Surrogacy and the significance of gestation: Implications for law and policy.

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor-assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere 'carrier'. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor-assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis.

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review.

BACKGROUND: During the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic. METHODS: A mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design. RESULTS: Fifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services. CONCLUSIONS: Parental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.

Identity Rights and Sensitive Ethical Questions: The European Convention on Human Rights and the Regulation of Surrogacy Arrangements.

Attitudes to surrogacy vary widely across Europe, leading to great variation in the domestic legal regimes of the Member States of the Council of Europe. Confronted with such diverse approaches, the European Court of Human Rights (ECtHR) faces a difficult task in seeking to apply Convention rights in the surrogacy context, which it has tackled in the recent cases of Mennesson v France and Paradiso and Campanelli v Italy. The primary purpose of this article is to propose an argument as to what the Convention requires of the Member States in the field of surrogacy. It is argued that while tensions exist between the leading cases, they may be reconciled by appreciating the importance of the right to identity, a facet of the right to respect for private life. Properly understood, the case law imposes obligations on the Member States as regards the legal status of surrogate-born children in both cross-border and domestic surrogacy. The secondary purpose of this article is to argue that, in the surrogacy context, the concept of identity should be given a richer interpretation which encompasses the child's relationship with genetic, gestational, and intended parents, and therefore that a narrow margin of appreciation must apply to all State interventions concerning the legal status of surrogate-born children.

The Right to Travel for Abortion Services: A Case Study in Irish 'Cross-border Reproductive Care'.

Abortion is illegal in Ireland, except in very limited circumstances, but the Irish Constitution guarantees the right of women to travel abroad to obtain abortion services. Every year, large numbers of women travel to the UK to obtain abortions. This article argues that this can be regarded as an illustration of cross-border reproductive care (CBRC). CBRC is the phenomenon whereby people travel abroad to obtain assisted reproduction services that are illegal in their country of origin. A leading commentator, Guido Pennings, argues that CBRC is to be welcomed as a means by which society might compromise on issues of profound moral disagreement. Other commentators believe CBRC is highly problematic. This article argues that the Irish abortion example, when examined as an example of CBRC, illustrates both the advantages and disadvantages of CBRC identified by Pennings and his critics.