Exploring the Role of Surrogates in Modern Reproductive Technology: Implications for Society and Future Perspectives

1. Introduction

Reproductive technology has advanced significantly, allowing individuals and couples to conceive despite infertility issues. Traditional surrogacy arrangements are now more rooted in scientific advancements rather than societal obligations. The rise of gestational surrogacy has transformed many surrogate roles from maternal figures to mere incubators for pregnancies. However, in less industrialized societies with stricter rules against artificial reproductive technologies, traditional surrogacy remains a common practice. Although surrogate motherhood has driven socio-political debates, there exists a gap in empirical research examining the cultural attitudes toward surrogate motherhood. This dissertation aims to deepen the understanding of the implications for modern reproductive technologies, with a particular focus on surrogate mothers. The first chapter explores how the roles of surrogate mothers vary across different societies and time frames. The second chapter examines the experiences of surrogate mothers in being seen as 'good enough' mothers despite being unable to care for the child post-birth. The third chapter analyzes the implications of autonomous thought on surrogate mothers' experiences and the tensions that arise in the face of stigma. In an attempt to provide a better understanding of surrogate motherhood and the cultural framing of its implications, the research moves beyond the legal, medical, and political aspects commonly addressed in debates. Instead, it delves into the smaller, personal lenses of mothers themselves. The research design values qualitative methodologies that best reveal the mothers' lived experiences. The field research prioritizes traditional surrogacy arrangements in socio-cultural contexts with a history of such practices. While surrogate motherhood is often framed in capitalist markets and regulatory ideas, the research hopes to shed light on the role of women's agency, labor, and maternal power in the arrangements. This research embraces surrogacy as a tool to explore women's complexities, differences, and definitions of fertility and motherhood. In finding a space that allows for the speaking of silenced voices, hopes are to highlight previously unexamined aspects of social and personal hierarchies concerning motherhood and femininity.

2. Historical Context of Surrogacy

Modern-day surrogacy is a complex social model encompassing legal, psychological, ethical, and religious aspects of assisted reproduction technology, with deep roots in history. Since the beginning of recorded history, women in various cultures and societies have served as surrogate mothers. Crossing boundaries of law, religion, tradition, and culture, surrogacy raises many questions. As a social model and an aftereffect of assisted reproduction technology, surrogacy has undergone many changes over time. Changes in technological advancement often bring a change in social mores and values; technology, in turn, is a product of social transformations. To understand these paradigmatic aspects of modern surrogacy, a brief historical overview of motherhood, infertility, surrogacy, and assisted reproductive technology is discussed here. (Farooqi et al.2022)

Theories of motherhood, welfare, and safety have existed since ancient civilization. From the conception of motherhood as a mystic relation to twentieth-century psychoanalysis, speculations about motherhood have largely depended on social community and various public values. The last two centuries mark the beginning of a political change, subjecting motherhood to state control and intervention, especially in Europe. During the nineteenth century, when there arose a fear of the decline of the European races, motherhood became the binding glue of the nation. This phase thus forms what is called "welfare motherhood," and pregnant women and mothers became bedrocks for the health of infant and child welfare services. (Suneja, 2022)(Shepherd, 2021)

Along with this expansion of welfare intervention, synthetic motherhood is epitomized by the concept of the "professional surrogate mother." A physiologist proposed a "surrogate motherhood," originated with the concern for an increase in the population, as it was thought that the loss of young people during the war, as well as cases of infertility due to post-war conditions, left the population dangerously unbalanced. (Whittaker2021)

Techniques that changed the reproductive process, such as artificial insemination at the onset of the century, spurred fears of the breakdown of the fundamental socio-biological organism - the family as mother and father. Surrogate motherhood epitomized a new dimension of "scientific motherhood" as there arose a full-scale mass production of babies without the need for women's bodies. Gradually, as in vitro fertilization techniques developed, surrogate motherhood is once again on the political agenda of scientific experimentation. Patent development of drugs or chemicals disassociating reproduction from coital relationships paired with cloning technology may bring the latest progression of reproductive technologies. (Sharma et al., 2024)

