Gestational Surrogacy: it’s complicated for everybody

October 18, 2010Carole 2 Comments »

I came across the article, Military Wives Turn to Surrogacy: Labor of Love or Financial Boost? and it annoyed me. I realize that the title and the article are meant to be provocative and this one is just a revival of an old story for a slow news cycle. There have also been other almost identical articles on military wives and gestational surrogacy published in years past including:

The underlying themes are the same, namely questioning the motives of women who act as gestational surrogates, questioning the appropriateness of Tricare military health insurance (read insurance paid from your taxes) paying for obstetrical care for surrogates and wondering whether military wives make better than average surrogates because they are more dutiful and better able to juggle home life by themselves. Why do we assume that motives behind surrogacy are EITHER wholly compassionate or wholly financial? What is wrong with motives that are a mix of both? Most human motives are a mixture of self interest and generosity.

It seems to me that the underlying expectation that gestational surrogates should not be financially compensated are steeped in our cultural expectations of women in general and mothers, in particular. Women should be self-sacrificing (like the military men serving their country oversees), mothers should not expect to be paid for hardships of pregnancy (even if they interfere with their existing obligations to their own children) and taxpayers should have a say about how women use their bodies (the abortion debate is the elephant in the room here).

Interestingly, in 2004, Tricare, the Department of Defenses health insurance provider wanted congress to drop OB coverage for surrogates. They were unsuccessful.  Perhaps someone realized that the surrogate is no less pregnant and no less in need of obstetrical care than any other patient, regardless of how she got that way.  I am also pretty sure that Tricare doesn’t ask female patients to justify their choice to get pregnant or ask how they got pregnant, making restricting OB services to some pregnant women and not others politically difficult. ASRM published an article about dueling insurance agencies and gestational surrogacy in 2004 that illustrates the lengths some insurance companies will go to prevent paying for health care.

The more I dig around in those articles, the more the feminist in me starts to twitch. If men were gestational surrogates, would we be making them justify why they should be paid for nine months of physical service to someone else? I don’t think so. We’d have seminars on how to cut the best deal with the intended parents, developing iron-clad contracts and how best to highlight surrogacy services on your resume.

Arguably, gestational surrogacy or “renting your uterus” is somewhat different from other living donor “donations”  because in most cases infertility is not life threatening. Having to pay someone for a kidney or part of a liver to save a life makes most of us squeamish because it raises issues of equal access to available organs and financial exploitation across social classes. If organ donation were performed for elective medical reasons, not necessary for saving a life, we might be more comfortable with the idea of paying for organs. (“Hey Dude, spent the big bonus on a second liver- can never have too many, you know. Heh Heh  Keg party on Saturday!’). Okay, maybe not.

Gestational services are more similar to elective egg or sperm donation which are typically compensated. If you can’t find someone to donate the use of their uterus to you, you usually aren’t risking death. I realize that suicidal depression from infertility or death from obstetrical complications from carrying a pregnancy against medical advice are exceptions to this general statement, but thankfully, these extreme consequences of not having a surrogate are uncommon.

In most, but not all states, gestational surrogacy is legal, readily available and some compensation is usually permitted for this elective service. Because gestational surrogacy is a 24/7 nine month commitment with real physical and emotional risks, compensation seems appropriate. Or conversely, asking someone to serve as your reproductive vessel for nine months without adequate compensation of some kind fails to recognize the real physical and emotional sacrifices that gestational surrogates make. What price would you place on nine months of your life?

This interview with gestational surrogates called “The other side of surrogacy” was a fascinating glimpse into surrogacy from the “other side of the stirrups”. Because we have this expectation that women should do surrogacy for other women purely on compassionate grounds, I think some surrogates may get into surrogacy with the best intentions and then later regret their choice because both parties only saw what they wanted to see in the negotiation phase. When potential surrogates are being interviewed by matching services, they must pass the “sniff test” to see if there is any financial motive at all. Having bills and finding a way to pay them in difficult times should not be automatically dismissed as unworthy motivation. If we allow surrogates to place a price on their services without feeling like prostitutes, maybe these complicated emotional issues could be fully explored and fewer problems may arise down the road.

