Ibone Olza MD, PhD., Perinatal Psychiatrist. European Institute of Perinatal Mental Health.
Translated by Lucy Lo Cascio.
The debate -if it can be defined as such- on the possibility of legislating so women carry babies to be later bought and raised by others rarely visibilizes the experience of these women. There are very few qualitative studies that analyze the experience of women who have gestated for others or that follow up on their health after childbirth (Olza Fernández 2018). The best known and most widespread are usually those of Susann Golombok, a Cambridge researcher who has -for years- been following a small group of families thus created in the United Kingdom (Imrie, Jadva 2014). Her results are not bad (Golombok et al. 2013), but context must be taken into account, since the study is carried out in the United Kingdom, in the form of “altruistic” surrogacy: pregnant women are legally recognized and appear as such in the identity documents of their children; they maintain contact with the families who keep the babies; there are good public health services and a follow-up is also carried out (Jadva et al. 2003). The results say little or nothing about the life experiences of women in poor countries who gestate for others for economic reasons, the so-called “commercial surrogacy”. So it is worth reading some of the few qualitative studies carried out in countries such as India, Iran, or of Latin America if we want to go deeper to understand the dimension of this form of reproductive exploitation. In fact, due to the closure of markets such as India or the war in Ukraine, the market for newborns has once again shifted to Spanish-speaking countries, where favourite destinations are now countries such as Mexico, Colombia or Argentina, where mafias dedicated to the trafficking and exploitation of women and babies are expanding their field of action and acting in increasingly dangerous ways[1]. The 2018 “Report of the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material (A/HRC/37/60)” already described surrogacy as a practice of trafficking, exploitation and sale of human beings[2].
In the studies economy is the main reason mentioned by these mothers from poor countries for accepting surrogacy, but when one reads their testimonies an aspect that probably encompasses almost everything appears which is gender-based violence. To begin with, the decision to undergo this practice almost always takes place in an explicit context of gender-based violence: it is the husband or partner who decides that the woman should bear a child; similar to pimping in sexual exploitation. This finding appears in several studies: it was the husbands who insisted that their wives gestate for others even if they did not want to (Karandikar et al. 2014). For example, in Iran only married women who have at least one living child can gestate for others and it is necessary that they have their husband’s permission (Taebi et al. 2020). Sometimes they do it to pay the debts that he has incurred, and some don’t even get to touch that money: “I did this for my husband. He had many debts. It was time to clear his checks. With the money we received, we paid all his debts” (Taebi et al. 2020). A 28-year-old woman said: “My husband took all the money. He didn’t give me anything. I was the one who tolerated the problems, but I didn’t see any money” (Taebi et al. 2020).
Others declare anger with the husband for similar reasons: “I was so desperate that I even thought of selling my child. A doctor told me that there was a center that would put a baby in my womb to carry for nine months, and I would be getting lots of money in return. I did this because I had no money to rent a house. My husband is sick and cannot work. But the money was not enough and it was spent very fast” (Taebi et al. 2020).
In another Iranian study a mother says: “The sexual relationship between my husband and I was in trouble. He didn’t tell me anything, but I figured out that he wasn’t willing to have intercourse with me because he thought that somebody else’s baby was in my belly. I got very upset but I tried not to bug him” (Ahmari Tehran et al. 2014).
Poverty stands out as one of the reasons of these women for making the decision to gestate for others. In fact, the first topic that appears in the qualitative analysis is that of “desperation”: the magnitude of poverty had made them choose to gestate for others; they described the situation as desperate.
“This process is so distressing that I would not have done it even if someone paid me 10 times the remuneration, had I been well-off, but I am so desperate (for money) that I would do it even if I was paid just one third the amount” (Saravanan 2013).
As to how they experience pregnancy, many describe it as extremely difficult. Partly because of the rejection they perceive in their social environment, partly because of the difficulties inherent in the pregnancy itself. They point out the pain and suffering. These are usually very medicalized pregnancies, with many treatments and physical problems. A mother who had a multiple pregnancy reported: “I had a triplet pregnancy. I was hospitalized from the fifth month of the pregnancy. I had hypertension. I couldn’t lie down anymore. I used to feel choked. I had to sit all the time. I wished I could sleep normally for one night. I couldn’t eat anything but chicken. I couldn’t drink milk. They gave me supplements. It was a terrible pregnancy. I was more like a sick person than a pregnant woman. Those who have had triplet pregnancies can understand what I am saying” (Taebi et al. 2020).
In many cases they also have to be away from their families of origin without their children for a long time and stay in houses with other pregnant women during the last months of pregnancy. One kept referring that “I constantly wanted to go back home to my children” (Karandikar et al. 2014). They also describe the constant stress of “having to be extremely careful for the baby so it would be fine and I could get paid” (Jacobson, 2021). In addition, the fear of having a miscarriage, or a cesarean section, “I had spotting, and I was anxious that I might lose this child after spending so much time and effort; enduring all these injections and treatments for nothing” (Taebi et al. 2020). All of them had been extremely concerned about the baby’s health. Emphasizing the fear of complications arising or losing it and not receiving the income. “I was always worried that this child would be retarded. I thought if the baby was abnormal, maybe his/her commissioning couple didn’t want him/her. Thereafter what could I do with a retarded baby.” “I was concerned about my money because if the baby had been aborted I could not have received the agreed money”(Ahmari Tehran et al. 2014).
