One of the joys of parenthood is to bear offspring, and one method of achieving this is through surrogacy, which has gained much popularity across the globe including Nigeria. While surrogacy, and other methods of assisted reproductive services, offer a lot of hope to intended parents, many fertility clinics, surrogate agents, and young women have turned it into a transactional affair and above all as an avenue to earn an income albeit illicitly.
To unearth the illegitimate practices beneath surrogacy in Nigeria, I posed as a mother of one who wants to be a surrogate to unsuspecting agents, who leverage the digital media to promote their ‘businesses’ online. During this mission, I saw firsthand the risks faced by young women who become surrogate or egg donors and the unethical methods employed by some fertility clinics.
‘Underground’ Online Surrogacy Network
In the digital underground world of this illicit act, different Facebook groups offer different services to the surrogacy community, while some are seeking donors and surrogates, some others are providing support systems for women who are surrogates or considering surrogacy as an option for their fertility challenges.
To start this journey, I created another Facebook account with the name ‘Patience Chris’, in April 2023, and within the first two weeks, I posted content about food, my supposedly carefree attitude to life, and my desire to make money at all cost.
I joined two groups Surrogate Mums in Nigeria (private) and Egg donor and surrogate mothers in Nigeria (public). After joining, I couldn’t ignore the numerous advertisements and requests for surrogates and bleeding donors with enticing remuneration. Each advert had a standard procedure, it came with requests for specific requirements, either age bracket, genotype, complexion, location, etc. A major requirement that was also listed was for surrogates to have given birth in the past.
Other elements of the various posts ranged from juicy offers of 1 million to 1.5 million Naira for surrogates, excluding feeding, accommodation, and wardrobe allowances, while egg donors were to get between 100,000 to 180,000 Naira, aside from their transportation allowance.
The next step I took was to post on the groups that I was a willing surrogate and currently resided in Lagos State, and also made myself available to different ‘agents’ who needed surrogates in Lagos. The conversation always took place under the veil of private messages (DM).
A little while after our conversation and juicy promises, my agent invited me to a fertility clinic (name undisclosed) to meet Nurse Oluchi. She then advised that I pay a visit to the clinic at a time I will be menstruating, I wasn’t sure why and I didn’t seek further clarification.
Infiltrating the clandestine world of surrogacy brokers
On Saturday, May 20, I visited the address, in the company of two female friends, not just to act as surrogate and fetus donor respectively, but for some form of protection in the event, anything went wrong, ironically none of them was a security operative.
Upon arrival at the looking newly-built story building with cream and chocolate brown color, the mention of ‘Nurse Oluchi’ opened the gate for us, and the security officer at the gate directed us to go through the side of the building to a small room.
Picture (image of the hospital. Source: Google Maps)
There was no signpost or anything to indicate that the building was a hospital or a fertility clinic. As such, I became a bit scared, but when we entered the room, we saw ladies roughly between the ages of 17 – 25, in their numbers, waiting to be attended to. The room was so full that I had to stand and my other friends sat outside.
The ladies we met grinned at the sight of us because we looked like ‘Jolly just come’ (a term used for those who are new to a place) in the surrogacy business, they had a lot to share with us, but we wanted to meet Nurse Oluchi.
There was no one to point us to Nurse Oluchi and when I told my ‘agent’ via Facebook Messenger that I had arrived at the clinic, she advised me to wait at the sitting area and that I would be attended to.
While waiting: the desperation and vulnerability of young women enticed into a donation
While we were waiting for Nurse Oluchi, nurses kept coming into the room through a different door that linked to the inner part of the hospital. No one ever gets to that part, except upon being invited for a test or hormone injections.
When the three of us eventually sat down, because some ladies had been attended to and left already, we heard the stories of ladies who had taken egg donation and surrogacy as a profession, an opportunity to live a ‘soft life’ or a quick fix to their immediate financial needs.
