Can surrogacy be truly altruistic if generosity is treated as free labour?
In April 2026, family creation lawyer and former surrogate Sarah Jefford OAM gave evidence to a New South Wales parliamentary inquiry into fertility support and assisted reproductive treatment. Her observation was simple and confronting:
“Everybody is paid except the surrogate.”
The lawyers are paid. The counsellors are paid. The fertility clinic, doctors, hospital staff and other professionals are paid. Each provides necessary expertise and deserves to be remunerated for it. Yet the person who undergoes medical screening, fertility treatment, pregnancy, birth and recovery is expected to contribute her time, labour and physical risk without compensation.
That is the tension at the centre of Australia’s altruistic surrogacy model.
At KinPath, we believe surrogacy should always begin with a genuinely voluntary and altruistic intention. A surrogate should choose the journey freely because she wants to help another person or couple become parents, never because financial pressure leaves her feeling that she has no meaningful alternative.
We also believe that altruism and compensation are not opposites.
Covering a surrogate’s expenses prevents her from losing money. Compensation does something different. It recognises the time, effort, discomfort, disruption and risk involved in what she is doing. No payment could ever equal the magnitude of this gift, but refusing any recognition beyond receipts does not make the arrangement more ethical by default.
What does Australian law currently allow?
Surrogacy is regulated by Australia’s states and territories rather than by one national law. Every jurisdiction permits altruistic surrogacy and prohibits commercial surrogacy. Under the current model, intended parents may generally cover or reimburse a surrogate’s reasonable surrogacy-related expenses, but she cannot receive a profit, fee or reward for being a surrogate. What counts as a reasonable expense differs between jurisdictions. The Australian Government’s surrogacy information service explains the current national position.
The laws also differ on eligibility, advertising, residency, age requirements, approvals and the expenses that may be reimbursed. In most domestic arrangements, the agreement itself does not automatically make the intended parents the legal parents. A post-birth parentage process is generally required under the applicable state or territory law. The Australian Government outlines how legal parentage is recognised.
There are further inconsistencies:
- New South Wales, Queensland and the Australian Capital Territory extend aspects of their prohibitions to residents who enter commercial arrangements overseas. The ALRC identified these extraterritorial offences in its national review.
- Western Australia still excludes single men and male same-sex couples from domestic surrogacy under the law currently in force. A new Act passed in 2025 will remove those barriers, but it is not expected to commence until mid-2027. HealthyWA outlines the existing restrictions and forthcoming reform.
- Medicare benefits are expressly unavailable for assisted reproductive services provided in conjunction with surrogacy arrangements. This exclusion remains in the current Medicare Benefits Schedule. See the official MBS note for assisted reproductive technology services.
Australia is now reviewing whether this fragmented system is fit for purpose. The Australian Law Reform Commission’s 2025 Discussion Paper proposed a nationally consistent framework, broader reimbursement of surrogates’ actual costs and losses, optional hardship payments, independently managed trust accounts and Medicare access for surrogacy-related fertility treatment. It also asked whether the law should permit an additional support payment recognising a surrogate’s time, effort, inconvenience and unique contribution.
These were proposals for reform, not current law. At the time of writing in September 2026, the ALRC’s final report had not yet been publicly released. Read the ALRC’s proposals and questions.
Reimbursement is not the same as compensation
The distinction matters.
If a surrogate spends $80 on travel to a medical appointment and receives $80 back, she has not been paid. She has simply been returned to her starting financial position. The same is true when intended parents cover prescribed medication, maternity clothing, childcare during appointments or a period of documented lost income.
Even a generous reimbursement model can leave much of the real burden invisible. Pregnancy can involve daily discomfort, medication, injections, disrupted sleep, dietary restrictions, time spent attending appointments, changes to family life and the assumption of medical risk. Birth is followed by physical recovery whether the pregnancy ends in a live birth, miscarriage or stillbirth. Some effects are difficult to reduce to a receipt.
Reimbursement prevents financial loss. Compensation recognises contribution.
