The recent case of “Baby Gammy” has highlighted the dubious nature of cross-border surrogacy, where rich couples use mothers in poorer countries to bear their children.  Gammy was one of two non-identical twin children born to a Thai surrogate mother on behalf of an Australian couple. But the couple took only his sister, and left Gammy, born with Down’s Syndrome, behind.

The story sounds bad enough. But it got worse when it was revealed that Gammy’s biological father had previously been convicted of child sex abuse.

It seems disturbingly possible that he was attempting to breed his own victims, as many abusers do, and to do so overseas to circumvent the eyes of Australian social care authorities.

The case has caused outrage in both Australia and Thailand. The Thai press has exposed other cases of abuse of surrogacy, such as the Japanese 24-year-old who had had no less than 13 surrogate Thai children in the last two years.

Commercial surrogacy is considered unethical by Thailand’s Medical Council, but there are many doctors willing to do it nevertheless. The scandals have sparked a set of reactive laws by the Thai junta that will ban surrogacy, putting the existing clinics out of business.

Even beyond clear abuse like this, there’s something profoundly disturbing about the rich renting the bodies of the poor, especially for a procedure so intimate and long-term.

I don’t mean to sentimentalise pregnancy here;  I have met quite a few women who talk of it as a vital part of bonding with their child-to-be, I also know others for whom it was nine months the deepest misery. And there are couples, especially same-sex couples, for whom surrogacy offers the most realistic chance of a child that’s biologically theirs.

Yet like the donation of organs, it cannot be left to the ravages of the free market. This shouldn’t be a case of just nationalistic pride, although the exploitation of Southeast Asian women by rich foreigners, whether from East Asia or the West, invokes particularly harsh historical memories. It’s also about wealth gaps within countries. In India, where commercial surrogacy is legal, it’s heading toward being a billion-dollar industry.

But in India women, who rent out their wombs to rich urban couples are almost inevitably poor and rural themselves, and often see only a fraction of the money the couples pay, the majority being snapped up by the agencies that act as middlemen.

Yet other approaches also create problems. The UK allows surrogacy but not for pay, only for “reasonable expenses.” This, however, has created a severe shortage of potential surrogates. After all, it’s a pretty serious ordeal to undergo, especially for strangers.

The case also highlights policy dilemmas for China. Under the family planning policy, the country currently has an absolute ban on surrogacy. In theory, this prevents abusive situations like the cases in Thailand.

But as The New York Times recently documented, the demand for surrogacy among prospective Chinese parents, especially older couples , is so great that more than 1,000 illegal agencies are now in operation in the country. Many couples also simply go to the US for surrogacy.

The industry, of course, is hugely sketchy; there have been cases of parents being cheated out of hundreds of thousands of yuan, of surrogate mothers left holding babies after parents disappeared, and of agencies with ties to organised crime extorting extra money from parents by threatening to kidnap their baby.

The best solution may be to regulate commercial surrogacy. What does this mean in practice? First, deals should be arranged through a government body or a registered and strongly supervised agency, not through unregulated middlemen.

As with responsible plastic surgery or organ donation, psychiatric evaluation should be part of the procedure. A fair going rate should be established, so that payment cannot become a race to the bottom.

There needs to be a clear legal framework, and from the start both the donor parents and the surrogate should establish agreement over issues such as disability and abortion. The surrogates should also have access to counselling to help them deal with the process.

In the short term, countries need to clean up the cross-border issues involved with surrogacy. At a minimum, having a child through a surrogate mother from another country should be treated in a similar way to cross-border adoptions by the home country, with potential parents evaluated by care agencies.

But the best way to avoid these issues would be to have well-regulated in-country surrogacy available in the first place.