrogates are “financially stable” women exercising their agency to create life for whomever they choose — infertile couples or gay men who dream of raising children of their own.
She says surrogacy in Canada is entirely different from the unregulated systems in place in countries like Ukraine or Georgia, where poor women are incentivized to earn money by carrying someone else’s child.
Canada attracts international clients, Cohen says, because unlike many other jurisdictions, our laws prohibit discrimination on the basis of sexuality, gender or marital status. Anyone who wants a baby and is willing to invest the money, time and emotional energy to get one is able to do so.
It is also cheaper to arrange surrogacy in Canada than the US, because of Canada’s prohibition on compensated surrogacy (although Canadian surrogates can be reimbursed for various expenses related to the pregnancy). And Canada’s taxpayer-funded health care system covers the costs of pregnancy and delivery.
‘Complete opposites’
But Gendron says the darker side of the Canadian surrogacy narrative has not been told.
She cites the 2020 PhD thesis of University of Ottawa law professor Stefanie Carsley, who interviewed 26 Canadian surrogacy lawyers. Carsley found surrogacy contracts contained clauses stipulating what surrogates could eat and where they could travel. Some contracts required surrogates to use condoms for sex with their partners. Some had clauses defining the circumstances under which prospective parents could ask a surrogate to abort a pregnancy.
This is the “complete opposite” of agency, says Gendron, who calls surrogacy the freedom “to lose my freedom.”
Gendron also notes that confidentiality clauses can silence unhappy surrogates and forbid them from publicizing negative experiences. She says that the public believes “what the media gives them.”
“Our articles are refused by the media,” she says. “Several times.”
There has been surprisingly little research into the health risks for gestational carriers. This September, Maria Velez, a clinician-scientist at McGill University, published a paper examining all singleton births in Ontario over 20 weeks’ gestation from 2012 to 2021. She found that surrogates experienced complications — including postpartum hemorrhage and severe pregnancy-induced hypertension — at three times the rate of women who conceived naturally, and almost twice the rate of women who carried their own IVF-conceived pregnancies.
Velez says she wonders if carrying genetically unrelated embryos triggers some sort of immunological revolt in the surrogate. She says her “robust” findings warrant further research. But she is not aware of any other Canadian scientists investigating maternal complications in surrogates.
Velez’s findings align with the observations of agency owner Rhoads-Heinrich. “We definitely see more negative outcomes with surrogacy pregnancies,” she said.
While Rhoads-Heinrich views altruistic surrogacy as a wondrous act, she says the prohibition on compensated surrogacy does a “disservice” to women who risk their health for others. She has sent 18 proposals to Health Canada urging the federal government to permit compensated surrogacy. She says she has never received a response.
Rhoads-Heinrichs says Canada’s laws prohibiting compensated surrogacy have created a “massive shortage” of Canadian surrogates. For every 300 potential surrogates who contact her agency, only five go forward after learning they will not be paid. She says there is just one surrogate available for every 100 interested couples.
In some US states, where compensated surrogacy is legal, it may take just a few months to match with a surrogate, says Sharma. In Canada, it can take up to 18 months.
Because Canadian surrogates are in such short supply, Canadian doctors can face pressure to medically approve potential surrogates.
“[We] sort of bend the rules,” said Sharma. “[L]ike maybe [the potential surrogate] has pre-diabetes, maybe she’s someone that, if you follow the rules, they shouldn’t be accepted.”
Sharma thinks surrogates’ elevated health risks could potentially be mitigated by following them more closely in clinics. She also believes surrogates should be compensated for their services.
“We’re so lucky,” she says. “We have great labs, we have donor eggs, we have IVF, we have surrogacy … I feel it’s the right of any person to be able to build their family.”
Lovely Read…thank you
Ofc, surrogates should be compensated. Surrogacy is beautiful. It creates families. All these people like Gendron just spread misinformation and their lie was debunked multiple times by psychologists, medical experts.