For four years, she waited for a miracle.
Marriage had brought with it the hope of starting a family, but pregnancy was never to be possible.
Rachel (not her real name) had struggled with recurrent fibroids – non-cancerous growths that develop in or on the walls of the uterus – eventually leading to surgery that cost her her womb.
But her faith in God remained firm. As she continued to hear testimonies of women who had suffered a similar fate but eventually became mothers through what they often described as divine intervention, she hoped hers would be no different.
After four years of marriage, and with no possibility of carrying a pregnancy herself, Rachel and her husband, on medical advice, turned to an option that is still poorly understood and often quietly discussed in Ghana – surrogacy.
At a fertility centre in Accra, the sperm of her husband was transferred into another woman who agreed to carry the pregnancy on their behalf.
The decision did not come easily.
“It took us over a year considering the option, making preparations and completing the necessary legal documentation,” Rachel says but “today, thanks be to God, we have a child we had long hoped and prayed for.”
Rachel’s story is one of the less visible faces of infertility in Ghana – a woman who did not choose to lose her womb, but found another way to become a mother.
Surrogacy is an arrangement in which a woman carries and gives birth to a child on behalf of another person or couple, often referred to as the “intended parents”.
Ghana’s Registration of Births and Deaths Act, 2020 (Act 1027), provides for surrogacy and assisted reproductive births, including the legal process for determining parentage through pre-birth and post-birth parental orders.
In gestational surrogacy, the surrogate carries a pregnancy created through in-vitro fertilisation (IVF), where an embryo created from the egg and sperm of the intended parents or donors, is transferred into her uterus.
In this arrangement, the surrogate does not have a genetic or biological relationship with the child.
In traditional surrogacy, the surrogate’s own egg is used. The sperm of the intended father or a donor is introduced into the surrogate’s uterus through intrauterine insemination (IUI), allowing fertilisation to occur using the surrogate’s own egg.
According to the World Health Organisation (WHO), about one in six people of reproductive age experience infertility during their lifetime globally.
It defines infertility as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse often resulting from male or female factors, a combination of both, or unexplained causes.
In Ghana, studies show that the incidence of infertility is estimated to be 11.8% for women and 15.8% for men.
Roughly two percent of women in their reproductive age, research says, suffer primary infertility (inability to ever conceive on their own) with 14 percent suffering secondary infertility (difficulty conceiving after a previous pregnancy).
Although there is still no comprehensive national data showing how many couples are using surrogacy as a pathway to parenthood, fertility experts say more people are becoming aware of it as one of the medical options available to families who cannot safely carry a pregnancy themselves.
Vice President of the Fertility Society of Ghana (FERSOG), Professor Promise Emmanuel Sefogah, in an interview says infertility should be viewed as a “medical disorder” that could be treated or managed like any other medical condition, instead of being shrouded by misconceptions and myths.
He said uterine fibroids, advanced age, some cancers and, in very rare cases, uterine agenesis – where a woman is born without a uterus – were among medical reasons that can make carrying a pregnancy difficult or unsafe.
“Nobody chooses to be childless, so when someone is suffering infertility, they are going through a lot of social, psychological and emotional stress and stigma.
What they need is help and that could be in the form of assisted reproductive technologies, which are available, including surrogacy,” he said.
Prof. Sefogah expressed concern over the cost of accessing fertility treatment in Ghana, including surrogacy.
Published estimates of the cost of surrogacy in Ghana vary widely, depending on the fertility procedure, clinic, legal services, surrogate-related expenses and other requirements.
The financial burden remains a major barrier for many couples seeking assisted reproductive care.
According to Surrogacy Insider, an independent international surrogacy consultancy, a surrogacy procedure in Ghana averagely cost between $30,000 and $ 100,000 depending on the type pf surrogacy opted for and service provider involved.
Yet, compared with some Western countries where surrogacy is more widely established, the costs in Ghana were relatively lower.
Prof. Sefogah said the fact that fertility treatment is largely paid for out-of-pocket in Ghana compounds the difficulties faced by people struggling with infertility.
“When somebody is suffering infertility, they are already suffering a lot of social, psychological and emotional distress and stigma. What they need is help, and it is high time financing mechanisms like the National Health Insurance Scheme (NHIS) came in to support childless couples rather than leaving this to individuals alone,” he said.
The Vice President of FERSOG called for infertility consultations, selected laboratory investigations and medications to receive some form of public financing through the NHIS, while more expensive procedures such as IVF could be supported through other mechanisms.
He noted that even where individuals wanted to consider adoption as another pathway to parenthood, Ghana’s current adoption processes remained cumbersome and difficult.
“We need to make processes simple, forward-looking and break the stigma around childlessness so that people know that they can have children beyond the natural means. The state must come in and take care of some of the cost of these procedures,” he said.
Most importantly, Prof. Sefogah said there was an urgent need for a comprehensive framework to regulate assisted reproductive technologies (ART) in Ghana to reduce abuses, exploitation and excesses within the space.
He said work was ongoing to lay a bill before Parliament soon to ensure standardisation in the sector.
Fertility Specialist and Chief Executive Officer of the Walking Egg Fertility Centre, Dr Nana Yaw Osei, reiterated the need for infertility to be seen as a health issue rather than a moral failure or religious “curse”.
He recalled a recent case at his centre in which a 30-year-old surrogate delivered quadruplets through IUI after the intended mother had lost her womb.
“Should we deny such women the opportunity to experience motherhood when ART offers hope to such families who would otherwise never have children?” he asked.
Reiterating the need for regulation, Dr Osei called for increased public education and awareness on surrogacy to change existing negative perceptions and stereotypes against individuals opting for the procedure.
He noted that religious factors were a major hindrance to women considering ART in dealing with infertility.
“No woman should be blamed for circumstances such as being born without a womb or losing it because of disease or using ART to have a child.
Even in cases where a couple opt for surrogacy, it should be seen as an act of love on the part of husbands who undertake the procedure with their partners who otherwise could have resorted to infidelity to have a child,” he said.
“The key people we have to consider are those who need children and embrace surrogacy as another viable option to parenthood,” Dr Osei added.
In Ghanaian societies where having children is often closely associated with marriage, family and social identity, infertility can carry a heavy emotional burden.
For women like Rachel who cannot carry a pregnancy on their own, the pressure can be even more painful.
But surrogacy does not necessarily have to erase the pain of losing the ability to carry a pregnancy.
It simply means that losing a womb does not have to mean losing the possibility of becoming a mother.
And that is where experts say the conversation on surrogacy must begin – not with blame, stigma and shame, but with understanding, medical support and the dignity of people trying to build families.
BY ABIGAIL ANNOH