Surrogacy—the act of using a surrogate to conceive and bear a child—is on the rise around the world. Defenders of this practice say that everyone benefits from it. But a U.S. woman named Annie (a pseudonym) found out what happens when the relationship between a surrogate and the couple who hope to raise the child goes wrong.

Surrogacy made so much sense to Annie at first. Following a series of bereavements, she and her husband, Pat, felt the need to “bring life into the world again,” she says.

“Pat’s brother passed unexpectedly, and then my cousin, who was like a mom to me, followed by Pat’s cousin, who was found dead in a hotel room; my great uncle; then my aunt,” Annie says. “All of this happened in the span of a year.”

She had four children from a previous marriage, but an ectopic pregnancy left her unable to conceive naturally again. Annie, in her late 30s at the time, was advised to try in vitro fertilization (IVF). She and Pat couldn’t afford that, however.

The couple wasn’t poor, “but time was a factor for us, and we didn’t think that we would be able to come up with that amount of money in a short amount of time,” Annie says.

She was aware of women being hired as surrogates, from the media and through word of mouth. “I began to wonder if that was a good way to pay for the IVF.”

Surrogacy involves inseminating or implanting an embryo into a woman’s uterus. Immediately after giving birth, the surrogate mother is required to give the child to the commissioning parents. Since the 1970s, more than 25,000 babies have been born in the U.S. through surrogacy.

There are two types of surrogacy: altruistic, in which the birth mother bears a baby for another couple simply as a gesture of kindness, and commercial, in which the surrogate is paid.

In the U.K., Canada and Australia, altruistic surrogacy is permitted, but commercial surrogacy is against the law. By contrast, all surrogacy is illegal in France, Germany and Italy. Commercial surrogacy is legal in a number of U.S. states, including California, Illinois, Arkansas, Maryland, Oregon and New Hampshire, as well as Washington D.C., and in New Jersey and Washington, commercial surrogacy laws go into effect this year. But even in states that outlaw commercial surrogacy, payment can be made by way of covering expenses and loss of earnings, which can amount to a full-time salary. In Iowa, for example, surrogates receive between $30,000 to $35,000, plus expenses.

Annie says her decision to become a surrogate was “spur of the moment.” She began checking out advertisements on the website Craigslist, where a number of couples were looking to hire a birth mother. One lived nearby and had already identified an egg donor and chosen a fertility clinic in Chicago where the implant process would take place. The couple planned to use the commissioning father’s sperm. “They were just waiting for someone like me to answer their advertisement,” Annie says. “At that stage, I had no doubts. I thought, ‘What a great gift it would be to have a child for someone who can’t have kids, and in return they pay for my IVF so I can have a baby.’ ”

The couple arranged to meet with Annie and her husband. “At first, we got on fine,” Annie recalls. “We all appeared to want the same thing. It was obvious we could help each other, and everyone seemed pleased to have met.”

They agreed that in return for Annie carrying a baby to term and immediately relinquishing responsibility for it, the commissioning parents would pay $13,000 for one cycle of IVF for Annie. “That was all we wanted,” Annie says. “We did not want to profit in any way, but just pay for the IVF so hopefully we could have our own child.”

The Chicago clinic offered a discount for providing both the embryo transfer for the couple and Annie’s IVF treatment.

Surrogacy is a profitable business in the U.S. But it has come under challenge as feminists and human rights campaigners question the ethics of what is sometimes known as “womb trafficking.”

These critics point to class and racial divisions between surrogates, egg donors and commissioning parents, which often are stark.

Surrogates tend to be working-class women with their own children; many are military wives. Surrogates must have had at least one pregnancy to demonstrate that they can carry a baby to term without complications. They are less inclined to want to keep the baby if they have their own children, the logic goes.

By contrast, an egg donor is more likely to be a college graduate from a more affluent background—features considered attractive to commissioning parents. Advertisements for egg donors are abundant on university and college campuses.

Advocates of commercial surrogacy insist it is a win-win situation: The surrogates are making an informed choice, and the money they earn can be life-changing. But as women like Annie sometimes discover, the process can be fraught with difficulty.

“I didn’t think anything would go wrong,” she says. “Everybody stood to get what they wanted.”

But things soon started to go very wrong. In the state where she lives, surrogacy contracts are enforceable by law.

“When Pat and I suggested getting an attorney to look through our contract, the intended mother got very upset,” Annie says. “She started accusing us of wasting time. So we went ahead and signed the contract.”

In states where commercial surrogacy is legal, surrogates are typically given legally binding contracts to sign, which spell out the agreement between the commissioning parents and the woman who will give birth. Commonly, these contracts include instructions regarding what the surrogate is allowed to eat and drink and which medications she can take during pregnancy; they can forbid smoking, riding a bicycle, having sex, drinking alcohol or going without prior permission to doctor’s appointments (which are paid for and monitored by the commissioning parents).

These contracts can also give the commissioning parents the right to demand the abortion of one or more fetuses in the event of a multiple birth, or to demand that the baby be handed over to the commissioning parents immediately, without even being seen by the surrogate mother.

To prepare her body for the procedure, Annie had to have a series of painful injections.

