Surrogacy During War
Ukraine is one of the leading countries in international surrogacy — even during wartime.
JANUARY 7, 2024
When Melanie Rivarola’s daughter was born in Lviv, a city in western Ukraine, she was sitting alone in a hospital room, without phone service, as an air raid alert sounded. She found out she had become a mother when a doctor came by to congratulate her. In another room on the same floor, Darya, a Ukrainian surrogate, had just given birth to her daughter.
Rivarola, who is from Florida, met her husband, an Argentine, at an Ironman sports competition when she was 38. They married two years later, but when they started trying for a baby, doctors told them she had a less than 5 percent chance of getting pregnant due to her age.
They couldn’t afford surrogacy in the U.S. and learned about Delivering Dreams, an international surrogacy agency, through acquaintances. In November 2020, they traveled to Ukraine to begin the procedure. After several failed transfers and a miscarriage, Darya became pregnant with their baby in February 2022. Two weeks later, Russian President Vladimir Putin’s army invaded Ukraine.
Now, nearly three years since the war began, the number of surrogacies is again approaching pre-conflict levels.
Before the full-scale invasion, Ukraine’s surrogacy industry accounted for up to a quarter of the global $14 billion surrogacy market, trailing only the United States. The country offers lower costs and a simplified process for prospective parents, including parental rights from conception, without court proceedings. For Ukrainian women, surrogacy represents a significant opportunity. The money they can earn through surrogacy, typically around $25,000, is far higher than the country’s average yearly wage of around $6,400.
When Russia launched its large-scale attack on Ukraine, agencies rushed to move pregnant surrogates to safer parts of the country, while medical professionals focused on preserving the embryos of foreign couples stored in clinics across the country. But even according to conservative estimates, more than 1,000 children were born in Ukraine via surrogacy in the first 18 months of the war. Now, nearly three years since the war began, the number of surrogacies is again approaching pre-conflict levels.
There is growing concern among some activists and lawmakers in Ukraine that the country’s regulations surrounding surrogacy are too lax and exploit women, who often enter surrogacy because of a lack of other opportunities and are obliged to move into flats rented by the agency toward the end of their pregnancy. For foreign couples, the Ukrainian market remains attractive, and sometimes the only avenue for surrogacy, as other countries enforce stricter protections. India, Nepal and Thailand, all large markets, have tightened restrictions in recent years over concerns including human trafficking. Most European countries have banned commercial surrogacy — where women can make a profit — and only some allow “altruistic surrogacy,” in which women receive no compensation beyond expenses.
Rivarola’s daughter, Juliana, was born at 38 weeks, via a C-section operation in October 2022. Rivarola and her husband stayed in the hospital until Darya recovered, then drove to Poland to get Juliana’s emergency U.S. passport and born abroad certificate, for which they applied at the U.S. Embassy in Warsaw thanks to a temporary war-time agreement between Poland and Ukraine. When the couple arrived at Rivarola’s parents in Florida, with their new baby, everyone was overwhelmed with happiness.
Juliana, who is now two years old, has her own Instagram account, managed by Rivarola. One of the first photos shows a pregnant Darya in Lviv. “I want her to know the lengths that we went to have her … When Juliana is a teenager, and starts to talk back to me, I already have what I’m going to say ‘girl, I went to war, literally war, to pick you up!’” Rivarola told me during a video call, laughing as the blonde toddler tugged on her leg. “She’s my miracle baby.”
Conception
Ukrainian surrogacy costs the prospective parents between $30,000 and $50,000, excluding travel, compared to $110,000 or higher in the U.S., $60,000 to 75,000 in Mexico or $45,000 to $65,000 in Cyprus. That is due, mainly, to the low cost of living in Ukraine and inexpensive medical procedures.
Surrogates receive approximately half of the total fee at the end of the pregnancy, plus a monthly allowance of $300 to $400, enough to live a comfortable life, while they are pregnant. The rest is retained by the agency, to pay its coordinators, translators and legal advisers, and the clinics that oversee the fertilization and pregnancy.
Surrogates must be mothers themselves — the rationale being that they have already carried a pregnancy to term and know what to expect — and between 18 and 35 in age. They go through multiple rounds of medical examinations, and around 30 to 50 percent of applicants will be accepted, according to estimates from agencies.
Ira, 34, found out about surrogacy through a friend, who added her to a group chat on Viber, a popular messaging app in Ukraine, where agencies seek women willing to become surrogates. Due to a lack of well-paid opportunities in her hometown, she struggled to make a living for herself and her 10-year-old daughter. Before the war, the average monthly wage in the Dnipropetrovsk Oblast region, where she is from, was the equivalent of around $350, close to the country’s average. While that figure has risen since, surrogacy remains a more lucrative option for her.
She learned about surrogacy from a woman posting on TikTok. The app contains hundreds of posts with Russian or Ukrainian-language hashtags, showing photos of pregnant bellies juxtaposed with signs of wealth: renovated kitchens, cars, jewelry.