The regret expressed by the surrogates interviewed in the article seemed to arise from a departure from the expectations they had at the beginning such as  unforeseen hardships from the pregnancy, or unexpected medical expenses from pregnancy complications. Surrogates generally have a history of easy pregnancies and may dismiss the real physical risks of pregnancy and not recognize that the loss of future reproductive function, though rare, is a possibility. What price should we place on the potential loss of fertility? The risk of multiple gestation pregnancy and associated complications is also much higher if IVF is used (as it always is for gestational surrogacy). Even surrogates who have had children before through intercourse may not be prepared for the supercharged experience of an IVF pregnancy, with multiple clinical interventions and excessive hormonal fluctuations.

Depending on the financial and emotional relationship of the intended parents and the surrogate, surrogates may feel under appreciated, particularly if they entered into the arrangement largely or entirely for compassionate reasons. In some cases, a straightforward financial arrangement with a surrogate who sees the arrangement as a job to be done well may serve everyone’s interests best in terms of expectations.

Both infertility patients and surrogates are served poorly by publications that are sensational, superficial, black and white caricatures of surrogacy arrangements and does nothing to illuminate the complex motivations that people have- on both sides of the surrogacy contract. I read the comments at the end of the piece about “the other side ” (never a good idea- only read if  you’ve not already had too much caffeine to avoid high BP and stroke).  As usual people were taking sides and throwing rocks, as though surrogacy arrangements were either all good or all bad.

I know there are heart-warming examples of surrogacy arrangements that worked out beautifully for all involved. Hey journalists- it might be useful to report on these and to analyze why these particular arrangements were considered positive experiences by all involved. I am willing to wager that this positive outcome was built on a thorough examination and discussion of all the emotional, legal and  physical  issues that this complicated arrangement creates. Sometimes it is best to solve a problem by working backwards from the desired end result. A good surrogacy arrangement ends like this:

  • A healthy child(ren) is given to the intended parents after nine months of gestational surrogacy. (So there should be no expectation of motherhood on the part of the surrogate. She should probably already have completed her family).
  • Both the intended parents and surrogate feel enriched, not cheapened by the experience. (Both parties likely understood the detailed expectations of both surrogate and intended parents regarding payment of bills and other compensation, dietary and behavioral expectations, and the privacy and autonomy of the surrogate and her family. Each party has assumptions about how it will go- these assumptions must be discovered and fully discussed in advance).
  • Neither the intended parents nor the surrogates regret the arrangement. (Would you do this again with your surrogate? Would she do it with you? If the answer is “Yes”, there are probably no regrets.)

One example of a surrogacy contract can be reviewed here. (I do not endorse this contract in any sense- see your own attorney!- but simply provide this contract so you can have some idea of the details that might be defined in a contract). If you have ferreted out all the details that interest any of the parties involved and decide whether you can come to an agreement based on realistic expectations,  you are more likely to have a good experience. It is better to hold out for a good match than to rush to an arrangement that is based on assumptions and wishful thinking instead of a clear headed recognition that three people (at least) are pioneers in an entirely new kind of reproductive arrangement.

© 2010 – 2012, Carole. All rights reserved.

2 Responses to this entry

  • gingerandlime Says:

    Great post, thank you for sharing it! People do seem to go a little crazy when the idea of compensating women for putting themselves at risk comes up.

  • Tina Says:

    This is great!! I am a surrogate of twin boys born to an infertile international couple. I’ve been heartbroken by the lack of contact since they’ve returned home.
    I have recently started to regret my decision to do this because of the almost two year commitment I gave to them involving a failed transfer, miscarriage and finally a complicated twin pregnancy that ended with a vaginal birth AND cesarian.
    I’m pissed off at the amount of scrutiny surrogates are put through while being screened. I like how you described it as a “sniff test”. So true! I’ve found that the amount of money a surrogate is compensated at BEST equals $100 dollars a day! In hindsight, I’m offended I was questioned and continue to be questioned if I did it for the money.
    The parents decided to take their American nanny back home for a few weeks while they adjust. Her price? $500 a day! How come her motives weren’t scrutinized? She kissed their a$$ from day one hoping they would take her home with them… And they did!
    I can’t believe I put my life at risk and had my family sacrifice their lives all for a special connection/bond. We established early in the contract that I wanted to have contact after the birth, but all I have received is a quick note saying they are home, and will be in touch. The agency provided 2 group therapy sessions after birth. It’s been almost 3 months and when I reach out to the thearapist, all I hear is, “move on”. How could I not feel regret?
    I feel bad saying this, but the best surrogates are low income women who need the money. I did this out of compassion for the couples situation, and in the process became very close to them. I feel used now that it’s over and the contact has stopped.

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