TBILISI -- Seven months into her pregnancy and battling dizziness and side effects of medicine to ward off a miscarriage, 38-year-old Nino is breathing heavily as she perches on the edge of a bed in her three-room apartment outside the Georgian capital.
She is carrying twins, and the doctor has advised her to stay in bed. Her three children share the housework when Nino is unwell, and laundry is hanging on clotheslines all around. Her husband works, but his income is unstable. The rent, of 600 laris ($218) a month, "is eating us up," she says. "That's why I agreed to surrogacy; maybe, somehow, I can buy a small house."
Her 22-year-old son "was fiercely opposed" to the idea, she tells RFE/RL's Georgian Service.
"But I explained that I was doing it for our well-being, that I could see no other way out," says Nino, who was married at 15. "The other solution was to go abroad and start working there, which I didn't want. I didn't want to leave my children and move far from home."
Families in this Caucasus state have long relied on remittances to keep them afloat financially from relatives in Russia and, increasingly, the European Union since visa regimes were liberalized there five years ago. But surrogacy is an increasingly conspicuous, homegrown industry that has flourished in Georgia under a loose legislative and regulatory framework seemingly aimed at capitalizing on rising global demand and a reluctance in other countries to embrace birthing-for-hire.
And its cut-price rate compared to the handful of other countries that allow surrogacy almost certainly ensures that it will continue to grow in Georgia.
Warnings of exploitation have been mostly brushed aside by women like Nino, and the price of a Georgian surrogacy birth remains among the cheapest in the world, starting at between $10,000 and $20,000 by most accounts versus around $120,000 to $180,000 in parts of the United States.
It is Nino's second time around on a transactional pregnancy; this one is for an Indian couple that should net her upward of $15,000, plus medical expenses.
She says she first considered surrogacy in 2015 when "we were in terrible trouble, but I still couldn't take this step," despite it seeming like "an incredible proposal." Five years later, in 2020, she gave birth to a baby boy for parents who she dismisses as "pretentious and demanding" and admits to mixed emotions the only time she ever saw the baby, in the maternity ward.
"We are all human," she says. "But before the embryo was transferred into my body, I instilled in myself that I am a 'nanny' who has a baby and I have to return this baby to its parents in nine months."
Nino and her husband managed to save some of the $10,000 from that pregnancy toward their dream of buying a house.
She knows these twins are her last chance, as agencies typically recruit surrogates between the ages of 21 and 38 to avoid potential health complications for the child and the child bearer.
After giving birth this time, Nino says, she'll tell the neighbors that her newborn son died.
A Handful Of Places
Only a handful of countries have legalized commercial surrogacy since 1985, when Detroit housewife Shannon Boff became the first woman in history to give birth to a child with no genetic relation to her -- so-called gestational surrogacy.
A heavily Orthodox Christian country of around 5 million people, post-Soviet Georgia became one of the first countries in the world to allow third-party reproduction in 1997.
Elsewhere, commercial surrogacy or surrogacy agreements are legal in some parts of Australia and the United States, Canada, Colombia, Mexico, Ukraine, and the United Kingdom; they are reportedly tolerated in Laos.
The first child carried through a gestational surrogacy in Georgia was born in 2007.
Georgian law also allows for so-called altruistic surrogacy, in which there is no compensation for the child bearer. It restricts surrogacy to heterosexual married or cohabitating couples but has otherwise continued to foster surrogacy and the burgeoning business of agencies to help simplify the process, especially for international clients.
It got a boost when one of the early global leaders of surrogacy, India, banned the practice to foreigners in 2015, and again when the European Union dropped visa requirements for Georgians. Georgian law also prescribes that the newborns in such gestational surrogacy immediately belong to the intended parents, whose ova and sperm were used in fertilization, and only their names appear on the birth certificates.
'Children Like Angels'
Maya, 50, and her 62-year-old husband, who live in Georgia, waited 11 years for a child -- through unsuccessful treatments and physically difficult procedures -- before turning to surrogacy.
In the end, they saved money earned from farming, beekeeping, and their vineyard. They never managed to save the $20,000 for a surrogate but raised the rest through a loan from a bank.
They used an agency, and never met their surrogate, but were kept informed of the pregnancy and heard through the agency that she was an extraordinary woman who tried to "take care of our twins like she takes care of her own children."