Monica James, a single mother of one, was receiving treatment as a surrogate mother for the second time. According to her, she needed to fend for her child who looked less than 18 months.
“My daughter and I need to survive and I think this is better than prostitution or stealing. I am helping those who cannot give birth on their own,” James said.
James confessed she would rather be a surrogate than an egg donor because the money is substantial, and she can make use of it effectively.
Speaking about how she spent the proceeds from her first surrogacy contract, James said “The money is not paid once, and if you are not careful, you would spend everything you have before delivery. You know once someone is pregnant, there are a lot of cravings and needs, so, you have to spend the money you have.
“Some agents also do not pay the agreed money in full because they want to take advantage of you, and you don’t have an option anymore,” she added.
She was however determined to save more for this round, as she lamented about the poor economy and her increasing needs.
On the contrary, Marvie George considered egg donation as an opportunity to make fast money and move on to other things, and of course, no one would question her about being pregnant, as it would have been the case if she was a surrogate.
Speaking in pidgin, George said “I no know why una dey do surrogacy. My own na to donate, make I comot papaapa. After like two months, I go to do another one. The money go enter my hand now and nobody goes dey ask me how I take get belle,” she explained.
George whose boyfriend was in Warri considered her actions as much better than cheating on her boyfriend to make money.
Around noon, a hijabi Yoruba lady, Aminat Ajagbe, entered the room with a lot of excitement and greetings to friends and colleagues that she met in the business. She was full of energy, she sat beside me and started interacting with her friends with whom they had earlier started the treatment together.
They came to receive their intramuscular injection as they were almost set for retrieval (when the eggs were ready for harvesting) and that meant they could be in the clinic for up to 72 hours for the retrieval process to take place.
Ajagbe had just written her JAMB examination in early May but was unwilling to share why she wanted to donate her eggs, whether for the money or any other purposes. It was however clear that it was not a soothing decision for her as she complained about the distance from her house in Ikotun to the clinic in FESTAC town.
Victoria Obi, who sat quietly in a corner all along, became agitated when one of the nurses gave her the same pill she claimed to have used in the last 28 days.
Obi recounted that the Nurse instructed her to visit the hospital when she menstruated, but the Nurse insisted that Obi was supposed to visit the hospital before her next menstruation as the stimulation medication was meant to prevent her from menstruating.
After a long argument and intervention from Obi’s agent who spoke with the Nurse, she was attended to and it was agreed that she would henceforth proceed to the next stage.
Unlike James and George, Obi is working with a Chinese firm in Ikeja and lives in Ikorodu, so she wants to use her gains from the egg donation to rent an apartment somewhere close to her office.
Even though it is not certain that less than 200,000 Naira can get a suitable accommodation within that location, Obi believes she is better than her friends that are donors all because they want to buy an iPhone or live pretentious sophisticated lifestyles.
Kingswill: Operations in Secrecy
The similarities in the stories of James, George, and Obi are tales of urban poverty and the near impossibility of earning a decent wage exacerbated by an increasing need to keep up with global consumerism, operators of surrogacy in Nigeria know this and go for the jugular of these vulnerable women, like the ones seated clutching their appointment cards, as expected of anyone visiting a hospital.
However, I observed that all of them were hiding their cards, especially to prevent the front part from showing, and I wondered why, especially because they were within the clinic and everyone was there for the same purpose.
James said “We have been told not to expose the name of the clinic because it is on the card. Even when we are here or outside, we are used to hiding it.
“You also know that it is not appropriate for people to see our cards so they won’t start asking questions about why we’re visiting a hospital or thereabouts.”
Obi corroborated her story and said she usually takes permission to be absent from work whenever she needed to visit the clinic, as no one knew what she was doing, and exposing the appointment card might jeopardize her chances.
Asked about how she would cope with work when she needs to stay in the hospital for multiple days at the point of the egg retrieval, Obi said “I would take a sick leave and take a picture of myself on the hospital bed. I am sure my boss will even give me money to pay my hospital bills.”
