Ghost mothers: Ethical challenges in Iran as an emerging destination for cross-border surrogacy: A case report

Background: Commercial surrogacy, as a method of assisted reproductive technology, raises profound ethical and legal challenges, exacerbated in developing countries due to economic disparities and the absence of comprehensive regulations. The purpose of this study is to examine the ethical, legal, and social challenges arising from a real case of international commercial surrogacy in Iran. Case Presentation: This article analyzes a real-life case in Iran involving a surrogate mother who, at 32 wk pregnant with twins, underwent an emergency cesarean section due to severe vaginal bleeding. The case raised significant concerns due to the absence of the American genetic parents at the time of birth, delays in issuing birth certificates, the temporary transfer of the newborns to welfare services, and the erasure of the surrogate mother's identity from legal documents. These issues spotlight questions regarding autonomy, exploitation, discrimination, and children's rights. Conclusion: Focusing on the ethical dimensions specific to this case in Iran, the study examines the broader challenges of surrogacy. The analysis reveals the impact of economic pressures on the surrogate's autonomy, discriminatory practices in recording the surrogate's identity in international cases, the lack of mechanisms to verify the eligibility of commissioning couples, and the urgent need for comprehensive legal and ethical frameworks to mitigate harm and ensure justice. The case positions Iran as an emerging destination for commercial surrogacy, highlighting the potential for exploitation due to the commercialization and erasure of surrogate mothers' identities. It is recommended that until precise regulations are enacted through public discourse and stakeholder participation, all commercial surrogacy, particularly international cases, be suspended.