A long-awaited reform of Taiwan’s Assisted Reproduction Act is currently underway to give single women and lesbian couples access to IVF treatment. But a heated debate over surrogacy and a divided parliament is dragging out the process with no end in sight. 

People seek fertility treatments for a variety of reasons – whether it’s heterosexual couples struggling to conceive, same-sex couples wishing to have a biological child, or single women looking to preserve their fertility or pursue motherhood independently. When the desire to build a family intersects with biological limitations, reproductive medicine can offer powerful solutions. But legislation introduces another layer of complexity, influencing the boundaries of what society considers permissible or prohibited in the realm of fertility treatments.

For Sarah Davis and her wife, Taiwan’s legislation has presented significant obstacles, preventing them from purchasing donor sperm or accessing in-vitro fertilization (IVF) within the country. Their names have been changed to protect their daughter’s identity.

Under the Assisted Reproduction Act (ARA) of 2007, only heterosexual couples can receive medical help with creating and implanting an embryo. Single women can retrieve and freeze their eggs but are unable to use them until they are married to a man. Woman couples simply don’t exist in the wording of the law.

“We felt so limited in how we could start a family,” says Davis. The 33-year-old American has been living in Taiwan for 10 years. When Davis met her Taiwanese partner, she knew immediately that she wanted to marry her. The couple tied the knot as soon as Taiwan legalized same-sex marriage in 2019. But when they started thinking about having a child, they realized that equality was still some way off for same-sex couples in Taiwan.

Until 2023, Taiwan only permitted gay and lesbian couples to adopt their spouse’s biological children, so adopting a child was also not an option. Accessing IVF treatment in another country would have required multiple lengthy trips abroad – an option that was financially out of reach for them.

Instead, the couple began searching for someone they trusted who was willing to donate his sperm privately. At the same time, they consulted with a lawyer to guarantee legal parentage for both mothers. Bringing up the subject with potential donors and asking personal questions about family health histories and STIs felt uncomfortable and intrusive, Davis says.

“All those are things that we wouldn’t have had to do if we could just do IVF,” she says. Still, their story has a happy outcome: Today, they are proud moms to a healthy two-year-old.

The law also affects single women like Kirsten Klitsch. The German national opted to freeze her eggs at age 37. She was well aware that she might never be legally allowed to use them in Taiwan. However, having recently ended a six-year relationship with her Taiwanese boyfriend, she was faced with many uncertainties about her future. To keep open the possibility of becoming a mother one day, she decided to undergo egg retrieval at a fertility clinic in Taipei, where she was living at the time.

Reflecting on the experience, Klitsch described the breakup as “devastating.” She found it particularly frustrating when the doctor explained that, under Taiwanese law, only her “future husband’s sperm” could be used to fertilize the eggs – a policy she felt was “patronizing” to women. “This constant reminding of ‘you need to have a husband [to use your eggs]’ felt almost like a punishment for not being able to stick it out,” says the now 39-year-old.

If Klitsch wanted to conceive a child without being married, she would have to transfer her stored eggs out of Taiwan – an expensive process fraught with bureaucratic hurdles. Even after overcoming these challenges, she would still need to undergo IVF treatment in another country.

For now, she is content with her decision to freeze her eggs and have them safely stored. She says that egg freezing is an empowering tool, offering women greater control and more options when it comes to planning their future.

No freedom, abundant risk

Dr. Chin Tzu-hsuan encounters patients in Klitsch’s situation every day. As a reproductive medicine specialist at the Taipei branch of Stork Fertility Center, the experienced OB-GYN is well aware of the challenges that Taiwan’s current legislation poses for single women and lesbian couples seeking fertility treatments.

“The cost and the risks of going abroad for medical treatment are rather obvious,” she says. “But there is also an aftermath. Let’s take the example of a lesbian couple who go abroad to have a child. The baby has two moms, but legally it only has one, and they have to sort it out with the court, even though there is nothing wrong.”

Dr. Chin argues that the legal loopholes need to be fixed to give women all the options available through fertility treatment. “Their eggs are their own, from their own body, but they can’t use them in Taiwan because of the legal standstill,” she says.

So why has Taiwan not yet reformed its outdated reproductive medicine law? The short answer: because of a heated debate over legalizing surrogacy. At the beginning of 2024, the Ministry of Health and Welfare (MOHW) announced plans to amend the ARA, promising a new legal framework for fertility treatments by January 2025. However, what followed was a political tug-of-war over the specifics of the reform, with lawmakers submitting 16 different draft amendments.

Legislators from the ruling Democratic Progressive Party (DPP) prioritized expanding access to IVF for single women and lesbian couples. Meanwhile, members of the Taiwan People’s Party (TPP) proposed a draft that included surrogacy access for both heterosexual and same-sex couples. Several lawmakers from the Kuomintang (KMT), Taiwan’s main opposition party, submitted drafts focused solely on surrogacy, with no provisions for expanding IVF access. Among them, two KMT proposals restricted surrogacy eligibility to heterosexual married couples only.

