Research finds health system unequipped for surrogacy amid ALRC review

An Australian mum who welcomed her daughter via surrogacy says she felt unfairly penalised for her chronic illness, as research reveals the health system is unequipped for the practice.

Surrogate Emily with Sarah and Tom Starkey with new baby Savannah Emily-Joan Starkey. Picture: Kelly Barnes

New research suggests Australia’s healthcare system is not equipped to handle the complexities of surrogacy,as an inquiry reviews laws governing the practice.

A Swinburne University study indicates clinicians do not have clear guidelines or ethical training around surrogacy pregnancies.

“Surrogacy isn’t like standard maternity care,” study lead Dr Jutharat Attawet said.

“There are multiple people involved, each with different needs and rights, but healthcare professionals aren’t being taught how to navigate that.”

The Australian Law Reform Commission (ALRC) is reviewing the nation’s surrogacy laws.

Commercial surrogacy is not legal in Australia but altruistic surrogacy, where the surrogate’s expenses are covered but they are not paid, is allowed.

Adelaide couple Sarah and Tom Starkey welcomed their daughter Savannah in December.

Sarah and Tom Starkey with baby Savannah

Mrs Starkey, who has Crohn’s disease, had experienced multiple miscarriages before the couple’s embryo was implanted in “incredible” surrogate Emily Stone.

Both women participated in the Swinburne research.

Mrs Starkey said while their experience with the health system was largely positive, there were times Ms Stone was incorrectly referred to as the mother.

“Often, when we did go to scans or appointments, we would have to tell them that there will be three of us coming,” Mrs Starkey said.

“Sometimes they would be a little bit funny, like ‘only two people in the room’, but once we explained … people were very accepting.”

Mrs Starkey said she did not receive Medicare rebates for the embryo transfer, and felt it was unfair to be “penalised” for her health issues.

Emily Stone, Sarah Starkey and baby Savannah. Picture: Supplied

She said the trio was the first surrogacy team their private obstetrician’s clinic had worked with.

After the birth, Mrs Starkey and her husband weren’t listed on the birth certificate and needed to attend youth court to get it changed, which she said created unnecessary stress.

Tom and Sarah Starkey with baby Savannah at the youth court, where they finalised the birth certificate due to surrogacy. Picture: Supplied

She is calling for the introduction of pre-birth parentage orders.

There were 376 Aussie children born overseas through surrogacy in the 12 months to June 30, 2024 — but significantly less are delivered in Australia, according to law firm Page Provan.

The Swinburne study draws on interviews with seven Australian surrogates and nine Australian intended parents, and Dr Attawet said final findings are being collated.

“What we hear again and again is that surrogates and intended parents can both feel sidelined in different ways,” Dr Attawet said.

Surrogates often report feeling invisible or not fully respected in decisions about their care, while intended parents could feel unrecognised as the central caregivers.

Dt Attawet said the lack of surrogacy birth care guidelines could create unnecessary distress and erode trust in the healthcare system.

Researchers are calling for national standardised surrogacy birth care guidelines, dedicated training for health workers, clearer clinical protocols, and a stronger ethical framework.

The study is in collaboration with the University of Technology Sydney, Rosemary Bryant AO Research Centre at the University of South Australia and The Kids Research Institute Australia.

An ALRC spokesman said it was currently processing submissions which would inform upcoming work.

“The ALRC is continuing its consultation and research, and will next invite submissions in response to the inquiry’s discussion paper, due for publication later this year, which will provide an update on what the inquiry has heard, ask further questions on the issues, and share options for reform,” he said.

The final report is due to the Attorney-General next July.