Ira is now carrying the baby of a Portuguese couple she has not met in person. “I deliberated for three years,” Ira told me. “I don’t want to depend on anyone else [financially].” Like all the surrogates quoted in this piece, she spoke to me on the condition of withholding her family name. With her payment of around $25,000, she plans to open a nail salon in her hometown, she said.
While surrogacy agencies do not release data on the number of women who apply to become surrogates, many Ukrainian women like Ira see surrogacy as their only option to make enough money to secure their future, according to Anastasia Lukinova, who oversees surrogacy applications at Alice Fertility Clinics. “The main reason is financial, the desire to buy an apartment or a car, or to fund their children’s education,” she told me when I visited the center.
Alice Fertility Clinic occupies a modern office block next to a large park. It contains two examination rooms and a medical lab, and offers IVF and fertility treatment, pregnancy support and gynecological examinations, as well as egg storage and the medical procedures for surrogacy.
Ilona, a 21-year-old woman sitting in the waiting room with her two-year-old, told me she was preparing to become a surrogate with the clinic. She learned about surrogacy from a woman posting on TikTok. The app contains hundreds of posts with Russian or Ukrainian-language hashtags, showing photos of pregnant bellies juxtaposed with signs of wealth: renovated kitchens, cars, jewelry.
Applicants like Ilona first fill out a questionnaire online, then come to the clinic for medical and psychological examinations, which have become a more important part of the process since the start of the full-scale invasion.
“Of course, everyone who is currently in Ukraine has anxiety,” said Inna Korolkova-Ditkivska, a psychologist who works with Alice Clinic. “But compared to the beginning of the full-scale invasion, women have learned to cope with it and adapt to the situation.”
Successful candidates are matched with prospective parents who apply online and choose a surrogate based on her profile. Both sides are given the opportunity to withdraw from the arrangement after a video call.
Ukraine’s requirements for intended parents are strict: They must be married and show medical reasons for their inability to have a child. Same-sex couples or single men and women are blocked from accessing surrogacy by law, as the country doesn’t recognize same-sex marriage. Prospective parents don’t have to travel to Ukraine for the start of the process: Their paperwork is carefully examined online, their biomaterial shipped in cargo tankers filled with liquid nitrogen, whether they use their own egg and sperm for full surrogacy, or, more commonly, an egg or sperm from a Ukrainian egg bank for partial surrogacy.
Although Alice Fertility Clinic operates with what they call a 70 percent “success rate,” meaning seven out of 10 prospective parent couples end up with a baby, the fertilization and transferal process often has to be repeated multiple times. That’s especially true in war time: due to regular air raid alerts, and subsequent road closures, women may be forced to miss appointments or not be able to take their medication at the specified time, said Alice Fertility Clinic’s embryologist Olena Dubova.
Pregnancy
Karina, 26, is six months pregnant with the child of a German couple. They often send her photos of their pets, and she returns pictures of her growing belly and two children. Communication must be initiated by the parents and Karina’s agency, Delivering Dreams, encourages both sides to keep it positive and supportive. If the prospective parents decide they don’t want to communicate with the surrogate — a rare occurrence, according to founder Susan Kersch-Kibler — the agency keeps them informed on the process.
In the fall of 2024, Delivering Dreams International Surrogacy Agency had 44 pregnant surrogates, which is more than before the war, Kersch-Kibler told The Dial. The rise in the number of surrogates at her agency, she added, is partly due to several other agencies shutting down since February 2022.
Studies conducted in other armed conflicts have shown that the stress and disruption caused by war can have a detrimental effect on pregnancy. Across Ukraine, hospitals have reported an increase in premature births and higher rates of C-sections since the beginning of the war, according to the U.N.
Before she became pregnant, Karina lived with her parents and her two children in Tarasivka, a city about a 30-minute drive southwest of the center of Kyiv. Her husband, who was in the Ukrainian army, died of cancer in 2020. With the payment from her surrogacy, she wants to buy a house of her own, she told me when we met in Kyiv.
While the capital remains largely safe due to its imported defense system, residents often wake to the sound of sirens. Some days, the loud thud of missiles intercepted above the city sends people rushing for shelter, and the city’s suburbs are often attacked by drones, which can fall on buildings when shot down. Shops, restaurants and bars remain open but sometimes struggle with power outages. Photos of soldiers killed in battle or in captivity are on display on the city’s main historic squares and billboards promoting the military loom over the streets. Still, Karina told me she doesn’t wake up during the night raids and manages “to remain calm and positive.”
Studies conducted in other armed conflicts have shown that the stress and disruption caused by war can have a detrimental effect on pregnancy. Across Ukraine, hospitals have reported an increase in premature births and higher rates of C-sections since the beginning of the war, according to the U.N. According to a recent study funded by the Canadian Institutes of Health Research, surrogate pregnancy carries a significantly larger risk of complications than pregnancies coming from natural conception or IVF. Women who donate their eggs for the pregnancy face the rare risk of potentially fatal hyperstimulation syndrome, and the long-term consequences of the fertility drugs are unknown.