Surrogacy is the act of carrying and birthing a child for someone else. In places where surrogacy is legal, like the United States, Canada, and Ukraine, couples can find a surrogate through specialized agencies. Local laws will dictate who is eligible to access surrogacy and whether it will be permitted as a commercial or altruistic service – determining, for instance, the level of compensation a surrogate can receive.

Taiwan has been debating whether to legalize surrogacy for over two decades. In 2023, TPP-presidential candidate Ko Wen-je picked up the issue as a campaign promise. His party’s legislator, Chen Gau-tzu, has been a vocal advocate for surrogacy, openly sharing her own struggle with infertility due to uterine lesions.

Following the submission of the draft amendments, DPP lawmakers and NGOs began cautioning against combining surrogacy legislation with the broader reform of the ARA into a single bill. The feminist Awakening Foundation raised concerns over what it described as a “serious lack of regulations and discussion” surrounding the surrogacy proposals. In a statement, the organization highlighted the absence of sufficient evidence on the long-term mental and physical impacts of surrogacy on both surrogate mothers and children, urging lawmakers to approach the issue with greater scrutiny and caution.

However, with the Lai administration operating as a minority government – where the opposition parties, the KMT and the TPP, together hold a parliamentary majority – passing an amendment to the ARA without addressing surrogacy was unlikely.

By July, the MOHW released a consolidated draft amendment that incorporated elements from the various proposals, including a 15-paragraph section legalizing surrogacy. The bill was set to be passed by the end of 2024.

However, the proposed legislation sparked opposition from both feminist NGOs and conservative family groups. Critics argued that the regulations were too vague to adequately protect surrogate mothers from exploitation. Others contended that the introduction of surrogacy amounted to the commercialization of life, raising ethical concerns about the commodification of reproduction.

Fertility doctor Chin agrees that legalizing surrogacy must come with clear regulations and insurance policies. “When pregnancy goes well, it’s easy,” she says. “But when it goes badly, it can be a matter of life and death.” Many have therefore demanded that the bill include life insurance standards for surrogates and the obligation for couples to take on the child regardless of any disabilities resulting from birth.

However, Dr. Chin is generally supportive of granting surrogacy access to individuals who are unable to carry children on their own. “The goal should be that everyone has the right to free choice, including potential surrogates,” she says. Dr. Chin acknowledges that her stance is more progressive than prevailing public opinion. “Because we don’t have surrogacy at the moment, everyone is scared. Like with gay marriage – there was a lot of opposition, but once it passed, people saw that it wasn’t a big deal.”

She suggests a phased approach to introducing surrogacy in Taiwan, initially making it available to women unable to conceive due to uterine anomalies or medical conditions. Over time, access could be extended to same-sex couples. “Prioritizing surrogacy on a medical basis for women with specific needs might be a more suitable approach for Taiwanese society,” she explains.

Uncertain future

For now, societal consensus on surrogacy remains elusive. In December, the MOHW announced it would withdraw its draft bill after receiving 600 public comments, with 80% opposing surrogacy. Minister Chiu Tai-yuan stated that the next version of the bill would focus solely on expanding access to IVF, with surrogacy to be addressed in a separate bill that has been shelved for the time being.

The decision sparked backlash from the TPP and the KMT, both of which had pushed for surrogacy legislation. In response, opposition lawmakers called for defunding the ministry, criticizing the administration for failing to deliver comprehensive reproductive reforms.

At the time of writing, a revised draft focusing on single women and lesbian couples has been submitted for executive approval. The exact wording will only be made public once it is passed by the Cabinet. Afterward, the bill goes back to Parliament for further discussion. With the ongoing deadlock between the parties, it’s unclear if and when the bill can be passed. 

This uncertainty is especially frustrating for couples like Sarah Davis and her wife. After the birth of their daughter, they faced an 11-month wait before the stepchild adoption process was completed, granting both mothers legal parental rights.

Even if IVF treatment becomes accessible to lesbian couples, much will depend on the precise wording of the bill – specifically whether both women in a same-sex marriage can be listed as parents on the birth certificate. Under current regulations, only the birth mother is granted immediate parental rights, while the other mother is recognized solely as a “spouse,” necessitating a lengthy and complex adoption process to secure full legal recognition.

Kirsten Klitsch has since relocated to the UK, where she is retraining to become a vocal coach. Despite moving abroad, she remains hopeful that Taiwan’s legal reforms will bring meaningful change for other single women seeking fertility options. For her personally, such reforms would also make it easier to use her eggs to start a family.

“I thought I’d never be able to use my eggs because I don’t have the financial means and it’s so much hassle [to move them abroad],” she says. “But if the law were to pass, it wouldn’t be such an unrealistic goal.”

She is unsure if her personal circumstances will ever be right for having a child. However, the legal reform would bring her some reconciliation with the turn her life took during her nine years in Taiwan.

“Egg freezing can be quite an emotional journey, and it’s important that women feel supported and empowered by the doctors, but also by the laws of the country,” she says.