3. Types of Surrogacy

The nuances of surrogacy largely rely on the type of procedure chosen by intending parents, but also on societies, medical institutions, religious authorities, and intended parents’ financial statuses. Traditional surrogacy, which consists of natural conception using the surrogate’s egg, has been predominant prior to the establishment of IVF technology, egg donation programs, and cryobanks. Since the surrogate is the biological mother of the conceived child, unintended kinship dilemmas due to societal or family pressure have often arisen in this type of surrogacy. Moreover, in cases where the intended parents do not know the surrogate, there is always a risk of disowning responsibility for the child after the birth. It has also been pointed out that this practice can be easily abused to exploit young women for procreation. Gestational surrogacy, on the other hand, has gained more popularity since the beginning of the 1980s when IVF technology was developed. Intended parents can make use of some kind of reproductive assistance while remaining excluded from the procedure itself. They can choose a location for the procedure, the surrogate, the initial medical examination, and preparation for embryo transfer. Even the rights for children born in this procedure can be transferred to another person, usually a single female or couple who are unable to carry a child. This led to the emergence of international surrogacy agencies that offer complete reproductive assistance or legal security. Nevertheless, in cases of unconsented embryo transfer or the surrogate’s refusal to give up her rights for the child, unintended kinship dilemmas can still arise. (Deonandan, 2020)(Brandão & Garrido, 2023)

3.1. Traditional Surrogacy

Traditional surrogacy, also known as partial surrogacy, is a surrogacy arrangement wherein the surrogate mother is artificially inseminated with the sperm of the intended father or donor. In this type of surrogacy, the surrogate serves as the biological mother of the child, while the intended father or sperm donor acts as the biological father. This artificial insemination is usually achieved through intrauterine insemination or in vitro fertilization. Traditional surrogates are often family members or close friends of the intended parents. (Gunnarsson et al.2020)

However, traditional surrogacy creates biological ties between the child and the surrogate mother, which could lead to emotional complications and legal issues for the intended parents. For example, the traditional surrogate mother may try to keep the child after birth, or the surrogate mother may refuse to consent to adoption in case of unexpected serious health issues. As a consequence, the intended parents are obliged to adopt the child, which could take at least six months to complete. Additionally, consent forms on behalf of the surrogate mother shall be held in court, as she can have the child placed for adoption if the intended parents are abusive or neglectful. Consequently, surrogacy contracts and legal processes are necessary in all surrogacy arrangements.

Indeed, traditional surrogacy is illegal in several countries. For instance, in European Union countries such as France and Germany, surrogacy contracts have been deemed null and void. In some cases, traditional surrogates are prosecuted for acting against the child's best interest and engaging in child trafficking. In India, commercial traditional surrogacy contracts may be contested in court. In contrast, most U.S. states and other countries do not recognize traditional surrogacy contracts, which may lead to disputes between the surrogate mother and intended parents. In Israel, intended parents have no legal standing until birth, while the surrogate mother may claim maternity rights. Legislation to clarify the status of traditional surrogacy arrangements is necessary to prevent exploitation of vulnerable women in developing countries and ensure that children's rights are protected. (Ellenbogen et al.2021)

