Cultural commentator Allie Beth Stuckey recently interviewed Center for Bioethics and Culture founder and president Jennifer Lahl on the thorny issues surrounding surrogacy — particularly gestational surrogacy — in which the woman who carries a baby is not the child’s biological mother. The wide-ranging conversation touched on the medical risks surrogates assume, the argument for treating surrogacy like organ donation, and why many couples choose to involve two anonymous women in the surrogacy process.
The conversation comes amidst renewed discussion about ‘social surrogacy,’ in which a couple hires a surrogate for career or other personal reasons unrelated to medical concerns.
Surrogacy Pregnancies are Higher-Risk than Spontaneously Conceived Pregnancies
Lahl observed that while informed consent requires full knowledge of the risks, benefits, and alternatives to a given medical treatment, many women don’t know that surrogacy pregnancies are “much higher risk” physically and emotionally than normal pregnancies. She said this is partly because the surrogate’s body is more likely to recognize the baby as ‘foreign’, leading to higher rates of complications like pre-eclampsia.
Research suggests that surrogate mothers are more likely to experience complications, such as gestational hypertension, gestational diabetes, and postpartum hemorrhage. And since in-vitro fertilization (IVF) is intrinsic to the process, these women assume the specific physical risks of IVF as well. What’s more, surrogacy contracts are time-limited, and may not cover medical bills associated with postpartum complications incurred after a certain point.
Lahl added that any pregnancy which is high risk for the mother is, by definition, high risk for the baby as well. Research bears out this claim, as babies carried by surrogates have higher rates of low birth weight and preterm birth as well as, in many cases, the increased risks associated with carrying multiple babies, according to a 2019 review of literature.
Even the American College of Obstetricians and Gynecologists (ACOG), which has demonstrated more partisanship than scientific objectivity regarding many other progressive causes, strongly urges caution for individuals and couples considering surrogacy, writing, “Because of the ethical, legal, and psychosocial complexities and potential medical risks to the gestational carrier, it is recommended that the use of gestational surrogacy be restricted to situations in which carrying a pregnancy is biologically impossible or medically contraindicated for the intended parent(s).”
And while pop culture articles deny higher rates of postpartum depression for surrogate mothers, Lahl found otherwise.
Lahl’s own research included surveying 97 women who had both conceived naturally and also carried babies as surrogates. It would certainly be logical to find higher rates of psychological complications in these women, who carry babies that aren’t their own for nine months only to give them up forever at the end. And while the ACOG insists that the “limited data” available on gestational surrogates’ mental health is “reassuring,” they also state that “the obstetrician-gynecologist should address the ethical and psychosocial complexities that are unique to gestational surrogacy, including the possibility that the gestational carrier may experience psychologic stress and grief after giving birth.”
Lahl also called out the hypocrisy behind fertility doctors telling women considering egg donation that “there’s no evidence this is risky to your health,” when in reality this is a largely unstudied area. Saying that the risks are unstudied is very different from saying with confidence that the risks are nonexistent or low.
Should Surrogacy Be Treated Like Organ Donation?
Lahl noted that the surrogacy industry is fraught with potential for the financial coercion of poor women, especially given that many couples pay upwards of $50,000, and even as high as $150,000 for the surrogacy process. The significant financial compensation they receive in exchange for the physical and emotional risks they’re incurring is a very likely motivator.
Lahl argued that surrogacy should instead be treated like organ donation, in which the donor is not paid. Because there are real physical risks for gestational surrogates, she argued, “We don’t have any business asking young women to put themselves in risky situations, especially when we’re paying them.” She also added, “Doctors are not in the business of telling us to do things that are harmful to us. And they are not in the business of offering money for us to do things that are harmful to us. That’s one of the main reasons why we do not allow organ donors to be paid. We don’t want money to be a coercive element in the whole area of informed consent.”
Just days ago, Bangladeshi author and physician Taslima Nasreen didn’t mince words in a series of tweets on exploitation in the surrogacy industry. “Surrogacy is possible because there are poor women. Rich people always want the existence of poverty in the society for their own interests. If you badly need to raise a child, adopt a homeless one. Children must inherit your traits – it is just a selfish narcissistic ego.”
Stuckey asked why couples choose gestational surrogacy, where the biological mother is not the woman who carries the baby, over traditional surrogacy, where the mother is biologically related to the child or children. Lahl responded with an example of two gay men hiring a gestational surrogate: “[O]verwhelmingly they want to make sure that neither one of these women can make a claim to having any maternal rights.” Lahl noted, “So legally we’ve had cases in U.S. law of disputed surrogacy, where the surrogate mother changes her mind and says ‘I cannot surrender the baby, even though I’m contractually bound to.'”
Gestational surrogacy, then, becomes “a legal maneuver to make sure that neither one of these women has a right to this child. She has no legal standing to make the case that she’s the birth mother or the genetic mother.” In effect, then “you’re exploiting, if you will, and risking the health of two women for money.”
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