Surrogate motherhood or surrogacy has been in the news these days in Spain because of two cases: a couple from Asturias who was not allowed to bring back to Spain their twins born in India via surrogacy and a Balearic gay couple who also used surrogacy in Thailand, and expect quintuplets! (one of the surrogate mothers is expecting twins and the other one, triplets).
I would like to tell you more about this topic and know your opinion about it. I think it’s something very important and controversial that can be seen in many ways.
When there is some news about reproduction, the media usually call me to discuss about them. Today, before speaking to a radio station, I was reading material that I had written ten years ago and I was surprised at how my opinion has changed. I’ve gone from believing that surrogacy was horrible, even a way to use the body of a woman in a situation of need, to help doing it to whom asks me to. This evolution comes after learning about different situations (like the one about a girl whose son died in childbirth and whose uterus had to be removed due to an hemorrhage), and also after seeing the dedication and love attitude of women pregnant thanks to surrogacy.
Where is it allowed?
Legally, in Europe the parenthood of the child is determined by birth; the law forbids to rent a womb.
As an exception, England allows it only if there is a family connection between the two women, if there is no financial arrangement and if both of them are English. Following the same law, in South Africa, a 48 years old woman could give birth to her daughter’s triplets.
It is also allowed in some states of the USA, Canada, Russia, Ukraine, and also in India and Thailand, but the problem in those last two countries is to bring the child back to Europe, as the documentation required is often difficult to obtain.
In the last few years and until January 2013, many surrogacy treatments have been performed in India because of their low cost and easiness during the process, since the fertility clinics themselves are also responsible for the surrogate mothers, from their selection up to the birth. Should the legal requirements change, I guess this will become again the main destination country.
Who may need to rent a womb?
We constantly take care of people who would like to have some information about how and where to do it.
On the one hand, it is requested by couples or single women presenting a medical inability to carry a pregnancy (because their uterus has been removed, because they were born with uterine malformations, because they are taking medications that are incompatible with a pregnancy or because they suffer from conditions where a pregnancy is contraindicated). Some people think that there are also women who would like to use it it in order to avoid risks and damaging their own body. I believe that is the answer to ignorance and a certain frivolity, and the truth is that I’ve never had this request at my clinic.
On the other hand, it is requested by gay men, singles or couples, as well as by heterosexual single males. Increasingly, men claim their rights to single parenthood; you all know celebrity cases which have used it.
Why is a woman willing to be a surrogate mother?
What kind of women are capable to go through a fertility treatment, a pregnancy and a birth and then deliver the newborn to other people?
A study presented in an international congress stated that surrogate mothers have no psychological consequences and that the reasons why they do it are in 91% of the cases to help, although it is actually to help their children. An 8% does it for the pleasure of being pregnant (our experience as gynaecologists says that being pregnant is not a pleasure, indeed, in most cases it’s just the opposite: the pleasure lies in having a child) and only 1% says that they do it exclusively for the money.
From what I’ve seen over the years, most surrogate mothers do it to get resources to support their children. They are proud of it and live it as “I’ll help you raise your child and you help me raise mine.”
A child conceived this way can have three mothers, the biological mother, (who provided the eggs), the gestational mother (who carried the pregnancy), and the legal mother, who will look after the child forever. It may also be that there is a legal father.
The woman who carries the pregnancy is the gestational mother but usually not the biological mother. The oocytes are either from the legal mother or from an egg donor; moreover they always have their own children, among other things to avoid the risk of becoming sterile because of a complication during birth.
What kind of relationship is created between the woman and the child’s parents?
The relationship between the legal parents and the surrogate mother is very different depending on the countries and cultures.
In the USA and Canada, they can meet and have the relationship that they have decided to establish. Online communication is very frequent, even visits and occasional gifts, but they can also remain anonymous. In these countries, the woman who is going to act as the surrogate mother sets the rules. She can even be the one who selects the legal parents.
After the birth, a fast trial is done in which the three parts are present and where the end of the contract they had made as a ‘temporary adoptive mother” is signed, that is, as someone who cares about the child during a period in which the legal parents are unable to do it: pregnancy. I know patients that, after this trial, a week after birth, went all together to a barbecue at the gestational mother’s house.
Emotional support is necessary in these cases and, in these countries, both the surrogacy agencies and the legal parents provide it.
In India and Thailand, the centre itself takes care of everything, they have homes in which they live until after the birth and there is no communication at all with the legal parents. Three possible candidate profiles (containing photos, medical and family history, etc.) are sent to the legal parents from Thailand or India for them to choose one of them. When patients ask me for advice about which candidate to choose, I feel very bad and I tell them that it should be the centre and not them to choose her. After the childbirth, there is paperwork to do in court and with the police. In many cases, they leave the country with the baby appearing as a child of the surrogate mother and the male partner, and then in Europe, the wife adopts him or her.
A surrogacy process is payable in stages; there are fees for each part of the process to be paid according to the evolution of it, with a price list for extras such as amniocentesis, twin pregnancy, etc.
The amount paid to the surrogate mother is much less than you think. Most of the money goes to lawyers, agencies, medical expenses for the fertility treatment and pregnancy, childbirth and the incubator if needed, insurance and trips. A process of surrogacy, if everything goes well on the first try, can cost around 50,000 Euros in India or Thailand, nearly the double in the USA and intermediate prices in other countries.
Obviously, there are many people who, despite a whole-hearted desire to have a child, can not afford it economically.
What must be taken into account?
It’s necessary to have an attorney specialized in this area in the parents’ country of residence. It’s also very desirable to have a specialist in reproductive medicine who has handled many cases and is up to date with the clinics’ medical aspects. I know of many patients who have privately organized the whole process through the Internet and have suffered a fraud.
I’ve been able to see and share all kind of experiences with the patients that I have accompanied through this adventure: negative experiences because of repeated failures or, for example, after arriving to India to start the process and noticing a rejection’s attitude of the centre’s staff because the husband is in a wheelchair (in their culture, it’s still widespread to conceive illness as a divine punishment), as well as fantastic experiences because of finally having that child in their arms.
Questions for the debate
Without a doubt, the scientific and medical progresses such as surrogacy create a social, cultural and legal debate. It’s quite clear that not everything that is technically possible is morally acceptable.
What do you think, on an ethical level, about surrogacy?
Do you think that the trouble and risks of pregnancy can be paid with money? Or instead, should it be seen as a help exchange?
How would you write the law in your country? Would you allow surrogacy in all cases, in just a few or never? Would you be a surrogate mother for your sister?