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As more people cross borders to seek assisted reproduction services, better regulation is needed to protect those at risk

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London, 16th August 2011

A study published in the UK journal Reproductive Health Matters has asked pressing questions about the rapid expansion of cross-border trade in medical services specifically for assisted reproductive needs including in vitro fertilisation (IVF) and surrogate pregnancy. "Cross-border assisted reproductive care in Asia: implications for access, equity and regulations" argues that cross-border reproductive care presents challenges to the way services are currently regulated.

Overall global trade in medical services was estimated by Deloitte to be worth US $60 billion in 2008 and is expected to grow to US$100 billion by 2020, as people from richer countries travel more to find cheaper services. The growth of the market and absence of regulation has allowed private clinics in countries such as India and Thailand to benefit from an influx of foreign capital. But people in poorer countries who cannot afford private medicine may be seeing few benefits from these high-priced services.

While some advocate a 'free market' approach, the study says, public health services and health professionals may be being diverted away from treating local people. Exploitation of poor women to carry surrogate pregnancies is also a risk. "Currently, the international trade in assisted reproduction services does little to improve local equity and access to treatment for loca populations in low-resource countries," writes study author Andrea Whittaker, Associate Professor at the School of Population Health, University of Queensland, Australia. "The growth of a global trade in commercial surrogacy in developing countries warrants attention, particularly in countries where lack of regulation offers little protection to women who act as surrogates."

Laws relating to assisted reproduction services vary widely from country to country. Only 48 out of 191 World Health Organization member states have the facilities to provide IVF and many restrict its use. Differing rules related to surrogacy is also a reason for many to cross borders. India legalized surrogacy in 2002 but is yet to pass its Assisted Reproductive Technologies (Regulation) Bill, while Thailand's Reproductive Health Bill has awaited ratification for years. An example of the need for regulation arose in February 2011 when Thai police exposed a "surrogacy ring" in which 14 Vietnamese women, seven of whom were pregnant, had been trafficked for the purpose of acting as surrogates.

Regulation could protect not only surrogates, but also those accessing care. "Lack of regulation has produced a lucrative international trade," Whittaker writes. "For foreign patients, there is little legal protection in cases of malpractice across borders."

Other articles in this issue of Reproductive Health Matters focus on many aspects of health care privatisation worldwide and include studies from Bangladesh, Turkey, Malawi, Poland, Madagascar and South Africa.