Stop 8: Cambodia

Unfortunately, fate (or at least a virus and dehydration) intervened and prevented me from making my final stop in Cambodia.  This is a real disappointment to me, as Cambodia is the newest player in the international surrogacy industry, really only appearing in late 2014, and in a direct response to legislative changes in Thailand.  As you are no doubt aware, surrogacy in Thailand was abruptly banned in February 2015, in the wake of the “Baby Gammy” case and another incident where a Japanese businessman concurrently fathered 16 children through different Thai surrogates.  Ongoing investigations of this latter incident are considering whether this matter in fact involves a child-trafficking ring.

But Thai clinics didn’t close, they simply moved across the border to Cambodia, and although Cambodia commenced surrogacy treatment only a year ago, there are now at least 16 different clinics operating there.  In November 2015, it was known that at last 20 Australian families had contracted to undertake surrogacy in Cambodia, and I assume that number has increased in the intervening 3 months.  A surrogacy arrangement in Cambodia costs around $AUD40,000 (rather less than the USA!) and in terms of travel proximity it is a very near option for Australians.

But is it a good idea to undertake surrogacy in Cambodia?

There are so many issues around this.  The legal situation in Cambodia is very very unclear.  The Australian Government released this statement last year on their website


In November 2014, Cambodian authorities advised the Australian Government that the act of commercial surrogacy, or commissioning commercial surrogacy, was illegal in Cambodia with penalties including imprisonment and fines. Australians are advised not to visit Cambodia for the purpose of engaging in commercial surrogacy arrangements. Those considering commercial surrogacy in Cambodia should seek independent legal advice. While in Cambodia, Australians are subject to the local laws of Cambodia and should not rely on assurances from commercial clinics or other agencies suggesting there are ways to circumvent or influence local laws.

See also our travel advice for Cambodia.

I understand that no laws have actually been enacted yet in Cambodia, but there is certainly an expectation that legislation will be drafted by the Cambodian government any time, and that the crackdown on surrogacy will be severe.

The clinics operating in Cambodia are inexperienced (even IVF is a new technology in this country) and the ethics and safeguards of many of the Thai clinics that had been operating before the Thai government changed it’s laws were highly questionable.  “DNA Negativity” (remember that cute little euphemism) was not uncommon.  Surrogate houses, high rates of multiple pregnancy and cesarian section deliveries were normal practice.  I was not able to visit the Cambodian clinics to check if these practices continued across the border, but I would have been surprised to find otherwise.

Before I left Australia, many were asking about the quality of the labs – the ones that create and how the embryos, and those that do the health checks on the surrogates.

Unfortunately, I didn’t have a chance to speak to the labs about their standards, but I have seen these statistics, which very clearly demonstrate the importance of good labs, not just for pregnancy rates, but also for the health of surrogates and babies.  If we just consider HIV infection rates, quotes 2014 prevalence rate In Cambodia for adults with HIV/AIDS to be 0.6% [0.4% – 1.3%], and the number of women aged 15 and up living with HIV to be 36,000 [23,000 – 70,000].  This compares to only around 27,000 Australians IN TOTAL currently living with HIV/AIDS. (The current total population of Cambodia is slightly less than 16 million, which is around 6 million fewer than Australia).

I am not certain how surrogates are being recruited.  I had heard that there is a preference for single women to work as surrogates in Cambodia.  When the primary motivation to become a surrogate is financial, I have to assume that these young women tend to be more vulnerable than most; to have less options available to them.  In my experience, poor vulnerable poor have exposure to far greater health threats than wealthier, empowered individuals.  In terms of selecting a healthy surrogate, that, to me, is the sound of escalating risk.

I had intended to meet with some clinics based in Cambodia, some of which have been advertising their services very visibly.  However, in the weeks leading up to my scheduled arrival, I noted that continuing contact with these clinics became increasingly difficult.  Some (like the one below) simply ceased correspondence, after being very positive about meeting me (for example, this email on 3/9/15)

Hello Narelle,

We would be happy to coordinate the details of your meetings in Phnom Penh at your convenience. Please let us know what days and times are most convenient for you, and I will coordinate through my Phnom Penh Office Manager, XXX.
All subsequent emails were resolutely ignored by the clinic.  And another clinic that had repeatedly (since September 2015) confirmed by email their agreement to meet, sent this on 2/2/16 ( I was due to meet with them on 6/2/16)

Dear Narelle,

Alerting message of our meeting on 6th Feb at 10 am. Since the Ministry of Health doesn’t have any proper guidelines in place yet, XXX doesn’t offer surrogacy though it’s at the expense of a business because XXX is a pioneering first fertility clinic in Cambodia. We’ll join the course with the ministry to have proper guidelines and/or regulations. Therefore, I am afraid I cannot meet with you this Saturday. May I wish you a pleasant stay in Cambodia!
Sincerely yours,
Managing Director
Then on 4/2/16, this “clarification” when I asked why the meeting had been cancelled

Dear Narelle,

Nothing has happened; as far as I know 3 other fertility clinics invested by foreigners. To date, no regulations and proper guidelines provided by the ministry.
Sincerely yours,
Managing Director
I would feel extremely fearful about engaging in a surrogacy contract with clinic who are determined to be so opaque in their practice.  My visit as a Churchill Fellow has been welcomed in other locations – the clinics who met with me elsewhere were clear that I was no threat to their service, and I have become increasingly suspicious of any agency or clinic that feels they have something to hide, even from another professional working within the fertility industry (such as myself).
I genuinely expect that the surrogacy industry in Cambodia will have short-lived access to foreigners.  I also genuinely fear that we will see another disaster (like the Baby Gammy case) before legislation is enacted. I do hope I am wrong.