3.2. Gestational Surrogacy

Gestational surrogacy relies on the use of assisted reproductive technologies to create an embryo genetically unrelated to the surrogate. Surrogacy and genetic testing are inherently linked, as surrogacy would not exist without assisted reproductive technologies, and assisted reproductive technologies would be a mere form of assisted reproduction without surrogacy. Because assisted reproductive technology treatments are always medically necessary, 'social' surrogacy would stem from a misuse of assisted reproductive technologies, contrary to natural 'social' surrogacy. It is further argued that assisted reproductive technology leads to a commodification of reproduction, which should be understood in distinctly political terms. If current reproductive politics persist, 'social' surrogacy, wearing the mask of freedom and choice, may proliferate. Gestational surrogacy is where a woman agrees to conceive and carry a child for commissioning parents, with no genetic relationship to the child carried. In this arrangement, either the commissioning mother carries the child, or an egg donor and gestational carrier are employed. Surrogates have no legal rights to the child; only upon birth does the surrogate relinquish her parental rights, with the commissioning parents being granted full legal custody and rights of parenthood. Surrogacy is not a simple choice with simple implications. As demonstrated through women's exploration of surrogate motherhood, the process raises unforeseen ethical and political concerns. Although women opt for surrogacy due to a perceived loss of control over their situation, they often find themselves negotiating complex parameters set by their clients, medical professionals, state officials, and surrogacy agencies. Surrogate mothers frequently become embroiled in legal complications, sometimes initiated by commissioning parents themselves. For instance, surrogate mothers may relinquish their child because the child's sex does not conform with the parents' desires, disability emerges following birth, or the parents decide to take the child to a different country where surrogacy is illegal. Moreover, surrogates often find themselves disturbed by their children's placement, despite previously agreeing to give them up, a change of heart most often triggered upon the child's birth and first meeting. Death, depression, and legal conflict may follow. In addition, women's surrogacy decisions are often shaped and troubled by socio-political contexts. (Romanis, 2022)(da et al.2023)

4. Legal and Ethical Considerations

The surrogate motherhood agreements in which a woman engages at a certain moment during or after her pregnancy can set off huge moral and legal debates in society, which makes it necessary to try to regulate these agreements in the modern world. Although legal acts can protect the most vulnerable group in them, the surrogate mothers, they are also identical in many states with a complete ban on surrogate motherhood. Well-written contracts provide a minimum protection against exploitation, bereavement, or maternal regret. Surrogate motherhood agreements are presented from a legal point of view on hard domestic and international law, which allows protection against deprivation of maternal rights, necessary psychiatric treatment after a child’s relinquishment, or decision-making rights. Contracts for surrogate motherhood agreements are often baseless, especially if the pregnant woman has decided to keep her child, but at the same time, they can be a potential form of exploitation of the poor. Well-written contracts are a minimum requirement to prevent legal anarchy in this sphere of social life. They help prevent chaotically formed international adoption markets. Moreover, they can help to avoid disappointment and legal clashes benefitting rich clients, who do not comprehend the deeper dimension of the agreement they want to form. Those in favor of a total ban on surrogate motherhood at the same time constitute a serious danger of the motherhood profession overtaking its present form in the coming decades, risking a loss of the right to be a “natural pregnant woman.” (Frati et al.2021)

Surrogacy contains different elements after procreation as well as values, which may vary in perception in people’s opinions. It determines, on the one hand, the attachment of the gestational mother to the child before birth and, on the other, her interaction with the newborn after childbirth. However, the same surrogate motherhood child may be considered and perceived by others as too great a burden. No one should ask the same pregnant women to willingly give up their own child after pregnancy, nor should they be punished should they choose to do so despite receiving great material benefits. In such a procreation situation, if accompanied by even mild pressure to give a child up for adoption, it is hard to imagine that mothers would not feel estrangement. Any child with innocent genetic bonds with a woman, whom the birth will be treated in such a procreation situation - thus all children born out of the surrogate motherhood agreements - will be viewed as too precious by all future mothers, equally those with no prior genetic relation to them, being shown respect in the pre-birth health state of the unborn child, the number of fetal tissue operations, or the health risk posed to the surrogate mother, much more than children considered as procreation objects or dead means of donation, irrespective of any genetic bonds.

5. Social and Cultural Perspectives

As with surrogacy, the acceptance of other assisted human reproduction technologies written into laws and public policies varies according to cultural and social circumstances. For the most part, it is becoming evident that the cultural perspective—how laws and regulations are shaped—differs from the reality of those who need these treatments. There is a tension created between norms and laws, which require families to follow prescribed rules in order to leave their mark on the world, and the ways in which so many feel obligated to procreate. More frequent technical possibilities do not change deeply rooted rules of conduct, such as marriage as a foundation for life, procreation as a sacred event, or the belief that protecting a child’s roots is worth more than protecting the child itself.

