Thailand’s recent legalisation of same-sex marriage marks a historic milestone in Southeast Asia yet falls short of achieving full reproductive equality. Same-sex couples remain excluded by restrictive surrogacy laws, developed in 2015, which only allow altruistic arrangements for married heterosexual couples. Proposed legal amendments aim to expand access to the healthcare system and surrogacy while hospital-based maternity and neonatal care remain critically unprepared. This paper discusses the gap between legal progress and clinical readiness, arguing that without national standardised surrogacy birth care guidelines, hospitals risk perpetuating inequality and confusion during one of life’s most sensitive moments. Drawing on international experience, the discussion highlights the need for inclusive protocols, staff training and ethical guidance. To realise the health equity potential of recent legal reforms, Thailand should incorporate surrogacy birth care into national healthcare guidelines and clinical pathways, advancing inclusive and standardised care across the health system.
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