The issue of gestational surrogacy presents concerns that correspond to the understanding of true motherhood. Hardly resembling natural pregnancies, surrogate pregnancies have never been a substitute for motherhood—a precious gift some wish to convert to a marketable resource or side-project. Parents cannot command children into existence, or “design” these children however they like. Children have a natural right to be brought into the world in an act of selfless love. “Womb renting,” as surrogacy is commonly called, completely distorts this gift. The artificial, mercenary character of surrogacy “undermines the dignity of human procreation, particularly when it comes to the women and children involved in the process,” says the National Catholic Bioethics Center. Surrogacy erases the sexual act that was beautifully designed to bring children into our world and foregoes its dignified purpose. It has amassed a plethora of problems for these children subjected to contrived pregnancies, naturally raising questions concerning their dignity and origins.
The Two Types of Surrogacies
Simply put, a surrogate mother offers to carry a child for someone else through assisted reproductive technology (ART). There are two types of surrogate pregnancies, “gestational” and “traditional” surrogacy. The first method utilizes in vitro fertilization (IVF) to fertilize the gametes and then implant the embryo in the uterus. Also called “host” surrogacy, gestational surrogacy involves an embryo unrelated to the surrogate. This means that the intended parents commissioning the surrogate may enlist a sperm or egg donor to fuse with an intended parent’s genetic material. In some cases, however, the parents search for an embryo donor. The child in this last arrangement is unrelated to the surrogate as well as his or her intended parents. This raises complex ethical and legal questions of parenthood, as up to five individuals helped bring the child into the world: the intended parents, the gestational surrogate, and the gamete donors.
In traditional surrogacy, the surrogate mother’s egg is fertilized through artificial insemination by a stranger or by the intended father. Traditional surrogacy is less common than gestational surrogacy, and it comes with even more concerns. Also called “partial” or “natural” surrogacy, traditional surrogacy brings natural emotional ties to the surrogate’s relationship with her child. She is both a pregnant woman and an egg donor, who has contracted to give up a future with her biological son or daughter. Contrarily, the unrelated mother in this situation welcomes the child with the intended father, who may or may not be a donor.
Ethical Concerns and Surrogacy Contracts
The first successful gestational surrogacy occurred in the United States in 1985, and since then gestational surrogate pregnancies have grown at a surprising rate. In particular, commercialized surrogacy has grown in an international market due to its increasing accessibility. In 2015, Allied Market Research estimated total gestational surrogacy revenues at $112.8 million. It surpassed $4 billion in 2020, giving way to predictions it would reach $27.5 billion in two years.
In the United States, existing surrogacy laws do not see international surrogacy as a threat. As the Heritage Foundation described, “The U.S. signed and ratified the optional protocol to the Convention on the Rights of the Child that prohibits the sale of children, but holds that “surrogacy arrangements fall outside the scope” of the protocol.” Moreover, it enables the perpetuation of trafficked women and commodified children by evading this critical concern. It is a form of imperialism conducted under the radar of some who willfully allow the outsourcing of a woman’s womb.
The ethical and legal concerns particular to the surrogate mother are consistent regardless of the type of surrogacy. Whether it is commissioned through funding or accomplished by altruistic volunteering (which is uncompensated), a surrogate contract operates like a transactional arrangement. The womb in surrogate motherhood becomes a mere thing of utility; like a specific good produced by a machine, the baby is seen as a commodity manufactured, bought, and shipped away.
Surrogacy laws vary state by state. Statutes and case law may distinguish traditional versus gestational surrogacy, and commercial versus uncompensated surrogacy.