An altruistic-only system can therefore avoid one kind of exploitation while creating the conditions for another. It may prevent a market from placing a price on pregnancy, but it can also normalise the idea that a woman’s reproductive labour should be freely available while an entire professional system is paid around her.
The moral value of a gift comes from the intention behind it. It should not depend on the giver being financially unrewarded.
A booming fertility system that does not serve everyone equally
Australia has a large and sophisticated fertility sector. The Australian and New Zealand Assisted Reproduction Database recorded 113,905 ART and laboratory-only cycles in 2024. Only 370 were recorded as surrogacy arrangement cycles, including 271 cycles undertaken by a surrogate or gestational carrier. The latest ANZARD annual report provides the full data.
The Australian assisted reproductive technology industry has also been estimated to generate more than $800 million in annual revenue. That does not mean fertility professionals should not be paid. Their work is specialised and essential. It does, however, sharpen the question of why the one person carrying the pregnancy is the only participant whose contribution cannot be compensated.
IVF is transformative, but it cannot solve every form of involuntary childlessness on its own. It can assist people who need help creating embryos or achieving pregnancy when an intended parent is able to carry. It cannot, by itself, create a pathway to parenthood for someone who has no uterus or cannot safely sustain a pregnancy.
This distinction disproportionately affects:
- gay male couples, who require both an egg donor and a surrogate if they wish to have a child through assisted reproduction
- single fathers, who face the same biological requirements
- women born without a uterus or who have lost it through illness or surgery
- women for whom pregnancy would present an unacceptable medical or psychological risk
- women who have experienced repeated pregnancy loss or repeated unsuccessful embryo transfers and are advised to consider surrogacy
Single women and female couples may also encounter significant financial and legal barriers to donor conception and IVF. The point is not that fertility treatment serves only heterosexual couples. It is that a system centred on treating a patient who can carry a pregnancy cannot offer an equivalent solution to people for whom gestation itself is impossible.
The Medicare exclusion makes that inequality more pronounced. Australia helps subsidise many forms of fertility treatment but specifically withdraws that assistance when the treatment is connected to surrogacy.
The people who have no alternative way to carry a pregnancy can therefore face the least public support and the most complicated legal pathway.
When domestic surrogacy is difficult, international pathways can offer a strong alternative
Australia’s restrictions have not removed the need for surrogacy. Instead, many Australians have chosen to pursue their journeys overseas.
The ALRC reported that in 2020 about 76 children were born through domestic surrogacy for Australians while about 275 were born through overseas arrangements. It estimated that 361 children were born to Australians through overseas surrogacy in 2023-24. In other words, most Australians using surrogacy are already doing so internationally. The ALRC’s official explainer summarises these figures.
These figures should not be interpreted as a warning against international surrogacy. International surrogacy is not one uniform system. It encompasses countries and programs with vastly different laws, safeguards and standards of care. There are places where regulation is unreliable, oversight is limited or exploitative practices exist. There are also international jurisdictions that offer ethical, well-regulated and highly supported pathways to parenthood.
The location of a surrogacy journey does not determine whether it is ethical.
A domestic arrangement is not automatically ethical simply because it occurs in Australia. Equally, an international arrangement is not inherently unethical because it crosses a border. What matters is the quality of the legal framework, the surrogate’s ability to provide free and informed consent, the support available to her, the transparency of the process and the protections in place for everyone involved.
Well-run international programs can offer a valuable alternative when domestic surrogacy is inaccessible or unsuitable. A responsible program should include thorough screening, independent legal advice, high-quality medical care, transparent compensation, ongoing emotional support and a clear legal pathway for the child and intended parents.
At KinPath, we do not believe the answer is to discourage people from considering international surrogacy. The better response is to help intended parents distinguish between programs, understand the legal and ethical differences between jurisdictions and choose a pathway where surrogates are respected, properly supported and fairly compensated.
This is particularly important for gay men, single fathers and women who cannot carry a pregnancy. Waiting for a more accessible form of IVF will never resolve the biological barrier they face. Surrogacy may be their only path to a genetically related child and a carefully chosen international program can provide the structure, protection and support that Australia’s domestic system does not always make available.