While in the West, life is still constructed around the dynamics of being and the need to leave a dose of power or a unique event, elsewhere in the world, life hovers closer to the social condition of being and is considered a normal community event. Procreation is merely the biological act leading to the existence of offspring and, as an inseparable part of society’s cultural and social organization, should be favored in order to humanize relationships. Such perspectives could mean that joy in birth, stemming from a desire fulfilled and reproduction begun, does not necessitate the necessity of such a need and that personal reunification can also be achieved through new regulatory mentions with a retrospective effect. It is inclusive of everyone who experiences an embryo transfer for social purposes. (Piersanti et al., 2021)

6. Psychological Impact on Surrogates and Intended Parents

In the development of reproductive technology, surrogacy has emerged as a compelling option for couples struggling to conceive. Surrogacy entails that a woman (the surrogate) carries a child for another couple or person (the intended parents). The surrogate mother’s egg is either fertilized by the intended father or a sperm donor in the case of traditional surrogacy, or a fertilized egg is implanted into the surrogate using in vitro fertilization in the case of gestational surrogacy. Surrogacy raises complex ethical, moral, legal, and psychological issues, and the surrogate’s and intended parents' psychological adjustments regarding gestational surrogacy remain less explored. This text explores the psychological experience of surrogates and intended parents considering modern reproductive technology. The future perspectives remain open. Becoming a surrogate can greatly impact women’s personal, marital, and maternal identity. Surrogates experience a gradual parental attachment over time, appreciating the surrogacy process as a powerful ongoing experience that ultimately contributes to their post-surrogacy well-being. Importantly, surrogates perceive a strong positive impact on both their own children and their caregivers’ attitude toward them. However, surrogates also report tensions between desire, honor, and renegotiation. After the surrogacy ended, many reported feeling their life purpose waned, the beginning of motherhood felt empty, their own children withdrew from their mothers, and some caregivers felt jealousy. When discussing their ongoing contact, concern arose as to whether the “checking role” could impede the parental attachment process, leading surrogates to focus more on the surrogate identity than prospective motherhood. In addition, there were developments in the anticipation of emotions and worry concerning the child’s needs, even more so in closed arrangements. Surrogates sought to prepare their own children as future siblings, whereby half envisioned continuing contact, while others found it impossible to explain. Intended parents demonstrated positive psychological adjustment following childbirth through surrogacy. Overall, they viewed the surrogacy process with satisfaction and appreciation, considering it an enriching experience and expressing gratitude toward the surrogate mother. Although intended parents had positive psychological adjustment of verbal and symbolic representations of surrogacy, they were concerned about their children’s emotional adjustment to surrogacy. Symptomatic psychological reactions concerning gestational surrogacy were infrequent among intended parents. While they demonstrated overall positive psychological adjustment, some experienced negative emotional responses. A decade after the situational adjustment, those who were still in contact with the surrogate had a tendency to feel more distressed, reveal more role conflict, and worry about the child’s adjustment. Of concern, an increased number of women relinquished the normative expectation of becoming pregnant and gave up the wish for biological motherhood one year following surrogacy. Adjustment to parenthood issues, such as the concern regarding the child’s health and development or feeling overwhelmed by the tasks and responsibilities, did not decrease among intended parents in the years following surrogacy and birth. Interestingly, only some of the intended parents experienced social stigmatization, and intended mothers generally perceived social attitude changes favoring surrogacy.

7. Technological Advancements in Surrogacy

Advancements in fertility technology, including gestational surrogacy, donor eggs and sperm, and pre-implantation genetic testing, have resulted in the birth of more genetically related children to parents who would not otherwise be able to conceive. As ARTs have become more available, a sub-industry of agencies and attorneys specializing in assisted reproduction has emerged. New technologies, such as the ability to freeze eggs and embryos, have created ways to establish and expand families. Eggs can be harvested from women in their 20s and frozen, either until later on when the woman’s own fertility wanes or donated to infertile women in their mid-40s. Moreover, although frozen embryos typically survive the thaw about 60 to 75 percent of the time, embryos can be tested before they are thawed or transferred to the uterus. Using a new method, embryos can be screened for aneuploidy and chromosomal abnormalities. If successful, only embryos with the correct number of chromosomes would be thawed for implantation. As one of 37 frozen embryos from the same donor, 25-celled “blastocyst” embryo #5019824 became “Brianna,” a healthy female born in December 2008. (Katagiri & Tamaki, 2021)

