Surrogacy: Ethical Issues

What's Wrong With Surrogacy?

Surrogacy announcements have become so common in Hollywood that it seems like an acceptable option for couples but there are some serious medical and ethical questions to consider about third-party reproduction.

Medical Ethics

One of the most famous celebrities to use a surrogate recently is tabloid magnate and reality television star Kim Kardashian West. In 2017, Kardashian West announced that she was expecting her third child, via surrogate. Kardashian West had already given birth to her older two children naturally, but she decided to hire a surrogate for the third after her doctor said that another pregnancy could potentially be life-threatening. However, in doing so Kim exposed her surrogate to the possibility of experiencing the same potentially life-threatening medical conditions.

Pregnancy and child birth may pose some medical risks to the mother, but a surrogate inherits these risks and others while the intended mother's or parents' health, especially in the case of male homosexual couples, is uncompromised. According to medical research, the risk for pre-eclampsia and ectopic pregnancies can increase for a woman who is a surrogate because of the IVF process. Both conditions can have potentially fatal complications.

The nature of IVF requires that women donate multiple eggs for the creation of embryos. This poses a danger to women who take high doses of hormones in order to trigger ovulation followed by an invasive procedure to extract the eggs. Research indicates that donated eggs used in IVF from the genetic mother or the donor can increase the risk for pregnancy-induced hypertension, which can lead to pre-eclampsia. In addition to the danger of using donated eggs, the doctor may implant several embryos at once to increase the chance of pregnancy, which has a higher probability of resulting in a multiple birth. The Centers for Disease Control and Prevention (CDC) report that multiples occur in more than 50 percent of all surrogate pregnancies. Carrying and delivering multiple preborn babies is medically more dangerous and by itself can increase the mother's risk of having pre-eclampsia in pregnancy.

Researchers are also discovering that the father and/or the baby can also contribute to pre-eclampsia. The result is that a surrogate woman, whose own pregnancy was uneventful, might develop pre-eclampsia because of the baby she is carrying. That is what happened to Jackie, a surrogate from Oregon.

A young mother with a six-year-old at home, Jackie became a surrogate and was paired with a couple from China. When Jackie met the genetic mother a couple of months into the pregnancy, the woman from China shared that her first child was lost due to complications from pre-eclampsia. Towards the end of her pregnancy, Jackie developed the same life-threatening condition and the doctors attributed it to the father's DNA in the baby. It's called "dangerous father effect."

A surrogate is taking a large medical risk by bringing a baby to term that is not her own, and often times some of the dangers are not clearly explained by fertility specialists.

Exploitation of Women

Surrogacy preys on the maternal and altruistic desires of women to help other women. It asks a mother who has already given birth to her own children to take the medical risk of a surrogate pregnancy for an average of $25,000. Many clients could pay much more to their surrogates but agencies maintain a strict payment scale to avoid surrogates choosing exclusively wealthier clients. A woman can also charge more for her second surrogacy arrangement, which encourages her to continue putting her health and life at risk by pursuing more pregnancies.

The element of financial compensation also raises the question, "Is the surrogate doing this of her own free will?" Due to the amount of money she receives, the surrogate's romantic partner or husband could be encouraging or manipulating her into pursuing surrogacy when it is not in her best interest. This is especially true in developing countries where a surrogate can provide an impoverished family with enough cash to build a modest home or pay off debt. Intended parents also search online for surrogates, which is less regulated than agencies.

The Exploitation of Children

Commercial surrogacy arrangements involve a woman giving birth to a child that is not hers for money. Sometimes surrogacy is described as akin to "baby selling" or "womb renting," which in some ways is an accurate description.

Regardless of how a mother tries to distance herself intellectually and emotionally from the preborn child, the child becomes attached to the mother it knows in the womb and not the mother who funded the surrogate. After birth, there is usually no time for the baby to bond with the mother he or she knew in pregnancy before the child is in the arms of what are essentially strangers to the child, even though they may be the biological parents.

Surrogacy encourages couples to use their own biological sperm and egg to create the embryo that is implanted into the surrogate; however, for the developing child, his or her mother is the woman growing the child in her uterus. Within hours after birth, studies have demonstrated that a baby has a preference and physiological response to its mother's voice. According to one study, "the fetal ear is well-equipped to detect auditory stimuli" and a mother's voice has a calming effect by decelerating the baby's heart rate. For the child to then be given to another woman or a homosexual couple could be disturbing, and research has shown that sometimes the child or children will eventually develop adjustment disorders due to the lack of the bonding relationship with the birth mother.

Though there are some similarities between surrogacy and adoption, surrogacy is different because the child is carried by a woman under legal contract who often gives up her rights to the child before he or she is born. For a child who is adopted, the birth mother believes that due to a difficult personal or family situation, adoption is the best option for the child's future. After birth, the mother placing a child for adoption often has the opportunity to change her mind, to bond with the child, if she wishes, and receives no financial compensation for giving birth. Many times surrogates never have the opportunity to bond or see the child they carried for nine months. In short, surrogacy is arguably based on the desires of the adults whereas adoption is primarily focused on the needs of the child.

Class Advantage

Another prominent aspect of surrogacy is that it is usually older, wealthier singles or couples who utilize younger, likely lower income women. The Center for Bioethics and Culture Network estimates that about 50 percent of surrogates in the United States are military wives because they are usually married, typically have a lower income and have children at a younger age. Surrogates are also most likely Christian, live in rural communities and have attended college but never received a degree. In contrast, prospective parents are usually wealthy, urban, educated and older.

This discrepancy in class was perhaps best illustrated in a New York Times Magazine article featuring writer Alexandra Kuczynski and her surrogate, Cathy. Kuczynski is the wife of a millionaire who lives in one of the most exclusive addresses in New York City on Park Avenue. After several failed fertility treatments, Kuczynski and her husband contracted with a woman from New Jersey to have their child since it is illegal to do so in New York State.

In her article, Kuczynski describes her various emotions throughout her surrogate's pregnancy, talking about her initial jealously that Cathy could give birth to her child and she could not. Later in the pregnancy, Kuczynski talked about how not being pregnant allowed her to "exploit" (her word) her last few baby free months by going to the Super Bowl and white water rafting while her surrogate had to deal with the physical side of pregnancy.

For the cover of the magazine, the New York Times had a picture of Kuczynski and her surrogate standing side-by-side. The distinction between the two women could not have been more obvious. Kuczynski looked sophisticated, wearing a nice cocktail dress with her hair up in a French twist and Christian Louboutin shoes. By contrast, Cathy seemed plain, wearing an outfit that would be more appropriate in the aisles of Walmart than the streets of Manhattan.

On the surface, surrogacy sounds like a win-win for everyone involved. A mother who has successfully given birth to her own children can return the favor by renting her body to a woman who is struggling to have her own, but the exchange has an exploitative quality that should not be ignored. When Cathy became a surrogate, she literally put her life on the line by agreeing to become pregnant at the age of 43 for another woman so she could help pay for her daughters' college education. Cathy's own daughter also sold her eggs, which is another risky procedure. There are real medical consequences with surrogacy, and the promise of financial return for pregnancy puts women in an untenable position where they risk exploitation, long-term health issues and even death.