Her statement made me wonder if truly her salary was not sufficient for her, or if she was just interested in doing what others were doing.
The appointment cards were also used as wallets to pay the donors. The nurses would enter the small room, collect cards from people depending on their appointment stage, and return the cards with money.
After opening the cards, the ladies are usually seen calculating how much they have collected so far as transportation costs and how much more to expect.
After a lot of zooming in and out on the appointment cards, my spy camera revealed the name of the clinic as Kingswill.
Spotlighting Kingswill Clinic
A public search on the Corporate Affairs Commission’s website revealed that Kingswill Specialist Hospital Limited was registered in July 2017 as a Private Company Limited by Shares with registration number 1424787. However, the status is inactive and the purpose of the operation is NIL.
I checked through the organization’s website on May 20, 2023, and it indicated that they offer IVF as a service. When I checked the website again on July 7, 2023, to extract more details, the website had been suspended by its hosting platform due to non-renewal.
On the other hand, the hospital does not have the logo of the Health Facilities Monitoring and Accreditation Agency (HEFAMAA), the agency saddled with the responsibility of monitoring both private and public health facilities to ensure registration and accreditation of all health facilities in Lagos State, and to ensure their operations are in line with ethical standards.
Speaking with Dr. Mrs. Yemisi Solanke ‘Koya, the Chairman of HEFAMAA, she explained that “whichever hospital where you do not see a logo of HEFAMAA, that means that facility is not registered by HEFAMAA, please do not go there.
“If there is anyone that has HEFAMAA’s logo but is involved in illegitimacy, please report to HFAMAA,” she added.
Speaking about malpractices in facilities registered under HEFAMAA, Dr ‘Koya shared that “the law empowers HEFAMAA to conduct at least 2 facility visits per year, and we did engage the collaboration of stakeholders; franchise organizations to expand our reach to meet the mandate of the regulation.”
Through this regular check by HEFAMAA and the franchise organizations, the agency can beam its search light on illegal health facilities and stop its operations.
In the same vein, Dr. Mrs. Abiola Idowu, the Executive Secretary of HEFAMAA said the agency is also counting on intelligence sharing from members of the public who might be aware of baby factories in the name of fertility clinics or fertility clinics operating illegally.
“We regulate fertility clinics, they fall under the Artificial Reproductory Therapy facilities and it is part of HEFAMAA’S regulatory oversight, so we set out standards for them. If we find any facility that is not operating according to the guidelines or is not registered, we will sanction them.
“I will enjoin the public if they see any facility that is running as a baby factory, they should let us know. If they see any facility without our logo or without our certificate pasted at their entrance, they should report to HEFAMAA,” she added.
While Kingswill Hospital might be run by professionals, its non-accreditation by HEFAMAA makes it illegitimate, engaging innocent young ladies as donors and surrogates and without proper enlightenment is also highly unethical.
My turn: No enlightenment for donors, poor attitudes of medical personnel
It was already past 3 pm and there were just about 6 of us in the room, including my friends and Obi. The Nurse who had been hostile and shouting at every provocation became calm and told me she was assisting me because they don’t take new intakes on Saturdays. She asked me to use the bathroom after which I would see the doctor.
She asked if my friends were egg donors, but I said no, that one of them was pregnant and she wanted to ‘give it out’. She corroborated what the agent told me via chat some minutes earlier, as the agent had offered to link my friend up with someone else in Anambra who would adopt the fetus.
After our conversation, the Nurse hurriedly directed me to a room to meet the Doctor and told me to beg the Doctor to attend to me, because the Doctor was not obliged to attend to first-timers on a Saturday.
I wasn’t sure of what to say or ask at that point and I remarked that ‘I am on my period’. She said that was okay and that I should proceed to meet the doctor.
I entered the small testing room where I was supposed to meet the doctor, but I didn’t see anybody and I thought I missed my way. I stepped out of the room, opening another exit door that linked to the hospital’s lobby. I saw a couple entering through the main door, it was obvious they were seeking one of the services of the fertility clinic.
