Mothers by contract: the moral and regulatory maze of surrogacy

Surrogacy is a complex and evolving practice that sits at the intersection of reproductive medicine, ethics, law, and social policy. This comprehensive review traces the historical, medical, and ethical foundations of surrogacy, from its roots in early IVF experiments to its current global practice. It explores the distinctions between traditional and gestational surrogacy, outlines medical and social indications, and evaluates associated perinatal and psychological outcomes. Central to the analysis is the debate between altruistic and commercial surrogacy, highlighting the ethical tensions surrounding compensation, autonomy, and potential exploitation. The review examines global legal frameworks, with detailed attention to Israel's uniquely regulated system, which balances reproductive liberty with strict oversight. The paper also considers religious perspectives, showing how cultural and theological differences shape national policy. The experiences of gestational carriers, commissioning couples, and children born through surrogacy are examined to underscore the psychological and social implications. While surrogacy offers hope to many, it raises profound questions about the commodification of reproduction, the fragmentation of motherhood, and the responsibilities of professionals involved in care. Ultimately, the review argues for nuanced, culturally sensitive regulation that protects all parties particularly the child, whose interests must remain central throughout the surrogacy process.