By Lennlee Keep


In 2018, over 100 children were born in Boise, Idaho, through surrogacy. The story behind this unique baby boom is explored in the Independent Lens documentary Made in Boise, an intimate look at how surrogates and parents are coming together to create new bonds and unique families.

Surrogacy is widely misunderstood and stigmatized by myths, so here are a few of the facts to address questions you may have after watching the film.

Types of Surrogacy

There are two types of surrogacy that represent the genetic relationship between the surrogate and the child. 

Gestational surrogacy: A woman carries a pregnancy that was created with another woman’s egg and the intended father or donor’s sperm. The surrogate shares no genetic material with the baby. All of the women Made in Boise were gestational surrogates.

*A gestational surrogate is not “giving away their baby.” So Nicole didn’t give her baby away to Shannon, Nicole was carrying Shannon’s baby.

Traditional surrogacy: The surrogate’s egg is used to create the embryo she is carrying. A traditional surrogate is the biological mother of the baby. There are no traditional surrogates in the film. 

In a traditional or a gestational surrogacy, the sperm can come from any male, donor, or intended parent.

There are also two types of payment situations for surrogates.

Altruistic surrogacy: a woman carries a pregnancy for no compensation beyond her medical bills and direct costs associated with the pregnancy; Altruistic surrogacies can be gestational or traditional.

Altruistic surrogacy seems to be more widely accepted as it is legal in many states and countries where commercial surrogacy is banned. 

Commercial Surrogacy: A woman is paid a fee for carrying a pregnancy, beyond covering her medical bills and expenses. Compensated surrogacies can be gestational or traditional. 

A tearful Cindy holds the baby after delivering for Julian. From Made in Boise.
From Made in Boise; photo: Crystal Kulack.

State Laws

Surrogacy is legal in the U.S. but not federally regulated, so the laws vary widely from state to state. 

  • Idaho and California have laws and legal precedents that are “surrogacy friendly,” as do Oregon, Nevada, New Hampshire, New Jersey, Illinois, Maine, Delaware, District of Columbia, Connecticut and  Washington, which just made commercial surrogacy legal in 2019. [Source: Surrogate.com]
  • Michigan, on the other hand, imposes a prison sentence of up to five years and a $50,000 fine for any commercial surrogacy. [Source: Michigan Legislature
  • Louisiana prohibits all surrogacy except for married, heterosexual couples using their sperm and egg. [Source: IFLG] 
  • Wyoming has no regulations and no legal precedents at all. [Source: American Surrogacy

International Surrogacy Laws

International surrogacy laws vary widely, as well. Italy, France, Iceland, Sweden, and Germany are just a few of the countries that have banned all forms of surrogacy completely. 

England, Canada, Ireland, Portugal, and South Africa are some of the countries that allow altruistic surrogacy, but even when allowed, there can be restrictions. For instance, in South Africa, altruistic surrogacy is only allowed for heterosexual married couples. 

Same-sex couples can have an especially difficult time finding a country that will allow them to have a child through surrogacy, so many come to the U.S. and places like Boise to make their dreams of parenthood a reality. [Source: Surrogate.com

Non-US citizens can access surrogacy, in states where it is legal. All children born via surrogacy in the U.S. are eligible for a U.S. passport, regardless of the citizenship of their intended parents. However, if U.S. citizens have a child via surrogate abroad they can face a battle getting citizenship for their child. [Source: Circle Surrogacy]  

In France, it was notoriously difficult for a child being born through surrogacy to establish French citizenship for a child born abroad via surrogate. This ended in 2015 when one of France’s highest courts ruled that the children were French citizens. [Source: BioNews

India was once the surrogacy capital of the world.  Reproductive medical tourism was a highly controversial, multi-million dollar industry.  Costs for a surrogate pregnancy and delivery in India were $25-30k, which was far more affordable to some than the $120,000-$200,000 that it costs in the United States. There was a public outcry that wealthy Westerners were exploiting the poverty of Indian women. [Source: Telegraph]

According to CDC reports on ART (Assisted Reproductive Technology), between 1999 and 2013 about 2% (30,927) of all assisted reproductive technology cycles used a gestational carrier.

  • Between 1999 and 2013, gestational carrier cycles resulted in 13,380 deliveries and the birth of 18,400 infants. The data shows 9,819 (53.4%) of these infants were twins, triplets, or higher order multiples. [Source: CDC]

In 2018, India banned all commercial surrogacy and now has strict rules about any surrogacy. The Surrogacy Regulation Bill put an end to any commercial surrogacy in India and put tight restrictions on altruistic ones. Surrogacy is only available to Indian couples who have been married for more than five years, and are between 23-55 years old. And it must be an altruistic surrogacy. The surrogate must be a married relative, between 25-35 years old, and with a child of their own. [Source: Times of India]

Map of world legal regulation of surrogacy: Dark blue:  Both gainful and altruistic forms are legal  | Grey-blue:  No legal regulation  | Light blue: Only altruistic is legal  | Lavender: Allowed between relatives up to second degree of consanguinity  | Red: Banned  | Grey:  Unregulated/uncertain situation [Creative commons map courtesy Wikipedia, user Fobos92]

Fees

Surrogacy fees in the United States range from $120,000-$200,000 depending on the state. Idaho is on the lower end of that number, which helps explain the Boise baby boom. 

Of the overall fee, the surrogates themselves personally receive anywhere from 25k to 50k above and beyond any medical costs.

Surrogates, even commercial ones can’t just “do it for the money.” They have to prove not only that they are mentally and physically healthy enough to carry a baby, but they also have to prove that they are financially solvent. [Source: Reuters]

Who determines the requirements for surrogates?

A Host of Possibilities, the agency featured in Made in Boise, along with many surrogacy agencies, follow the standards set by The American Society for Reproductive Medicine. Some of those requirements include that the surrogate be between the ages of 21 and 44 and have had at least one previous successful pregnancy with no major complications. The surrogate is also ideally finished growing their own family.


Lennlee Keep is a nonfiction writer, filmmaker, storyteller, and reticent D&D player. Her writing has appeared in The Rumpus, The Southeast Review, and ESME. Her films have been shown on PBS, A&E and the BBC. The ex-wife of a dead guy, she talks about death more than most people are comfortable with. She is working on a memoir about addiction, grief and a literally broken heart. She lives in Austin, Texas with her son and their guinea pig, Chuck Norris.