While wandering and trying to identify the doctor’s office genuinely, I was hushed and directed by the other nurses and asked to go back to the testing room I came from.
I went back into the room which had a small bed, a transvaginal ultrasound scanner, a table, and a few items placed in the wardrobe section.
After waiting for about 10 minutes, a female Doctor, beautiful, fair, and petite came in. She didn’t ask too many questions, but also verified if I was menstruating and if I had given birth before, both to which I said ‘Yes’.
She placed a mackintosh on the bed and asked me to lie down for a test and to remove my underwear. I reminded her that I was on my period and asked about what she wanted to do. She told me she wanted to test me. I asked a lot of questions, but she wasn’t interested in answering. All she wanted to do was to conduct the vaginal scan, to ascertain if I was ‘okay’, I could proceed with other blood tests and begin treatment.
To do the vagina scan, she would insert the ultrasound probe (transducer), covered with a condom, into my vagina. I genuinely tried to do the vaginal scan, but I couldn’t imagine the procedure. On the other hand, the doctor wasn’t sure why a lady who has supposedly given birth before would be cringing all because of a vagina scan. I gave her the excuse that I was menstruating and I found it irritating that she wants to do the scan.
Displeased, she shouted at me, saying “I should be the one to complain that you’re on your period. If you’re not ready, I will walk you out and never come back here.”
She told me if I ever came back, she would be the one to attend to me, and she would need to conduct a vagina scan on me during my menstruation.
She thought I was one of the ladies they treat as subjects, who dared not complain whenever the nurses or doctors treated them anyhow. I wondered why the doctors nor the nurses wouldn’t take the time to enlighten a surrogate or donor about the steps they were taking. I believe they were only interested in making money and not in the welfare of innocent young women.
I left the room, of course, I wasn’t interested in going back to the hospital. I went back into the room where the ladies were, and she came in to complain to the others and the nurses about my bad attitude and how I wasn’t ready. The people in the room couldn’t fathom why I declined. I also do not know why, but I guess I wasn’t mentally prepared for such, and I wasn’t ready to go through any form of psychological trauma after the vagina scan.
My experience in the room confirmed that surrogates or egg donors were not informed about the decisions they were taking, a life-altering and, definitely ignorant about the long-term consequences and health risks involved.
Human Cost: Health and Emotional Consequences
There are short-term and long-term physical risks and complications faced by surrogates and donors. These also include psychological and emotional toll on participants in surrogacy arrangements as well as lack of post-surrogacy care and support for the women involved.
According to Public Health Post, “Egg donors have reported long-term effects including aggressive breast cancer, loss of fertility, and fatal colon cancer, sometimes occurring just a few years after donation. Without any family history of these illnesses, they suspect their egg donation is the cause. However, without scientific research, no one can confirm or deny a causal association between the medical procedure of egg donation and any reported long-term effect.”
Regarding the emotional consequences, Mrs. Dayo Odukoya, Founder of Parah Family Foundation, an NGO that creates awareness among couples going through infertility challenges, shared that some of the measures that fertility clinics and surrogate agencies take to cut off ties between the surrogate mothers and babies include delivery through cesarean section.
She said “They don’t allow the surrogate mothers to see the baby after being taken out through Caesarean section. They don’t want the woman to hear the first cry of that baby or breastfeed the baby at all. This is to avoid any form of bond between mother and child.”
Mrs. Odukoya thereafter noted that these terms are usually known by both parties and should prepare the donors before getting started.
However, James didn’t have all the information to help her make an informed decision before her first surrogacy contract, although she didn’t seem keen on knowing too much as she was in it all for the money.
According to her, experience is the best teacher, and she believes she is better prepared for her second surrogacy contract, which might be her last, but also unsure.
“I have a child before which I delivered through natural birth. This is my second surrogate process and if I deliver through CS, I might not be able to do another one. I also want to give birth later in the future and I don’t want to ruin my chances,” James added with so much uncertainty.
