The proposed healthcare services bill, which includes provisions to formally legislate surrogacy in Rwanda, continues to stir a vigorous debate, many diverse views beings raised by the general public, parliament and the civil society. The Government of Rwanda has severally provided legal clarity on the proposed law, assuring all sides that the protection of all parties involved in surrogacy will be guaranteed, but that has not been enough to stop the contentions on some of the issues. Several contentious issues in the law, which was back on the table in Parliament on Friday, May 2, in the Committee on Social Affairs, continue to provoke discussion on ethical and legal dilemmas as well as concerns over health, equity, and oversight. The committee met with representatives of civil society organisations which have been advocating further refining and a need to address some of the issues which are not well explained in the proposed healthcare bill, such as miscarriage and other pregnancy-related complications that can come with surrogacy. The parliamentary committee was seeking feedback from civil society organisations, many of which have been engaged in public activities to seek the views and input of citizens in the law which has drawn a lively debate. Some organisations such as Health Development Initiative (HDI) have been conducting nationwide discussions in universities on the law, to hear what young people have to say. ALSO READ: Surrogacy: Civil society seeks clearer legislation on pregnancy risks During the committee session, Dr. Athanase Rukundo, acting Head of Clinical and Public Health at the Ministry of Health, yet again assured the legislators and members of the civil society that while the debate is welcome to continue, the bill already addresses some of the issues highlighted. He said, however, that it is important for the debate to continue so that the provisions and guidelines in the draft bill address the concerns and ensure that surrogacy and other assisted reproductive technology services fairly uphold everyone’s reproductive rights. The ministry says all areas, including grounds for surrogacy acceptance, requirements, obligations of both intended parents and the surrogate mother, responsibility of healthcare facility and legal process to follow, are all catered for in the proposed bill. Representatives of the civil society, who included Xavérine Uwimana from Réseau des Femmes Oeuvrant pour le Développement Rural, a local women-led non-governmental organisation, Dr. Joseph Ryarasa Nkurunziza of Never Again Rwanda and Bernard Muramira from Strive Foundation Rwanda, highlighted some of the issues that need to be addressed before the bill is passed into law. Below are five key issues that have been and continue to be at the forefront of the conversation, which were raised by the representatives of the civil society. Ethical concerns and the risk of exploitation One of the most debated aspects of the proposed surrogacy law is the ethical risk that it may commercialise and exploit women’s bodies, particularly among economically vulnerable populations. Representatives of the civil society argue that women might be encouraged—or even coerced—into becoming surrogates not out of personal choice but due to financial pressure, which raises moral concerns about commodification of reproductive services. Furthermore, there is discomfort around the idea of young adults, especially those with limited economic options, being drawn into the surrogacy market for profit, something the civil society says goes against the intended purpose of the law. These concerns have prompted calls from custodians of culture, civil society and youth organisations for stronger legal safeguards and ethical oversight to ensure that surrogacy remains a voluntary, informed, and non-exploitative arrangement in Rwanda. 2. Legal ambiguity around parental rights During a debate organised by HDI at Kepler College, one of the key issues raised by the youth revolved around determining who holds legal parenthood in a surrogacy arrangement, with some asking how the law can ensure that the intended parents forever live in peace, without any fear of losing their child to the surrogate mother. It is a complex issue which touches on people’s emotions and goes with many unanswered questions. However, the proposed law suggests that the intended parents are the legal guardians of the child born through surrogacy, which means that the surrogate mother immediately loses the right to the child as soon as she hands the child over to the intended parents. Easier said than done. There is a possibility that the surrogate mother could develop an emotional bond to the child upon birth and refuse to relinquish the child or she might even want to reach the child later in life. ALSO READ: There will be no price for surrogacy, minister defends new healthcare bill This potential conflict between biological and emotional motherhood has been a point of contention, with many urging the government to ensure that such a delicate issue is well addressed. “Chances are, a surrogate mother might know the address of the intended parents and later want to create contact with the child. Obviously, this can be a source of discomfort for the parents,” says Laissa Gaju, a third-year university student. Gaju says that while there could be laws and binding contracts between involved parties, it is different when it comes to motherhood, especially considering the bond between a mother and child. This also means endless discomfort for the intended parents who will forever live in fear that the child might reunite with the surrogate mother at one point. These are the issues Gaju says Rwandans who opt for surrogacy might grapple with in the future and which have to be addressed in the law. The issue is further complicated by the lack of precedent and the need to ensure that legally binding agreements are enforceable while also protecting the emotional and psychological well-being of the surrogate mother. 3. Limited access and lack of inclusivity Members of the civil society have also argued that the law is not inclusive and will only benefit the rich, while the less privileged, who might also be dealing with infertility, cannot afford it. The cost of surrogacy—especially when it involves assisted reproductive technologies like IVF—is significant and remains out of reach for many families. They argue that without insurance coverage or financial support systems, access to surrogacy in Rwanda could become a privilege reserved for the wealthy. Others also argue that the draft law currently limits access to surrogacy services to married couples, which excludes single individuals and unmarried couples from benefiting from the service. This has sparked a broader conversation, including on social media, about fairness, discrimination, and whether the law should evolve to reflect changing family structures and diverse parenting situations in the modern world. 4. Health risks and the absence of clear medical protocols Medical experts and advocates have also pointed out that the current draft law in parliament lacks detailed provisions addressing the physical and psychological health risks surrogate mothers in Rwanda might face. These include potential complications during pregnancy, mental health challenges after delivery, and inadequate postnatal care. The absence of clear medical guidelines has led to concerns that surrogate mothers could be put in vulnerable positions without adequate healthcare support. ALSO READ: Surrogacy: Justice foundation on why further regulation is needed Those calling for further refining of the bill have highlighted the need for a comprehensive medical framework that includes screening, informed consent, pre- and post-natal care, and long-term follow-up for both surrogates and intended parents. 5. Oversight and enforcement mechanisms There have been significant questions asked about how the law will be enforced once passed and the responsible organ that would ensure that it is not abused. Among these concerns include how surrogacy agreements will be monitored, how clinics will be accredited, and what systems will be in place to handle disputes or breaches of contract. There is also concern about whether existing institutions have the legal and administrative capacity to implement and oversee surrogacy practices effectively. Without strong enforcement and regulatory structures, the risk of abuse or procedural failures remains high. Striking a balance Senior government officials, including the Minister of Health, Dr. Sabin Nsanzimana, have assured the public that most of the concerns are catered for in the bill, what remains will be putting in place implementation measures. But for now, the debate over surrogacy in Rwanda remains a contentious one, underscoring the complexity of legislating reproductive technologies in a rapidly evolving society, where both the young and the old have diverse views and understanding of issues. Dr. Nsanzimana previously said that the government will ensure that there are legal frameworks to ensure that surrogacy is done in an ethical, inclusive, medically sound, and enforceable manner.
