Assistant Professor of Practical Theology & Spiritual Care, Emory University, Emory University
Danielle Tumminio Hansen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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In her new book, actress Gabrielle Union became the latest celebrity to discuss her decision to become a parent via surrogacy. She joins the ranks of household names such as Neil Patrick Harris, Nicole Kidman, Kim Kardashian, all of whom have hired a surrogate to give birth to their future child.
The publicity Union generated about surrogacy reignited ethical questions about this controversial form of assisted reproduction that range from whether women should be able to sell their reproductive abilities to what it means to be a parent.
There is global disagreement about the ethics of surrogacy. Several countries have banned it, while others have limited its scope. In the United States, laws permitting surrogacy vary by state.
The legal range is due to ethical concerns, ranging from the potential exploitation of surrogates to worries that surrogacy negatively affects the life of the resulting child.
In the decade that I’ve been researching this form of assisted reproduction, I’ve discovered that surrogacy can be exploitative, but it can also be a positive experience when undertaken with appropriate societal support and when all participants practice mutual respect, kindness and empathy. At its best, it can also encourage people to adopt a more expansive view of what it means to be a family.
One could argue that the concept of surrogacy dates back to a biblical story in the book of Genesis in which Sarah, the wife of Abraham, pleads with him to have children with the slave Hagar because of Sarah’s inability to conceive.
Fast forward to modern times, and surrogacy is now performed predominantly in high-priced in vitro fertilization centers in one of two ways. In “traditional surrogacy,” the fertilized egg belongs to the surrogate. In “gestational surrogacy,” which is more common today, the fertilized egg comes from either the intended mother or a donor. In both cases, that egg combines with a sperm to become an embryo that grows in the surrogate’s womb and not the intended mother’s.
Gestational surrogacy may be preferable because it allows intended mothers to maintain a genetic connection with their child. Others may prefer it because of fears that a surrogate could lay claim to the child with whom she had a biological connection.
The fear that a surrogate will try to steal or adopt a child is one of many legal and ethical fears surrounding surrogacy. In the 1980s, the Baby M Case in the United States attracted much media attention because it tapped into these fears. In this situation, the surrogate named Mary Beth Whitehead attempted to retain custody of the baby she birthed.
The case fueled a stereotype of surrogates as emotionally unstable, defying the reality that surrogates undergo psychological testing before participating in a procedure.
Documented instances of surrogates retaining children are rare. Research shows that surrogates often experience pregnancy and birth differently than they did with their own children. They also often see themselves as heroes or gift givers instead of mothers.
If the public perceives surrogates negatively, intended parents often fare no better. They are often categorized as selfish, desperate and filthy rich, especially when they choose surrogacy without a medical reason.
Those popular images of intended parents fail to account for the reproductive trauma many of them experience prior to turning to surrogacy. Psychologists have shown that the inability to start a family can be a form of reproductive trauma. The decision to hire a surrogate, then, is often the last option for parents who have tried everything else. What is seen as desperation, in other words, is actually, as I’ve proposed in my own research, an attempt to write a happy ending to the story of their reproductive lives.
It is true that this way of becoming a parent is expensive, at least in the United States, where use of the technology routinely costs over US$100,000. The cost is so extreme because intended parents pay health care fees for both themselves and the surrogate, many of which aren’t covered by insurance.
They also have to pay legal fees, agency fees, and compensate the surrogate, which alone can range from $45,000 to $75,000. Contrast that price tag to one in India prior to its ban on international surrogacy in 2015: Couples who traveled there could expect to spend between $15,000 to $20,000 in total for their surrogacy journey.
The extreme costs of surrogacy in the U.S. limits its availability to the wealthy and to high profile celebrities like Union, raising important ethical questions about whether this is an appropriate use of resources, especially given the possibility of adopting.
In addition to ethical questions about surrogacy’s relation to wealth, feminists are divided on how surrogacy affects women. Some feminists feel that surrogates have a right to choose what to do with their bodies. Others object to surrogacy on the grounds that systemic oppression drives women into surrogacy; or that it’s unethical for women to sell their bodies, arguing that it parallels prostitution.
Cases documented in India support these concerns. Investigative journalist Scott Carney found one prominent Indian surrogacy clinic where surrogates were kept in crowded bedrooms on restricted diets and forced to have caesarean sections in order to streamline the labor and delivery process.
Scholars also worry about surrogacy’s impact on children. Studies suggest that children of surrogates may struggle with their identity, especially if those children are not told of their origins.
Extensive research hasn’t been conducted with children of surrogates. Research by social scientists studying children born via egg and sperm donation largely mirrors the findings of adoption research: Children have questions about their identity, and answers to these questions are often most accessible when children have access to those individuals who are part of their birth story. Yet agencies and governments rarely regulate how surrogates, intended parents and children interact following the baby’s birth.
Finally, many religious groups, most prominently Roman Catholics, object to surrogacy because it results in the destruction of human embryos during IVF cycles and violates their theological conviction that life begins at conception. Roman Catholics encourage heterosexual couples who cannot procreate via intercourse to adopt as an alternative.
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Such objections might lead to the conclusion that there is never a reason to hire a surrogate. But this might be too simplistic. Even with the documented struggles on the parts of both intended parents and surrogates, many are profoundly grateful for the technology.
Intended parents often feel surrogates are “gifts from God” who help them reach their dream of parenthood. Meanwhile, some surrogates believe their powers of procreation provide them with a unique opportunity to help others. Many surrogates see their ability to create life as a source of power, a profound act of altruism and part of their legacy.
When I spoke with a group of surrogates in Austin, Texas, while conducting research for my book, I found that their stories aligned with the findings of other researchers who discovered that many surrogates had positive experiences in which they experienced themselves as heroes. These women felt empowered because they helped infertile heterosexual couples and gay couples create families. Without surrogacy, these individuals would have no way to have a genetic connection with their children.
The surrogates acknowledged that sometimes intended parents could be difficult, that pregnancy and labor could be challenging, and that it could be confusing when a checkout clerk at the grocery store asked what they were planning to name the baby.
Becoming a parent through surrogacy can, as Union explains, be awkward and humbling, confusing and miraculous all at the same time.
But when surrogates and intended parents can act freely, out of a sense of religious calling and with the support of society, then there is the potential for them to discover that family is not just biological but also social and relational. In those encounters, many experience the technology as life-giving, both metaphorically and literally.
The Candler School of Theology at Emory University is a member of the Association of Theological Schools.
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