However, because they express expectations imposed by private contracts, most surrogate arrangements result in complex outcomes. In an interview with Jennifer Lahl of the Center for Bioethics and Culture Network, one woman revealed the unexpected demands made upon her throughout all three of her surrogate pregnancies. Those procuring the agreement never warned her of the health risks one might expect during or after these pregnancies. During her third surrogate pregnancy, the surrogate Lahl interviewed admitted to developing pre-eclampsia, which can be a life-threatening illness causing high blood pressure. She delivered the twins prematurely due to this condition—and while on the verge of a stroke. While all of this took place, the surrogate dealt with another issue hanging over her head: the commissioning parents had no desire to keep her twin boys. The stress this caused her, along with other health issues with her pregnancy, gave her an accurate picture of the reality of surrogacy.
Surrogates like the one mentioned above breach their contractual agreement when they do not comply with the intended parents’ demands. More often than not, the intended parents make these demands after the agreement is arranged. They can opt to abandon the child or demand money from the surrogate. In some cases, the agreement includes an abortion clause, indicating the intended parents can direct a surrogate to abort an unborn child for contractual reasons, such as when the child has disabilities. There is little reproductive “choice” when the intended parents control a woman’s body through a surrogacy contract. The surrogate in these situations becomes responsible for the financially binding ties initially stated in the contract. The conflict pulls her here and there, causing her to seek financial or emotional support elsewhere.
Health Issues for Surrogates and Their Children
Recent studies investigating the surrogacy movement’s consequences have revealed adverse results among its participants. Surrogates were found to have significant psychological and emotional distress post-surrogacy. In many situations, those seeking surrogates are women experiencing infertility. Commissioning a surrogate, then, only perpetuates a woman’s health issues by giving the false impression that a surrogate pregnancy can erase her own health issues. Still many others “outsource” these women to have their children because they are unable to. The most common example of this, other than those couples who are experiencing infertility, are same-sex couples. In either case, surrogate children have struggled to build healthy relationships with these intended parents. Through glamorous coverage in the media, surrogacy has catered to those whose needs have led them into these difficult circumstances. It has contributed to the present world of womb renters—and the women have followed suit, unaware of all that is involved.
In September 2022, Dignity published a study comparing the outcomes of gestational surrogate pregnancies and “spontaneous” or natural pregnancies. One of the most comprehensive surrogate studies ever conducted in the United States, the investigation revealed many health risks for surrogate mothers and their children. The 96 American surrogates who participated in the study experienced the following results:
- A caesarean section, or C-section, was three times more likely to occur with surrogate pregnancies than non-surrogate pregnancies.
- Surrogate babies were 5X more likely to be delivered at an earlier gestational age than non-surrogate babies.
- Postpartum depression was much more evident in women undergoing surrogate pregnancies than those with non-surrogate pregnancies.
- High blood pressure (HBP), pre-eclampsia, hemorrhage, miscarriage, placenta previa, and post-partum HBP were considerably higher for surrogate pregnancies than non-surrogate pregnancies.
- Chronic health issues were far more likely to occur with surrogate mothers. “Among the participants, 18 women stated that their doctors had diagnosed them with a new illness or medical condition after their surrogate pregnancies.”
- Mothers indicated great distress post-surrogacy by their desire to nurse and produce enough milk for the baby taken away from them.
The study shared many other related health risks caused by surrogacy. It shared stories of women emotionally disconnected and targeted. It concluded that further studies are necessary to examine the health risks imposed on these children post-surrogacy.
Commercial surrogacy is, in fact, incompatible with a free society and the human right to life understood in its fullness. The evidence showing the egregious errors of surrogacy delivers a startling message: surrogacy perpetuates women’s health issues, distorts parental roles, and may depend on abortion clauses embedded in the contracts. The surrogate seeks solutions to her legal and emotional burdens and encounters another, yet even more binding, conclusion: regardless of her prior intentions, the connection of child and mother remains. It can be neither easily erased nor forgotten. Imagine a mother’s distress, perhaps after experiencing profound doubts about her contractual and financial agreement, when she delivers a child whom she is often not even permitted to look upon or hold. The realities of motherhood and the rights of children are not so easily reducible to the vocabulary of consent, free markets, or financial compensation. Mother and child, and the relationship between the two, are irreducible.