The Ethical Implications of Reproductive Tourism in the U.S.

The recent Supreme Court decision on birthright citizenship has sparked discussions about the use of American surrogates by foreign nationals. Lawmakers are urged to address not only birth-tourism but all forms of reproductive tourism. The reproductive industry extends beyond surrogacy; many seek in vitro fertilization (IVF). Before making decisions, Congress should question the broader implications: What is the U.S. essentially offering?

Stripping away terms like “family-building” and “fertility journeys,” reproductive tourism involves creating and selecting human embryos, trading human eggs and sperm, and potentially offering an American passport due to birthright citizenship. According to industry data, between 2014 and 2022, non-U.S. residents accounted for 59,246 assisted reproductive technology cycles in the national IVF registry. Patients from 182 countries participated, with China leading at 19,718 cycles, almost triple the next highest country.

Foreign patients often seek services unavailable in their own countries, such as pre-implantation genetic testing and donor eggs. While U.S. patients use these services at lower rates, foreign nationals are drawn by the lack of restrictions present in the U.S. Other countries like Britain, Canada, France, and Australia enforce strict regulations preventing certain practices, such as donor anonymity or non-medical sex selection. In contrast, the U.S. lacks comprehensive federal regulations for these practices, leaving decisions up to clinic discretion.

“Britain abolished donor anonymity to uphold the rights of children to know their origins.”

The process for foreign nationals seeking reproductive services in the U.S. is uncomplicated. They can apply for a B-2 medical visa or travel authorization, arrange the necessary medical procedures, and provide financial proof. Embryos can be shipped into the U.S. classified as “human cells and tissues” for testing or surrogacy.

Analyzing elements of reproductive tourism reveals:

• Creation of embryos on a large scale, with many remaining unused. It is estimated that 1.5 million human embryos are currently frozen in American storage.
• Selection services marketed as “family balancing,” allowing choices on sex and traits based on genetic screening, shifting focus from child creation to child design.
• Commercialization of donor characteristics like height, race, and education, akin to catalog shopping for human traits.
• The sale of citizenship, as foreign nationals commissioning births in the U.S. receive citizenship benefits for their children.

Clinics promote these services openly, catering to international clients with comprehensive packages including legal assistance, accommodation, and more. The disparity in regulatory environments makes the U.S. a unique destination for reproductive tourism. The practice raises questions: Is the U.S. focusing on helping its citizens with fertility, or is it facilitating the commercial design and sale of children to global clients?

Emma Waters, Policy Analyst at the Center for Technology and the Human Person, highlights the need for U.S. policies to reflect ethical considerations in reproductive tourism.