“Getting my body ready for the embryo was hard. I gained so much weight because of the shots,” she says. “I was left to inject myself with progesterone in my buttocks area and Lupron [an artificial hormone] in my stomach. I didn’t know anything about surrogacy and I didn’t really do any research. I was just looking at the end result of a family having a child they wanted, and for Pat and I to have the child we wanted.”

Annie became pregnant in 2016, after the first embroyo transfer. She discovered that she was expecting twins when she began to bleed six weeks later.

“I called the doctor’s office in Chicago,” Annie says. “The doctor told me to take bed rest and that it was normal, so that’s what I did, until my husband came home from work. I didn’t feel comfortable, so I went to the hospital to check [that] all was OK. The commissioning parents got very upset with me, saying I needed to ask permission before I went to the hospital again.” Annie was not, in fact, violating the contract at this stage. Nowhere in her contract did it say she had to ask for permission from the commissioning parents to attend a doctor’s appointment or hospital.

Trust and communication between the two couples quickly broke down. Annie and her husband decided they did not want to receive IVF treatment from the same clinic that had done the embryo transfer, because Annie wanted to be free of any involvement with the commissioning parents.

When they discovered that an IVF cycle for Annie and Pat would cost more than the discounted rate at the original clinic, the commissioning parents “acted as though we were trying to extort more money from them,” Annie says. “The next thing we knew, the other couple was accusing us of planning on selling the babies on the black market.”

Annie says the commissioning parents began to renege on paying certain expenses they’d agreed to, such as the travel expenses for Pat to join Annie at the clinic in Chicago. They also complained about the increased cost, due to complications, of Annie’s medication to sustain the pregnancy.

“They asked why I couldn’t claim these expenses on my own medical insurance, which was outrageous, because that would mean I would be penalized by my insurance company,” Annie says. “After months of harassment, I got the police involved. I had been called the N-word [Annie is African-American] and my husband a ‘dirty Mexican.’ I couldn’t trust the commissioning parents any more, and did not feel the babies should be raised by people like them.”

Annie did not want to take money for IVF treatment from the commissioning parents, which meant she and Pat had to put their plans to have a baby together on hold.

A few days later, just six months pregnant, Annie went into premature labor and gave birth to twin girls. Eight days later, one of the twins died.

“When I went into labor days later, the last thing on my mind was the contract,” Annie says. “The main thing was to make sure the babies were OK. I was able to hold the babies [which is usually not allowed]. The hospital didn’t know about the surrogacy arrangement. They were so young and so tiny. [The baby who died] was a fighter, and she was gaining weight and we were actually able to hold her and breastfeed her. When we lost [her], it was so hard, but I still had to get up to be there for [the surviving baby]. It was heartbreaking.”

Annie stayed at the hospital for more than two months, sleeping in a room next to the maternity ward, until she was told she had to leave by the attorney of the commissioning parents.

“They had got the courts involved, accusing us of going against the contract and saying that we should not be having a relationship with [the surviving baby],” Annie says. The commissioning parents took the baby away and Annie never saw her again.

A number of surrogate mothers I met in India and the U.S. have spoken about the agony of delivering babies who are immediately taken from them and handed to the commissioning parents, usually in the delivery room.

One of the hardest things about the experience is not knowing how the babies are doing after they are taken away, and yet, at the same time, feeling a huge responsibility and deep connection with them.

“If, years later, I saw something had happened to [the surviving] baby, I would never be able to forgive myself,” Annie says. “Would people blame me for not protecting her?”

The pain of bearing twins, giving birth, and losing one and then the other soon afterwards was unbearable, Annie says. “But not knowing how [the surviving baby] is, or being able to tell her I am here for her, is a terrible thing.”

Two years later, Annie has given up the idea of keeping the baby, and recognizes that she should stay with the parents she has known since she was a few weeks old.

“I’m not a heartless person,” she says. “I know [the baby] has been with them all this time and she doesn’t remember us, so I don’t want to scare her. I don’t want to take her from the only people that she has known. The only thing I want is for this not to happen to anyone else.”

Currently, British surrogates are only allowed only out-of-pocket expenses. Meanwhile, the practice of commercial surrogacy is increasingly being outsourced from the U.S. to countries like India, Ukraine, Thailand and Mexico. In India alone, the annual surrogacy industry is valued at more than $450 million.

In a number of countries, including the U.K., there are moves to legalize commercial surrogacy, which would allow the surrogates to receive a fee, as well as expenses, and give legal rights to the commissioning parents. Lawyers and campaigners lobbying for such changes often use California as a “best practice” model. Barrie and Tony Drewitt-Barlow, for example, a U.K. gay couple who have five children through surrogacy, now run the British Surrogacy Centre of California, which allows British commissioning parents to sidestep current U.K. surrogacy laws.

I asked Annie what she would like to see happen to educate potential surrogates about the realities of the experience.

“I want surrogacy to be illegal,” she says. “If I had known what I know now, I never would have done it.”

After going through such an ordeal in their quest to pay for IVF, Annie and her husband recently discovered they are going to have a baby—without assisted reproductive technology playing a part.

Annie beams as she tells me, “Our beautiful daughter … is due in the spring of 2019, and we could not be happier.”