Many believe that the rapid evolution of fertility technology in surrogacy will continue. This belief is driven by a desire to establish and expand families as much as technology will allow. In light of ARTs now considered “traditional,” families in a post-modern society will no longer be limited to domestic adoption or a child of one’s own. Parents 70 years past menopause will bear genetically related children, and families of five genetically different children with clones as siblings could also be established. With this capacity for new family formation comes the blessing and burden of exponentially more snowflakes—cryopreserved and dispositioned embryos of donated eggs and sperm. (Piersanti et al., 2021)

In light of the proliferation of new ARTs, questions arise about the nature of becoming a parent and having a family. Would the frozen embryos of “Brianna”’s parents still want to have children if the implantation failed or she was not born? Would it matter if frozen embryos were thawed, tested, and later destroyed under a process? Would it matter if a mere cell from “Brianna” were taken and multiplied into dozens of humans born in a single day? Would it matter if she were cloned? With the advent of these technologies also come moral and ethical concerns. Would the family that one envisioned having remain the same if these ARTs became available?

8. Future Trends and Ethical Dilemmas

As reproductive technology continues to advance, potential changes and developments may alter the role of surrogacy and the surrogate itself in the reproductive family. One possibility is changing the traditional model of surrogacy or the jobs the surrogate undertakes, mainly through the use of new technologies. Humanity may have the ability in the future to grow babies in an artificial womb for either the detriment or benefit of society. Women may no longer be required to carry fetuses for nine months in their wombs, as an outside chamber may allow the laws of nature to be circumvented. Such development would allow for women assisting with reproduction by holding either the sperm or egg donor role only. This prospect may cause a largely negative impact on the future ability of women to give birth naturally and alter the very essence of gender roles.

Surrogacy and assistance in reproduction through a female role may become more acceptable to make female birth easier, with much less harm done to the body. One would only need to inject hormones; eggs may be taken out and fertilized in a lab, and then soon a family could be made, although not necessarily the natural way. There has always been resistance towards couples or individuals characterizing reproduction in anything other than this unnatural way, although with technology becoming more sophisticated, so do the means of reproduction. How this may affect society remains to be seen, but surely there will be great ethical dilemmas about what role surrogacy plays in the modern world and the acceptance of egg cell fertilization only as the criteria for having offspring. (Joslin, 2021)

Another possible approach to this subject matter would be to take a closer look, with current focus and interest being on inclusivity and same-sex couples who want to reproduce their own kind. While for many this issue is solved through adoption and they do not need to worry about this topic, it still affects a large portion of the population, especially open-minded, western progressive countries where it is becoming a common sight. The biggest problem is still reproduction when neither male nor female is able to produce a viable egg or sperm cell, regardless of how they would go about it. Although this kind of natural reproduction is impossible, there is a greater possibility of egg cells becoming fertilized, leading either to spin-offs or reproduction. Being forced to turn to third parties and crossing genetic boundaries is always a moral dilemma that opens itself to questionability.

