In her article titled "International surrogacy: new HFEA guidance and the dangers of oversimplifying a complex picture", fertility lawyer Natalie Gamble points out that despite the domestic surrogacy option, research conducted in 2018 showed that an increasing number of British prospective parents still pursue surrogacy in the USA and elsewhere due to "the lack of professional services for matching in the UK [and] the lack of legal certainty available at the outset that intended parents would ultimately be the legal parents of their child."

As COVID-19 related travel restrictions prevented intended parents from crossing borders to complete their surrogacy journeys, the UK government created a new emergency UK passport application process to help British parents bring surrogacy babies home. Subsequently, the UK's Human Fertilisation and Embryology Authority (HFEA) also relaxed its guidance on exporting eggs, sperm and embryos. In doing so, the HFEA confirmed that "UK fertility clinics no longer need to ask whether intended parents plan to compensate their surrogate or to use a paid surrogacy agency."

Gamble sees these developments as evidence of the growing realization that so called "commercial" surrogacy outside the UK cannot be be ignored, in contrast to the "policy myth that UK surrogacy is preferable to international surrogacy." Gamble proposes that we should ensure surrogacy is ethical rather than categorizing it as altruistic vs. commercial or domestic vs. international. According to Gamble, the criteria for ethical surrogacy include key questions such as: "Is there fully informed consent and a healthy balanced relationship between the intended parents, surrogate and any intermediaries involved?  Is there a strong direct relationship between the intended parents and the surrogate, based on honesty and transparency? Are any professionals involved regulated and do they add valuable input in respect to safeguarding, screening and support? And most importantly, are the child's rights and welfare put centre stage to ensure children are born with secure legal status, a positive and honest conception story and access to information about their birth story?"

Gamble noted that while there are locations outside the UK where significant wealth inequality and controlling commercial intermediaries lead to unethical surrogacy practices, there are also locations where robust ethical standards are in place. Gamble references several US states which "require surrogates to have independent legal advice, psychological screening and a significantly more stringent medical screening than in the UK." Furthermore, she claims surrogacy is safer for all parties with the use of regulated professionals and compensated surrogates, chosen from a pool large enough "to apply high standards of medical and psychological suitability."

Gamble concludes by urging people to no longer think about surrogacy as a dichotomy between altruistic and commercial but instead asking rigorous questions to ensure ethical surrogacy practices.

"This approach, and the criteria Gamble suggests, are closely aligned with Men Having Babies' approach, and our Framework for Ethical Surrogacy," said Ron Poole-Dayan, MHB's executive director.