[Big read] China’s underground surrogacy: Clash of wealth, ethics and tradition

The air is filled with tension and unease as Peng Yu (pseudonym) and Li Xiaoyun (pseudonym) wait nervously behind a curtain. Peng, his hands trembling uncontrollably, attempts to record an audio clip on his phone, hoping to capture the moment a new life enters the room.

Suddenly, they hear a faint “it’s here”, followed by a baby’s cries. The Chinese couple look at each other before exchanging a high five. On the other side of the curtain, their offspring has been brought into the world by another woman.

Their newfound status as parents also marks the end of their nearly three-year journey of surrogacy in the US. For the American woman who carried their child for nine months, her role is now complete.

For Peng and Li, surrogacy, despite its controversial nature, was a compromise. Li, while open to raising children, wanted to avoid pregnancy and childbirth. Peng longed for children but understood his wife’s apprehension. They began exploring surrogacy about four years ago. 

Believing they were venturing down a unique path, the couple started their surrogacy journey in August 2021. Midway through the process, however, they discovered several friends who had either completed or were currently pursuing surrogacy.

In China, surrogacy has become more common than generally thought, with a growing number of couples and even singles opting for it. Many financially well-off couples of childbearing age head to the US where surrogacy is legal with comprehensive laws and advanced medical care.

Both American surrogacy organisations interviewed by Lianhe Zaobao confirmed that around half of their clients are from China and the proportion is rising. West Coast Surrogacy, which has been operating in the US for many years, revealed that even a decade ago, 40% of its clients were from China.

Various countries have different legal positions towards surrogacy, with different social values and levels of acceptance. In Singapore, surrogacy is illegal; many European countries forbid commercial surrogacy but allow altruistic surrogacy; some American states allow commercial surrogacy services.

However, in the US, it costs between US$180,000 and US$250,000 for a surrogate child, which is a significant financial barrier. So, the bulk of Chinese surrogacy demand is met domestically, resulting in a complex underground surrogacy industry that is not accepted by mainstream society and which treads legal grey zones.

Founded in 2004, AA69 claims to be the first surrogacy company in China. In the two decades since its inception, the number of Chinese surrogacy organisations has grown tremendously.

Based on estimates from Chinese media outlet Caixin, in 2017 there were about 1,000 companies in China providing surrogacy services, with 20 to 30 of them being of some scale — the annual number of surrogate births in the country then was estimated to be 20,000. Seven years on, these figures have probably grown.

These discreet surrogacy companies are mainly found in first and second-tier Chinese cities with higher income levels, such as Beijing, Shanghai, Guangzhou, Wuhan, and Hangzhou.

After contacting five such agencies based in Shanghai and Wuhan, I found their surrogacy processes to be largely the same, including physical checks, ovulation, embryo cultivation and transplanting, pregnancy check-ups for the surrogate, and giving birth. The cost of having a child through surrogacy is between 450,000 RMB (US$62,150) to 800,000 RMB.

The staff I spoke with referred to themselves as “birth consultants”, with some even showing their professional head shots to create an impression of professionalism and reliability. They were also able to discuss the various service packages fluently and in detail. To avoid sensitive terms, the industry uses a set of obscure yet immediately understandable code words: “dy” for “surrogacy” (代育, dai yu) and “取 L” for “egg retrieval” (取卵, qu luan).

To allay the worries and concerns of potential clients, the “birth consultants” confidently provide well-rehearsed responses. They claim pre-arranged agreements with collaborating maternity hospitals, promise to handle any legal problems involving doctors or organisations, and insist “surrogacy is not a crime”, assuring clients of same-day release even if caught.

These surrogacy organisations operate through illicit connections with local hospitals. Qingdao authorities recently released investigation findings on northern China’s largest underground surrogacy laboratory, implicating a local 3A public hospital and its doctors.

Lianhe Zaobao understands that currently, the surrogates offered by Chinese surrogacy companies are mainly low-educated village women from the economically-underdeveloped regions of Yunnan, Guizhou and Sichuan.

At the same time, it is getting harder to recruit women who are willing to be surrogates, possibly due to improving economic conditions across China and the high demand for surrogacy. Some resort to private methods, placing small advertisement posters in specific areas to recruit and select candidates.

