Intercountry adoption (ICA) has declined significantly since 2004. Now with fewer options for family building with a healthy child or infant via ICA, global surrogacy appears to be replacing the practice in some cases. This article presents a brief history of ICA and ethical dilemmas and human rights concerns and explores global surrogacy, starting with surrogacy practices in India. It then considers the new and emerging practice of surrogacy in Guatemala, with concerns about informed consent in the context of poverty and human rights abuses, including human trafficking and violence against women.