Delivering Dreams says its surrogates are closely monitored during their pregnancy and receive medical and practical support from the agency. Lyubov Omelchuk, a sturdy woman with jet-black hair and the surrogate coordinator at Delivering Dreams, said she makes herself “available 24/7.” She provides the women with a power bank big enough to power their household appliances in case of blackouts, and makes sure they attend their medical checks, which happen initially once a month, then once a week, at private clinics in Kyiv or Lviv.
A few weeks before their due date, Omelchuk helps the women move into a flat, which is rented by the agency, in either city, to make sure they are safe and close to the clinics, she said. The surrogates can choose to bring their family with them or get household help to cook and clean, at the agency’s expense, to ensure they are not alone in the last days before the birth.
Birth and postpartum
In 2020, Ukraine’s maternal mortality rate stood at 17 deaths per 100,000 live births, compared to a global rate of 223, according to UNICEF. But since the start of the war, staying in a Ukrainian hospital carries additional danger.
According to research by the global humanitarian NGO International Rescue Committee, and Ukrainian healthcare organization ZDOROVI, nearly 1,900 of the country’s medical facilities have been damaged or destroyed since the start of the war, and over 100 civilian doctors have been killed. In July 2024, a missile strike damaged Kyiv’s Ohmatdyt Children’s Hospital, the country’s biggest pediatrics facility, killing two people; seven people died at a nearby maternity clinic. One of the doctors who consulted for Delivering Dreams died in the blast.
Sitting in a cafe in central Kyiv, Kristina, whose birth the doctor was involved in, showed me photos of her huge belly, and of herself with the twins she safely delivered in July 2023. With the money she received, she bought a house for herself and her two children. Now, she is preparing for a second pregnancy, again with Delivering Dreams. This time, she plans to use the money to renovate her home.
According to the agency, many surrogates decide to repeat the experience. There is no legal limit to how many times a woman can be a surrogate, but they need to recover physically and be ready emotionally.
Tanya, 34, a surrogate working with Delivering Dreams for the second time, said she sees surrogacy as a way of giving couples “the opportunity to be parents.” The biological parents of the first child she delivered, in May 2023, often send her photos of him, she told me. “The main thing for me is that these parents and the child are happy.”
Maria Dmitrieva, an activist who supports the abolition of surrogacy, said the issue is not getting enough attention during the war.
Yet surrogacy is first and foremost a business. After investigations revealed the mistreatment of women, abandoned children and missing embryos at several agencies, Ukrainian police opened an investigation into at least one agency operating in the country, Eurosurrogacy, and its partner BioTexCom. The IVF clinic InterFiv, which shares an owner with Eurosurrogacy, was accused of human trafficking in 2021. According to investigative outlet OCCRP, the authorities alleged that InterFiv gave parents babies who were not theirs biologically and falsified documents to smuggle babies out of Ukraine. No charges were brought against the owners, and the investigation was delayed by the full-scale invasion.
In a joint investigation in 2023, POLITICO and WELT accused BioTexCom of failing to provide proper medical care for its surrogates and withholding payment, among other allegations. The owner of the agency was investigated for possible human trafficking and spent two months under house arrest, but after being transferred to another court the case was ultimately dropped.
Denis Herman, the agency’s legal representative, denied the mistreatment of women. “We do our best,” he said in a video call. At the beginning of the war, the agency had “hundreds” of pregnant surrogates around the country. “We never left a surrogate alone,” he said during that time. “Even if they needed to share the apartment or a bed, it was still a safe bed, a warm bed and a bed on the territory which was not under attack and which was under full control of the Ukrainian government.” Now, the surrogates share a flat but have their own rooms, he stressed.
Maria Dmitrieva, an activist who supports the abolition of surrogacy, said the issue is not getting enough attention during the war. She warned that surrogacy agencies operating in Ukraine are essentially advertising that prospective parents can “get a baby on the cheap.” Many highlight that Ukrainian surrogacy is “affordable,” “lower cost” or the “cheapest in Europe” on their websites.
In March 2023, a group of Ukrainian MPs proposed a bill that would ban surrogacy for foreign parents during the period of martial law (and up to three years after martial law has ended) and would mandate that prospective parents register with the Ukrainian state. A government body, rather than an agency, would then carry out the necessary checks on the couple — a measure designed to assuage fears that Ukrainian babies are being trafficked. MP Viktoria Wagnier, who co-authored the bill, has alleged that foreign couples “use Ukrainian women” and that there is no way to find out “what happens to these kids afterwards.” The former presidential commissioner for children’s rights warned in a 2020 Facebook post alleged that insufficient checks mean gay couples or “rapists” could adopt children by creating fake spouses.
The bill was rejected in May 2023.“There are many other urgent issues for the [Ukrainian parliament],” surrogacy lawyer Oksana Kashyntseva told The Dial about the decision. She is supportive of stricter regulation, she said, but argued against a complete ban on surrogacy. The law should “protect all parties: intended parents, children, and women who participate as a surrogate mother. But [it shouldn’t] stop it.”
✺ Published in “Issue 24: Bodies” of The Dial
ILLUSTRATION: Ukrainian Flag & Sonogram (via Envato)