George wasn’t worried about any health complications, but according to her “You gas chill for like two or three months before you fit run onoda egg donation. Na makes the eggs dem fit plenty before you run am.”
Legal Provisions and Grey Areas
For George and many other vulnerable women that take this oft-exploited and unethical path, it is fraught with so many half-truths, hearsay, and a conditioning of their minds without any recourse to their personal health and future complications. It brings one to question if there are legal frameworks to protect them.
This has led many to argue that surrogacy is legitimate in Nigeria, but the surrogacy laws in Nigeria remain ambiguous, this has created room for exploitation and illegitimate practices to thrive.
Generally, parties involved in surrogacy are usually bonded by a written agreement that states all the rights and obligations of all parties involved. However, a critical look at Section 30 of the Child Rights Act (2003) prohibits the ‘buying, selling, hiring, let on hire dispose of or obtain possession of or otherwise deal in a child’.
Also, the Trafficking In Persons (Prohibition) Enforcement and Administration Act condemns all forms of human trafficking.
Onyekachi Umah, Esq in his daily law tip 778, said “Section 30 of the Child Rights Act is against surrogacy in Nigeria. The section reads; “No person shall buy, sell, hire, let on hire, dispose of or obtain possession of or otherwise deal in a child”. This provision frowns at the processes and procedures of surrogacy, even without mentioning the term, “Surrogacy”.
Speaking to BONews, Barr Oluyemi Orija, the Founder of Headfort Foundation, a pro-poor legal firm, noted that Nigeria is still struggling to find the appropriate legal framework to provide guidelines for this reproductive process.
Orija said “In Nigeria, there are no specific laws regulating Assisted Reproductive Technology. Surrogacy being one of the techniques has no law regulating the procedures in Nigeria. The closest law that has come to regulating surrogacy is the Assisted Reproductive Technology [ART] Bill 2016 but this bill is yet to be promulgated into a Law or Act.
“Lagos State on the other hand passed a guideline on assisted Reproductive Technology in 2019 leaving the remaining 35 states of Nigeria and the FCT with laws on surrogacy or Assisted Reproductive system. It is important to state that surrogacy is not a crime in Nigeria, and neither is there any law providing for it,” she added, Timothy Adewale, a lawyer and the Executive Director of Centre for Health Equity and Justice (CEHEJ), an NGO that promotes reproductive health rights, decried the absence of substantial law to regulate Assisted Reproductive Technology (ART) in Nigeria, which according to him has left Nigerians to dictate their terms.
Adewale told BONews that, “we do not have laws that regulate ART in Nigeria, whether it is egg donor, IVF or surrogacy. It is more or less left to the dictates of those who are involved, and we have seen cases of manipulations of different kinds.”
Adewale who commended Lagos State for regulating ART through HEFAMAA, noted that there is a need for a substantial law at the National and state levels, to guide what he described as an important part of life.
He said, “Normally, the National Assembly is supposed to pass a bill and when it has been signed into an Act, it then trickles down to the states for domestication. For instance, the National Health Act covers the issues of using humans, and fetuses as scientific research, but doesn’t specifically say about ART.
“There is a need for a law to regulate ART at the National level because if it is well guided in a state, people can go to another state to do whatever they like,” the CEHEJ Director said.
Absence of law: an opportunity for illegal practices
Mrs. Odukoya of the ParahFamily Foundation noted that the absence of a legal framework has led to the prevalence of sharp practices in some fertility clinics and some surrogacy agencies run like baby factories.
Odukoya said, “You cannot rule out sharp practices since there are no guiding principles. I don’t know any hospital that is involved in illegality but there are a lot of baby factories under the guise of fertility clinics.
“Some clinics would even give injections to women that will make their stomachs feel bloated but they are not pregnant, and at the end of the day, they would just give out a baby to such a woman, and the woman might have thought she did IVF,” she added.
