The Politics of Women's Health

Surrogacy and Gestational Care

The idea of one woman carrying a baby for another dates back at least as far as the biblical story of Sarah and Hagar.  This arrangement, known as “surrogacy,” was practiced informally and through legal contractual arrangements over the years. Surrogacy became more common in the aftermath of Roe v. Wade, which legalized abortion in the United States in 1973. As fewer healthy white newborns were available for adoption, some infertile couples turned to other women -- surrogates -- to carry babies for them. However, surrogacy, as it was practiced at that time, was fraught with ethical and legal dilemmas, since it meant that a woman was entering into a pre-conception adoption arrangement.

The arrival of in vitro fertilization (IVF) in 1978 transformed surrogacy into what is now known as gestational carrier pregnancies or, sometimes, gestational care.  With gestational care, IVF is used to create an embryo with the egg of one woman and the sperm of the husband, partner or sperm donor. The embryo is then implanted into the uterus of a second woman, who then gestates and gives birth to a child with whom she has no genetic connection.

There are few benefits to having a family member or friend carry a baby, unlike with egg donation, in which a sister’s donation enables the recipient sister to have a genetic connection to her child. Also, few people seeking a gestational carrier have a ready, willing, and able volunteer. Therefore, most arrangements occur between strangers.  Prospective parents and potential gestational carriers meet through websites, lawyers, and agencies that advertise for and recruit women. Typically, agencies require that gestational carriers already be mothers ourselves, have stable, healthy lifestyles, be medically and emotionally healthy, and be financially stable. Women who choose to carry a baby are generally paid between $15,000 and $25,000 in addition to having all medical costs covered.

Any pregnancy carries with it certain medical risks. Because IVF often involves the transfer of two or more embryos, it frequently carries the additional risks that come from carrying multiples. 

The practice of gestational care raises many questions: Should women be encouraged or permitted to carry children for other women? If so, under what circumstances?  Should a woman carry for her sister or a friend? If she offers to do so, does this offer come free and clear or does she feel some pressure—overt or covert—to assist a loved one? What does it mean if poorer women are gestational carriers for richer women? What does it say about our culture that many of us so deeply desire having a biological child?

The following two articles explore the realities and ethical questions raised by new reproductive technologies. In Making Babies: Ideals, Technology and Politics writer Sarah Buttonwieser turns a critical eye on the celebratory mothers who engage surrogates, while Gestational Care: Another Perspective looks at the experiences of women who choose to become gestational carriers.

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