Surrogacy has been from time immemorial. A case of natural surrogacy was recorded in the Holy Bible; Genesis 16: 1-4. Here, Sarah hand over her maid Hagar to his husband Abram when she couldn’t conceive. This led to the birth of Abram’s first son, Ishmael. A more refined and advanced way of surrogacy is being used today, either by through a gestational surrogate or traditional surrogate. These methods are not uncommon in Nigeria as there have been reported cases of child deliveries even though the gestational seems to come out on top.
There was a reported case of a 35-year-old married graduate trader who had a child through surrogacy in the southeastern part of Nigeria in 2014. She was diagnosed with primary infertility of 7-years duration due to Mullerian dsygenesis. She was unable to achieve pregnancy despite frequent unprotected sexual exposure and with a background history of absence of menstruation since birth. A fertility evaluation for the couple at the hospital revealed normal male factor and functional ovaries but absent uterus. She was then recommended for surrogacy. At the end of the whole procedure, she had a baby through a gestational surrogate.
This is one of the few reported cases of assisted reproductive technology by surrogacy due to the side our society shows to issues of reproduction and reproductive health. The cost of having a procedure done is also expensive for an average Nigerian; it costs $3000 and an average Nigerian lives on less than $2 per day. Another reason is that assisted reproductive technology (ART) is still seen as a taboo (religious beliefs, cultural beliefs, etc.) but the practice is being conducted in Nigeria. There are also 45 fertility clinics in the country with 5 of them public-owned.
Nigeria has one of the highest birth rates in the world with 37.3 births for every 1,000 people or an average of six children per woman meaning more than 7 million new Nigerians are born every year, an estimated 25% of couples still suffer from infertility. Our society rates childbearing very high in marriages; if a couple failed to bring for a child one or two years after marriage, there become subjects of ridicule and shame by their family members. Some intended parents now seek for assisted reproductive technology as a way to save their marriages.
Surrogacy which involves a legal agreement whereby intended parents works with a surrogate (woman who carries a baby to term for another woman) so as to have baby(ies) is now a viable option. This can be in two ways; Gestational Surrogacy and Traditional Surrogacy. Gestational Surrogacy makes up the vast majority of modern surrogacy arrangements. Here, intended parents create embryos (by donating gametes i.e. egg and sperm) through in-vitro fertilization. The surrogate known as the gestational surrogate/carrier help to carry the baby to term and doesn’t have any genetic connection with the baby conceived except for the parents/donors. In contrast, Traditional Surrogacy involves the surrogate using her eggs while the sperm is donated. In this case, the baby carried to term have the genetic materials of the surrogate mother.
Gestational vs Traditional Surrogacy in Nigeria
Surrogacy as a technique of assisted reproductive technology is yet to have a federal law backing in Nigeria. As there are no laid down guidelines in Nigeria, fertility clinics apply that of the USA and UK. In the few reported cases of surrogacy in Nigeria, the gestational surrogacy method is the most used. Indications for surrogacy may be as a result of congenital absence of the uterus, repeated failure of IVF, and removal of uterus in cancer surgery, postpartum hemorrhage or for other reasons such as recurrent abortion, and severe medical conditions that maybe complicated or complicate pregnancies.
Gestational surrogacy can be used as the treatment when a woman still has functioning ovaries so can produce healthy eggs. A gestational surrogate will then help to bring the child to term. Although gestational surrogacy is the more expensive of the two techniques, it is the most widely used. 99% of intended/commissioning parents don’t meet with their surrogate mother because it is not done openly for personal reasons so the fertility clinics serves as their mediator. This is to show they only want to have connections with their babies and not the surrogate. They are counselled on the procedure and made to pay monetary compensation either in full or in batches.
For the fact that the baby to be carried to term would have connections (through their genetic materials) with the intended parents, this technique is seen as the most favorable. Their donations (eggs and sperm) made them the authentic parents of the child/children whereas in the traditional surrogacy method, there is still a link to the baby which can even make the surrogate not to cede the baby to the commissioning/intended parents.
Many women who act as surrogates does this because they enjoy becoming pregnant, while others do this for financial reasons or a desire to help another to raise a child. In fact, some women contact their sisters or a female relative to be their surrogate just as the case of the biblical Sarai discussed earlier. This can be dangerous and complicated as surrogates may not want to cede the baby. Surrogacy surely raises a lot of potential legal, medical, moral, and socioeconomic issues, particularly in Nigeria where guidelines for it barely exist.
To avoid stories that touches the heart, gestational surrogacy is a better option for intended parents in Nigeria who cannot have a child as a result of infertility. It is a veritable option for the management of infertility in our environment, particularly knowing the high degree of premium placed on childbearing in Nigeria and Africa at large. The need for legislation guiding the procedure is important as well as government support for the financing since this will save the burden and strain placed on marriages in our society due to childlessness.
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