"Every time she visited the doctor, I felt like I was going for a checkup myself," Maya says, who adds that they didn't keep the process a secret.
Eight months ago, they got the call that their surrogate had gone into labor in the capital one month prematurely. She recalls rushing to catch a taxi for the hours-long drive on a snowy highway to Tbilisi and getting the phone call congratulating her on the birth of her twins, a girl and a boy.
"I was surrounded by strangers. I didn't know how to express my emotions anymore," Maya says. "I couldn't cry. I couldn't scream. I don't even remember how I got to the maternity hospital."
Coronavirus restrictions were in place, so a friendly doctor showed her photos of the children.
The newborns had to spend a month in the maternity ward, and every day she called or went to visit them.
"The whole district stood by us," she says.
More than a dozen in vitro or assisted reproductive clinics operate in Georgia. There are also dozens of surrogacy agencies like the one Maya and her husband used, matching childless couples with potential surrogates.
Tamar Gvazava, who has been working for 15 years in the sector and has had her own agency for the past nine years, says such services are essential. She says she's helped bring more than 3,000 children into the world.
"The clinic and the doctor don't have time to pay attention to the surrogate and check that she's really taking medicine or really going to appointments at the right time or is really paying attention to both her health and the health of the embryo," Gvazava says. "Moreover, we're an intermediary between the couple, the clinic, and the surrogate."
Criteria that most agencies use for surrogacy candidates are fairly simple, on the face of it, she says. They must be adults and no older than 38, and most agencies require them to have given birth before in order to understand the tribulations of pregnancy, as well as to avoid becoming overly attached in a way that could derail the process.
She says she can recall just one case of an altruistic surrogacy, when a woman gave birth to a baby for her sister.
"The majority of surrogate mothers take this step because of the harshest of social conditions," Gvazava says. "These women [usually] have children, no house, no income [of their own]."
But she says they screen candidates thoroughly to avoid what she would regard as "coerced" surrogacies, where things like debts or irresponsible spouses might be overriding factors.
In her experience, a majority of successful surrogates return soon afterward to do it again. In cases of natural childbirth, a six-month recovery period is required that some less scrupulous agencies ignore because of the high demand for surrogates.
One agency with billboards on the Tbilisi subway recently recruiting prospective surrogates was offering the equivalent of $20,000 to $25,000. Another hung notices on lampposts with a name and number for would-be surrogates to call. Agencies in Georgia include locally run businesses, as well as multinational ones.
Beginning in 2020, the Georgian Justice Ministry has made it an obligation that an agency representative and the surrogate appear in person to sign a notarized contract to help better regulate the practice.
Gvazava says the overwhelming majority of clients for surrogacy and donation in Georgia are foreigners. Georgia has received heightened interest since February when Russia launched its invasion of Ukraine, which has been a popular destination for surrogacy.
"We're already looking for ways to bring surrogate mothers from neighboring countries, transfer embryos here, then return [them] to their own countries and, in the final months of pregnancy, bring them back to Georgia to give birth here," Gvazava says.
'I Hope I Made Others Happy'
A number of the women who talked to RFE/RL's Georgian Service about their surrogacies said they felt embarrassment and took steps to hide their pregnancies from neighbors or family.
Salome is 33 with two children of her own, 11 and 4, and is due to give birth to her third surrogate child in two months.
When she first became a surrogate in her early 20s, for a Georgian couple for about $9,000, she and her husband kept it a secret. As her pregnancy progressed, she simply told her mother she was going to the village to live for a while.
"I did everything so that no one knew anything about it," Salome says. "Even if I call this a job, I'm embarrassed."
She hopes to buy an apartment but also says she "realized the joy of giving someone hope to hold their own child.
"This is her last surrogacy," she insists, adding, "I hope I made others happy and helped my family, too."
Thirty-four-year-old Elena expects to find out any day now that she's pregnant again. A mother of four who says she and her husband are increasingly unable to support the family, her husband still doesn't know she is becoming a surrogate. If the pregnancy ultimately fails, she says, he may never even find out.
"Even now, there is an attitude in society that she is a 'surrogate' -- she's selling her child," she says. "Where I live, in the region, this topic is still embarrassing. If I get pregnant, I know my husband will understand. He has to understand me in any case: I want it for all of us."