Surrogacy

Surrogate motherhood is one of many currently available forms of Assisted Reproductive Technologies (ARTs) that have developed in response to the increasing number of individuals/couples who find themselves unable to conceive a child on their own. Surrogate motherhood involves the services of a woman who agrees to carry/gestate a child for the express purpose of surrendering that child to the intending/commissioning couple upon the birth of the child. The demand for surrogate motherhood is created by a diagnosis of female infertility, although a woman need not be infertile in order to employ the services of a surrogate. Factors that have contributed to the popularization of surrogate motherhood and other reproductive technologies are both medical and social in nature. In the United States there are reportedly two to three million infertile couples (Office of Technology Assessment 1988). A diagnosis of infertility is defined as the inability of a heterosexual couple to produce a pregnancy after one year of regular intercourse, that is, unprotected intercourse (Stangel 1979). The social factors that have contributed to the rise in the rates of infertility and that have resulted in an increase in the demand for reproductive technologies are the trend toward later marriages and the tendency for growing numbers of women to delay having children until later in their reproductive years. With advances in reproductive medicine, couples who would not have been able to reproduce in the past are now able to have children who are completely or partially genetically related to them.

Approximately 35 percent of couples who choose surrogacy have either attempted or considered adoption (Ragoné 1994). The majority of those who eventually choose surrogacy view the adoption process as one that is riddled with problems and that has been, in most cases, unable to provide them with a suitable child (Ragoné 2000). For example, in 1983, 50,000 adoptions were completed in the United States, but an estimated two million couples were still seeking to adopt (Office of Technology Assessment 1988).

Historically, there have been three profound shifts in the Western conceptualization of the categories of conception, reproduction, and parenthood. The first occurred in response to the separation of intercourse from reproduction through birth control methods. A second shift occurred in response to the emergence of assisted reproductive technologies and to the subsequent fragmentation of the unity of reproduction, when it became possible for pregnancy to occur without necessarily having been "preceded by sexual intercourse" (Snowden, Snowden, and Snowden 1983). The third shift occurred in response to further advances in reproductive medicine that called into question the "organic unity of fetus and mother" (Martin 1987). It was not, however, until the emergence of reproductive medicine that the fragmentation of motherhood become a reality; with that historical change, what was once the "single figure of the mother is dispersed among, several potential figures, as the functions of maternal procreation—aspects of her physical parenthood—become dispersed" (Strathern 1991). It is now possible for five separate individuals to claim parenthood in a given situation: the woman who contributes an ovum (genetic mother), the woman who gestates the child (gestational mother), the intending mother (the social mother/the woman who will raise the child and may also gestate the child), the sperm donor (genetic father) and the intending father (the social father/the man who will raise the child).

During the early 1980s, all surrogate motherhood arrangements (traditional surrogacy, in which the child was genetically related to the husband only) involved the union of the husband's sperm and the surrogate's ovum. Since 1994, however, over 50 percent of all surrogates are gestational, in other words, the surrogate gestates the couples' embryos (providing them with a child that may be genetically related to both wife and husband). However, one should not assume that it is the intending father's sperm or the intending mother's ovum that creates the embryo; the ovum may have been procured through ovum donation then mixed with the husband's sperm. Should a couple use the intending father's sperm, donor ova, and a gestational surrogate, the couple will have the same genetic relationship to the child as that provided by traditional surrogacy (i.e., a genetic tie for the father only). However, one of the reasons cited for choosing gestational surrogacy is consumer choice; specifically, couples who choose the route of donor ova plus gestational surrogacy rather than traditional surrogacy have a significantly greater number of ovum donors from which to choose.

Contexualizing Surrogacy

Many individuals view surrogate motherhood as a positive addition to the ever-expanding range of technologies now available as remedies for infertility. Others, however, view it as symptomatic of the dissolution of the traditional/nuclear U.S. family and the sanctity of motherhood, as something structurally akin to prostitution that reduces or assigns women to a breeder class (Dworkin 1978), or as a form of commercial baby selling (Annas 1988; Neuhaus 1988).