Among the many who require surrogacy services, there are rich families who opt for surrogacy despite not having reproductive difficulties and singles who want kids, but a greater number are those who are unable to give birth due to physiological reasons, such as infertile couples, elderly people who have lost their only child, and older couples who intend to have a second or even third child. Two American surrogacy companies told me that this group accounts for 60% to 90% of the overall demand for surrogacy services.

Among those interested in surrogacy services in China, there is a small niche group: sexual minorities.

In May, 33-year-old Liu Zifan (a pseudonym) and his same-sex partner welcomed their surrogate child in the US. Liu grappled with the decision between adoption and surrogacy, viewing adoption as an opportunity to help an existing child, while surrogacy meant creating a new life with the added responsibility and burden of a blood connection. Ultimately, he chose the path of biological ties.

Surrogacy is the only way for Liu to have a biological child. However, those with a more progressive mindset may not consider blood ties essential for pursuing surrogacy.

Peng and Li belong to this category — while their son has Peng’s genes, he is not related to Li by blood. After their doctor found that Li has a low egg count, after much deliberation, the couple decided to use donated ova for a better chance of success.

Li does not mind that their son is unrelated to her by blood, as she does not think that this would affect their marriage or her love towards the child.

There is also a growing trend of Chinese surrogacy clients opting for DNA of other races to have a mixed-race child. Shen Jia, the Californian ethnic Chinese founder of GSHC, a surrogacy company, told me that a number of Chinese singles and families want to have mixed-race babies through surrogacy. Among them are couples who want a mixed-blood second or third child by surrogacy after having one on their own.

Shen said, “Based on the premise of ‘big love’, this family can be more diverse. I can love a child even if it doesn’t carry my genes, right?”

While the idea of using surrogacy to make a family more diverse seems very broad-minded, it begs the question: Why not adopt instead? While surrogacy increases the diversity of family structure in China, it also challenges the traditional notions of family.

A key question to the ethical debate over surrogacy is this: now that reproductive technology is able to completely separate genes from birth-giving, how do we define the parent-child relationship? Is the real mother of the child the woman who donated her ovum, the surrogate mother, or the commissioning mother?

In the natural process of gestation, a woman builds emotional ties with her child over the 10 months of pregnancy before suffering the ordeal of giving birth to become a mother. Will bypassing this process render the parent-child relationship incomplete, or make people value birth-giving and parenthood less than before?

In an interview with Lianhe Zaobao, Associate Professor Xu Wenhai from the East China Normal University (ECNU) Law School pointed out that surrogacy poses a challenge as to who is the legal mother of the child and “significantly destabilises” the parent-child relationship, which is one of the reasons why most countries in the world have not legalised surrogacy.

Another ethical debate over surrogacy revolves around the exploitation of women. Its opponents argue that commercial surrogacy makes giving birth a commodity, which is exploiting women, which would exacerbate gender inequality.

On the other hand, its supporters feel that surrogacy will enable those with reproductive difficulties to become parents, so that all groups enjoy birth-giving rights. In countries such as the US where surrogacy is legalised, both parties participate in the transaction voluntarily, and the law can also protect the rights of surrogate mothers as much as possible.

Cong Yali, a professor in the Department of Ethics and Law at Peking University’s School of Medical Humanities, told Lianhe Zaobao that even though those who are unable to reproduce “are well worthy of sympathy”, ethically, surrogacy creates more potential issues and harm.

Cong observed that most surrogates are impoverished women who may feel compelled to participate due to financial hardship, rather than by choice. “She might have been forced to make sacrifices due to genuine difficulties,” Cong explained. Later, these surrogate mothers often experience regret. 

ECNU’s Xu agreed, arguing that while individuals have a right to reproduce, this right cannot supersede others. Until concerns about the exploitation of surrogates are addressed, “legal and technological restrictions must be accepted.”

But Xu also believes that surrogacy will be commercialised in China one day. Currently, sperm donation is already legal and the non-commercial donation of ovum is slated to follow suit. With technological progress, artificial womb surrogacy would also become possible. He added, “We are slowly moving in this direction, and time will give us the answers.”

On the first night of their son’s birth, Peng and Li stayed in the hospital. Caring for him felt like “doing battle through the night” for the overwhelmed couple.

