What is the Price of a Womb?

At the start of this semester, a few friends and I gathered over homemade brunch and exchanged stories of calming onsens, desert safaris, Senegalese weddings and a surprise proposal. Somewhere between the sausages and small talk, we decided to put another organ on the hot seat: the womb. Soon we were debating commercial and lifestyle surrogacy, Aldrich style.

For context, no one in our group is an expert in surrogacy, either as a physician or as a legal scholar. Our interest was not academic. As a group of mostly high-functioning women with bodies not getting any younger, the conversation felt personal: one day, many of us might consider surrogacy. 

My question to the group was simple: “If we’re uncomfortable with commercial organ transplantation, why are so many of us willing to sign up for commercial surrogacy?” Without a professor moderating, the discussion dissolved into the familiar symphony of overlap with defending arguments bleeding into rebuttals. I left dissatisfied, not because anyone was malicious, but because we didn’t have a common fact base and failed to distinguish values (ethics), rules (law), and mechanisms (markets).

So, I opened my ChatGPT Pro account (thanks HBS) and gave it two tasks: (1) scan the literature regarding commercial surrogacy and (2) provide contrary arguments to challenge my thinking. What follows is a recreation of that conversation, my attempt to pressure-test instincts, build empathy for opposing views, and think like business leaders even when the topic is emotionally loaded.

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Case Summary: Surrogacy is a family formation method whereby a surrogate or gestational carrier carries a child for intending parents. Commercial surrogacy involves financial compensation while lifestyle surrogacy provides an avenue for intending parents, with no biological or fertility constraints, to seek a surrogate.  

Argument 1

Critique: Most countries restrict organ sales not only because of the inherent dignity of the human body but also because these markets have a proven habit of recruiting the desperate and turning inequality into supply. In the handful of countries where organ sales are permissible and even regulated, poverty fuels illegal organ commerce (two words I never thought I would use together). Kidneys and uteruses are both organs, but the similarities end there. Kidneys are life-saving; the womb is not. Both are scarce but wombs are arguably scarcer given that less than half of the population has a functioning uterus. If deontology tells us to treat people as ends in themselves and not merely as means, why is a market in kidneys widely treated as inherently suspect, but a market in pregnancy labor often treated like another contract?. Even if we accept that a surrogate can consent to bear bodily risk for someone else, what rights should be non-waivable because they attach to dignity and autonomy?

Rebuttal: Kidney transplantation, compared to pregnancy, carries different risks. For one, organ transplants are typically one-time, permanent procedures that, while requiring post-op care, differ sharply from a nine-month gestational period that can have long-term consequences for a surrogate’s body. Evidence also suggests that gestational carriers are at higher risk of hypertensive disorders and maternal morbidity, often due to the bodily reaction to extraneous genetic material following embryo implantation. The bodily risks involved in surrogacy aren’t an excuse to avoid markets. In fact, they provide even more reason to regulate consent as if life and blood pressure depend on it—because sometimes they do.

Demanding free pregnancy is not necessarily anti-exploitation; it’s mandating uncompensated reproductive labor which has its own classist and sexist history. Like any other risky and legal work, why shouldn’t it be compensated? If the surrogate has full information, real consent, independent legal counsel, psychological support, and autonomy over medical decisions, commercial surrogacy can at least in principle, expand women’s agency. In countries such as Canada and the UK, surrogates may also retain legal rights that survive the contract itself, including recognition as the child’s legal guardian at birth until parentage is formally transferred. 

Argument 2 

Critique: Speaking of Canada, it permits surrogacy but criminalizes commercial surrogacy. Instead, it uses an expense-only model, under which the surrogate may be reimbursed only for pregnancy-related costs. In practice, this frames surrogacy as a more altruistic arrangement rather than a commercial one. It also avoids the $50,000-plus price tags that can make family formation through surrogacy accessible only to the wealthy. Why not pursue an expense-based model like this in the U.S. as a principled compromise? 