The opinion among both scholars and the general population that surrogates are motivated primarily by financial gain has tended to result in oversimplified analyses of surrogate motivations. In surrogate mother programs surrogates receive on average between $10,000 and $15,000 (for three to four months of insemination and nine months of pregnancy), a fee that has changed only nominally since the early 1980s. Although surrogates do accept (and appreciate/value to varying degrees) monetary compensation for their reproductive work, the role of this compensation is a multifaceted one. The surrogate pregnancy, unlike a traditional pregnancy, is viewed by the surrogate and her family as work, and surrogates rarely spend the money they earn on themselves. The majority spend the money on their children, for example, as a contribution to their college education funds, whereas others spend it on home improvement, gifts for their husbands, a family vacation, or simply to pay off family debts.

One of the principal reasons that most surrogates do not spend the money they earn on themselves alone appears to stem from the fact that the money serves as a buffer against and/or reward to their families, in particular to their husbands who must make a number of compromises as a result of the surrogate arrangement. One of these compromises is obligatory abstention from sexual intercourse from the time insemination begins until a pregnancy has been confirmed (a period of time that is an average of three to four months in length, but that may be extended for as long as one year). Surrogates embrace the gift formulation, which holds particular appeal because it reinforces the idea that having a child for someone is an act that cannot be compensated monetarily (Ragoné 1994, 1996, 1999, 2000).

Cultural/Legal Implications

The United States is unquestionably the world's leader in availability of surrogacy arrangements. Britain, for example, implemented a ban against commercial surrogacy—in other words, any arrangement in which a surrogate receives payment for her services. On the other hand, Israel permits commercial surrogacy but the EmbryoCarrying Agreements Law (1996) advances the position that a "severe effort" be made to permit only unmarried women to serve as surrogates because it is reasoned that allowing married women to serve as surrogates would violate culturally prescribed definitions and norms about kinship, the status of the child that is born, and family (Kahn 2000). This position stands in contrast to U.S. arrangements in which established surrogate mother programs typically insist that their surrogates be either married or in a committed relationship. They also require surrogates to have children of their own in order to discourage them from wanting to keep the child. Programs reason that an unmarried woman who has never had children is much more likely to want to keep a child produced through surrogacy than a married woman with children of her own (see Ragoné 1994, 1996, 1998).

From the couple's perspective, surrogacy is conceptualized not as a radical departure from tradition but as an attempt to achieve a traditional and acceptable end: to have a child who is biologically related to at least one of them—that is, traditional surrogacy. In the gestational surrogacy arrangement, the child may be related to both the mother and father. This idea is consistent with the emphasis on the primacy of the blood tie in EuroAmerican kinship ideology and the importance of family. One of the most interesting aspects of a surrogate's perception of the fetus she is carrying is that it is not her child. This belief holds true whether the child is produced with her genetic contribution (50% in traditional surrogacy and, of course, in a traditional pregnancy) or not genetically related to her at all, as in gestational surrogacy. It will be interesting to learn whether the Israeli policy, which allows only unmarried women to serve as surrogates, will result in an increase in the number of surrogates wanting to keep the child(ren) they produce.

Because of the liberal policies and efficient programs available in the United States, couples routinely travel from abroad to participate in surrogate motherhood arrangements. The growing prevalence of gestational surrogacy has introduced a host of new legal and social questions, especially concerning a recent legal precedent in which a surrogate who does not contribute an ovum toward the creation of a child has a significantly reduced possibility of being awarded custody of the child.

But not all gestational surrogacy arrangements involve the couple's embryos; numerous cases involve the combination of donor ova and the intending father's semen. Why, then, do couples pursue gestational surrogacy when traditional surrogacy (with the surrogate providing the ova) provides them with the same degree of genetic linkage to the child, has a higher likelihood of being successful, and costs less? Several reasons were cited by members of the staff of the largest surrogate mother program in the world, the primary one being that many more women are willing to donate ova than are willing to serve as traditional surrogate mothers.

The second reason, as previously mentioned, is that the U.S. courts would, in theory, be less likely to award custody to a gestational surrogate. The growing prevalence of gestational surrogacy is, in part, guided by recent legal precedents in which a surrogate who does not contribute an ovum toward the creation of the child has a significantly reduced possibility of being awarded custody in the event that she reneges on her contract and attempts to retain custody of the child. However, although legal factors have certainly contributed to the meteoric rise in the rates of gestational surrogacy, it should be remembered that for couples the ability to create a child genetically related to both parents is the primary reason that gestational surrogacy continues to grow in popularity.