9. Conclusion and Recommendations

The conclusion summarises the aims and methods of the study, briefly discusses major findings, and outlines recommendations for future research. Surrogacy is a common form of ART where a third party provides their uterus and, in many cases, their eggs for the conception of a child. With surrogacy, a woman can conceive a child with no connection to her own gametes or womb. Surrogacy is not exempt from the psychosocial and emotional considerations present with traditional ART processes such as oocyte and sperm donation. This study explores the impact of surrogacy on society, with a focus on previous research investigating the psychosocial and emotional implications for the parties involved. Additionally, future perspectives of surrogacy and ART more generally are discussed. Surrogacy is a common form of ART where a woman with childbearing difficulties, or an individual or a couple who wish to conceive a child without any connection to her own gametes or womb, engage a third party, called a surrogate mother, to provide her uterus for the gestation of the conceived child. Surrogacy is a complex, emotionally, socially, and legally charged pregnancy. Connecting to the womb during pregnancy, and giving birth, eventually puts the surrogate mother in a maternal position, which results in emotional attachment to the child and post-pregnancy separation anxiety. With the consideration of the child’s well-being, research about the impact of surrogacy on society, with a focus on the psychosocial and emotional implications for the parties involved, particularly the surrogate mothers, is warranted. Surrogacy is a sensitive issue and poses several ethical and moral questions. Concerns for the welfare of the child include multiple births, congenital defects, low birth weight, premature delivery, and other potential maternal and neonatal complications and treatment of the child as a commodity. The general belief is that a woman should genetically and/or gestationally conceive with the child or vice versa. Surrogate mothers are at risk for anxiety, stress disorder, depression, and other psychosocial concerns. Existing studies on opinions towards surrogacy are limited in scope and commonly undertaken in Western societies. Researchers, practitioners, and legislators should be aware of these concerns when contemplating offering surrogacy as an ART option.

References:

Farooqi, M.A., Rizvi, A. and Khan, A.R., 2022. Exploring the Legality and Socio-Cultural Challenges of Surrogacy: An Islamic Bioethical Perspective. Pakistan Languages and Humanities Review, 6(2), pp.1302-1313. plhr.org.pk

Suneja, C., 2022. Printed and Bound: the Publishers' Case Binding and 19th-century Women's Critique of Marriage. uwm.edu

Shepherd, D., 2021. Working Class Women's Agency in the Labour Movement in East London, 1840–1914. herts.ac.uk

Whittaker, A., 2021. 16 Surrogacy. The Routledge Handbook of Anthropology and Reproduction. [HTML]

Sharma, E., Malhotra, I., & Gandotra, A., 2024. Navigating Motherhood through Surrogacy: Biological Citizenship and Maternal Agency in Meera Syal's The House of Hidden Mothers (2015). South Asian Review. [HTML]

Deonandan, R., 2020. Thoughts on the ethics of gestational surrogacy: perspectives from religions, Western liberalism, and comparisons with adoption. Journal of assisted reproduction and genetics. nih.gov

Brandão, P. & Garrido, N., 2023. Commercial surrogacy: an overview. Revista Brasileira de ginecologia e obstetrícia. scielo.br

Gunnarsson Payne, J., Korolczuk, E. and Mezinska, S., 2020. Surrogacy relationships: a critical interpretative review. Upsala journal of medical sciences, 125(2), pp.183-191. tandfonline.com

Ellenbogen, A., Feldberg, D. and Lokshin, V., 2021. Surrogacy: A worldwide demand. Implementation and ethical considerations. Gynecol Reprod Endocrinol Metab, 2, pp.66-73. researchgate.net

Romanis, E. C., 2022. Assisted gestative technologies. Journal of Medical Ethics. bmj.com

da Silva Junior, A.L., Fortuna Pontes, M. and Uziel, A.P., 2023. Assisted reproduction technologies and reproductive justice in the production of parenthood and origin: Uses and meanings of the co‐produced gestation and the surrogacy in Brazil. Developing World Bioethics, 23(2), pp.122-137. [HTML]

Frati, P., La Russa, R., Santurro, A., Fineschi, B., Di Paolo, M., Scopetti, M., Turillazzi, E. and Fineschi, V., 2021. Bioethical issues and legal frameworks of surrogacy: A global perspective about the right to health and dignity. European Journal of Obstetrics & Gynecology and Reproductive Biology, 258, pp.1-8. [HTML]

Piersanti, V., Consalvo, F., Signore, F., Del Rio, A., & Zaami, S., 2021. Surrogacy and “procreative tourism”. What does the future hold from the ethical and legal perspectives?. Medicina. mdpi.com

Katagiri, Y. & Tamaki, Y., 2021. Genetic counseling prior to assisted reproductive technology. Reproductive Medicine and Biology. wiley.com

Joslin, C. G., 2021. (Not) just surrogacy. Cal. L. Rev.. [HTML]