By The America Tonight Digital Team
May 15, 2014 / Updated February 13, 2015 

Where do babies come from?

In our increasingly interconnected world, the answer to that question is growing more complicated.

This week on America Tonight, our “Making Babies” series featured an American couple hoping to become parents using an egg donated in London, a surrogate in India and a delivery planned in Nepal.

Some couples have gone south of the border to find surrogates. But in an industry where the clients are desperate, the surrogates are poor and the profits for the middlemen agencies are huge, there can be heart-wrenching results.

And it’s not just U.S. couples entering the brave new world of reproductive tourism. Would-be parents from China and Europe are also coming to American shores for fertility treatments and to find surrogates who will give birth to American citizens.

Surrogacy is now a multi-billion dollar global industry, but there are only a handful of countries where it’s explicitly legal to hire a woman to bear your child. Here’s a guide to some of the international surrogacy hotspots, and how they’re handling the outsourced baby boom.

Russia

Russia is “a sort of reproductive paradise,” according to Konstantin Svitnev, the general manager of Rosjurconsulting, a Russian law firm specializing in surrogacy. The country has one of the most liberal surrogacy laws in the world, as well as some of the cheapest rates. Svitnev estimates that the procedures cost, on average, between $15,000 to $30,000. In 2012, surrogate mothers in Russia reportedly gave birth to around 1,000 children, although there was no data on how many of those were for foreign couples.

Then, last fall, the tide shifted. Russian pop diva Alla Pugacheva, 65, and her husband had twins through a surrogate, rattling conservative corners of the country. A Russian Orthodox Church official decried surrogacy as a “mutiny against God” and “very happy fascism with a contract,” reported Russia Today. Elena Mizulina, the architect of the nation’s infamous gay propaganda law declared that surrogacy was “threatening not only Russia, but humanity as a whole with extinction,” likening the practice to nuclear weapons, according to BuzzFeed.

As part of a conservative surge in the country, Russian parliamentarians drafted a bill in April that would ban commercial surrogacy entirely, and restrict its use to married people. The bill excludes gay couples, as same-sex marriage isn’t recognized in Russia.

Ukraine

Lax surrogacy laws and its European locale have made Ukraine one of the newest Meccas of international baby-making. For foreign couples, the price tag reportedly ranges from $30,000 to $45,000, less than half what it costs in the U.S. Only written consent is required, and Americans and Europeans don’t even need a visa.

As long as parents are infertile, legally married and straight, the laws in the post-Soviet nation are stacked to protect the rights of the intended parents. Couples can select their baby’s gender and scoop up the birth certificate of their surrogate-born kid, almost as soon as he or she takes a first breath, essentially extinguishing the rights of the surrogate mother entirely.

But this breezy arrangement can hit a few snags. For example, French couple Patrice and Aurelia Le Roch had twins through a Ukrainian surrogate in January 2011. Surrogacy is illegal in France, and the country doesn’t grant French citizenship to surrogate-born infants. So Patrice Le Roch and his dad, Bernard, tried to smuggle the stateless babies across the border to Hungary, but were busted and fined a couple thousand dollars a piece. The couple finally managed to get Ukrainian citizenship for their children, the AFP reported, and went home after eight Kafka-esque months stranded in Kiev.

India (and Nepal)

In a nation with 1.2 billion people, plentiful English speakers, abundant hospitals and widespread poverty, it’s little wonder that India has become a surrogacy destination for many Westerners. Leslie Morgan Steiner, author of “The Baby Chase: How Surrogacy Is Transforming the American Family,” says India has turned into “the largest provider to infertile couples in the Western world outside the United States.”

Commercial surrogacy has been legal here since 2002, getting its start largely thanks to infertile couples of Indian origin in the U.S., U.K. and Middle East. Even factoring in costly plane rides, seeking help at one of India’s more than 1,000 fertility centers can be a relative bargain. India’s surrogacy prices of $18,000 to $30,000 are roughly one-third of the cost in America, according to Time magazine.  Sudhir Ajja, who co-founded Mumbai clinic Surrogacy India, told ABC News that nearly all of his clients are from overseas – many coming from the U.S., Australia and Sweden. The exact size of India’s industry is unclear, with estimates ranging from $450 million to $3 billion a year.

But India’s big business of renting wombs has raised thorny ethical concerns. Many surrogates come from crushing poverty, but stand to earn $5,000 to $7,000 in nine months – a huge sum for women who would otherwise bring in well under $1,000 annually. Some surrogates, however, are lured into contracts they don’t understand or are cheated by shady middlemen. Others are confined to sometimes crowded shelters near the fertility clinics, where their personal freedoms — like family visits — are restricted.

Some clinics have introduced more out-patient care models for surrogates, and there have been attempts to monitor and regulate the growing industry. A bill to reduce exploitative practices has gone unsigned for more than four years, but in that time, one major regulation has taken effect. In 2012, India’s Home Ministry decreed that foreigners seeking a surrogate must be a man and a woman, pushing same-sex couples and would-be single parents to look elsewhere for help. But some Westerners have gotten around the rule by hiring Indian or Nepalese women to get in vitro fertilization in India, only to deliver the babies in Nepal.

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