In June 1993, in a precedent-setting decision, the California Supreme Court upheld lower and appellate court decisions with respect to a gestational surrogacy contract. In Anna Johnson v. Mark and Crispina Calvert (SO 23721), a case involving an African-American gestational surrogate, a Filipina-American mother, and a EuroAmerican father, the gestational surrogate and commissioning couple both filed custody suits. Under California law, both of the women could, however, claim maternal rights: Johnson, by virtue of being the woman who gave birth to the child, and Calvert, who donated the ovum, because she is the child's genetic mother. In rendering its decision, however, the court circumvented the issue of relatedness, instead emphasizing the intent of the parties as the ultimate and decisive factor in any determination of parenthood. The court concluded that if the genetic and birth mother are not one and the same person, then "she who intended to procreate the child—that is, she who intended to bring about the birth of a child that she intended to raise as her own—is the natural mother under California law." Perhaps most important, when commissioning couples choose to use donor ova and gestational surrogacy, they sever the surrogate's genetic link to and/or claim to the child, whereas in the traditional surrogacy arrangement the adoptive mother must emphasize the importance of nurturance and social parenthood while the surrogate mother deemphasizes her biological and genetic ties to the child in order to strengthen the adoptive mother's relationship to the child.

An additional reason for choosing gestational surrogacy, and one that is of critical importance, is that couples from certain racial, ethnic, and religious groups (such as Japanese, Taiwanese, and Jewish couples) in the past often experienced great difficulty locating surrogates from their own groups. They were, however, able to find suitable ovum donors. Thus, couples from various ethnic/cultural, racial, or religious groups who are seeking donors from those groups often pursue ovum donation and gestational surrogacy. Gestational surrogates reason that they (unlike traditional surrogates and ovum donors) do not part with any genetic material, and they are thus able to deny that the child(ren) they produce are related to them. Ovum donors however do not perceive their donation of genetic material as problematic. Why women from different cultural groups are willing to donate ova but not serve as surrogates is a subject deserving of further study.

In conclusion, it can be said that all the participants involved in the surrogacy process wish to attain traditional ends, and are therefore willing to set aside their reservations about the means by which parenthood is attained. Placing surrogacy inside of tradition, they attempt to circumvent some of the more difficult issues raised by the surrogacy process. In this way, programs and participants pick and choose among U.S. cultural values about family, parenthood, and reproduction, now choosing biological relatedness, now nurture, according to their needs.

See also:Assisted Reproductive Technologies; Fatherhood; Fertility; Gay Parents; Lesbian Parents; Motherhood

Bibliography

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martin, e. (1987). the woman in the body: a culturalanalysis of reproduction. boston: beacon press.

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ragoné, h. (1996). "chasing the blood tie: surrogatemothers, adoptive mothers and fathers." american ethnologist 23(2):352–365.

ragoné, h. (1998). "incontestable motivations." in reproducing reproduction: kinship, power, and technological innovation, ed. s. franklin and h. ragoné. philadelphia: university of pennsylvania press.

ragoné, h. (1999). "the gift of life: surrogate motherhood, gamete donations and constructions of altruism." in transformative mothering: on giving and getting in a consumer culture, ed. l. layne. new york: new york university press.

ragoné, h. (2000). "of likeness and difference: howrace is being transfigured by gestational surrogacy." in ideologies and technologies of motherhood: race, class, sexuality and nationalism, ed. h. ragoné and f. w. twine. new york: routledge.

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strathern, m. (1991). "the pursuit of certainty: investigating kinship in the late twentieth century." paper presented at the american anthropological association meeting, chicago.

HELÉNA RAGONÉ

Surrogacy

Surrogacy involves the gestating of a fetus by one woman, the surrogate mother, with the understanding that the baby she bears will be raised by another person or couple, usually including the man who contributed the sperm. In what is known as traditional surrogacy, the surrogate mother is artificially inseminated, contributing her own egg to the fetus. In gestational surrogacy, the embryo is produced through in vitro fertilization (IVF) and implanted in the surrogate mother.