For the tens of thousands of Chinese families with surrogate children, the birth of the child does not mean the end of surrogacy, but the start of a new journey in life, as they may have to deal with the legal, emotional, and social implications of surrogacy in the decades to come.

Despite repeatedly calling surrogacy a “rational choice,” Peng revealed a deeper emotional motivation during the interview. “I desperately wanted a child,” he admitted, “but we weren’t brave enough to end our relationship over it.” 

While surrogacy freed Li from pregnancy and childbirth, she harbours anxieties about feeling emotionally distant from her son and husband. “Do your friends talk about me behind my back,” she pointedly asked Peng during the interview, “saying I won’t be close to our son?”

Every day, rookie dad Liu gets up in the middle of the night to feed his son. Living with his family in Shanghai, Liu sometimes considers that the boy with blue eyes will one day notice that he is different. What will he tell his son then about his hometown and roots?

He is even more worried about his son being discriminated against at school. He said, “I think we need to give him enough love so that he is strong, and knows that surrogacy is OK…”

In a small village in central Hubei, the first thing the locals said to me at the clinic, provision shop, and mahjong centre was, “You are looking for a surrogate mother, aren’t you?”

Before I opened my mouth, I would be given the nearly identical reply that surrogacy services are no longer available here. The owner of a local mahjong centre even told me earnestly, “Just give up on the idea.”

Qili village in Hubei province used to be a famous “surrogacy village” in China. Its geographical proximity to Wuhan where surrogacy companies aggregate allows many of its female villagers to make money in the city by providing surrogacy services. Each surrogate baby can earn a family 150,000 RMB to 250,000 RMB. In an interview conducted by Chinese media seven years ago, villagers shared that “99% of the women had been surrogate mothers”.

When I visited in late October, I found out after speaking to villagers and shopkeepers that the village no longer relies on its women’s bellies to survive. As the former surrogate mothers born in the 1980s get older and economic conditions in the village improve, very few locals are willing to be surrogate mothers these days.

The fact that it is now difficult to find surrogate mothers in a village where there used to be mass surrogacy reflects the regional shift of China’s underground surrogacy industry over the past decade from its economically backward central region to even less developed areas such as Yunnan, Guizhou and Guangxi.

However, Chinese laws on surrogacy have basically not changed over the last 20 years. The Measures for the Administration of Human-Assisted Reproductive Technology (《人类辅助生殖技术管理办法》) published by the Chinese Ministry of Health in 2001 stipulates that medical institutions and personnel are not to carry out surrogacy procedures in any form.

Some argue that these outdated, ministry-level regulations are ineffective, creating a legal vacuum that allows commercial surrogacy companies to operate unchecked. Others believe the ambiguity in Chinese surrogacy laws is deliberate. ECNU’s Xu is in favour of proportionate punishment, suggesting that effective legislation must clearly target the most culpable party.

He said that while surrogacy does impact the surrogate’s body, as long as she willingly sells her reproductive rights and no disputes arise, the damage to social justice is minimal. At the same time, the desire of childless parents for children should also not be overly criticised and punished. 

Xu also believes surrogacy companies deserve punishment, possibly criminalisation, due to the current low risk and high reward of operating illegally — many simply reopen under a new name after being caught.

Others argue that Chinese law must more clearly address surrogacy, differentiating between legal and illegal practices and protecting surrogates’ rights. Without clearer legal boundaries, vulnerable women may face increased exploitation within the industry’s grey areas.

Looking at public opinion, the Chinese public generally views surrogacy negatively. Zheng Shuang, a formerly popular Chinese actress, was widely condemned in 2021 for abandoning her surrogate babies. After being criticised by more than 10 official Chinese media agencies, she vanished from public view.

Negative public opinion stems partly from surrogacy’s high cost, making it a privilege for the wealthy and creating resentment, especially among those who need but cannot afford it. Furthermore, surrogacy clashes with traditional Chinese morals and ethics, where using another woman’s womb is viewed as unacceptable and immoral. Official Chinese media criticised Zheng Shuang’s surrogacy case, stating that it “exposed a confused worldview, values, and outlook on life, tarnishing common morals”.

This article was first published in Lianhe Zaobao as “隐匿爱与伦理之争 血缘代工需求与产业悄然发展”.

Related: A woman’s right to freeze her eggs: Chinese society debates | Can cash and coercion fix China’s demographic crisis?