The goal should not be to close the door on international surrogacy. It should be to ensure that every available pathway meets a genuinely high ethical standard.
Australia is not alone
Several comparable countries also permit surrogacy only on an altruistic or non-profit basis.
In the United Kingdom, surrogacy is legal but agreements are not enforceable. A surrogate may receive reasonable expenses but cannot generally be paid for carrying the pregnancy. She is the child’s legal parent at birth and intended parents must later seek a parental order. UK Government guidance explains the current position.
In Canada, federal law makes it a criminal offence to pay or offer to pay a surrogate for her services. Reimbursement is permitted for eligible out-of-pocket costs directly connected to the pregnancy, with rules governing the evidence required. Canadian law also prohibits payment to a third party for arranging a surrogate’s services. Health Canada explains the federal prohibitions and reimbursement exception.
In New Zealand, a surrogacy arrangement is not itself illegal but is unenforceable. Commercial consideration is prohibited, with a statutory exception for reasonable and necessary expenses connected with the arrangement. See section 14 of New Zealand’s Human Assisted Reproductive Technology Act 2004.
These systems use slightly different definitions and processes, but they share a central limitation. Reimbursement can make a surrogate financially neutral in theory without recognising the labour and risk that cannot be itemised. It can also create uncertainty about which expenses are acceptable, what evidence is needed and who carries the loss when the rules do not reflect real life.
Compensation is not the purchase of a baby
The strongest concern about compensated surrogacy is that payment may create coercion or encourage financially vulnerable women to accept risks they would otherwise decline. That concern deserves to be taken seriously. Poorly regulated surrogacy can exploit surrogates, intended parents and children.
However, it does not follow that all compensation is exploitative or that a ban on compensation guarantees free consent.
Payment should never purchase a child, a pregnancy outcome or control over another person’s body.
A surrogate must retain complete authority over her medical care and informed consent throughout treatment, pregnancy and birth. Compensation should recognise her contribution and the burdens she assumes. It should never be conditional on surrendering bodily autonomy or delivering a healthy baby.
The ethical question is not simply whether money is present. Money is already present throughout fertility treatment and surrogacy. The better question is whether the system is transparent, proportionate and designed to protect every person within it.
What could an ethical compensated model look like?
A fair model does not need to resemble an open market. Australia could preserve altruistic intent while allowing carefully regulated compensation. Essential safeguards should include:
- independent legal advice and counselling for the surrogate and intended parents
- medical and psychological screening based on clear national standards
- informed consent in the surrogate’s own language and an independent advocate available to her
- a surrogate’s continuing and non-negotiable control over her medical decisions
- complete reimbursement of medical costs, travel, childcare, household support, lost earnings, superannuation, insurance and appropriate post-birth care
- a regulated support or hardship payment recognising time, discomfort, risk and recovery
- compensation that is not tied to a live birth, the number of babies or any particular medical decision
- funds secured before treatment and administered independently through a trust or escrow-style account
- clear limits and public rules to prevent bidding, hidden payments and financial pressure
- ongoing support after birth, miscarriage, stillbirth or medical complications
These safeguards recognise that both underpayment and unregulated payment can create exploitation. The answer is not to ignore money. It is to regulate it openly and place the surrogate’s rights, welfare and autonomy at the centre of the process.
Altruism should describe the intention, not the absence of recognition
Surrogacy is one of the most profound things one person can do for another. A surrogate gives far more than nine months. She gives her time, energy, body, trust and care. She accepts uncertainty and risk so that another person can experience parenthood.
We should never reduce that gift to a transaction. We should also never use the language of generosity to make her contribution invisible.
At KinPath, we believe ethical surrogacy requires both altruistic intent and fair compensation. Voluntariness must be protected. Exploitation must be actively prevented. Children’s rights and wellbeing must remain paramount. Surrogates should be fully supported, properly advised and free to make every decision concerning their bodies.
They should also not be expected to work for free while everyone around them is paid.