Rebuttal: Expense-only models can create the very gray zones that they are meant to prevent. In these systems, payments are relabeled as ‘expenses,’ and enforcement becomes a matter of wrangling through jargon, lawyers, and court review. The UK faces a similar challenge: surrogates may not receive more than “reasonable expenses” without the court’s authorization. However, many of the costs surrogates actually bear—housekeeping, childcare, transportation—are paid informally and without clean receipts, leaving either the surrogate to absorb them or the parties to rely on opaque reimbursements. So it’s not that Canadian or the UK model are automatically better or worse but they force the question: do you want a visible regulated system, or an invisible unregulated one?

Argument 3

Critique: People dismiss the class critique as “whataboutism.” But it’s disingenuous to pretend like class doesn’t matter. It does and cross-border commercial surrogacy often reflects a downward transfer of risk. A 2018-2020 survey of international surrogacy agencies across multiple destination countries found clear evidence of surrogacy tourism, with U.S. clients making up a large share of foreign intended parents in countries such as Mexico, Guatemala, Kenya, and Georgia.

The vulnerability concern is not merely theoretical. In India’s pre-ban commercial surrogacy market, one study of surrogate mothers in Gujarat found that many were extremely poor before surrogacy, and that most remained very poor afterward; some households reportedly fell deeper into poverty.

We are concerned, and rightfully so, about predation risk on the most vulnerable in organ markets. Why do we seem less troubled when similar dynamics emerge in surrogacy markets built around women’s bodies, which have historically been sites of extraction and control? Even if some women gain agency, is the system fair if it predictably allocates embodied risk downward and benefits upward? 

Rebuttal: But as much as class matters, so does design. In the US at least, the picture isn’t always “wealthy intended parents and desperately poor surrogate.” A 2024 study of US surrogates found that they tend to have above-average income for their state, higher education, health insurance, and are employed, with primary motivations described as prosocial/altruistic. If exploitation is the problem, the response is to make the global system auditable, transparent, and protective and not to pretend markets can be wished away. Power imbalances exist in other industries, from e-commerce to agriculture and healthcare. The solution isn’t to deny that markets create these pressures, but to regulate markets with those pressures in mind. 

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In Margaret Radin’s “Market Inalienability,” she argues that some things may be fine to give but harmful to sell, because commodification can undermine personhood and social meaning. That is the nerve this debate hits for me, and it’s at the heart of why commercial lifestyle surrogacy makes me uncomfortable.

My discomfort isn’t that parents should suffer, or that support is illegitimate. It’s that choosing to become a parent creates duties to a child who is an end in themselves. If we are able to carry and care but instead treat pregnancy and caregiving as inconveniences to be offloaded, I start wondering what else in the core relational work of parenthood (and of intimate relationships more broadly) that becomes “inconvenient” once we accept that logic. At that point, we risk turning parenthood into a consumer identity rather than a relationship of responsibility. (I have more to say about our obsession with genetic replication but I’ll save that for my private Substack.)

I also recognize that pregnancy is not the same thing as parenting, and that we rightly celebrate other avenues for family formation, including adoption. Moreover, in a capitalist world, pricing does more than signal value; it signals power. Because so much of the labor traditionally performed by women was never priced, it obscured the women’s material contributions to building societies, even from the confines of their homes. There is also something paternalistic, and frankly condescending, about assuming women cannot exercise autonomy or make informed decisions to become surrogates.

Yet as a skeptic of capitalism, I’m still conflicted, especially given global evidence that often reflects the class dynamics that I worry would persist even with the strongest “controls”. Now, the question I’m left with isn’t whether surrogacy is “good” or “bad.” It’s the more uncomfortable one. As business leaders that study the price thermometer and pricing customization, even if you can price something, should you?  And if compensation is allowed, should the price be set by willingness to pay (wealth), or by a fairness principle such as reciprocity for burden and risk, plus safeguards that make consent meaningful? 

Bolu Akinola (MBA ‘26) is a second year student; prior to HBS, she worked at the Bill and Melinda Gates Foundation and at McKinsey.