Mrs. Odukoya thereafter highlighted the importance of counseling for couples seeking alternative fertility options so they can make informed decisions, instead of being made to get involved in illegality.
Orija said she has not had first-hand experience of any illegality in fertility clinics, adding that ‘nothing is impossible’.
She said, “I have heard stories where the oocytes (eggs) of young ladies are collected for a meager amount of money by fertility clinics without proper sensitization on the consequences to the girls.
“Girls who are in dire need of money continually donate eggs, with no proper documentation, medical care after donation, and sensitization, to me are inappropriate .”
The absence of comprehensive legislation governing surrogacy in Nigeria allows unscrupulous individuals to exploit vulnerable women and couples desperate for a child. Urgent attention from lawmakers is required to establish clear guidelines and protect the rights of all parties involved.
International Practices and Guidelines
Comparing Nigeria’s surrogacy landscape with other countries, I found that well-regulated surrogacy programs focus on transparency, informed consent, and the protection of the surrogate’s physical and emotional well-being.
Several countries have adopted comprehensive laws that balance the interests of intended parents, surrogates, and donors.
For instance, in countries like Australia, Ukraine, Mexico, and Colombia where surrogacy is legalized, the surrogates do not get paid, other than being reimbursed for medical and other ‘reasonable’ expenses.
Perhaps, if surrogates are not rewarded handsomely, maybe many women would not consider it as a survival option.
The importance of regulation cannot be overemphasized as Adewale remarked that “It is important to note that ART has come to stay and it should be regulated in line with global best practices.”
Adopting a Better Approach to Surrogacy
For Mrs. Odukoya, counseling of couples, regulation, and collaboration among key agencies are vital to improving the fertility sector in Nigeria.
Odukoya stressed the need for legislation and said, “Surrogacy is not a government-legalized option in Nigeria, most of the things we do, we don’t have legal backing to it. Some individuals make legal arrangements, between the hospital, the surrogate mother, and the hospital involved. But this cannot be taken to court if anyone defaults.
“In Parah, when we bring our members together, we bring all these options to the table, so they know why they should select a specific option, and they are better informed about all it entails,” she added.
She believes that the government needs to show more commitment to the lives of citizens by setting up laws to guide surrogacy and other assistive fertility methods in Nigeria.
“There is a need for collaboration between surrogacy agencies, hospitals, and the government to establish ethical practices and regulations in the fertility space. The current lack of government attention and involvement allows unethical practices to flourish,” she explained.
Odukoya hinted that some surrogacy agencies do not have proper accreditation and hide under the hospital and noted that “there should be continuous monitoring of health facilities so that there can be a clampdown on those who are involved in illegality.”
With the adoption of relevant laws, it is important that transparency, ethical standards, and proper medical protocols are enforced, to ensure the safety and dignity of surrogates and intended parents alike. Only then can Nigeria move towards a surrogacy industry that operates within legal boundaries and upholds the highest ethical standards, providing hope for couples, without exploitation of innocent women.
Barrister Orija also substantiated that the government must put a legal framework in place to regulate all the processes involved in ART to curb the excesses and unethical practices of agencies, individuals, and hospitals.
She said “The creation of laws to regulate how Assisted Reproductive Technology is carried out is essential to prevent shady practices like baby-making factories, prostitution, human trafficking, illegal semen, and egg harvesting agencies amongst others.
“When all necessary measures are put in place, there will be a huge reduction in all these atrocities because when there’s a law or laws in place regulating Assisted Reproductive Technology, the perpetrators of evil where Assisted Reproductive Technology is concerned will be apprehended, brought to book, and prosecuted.”
But before then, very desperate couples in search of parenthood will continue to swim and search the murky waters of surrogacy in Nigeria for self-fulfillment. Lawmakers in Nigeria should hearken to the saying that a stitch in time saves nine, this time around there are vulnerable women to be saved.
Editor’s Note: All the names of the donors in this story are not real names, to protect the identity of the ladies.