On an emotional level, they describe how hard it was to gestate and feel a baby that was not going to be theirs. All the participants stated that they tried not to have maternal feelings towards the baby in their womb. The relationship with the rest of the family is not usually easy either: “I have a little girl who is very smart and understands many things so I did not know how to tell her. She frequently asked: “Mom, do you want to bring me a brother or a sister?”. I could not really explain it to her. I did not know what to say”. “My husband and I did not want another child because we had financial problems. I did not know how to tell the others I was pregnant while we had money issues. My husband said: “tell them it was an accident”. I was always worried that if other people found out I got pregnant this way, what would they think about us? (Ahmari Tehran et al. 2014).
With respect to childbirth and postpartum they outlined how hard the surrendering of the baby was: “Just exchanging money for a baby is very cold and heartless. It makes you feel bad as if it is a duty” (Taebi et al. 2020). Many try to consider the baby they give as not their own and repeat to themselves that they are carrying “someone else’s child for them” (Yee et al. 2020). They also describe disappointment in many cases with the purchasers of the baby: “She didn’t even come to see if I was ok after having a C-section” (Yee et al. 2020). They also tell about the emotional suffering after handing over the baby which results in a very difficult mourning. A 33-year-old Iranian doctoral student says, “After delivery, I suffered from severe depression. I couldn’t continue my studies; I couldn’t even take care of my own child; I didn’t want to see my husband, because I thought if he had more money I shouldn’t go through this. I went to my parents’ house for six months and started treatment. Now, it is about eight months that I have stopped my pills and started my education in university”(Taebi et al. 2020). “Sometimes I think whether he will recognize me after 20 years when he is a young man? How will he look like? What should I tell him if I see him? Will he like me or not?” (Taebi et al. 2020).
In conclusion, regardless of how much the assisted reproduction industry embellishes and dresses it up, childbearing for others (surrogacy) is a very hard experience, a form of extreme reproductive exploitation in contexts of gender violence and economic poverty, that generates significant suffering for those who go through it and with high risks to their physical and mental health in the short and long term. As feminists and health agents, it is urgent that we make all these impacts visible.
AHMARI TEHRAN, H., et al, 2014. Emotional Experiences in Surrogate Mothers: A Qualitative Study. Iranian Journal of Reproductive Medicine, July 01, vol. 12, no. 7, pp. 471-480 ISSN 1680-6433.
GOLOMBOK, S., et al, 2013. Children Born through Reproductive Donation: A Longitudinal Study of Psychological Adjustment. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 20121123, Jun, vol. 54, no. 6, pp. 653-660 ISSN 1469-7610. DOI 10.1111/jcpp.12015 [doi].
IMRIE, S. and JADVA, V., 2014. The Long-Term Experiences of Surrogates: Relationships and Contact with Surrogacy Families in Genetic and Gestational Surrogacy Arrangements. Reproductive BioMedicine Online, Oct 1, vol. 29, no. 4, pp. 424-435. Available from: https://www.clinicalkey.es/playcontent/1-s2.0-S1472648314003538 MEDLINE. ISSN 1472-6483. DOI 10.1016/j.rbmo.2014.06.004.
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TAEBI, M., ALAVI, N. and AHMADI, S., 2020. The Experiences of Surrogate Mothers: A Qualitative Study. Nursing and Midwifery Studies, Jan 1, vol. 9, no. 1, pp. 51-59. Available from: http://www.nmsjournal.com/article.asp?issn=2322-1488;year=2020;volume=9;issue=1;spage=51;epage=59;aulast=Taebi;type=0 CrossRef. ISSN 2322-1488. DOI 10.4103/nms.nms_19_19.
YEE, S., HEMALAL, S. and LIBRACH, C.L., 2020. “Not My Child to Give Away”: A Qualitative Analysis of Gestational Surrogates’ Experiences. Women and Birth: Journal of the Australian College of Midwives, May, vol. 33, no. 3 [viewed Nov 4, 2020], pp. e256-e265 ISSN 1878-1799. DOI 10.1016/j.wombi.2019.02.003.
[1] https://elpais.com/america-colombia/2023-01-03/el-mercado-de-los-vientres-de-alquiler-en-colombia-un-bebe-a-4000-dolares.html [Colombia’s surrogacy market: Buying a baby for $4,000]
[2] Report of the Special Rapporteur on the sale and sexual exploitation of children, including child prostitution, child pornography and other child sexual abuse material (A/HRC/37/60). https://reliefweb.int/report/world/informe-de-la-relatora-especial-sobre-la-venta-y-la-explotaci-n-sexual-de-ni-os