The Civic Chamber of the Russian Federation has prepared recommendations regarding the provision of specialized medical care to citizens using assisted reproductive technologies (ART),
including in vitro fertilization (IVF) and surrogacy. The recommendations were based on public discussions held at the Civic Chamber of the Russian Federation in July 2020.
“According to the World Health Organization, the frequency of infertile marriages in Russia exceeds 15%, which is considered a critical level for the reproduction of the nation's population,” said Lydia Mikheeva
, President of the Civic Chamber of the Russian Federation. "It is not surprising that assisted reproductive technologies are of interest to Russians since their use helps tens of thousands of people find and experience the happiness of parenthood."
According to the Head of the Civic Chamber of the Russian Federation, several legislative problems remain unresolved, including those caused by the activities of intermediary agencies in the field of surrogacy.
“We consider it necessary to study all aspects of the legal regulation of the ART sphere and to introduce amendments to the legislation that would ensure the protection of the interests of the child,” she said. “This work should be carried out with the participation of representatives of state authorities, the Civic Chamber, the Ombudsman for the Rights of the Child in the Russian Federation, representatives of specialized medical and public organizations, as well as the legal community,” she added.
The recommendations prepared by the Civic Chamber of the Russian Federation emphasize that, in accordance with the Constitution of the Russian Federation, motherhood, childhood, and family as a whole are under the protection of the state.
Due to the development of the Russian reproductive medical industry over the past few decades, the effectiveness of ART programmes has significantly increased, according to experts. However, despite the fact that the availability of medical assistance with their use is increasing annually, the level of accessibility of the population is lower in comparison to international indicators.
What is more, as of today the ART register of the Russian Association for Human Reproduction has collected information on more than 1 million ART cycles (1,067,514) conducted in the Russian Federation. The latest annual report for 2018 obtained information on 158,815 ART cycles. At the same time, there is no state register in Russia that contains information about children born with the use of assisted reproductive technologies.
Several problems remain unresolved related to the need to improve legislative regulation in the field of assisted reproductive technologies (ART). One of these problems is the lack of a comprehensive mechanism in the legislation that guarantees the protection of the interests of a child born under a surrogacy programme.
The Deputy Chair of the Commission of the Civic Chamber of the Russian Federation on Health Care and Public Health Development, Director of the clinic ART-ECO, Doctor of Medical Sciences Elena Kalinina
noted that for a long time the issue of surrogacy was controversial in society. According to her, it is necessary to separate the medical side of the issue and the legal and commercial side.
“A surrogate mother receives money, she consciously takes this step to solve her material problems. And here the question of the correct drafting of the contract between the surrogate mother, the clinic and the patients who seek assistance is very important. The task of the clinic is to implement the medical part of the issue – to examine the surrogate mother, carry out a programme for collecting cells from the genetic parents and transfer the embryos to the surrogate mother. Afterwards, we are left with the commercial and legal aspects. Therefore, members of the Civic Chamber turn to the government with a request to help resolve the issue of formalizing these agreements,” said the social activist.
Currently, a large number of intermediary organizations operate in the field of surrogacy, and their activities are not regulated or controlled in any way by state authorities, according to experts of the Civic Chamber of the Russian Federation. The Civic Chamber experts propose compulsory licensing of the activities of such organizations that will help to properly organize their activities and increase the level of responsibility.
Participants of the public discussion at the Civic Chamber of the Russian Federation also drew attention to the fact that the existing system of distributing compulsory health insurance funds does not allow patients to choose a medical organization for the treatment of infertility using ART. The amount of funding is pre-allocated between medical organizations. As a result, already at the beginning of the year, institutions most in demand among consumers of medical services start experiencing the problem of lack of funds to provide medical care to citizens who have chosen them. It is proposed to consider the issue of introducing personalized financing mechanisms, including the issuance of personalized certificates to patients for payment for the services of medical organizations chosen by them independently.
Several recommendations of the Civic Chamber of the Russian Federation concern the topic of medical assistance with the use of ART for citizens of reproductive age who are to be treated for oncological diseases. In particular, it is proposed to enshrine into law the obligation of the medical organization, which will conduct treatment of the malignant disease, to inform citizens in writing about their right to donate and store biomaterial before undergoing specialized treatment in order to implement reproductive function after recovery.
The participants of the discussion at the Civic Chamber of the Russian Federation expressed the opinion that the use of surrogacy should, in exceptional cases, be allowed based on social indicators. First of all, we are talking about cases when, in the presence of cryopreserved embryos, their genetic mother has died, and their genetic father has expressed a desire to complete the commenced ART programme for the birth of the child.
Based on the results of the discussion at the Civic Chamber of the Russian Federation, the Government of the Russian Federation shall be recommended to consider the possibility of developing and submitting to the State Duma amendments to the Family Code of the Russian Federation, the Federal Law "On the Basics of Health Protection of Citizens in the Russian Federation" and the Federal Law "On Acts of Civil Status", among others, which imply the establishment of requirements for a surrogacy agreement, the procedure for its conclusion, determination of the rights and obligations of the parties, criteria and legal consequences of unfair behaviour of the parties to the surrogacy agreement, their responsibilities, and so on.
It is also proposed to enshrine into law requirements for foreign citizens (genetic parents of an unborn child) their rights and obligations in relation to a child born with the use of surrogacy; expand the categories of citizens eligible for surrogacy; to define the concepts of “providing medical assistance using IVF under the surrogacy programme” and “legal support for the surrogacy programme”; to consolidate the procedure for the advanced (before the birth of the child) transfer of acts of civil registration to authorities on the use of the surrogacy programme in order to exclude the possibility of foul play.
The Government is also asked to consider the possibility of establishing compulsory licensing of the activities of organizations providing intermediary services in the field of surrogacy, as well as requirements for such organizations; development and adoption of regulatory legal acts providing for the implementation of state control over the activities of intermediary organizations in the field of surrogacy.
The Civic Chamber of the Russian Federation also recommends that the Government include additional ART procedures in the compulsory health insurance system, consider the introduction of personalized financing mechanisms, including the issuance of personalized certificates to patients for payment for services of medical organizations chosen by them independently.
The recommendations of the Civic Chamber of the Russian Federation also mention the need to create an interdepartmental body to work out issues in the field of ART, which would include representatives of state authorities, the Civic Chamber, the Ombudsman for the Rights of the Child in the Russian Federation, representatives of specialized medical and public organizations, as well as the legal and expert community.
The Ministry of Health of the Russian Federation is invited to ensure the development of a state register on information about children born with the use of assisted reproductive technologies (ART), as well as conceive of a procedure for maintaining such a state register.