Surrogacy, while resembling practices familiar to many times and cultures (for example, the practice in traditional Chinese families of a concubine's sons becoming the ritual and legal children of the primary wife in cases where the primary wife did not bear sons), was first legally and socially recognized in the United States in 1980. It has received a great deal of critical attention and debate in the United States and Europe, especially in cases where surrogacy has been commercialized through payment to the surrogate mother or to a for-profit surrogacy agency. By 2000, commercialized surrogacy had been banned in most of Europe and North America.

Social and religious conservatives have opposed surrogacy because it separates sex, reproduction, and family creation, thereby challenging the "natural" basis for the heterosexual nuclear family. Some feminists have supported surrogacy for the same reason, but debates over surrogacy have made clear fundamental differences among feminist philosophies regarding reproduction. Some feminists have compared surrogacy to slavery and prostitution, arguing that surrogacy is likely to become a means of exploiting poor women's sexual and reproductive capacities by wealthier women and men. Others, emphasizing reproductive choice for women and the right of a woman to control her own body, have argued that just as people are allowed to choose dangerous jobs such as fire fighting, they should be allowed to take on the physical and psychological risks of surrogate mothering, with the caveat that surrogate mothers should retain legal control over their bodies during the pregnancy, and that they should be significantly better paid than they are currently.

Contested surrogacy agreements, debated in court, have served as a focus for contemporary public discussion. In the late 1980s, public attention was riveted on the case of Baby M, in which a "traditional" surrogate mother tried to break her contract and keep the baby she had birthed. Notably, the arguments on both sides of the case, as well as the judges' decisions, were made in terms of upholding the "traditional family." William Stern, the biological father, argued that surrogacy was a legitimate mode of infertility treatment to provide the traditional family he and his wife desperately wanted. Mary Beth Whitehead, the surrogate mother, argued that she had grown unexpectedly attached to Baby M as a natural part of gestating a fetus, and that this natural connection between baby and mother should not be broken. On appeal, the New Jersey Supreme Court ruled that the commercial surrogacy contract was illegal under New Jersey laws prohibiting baby-selling, and treated the case as a custody battle between two parents, Stern and Whitehead. Critics pointed out that Stern received custody based on criteria, such as financial stability, which favored the higher-income party, and that these criteria will almost always be biased against the surrogate mother. Surrogacy is likely to remain controversial as long as biology is regarded as the "natural" basis for social parenting; two-parent, heterosexual, nuclear families are considered the norm and the ideal; and economic and social inequities leave some women particularly vulnerable to exploitation.

See also: Adoption; Artificial Insemination; Conception and Birth; Egg Donation; Fertility Drugs; Obstetrics and Midwifery.

bibliography

Cohen, Sherrill, and Nadine Taub. 1989. Reproductive Laws for the 1990s. Clifton, NJ: Humana Press.

Dolgin, Janet L. 1997. Defining the Family: Law, Technology, and Reproduction in an Uneasy Age. New York: New York University Press.

Farquhar, Dion. 1996. The Other Machine: Discourse and Reproductive Technologies. New York: Routledge.

Hartouni, Valerie. 1997. Cultural Conceptions: On Reproductive Technologies and the Remaking of Life. Minneapolis: University of Minnesota Press.

Holmes, Helen B. 1992. Issues in Reproductive Technology I: An Anthology. New York: Garland Publishing.

Lara Freidenfelds

sur·ro·gate / ˈsərəgit; -ˌgāt/ • n. a substitute, esp. a person deputizing for another in a specific role or office: she was regarded as the surrogate for the governor during his final illness. ∎  (in the Christian Church) a bishop's deputy who grants marriage licenses. ∎  a judge in charge of probate, inheritance, and guardianship.

sur·ro·gate moth·er • n. 1. a person, animal, or thing that takes on all or part of the role of mother to another person or animal.2. a woman who bears a child on behalf of another woman, either from her own egg fertilized by the other woman's partner, or from the implantation in her uterus of a fertilized egg from the other woman.

surrogate (su-rŏ-găt) n. (in psychology) a person or object in someone's life that functions as a substitute for another person. s. mother a woman who becomes pregnant (by artificial insemination or embryo insertion) following an arrangement made with another party (usually a couple unable themselves to have children) in which she agrees to hand over the child she carries to that party when it is born.