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McCoy DE, Haig D, Kotler J. Egg donation and gestational surrogacy: Pregnancy is riskier with an unrelated embryo. Early Hum Dev 2024; 196:106072. [PMID: 39106717 DOI: 10.1016/j.earlhumdev.2024.106072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 08/09/2024]
Abstract
Modern medicine has revolutionized family planning. Remarkably, women1 can carry to term embryos with whom they share no genetic connection, a feat made possible through egg donation and/or gestational surrogacy. Our reproductive systems evolved to accommodate embryos that are 50% related to the carrier, not 0% related. Here, we apply evolutionary theory to explain how and why pregnancy is riskier with an unrelated embryo. When a woman gestates an unrelated embryo, she is significantly more likely to develop preeclampsia and other diseases above and beyond the known risks associated with advanced maternal age, IVF, multiple gestation, and subfertility. Such "allogeneic pregnancies" are riskier even in fertile, healthy, commercial surrogates and when the egg is donated by a young, healthy donor. We propose that unrelated embryos present a special immune challenge to the gestational carrier, because they have fewer matching genes to the maternal body-therefore exacerbating symptoms of evolutionary maternal-fetal conflict. Indeed, maternal risks seem lower when the embryo is more related to the carrier, e.g., if a sister donates the egg. Finally, we discuss microchimerism in egg donation pregnancies, whereby wholly foreign cells pass from mother to embryo and vice-versa. We conclude with several medical proposals. First, egg donors and surrogates should be informed of the increased health risks they would face. In considerations of risk, these young, fertile women should not be compared to older, infertile women undergoing IVF; the proper comparison group is other young, fertile women. Second, contrary to some medical advice, perhaps genetically-related egg donors and surrogates should be preferred, all else equal. An immunological matching scheme, like what is used for organ transplants, could improve surrogate pregnancy outcomes. Third, more research is needed on microchimerism, sperm exposure, and the long-term impacts of allogeneic pregnancies on maternal and child health.
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Affiliation(s)
- Dakota E McCoy
- Department of Ecology and Evolution, The University of Chicago, Chicago, IL 60637, United States of America; Marine Biological Laboratory, Woods Hole, MA 02543, United States of America.
| | - David Haig
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02136, United States of America
| | - Jennifer Kotler
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02136, United States of America.
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2
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Attawet J, Alsharaydeh E, Brady M. Commercial surrogacy: Landscapes of empowerment or oppression explored through integrative review. Health Care Women Int 2024:1-19. [PMID: 38252790 DOI: 10.1080/07399332.2024.2303520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
The surge in demand for surrogacy treatments, combined with regulatory loopholes, has spurred the widespread adoption of global commercial surrogacy. This phenomenon poses potential risks to all involved parties, including surrogates and children, encompassing ethical, legal, physical, and psychological concerns. Although commercial surrogacy is under discussion in various jurisdictions, some countries may reintroduce legislation on the matter. In addressing this intricate landscape, the researchers performed an integrative review of existing literature with the intention of providing guidance to researchers and policymakers. The researchers emphasized notable legal and ethical challenges linked to commercial surrogacy. Surrogates often experience disempowerment and oppression, exacerbated by the contractual nature of these arrangements, perpetuating structural inequalities. Children born through commercial surrogacy, especially internationally, risk losing cultural heritage and future benefits. Banning commercial surrogacy may drive it underground, harming surrogates. Reconsidering prohibitions without penalizing surrogates could mitigate downstream issues and safeguard them from exploitation.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, Charles Darwin University, Sydney, New South Wales, Australia
- Charles Darwin Centre for Evidence-Based Practice: A JBI Affiliated Group, Darwin, Northern Territory, Australia
| | - Ethar Alsharaydeh
- Faculty of Health, Charles Darwin University, Sydney, New South Wales, Australia
| | - Mark Brady
- School of Law, Faculty of Arts and Society, Charles Darwin University, Casuarina, Northern Territory, Australia
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3
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Brandão P, Garrido N. Commercial Surrogacy: An Overview. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:1141-1158. [PMID: 36580941 PMCID: PMC9800153 DOI: 10.1055/s-0042-1759774] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide. METHODS This is a review of the literature published in the 21st century on commercial surrogacy. RESULTS A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers. CONCLUSION Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Nicolás Garrido
- University of Valencia, Valencia, Spain
- IVI Foundation, Valencia, Spain
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4
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Attawet J, Wang A, Sullivan E. 'Womb for work' experiences of Thai women and gestational surrogacy practice in Thailand. HUM FERTIL 2022; 25:912-923. [PMID: 34162302 DOI: 10.1080/14647273.2021.1937716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Risks to gestational surrogates became a concern for public health. In commercial gestational surrogacy arrangements, gestational surrogates are commonly recruited from low- to middle-income countries. Thailand is well known as a surrogacy hub in this regard. However, little is known concerning Thai surrogacy practice and the risks that Thai gestational surrogates experiences. The semi-structured interviews with fifteen Thai women who had been gestational surrogates were conducted over the telephone in Thai between March and May 2020 and lasted approximately 30 minutes. Thematic analysis was applied to analyse the translated interviews. The findings indicated that 'womb for work' was perceived as a surrogacy career among Thai women. 'Womb for work' was defined as a superordinate theme that consisted of three subthemes: (i) gestational surrogacy arrangements in Thailand; (ii) the business model of gestational surrogacy arrangements in Thailand; and (iii) risk experiences of gestational surrogates. Clear deficiencies in surrogacy practice and regulations were identified, which put gestational surrogates at risk, including those associated with embryo transfer, transnational gestational surrogacy, and unsupported pregnancies. This study shows the urgent need to introduce regulations to protect women's health transnationally in this domain more effectively.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Elizabeth Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.,College Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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5
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Attawet J. The nexus between self-perception and behavioural responses of gestational surrogates' risk experiences. HUM FERTIL 2021; 25:562-568. [PMID: 33412959 DOI: 10.1080/14647273.2020.1870171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite associated risk and public concern, commercial surrogacy remains a thriving business, and opportunities for gestational surrogates continue to exist. Surrogacy arrangements have been found to place gestational surrogates at risk, with little support or guidance to help them understand or mitigate these risk factors. This study aims to investigate the self-perception of gestational surrogates through their reflection of their own risk-related behaviours throughout the surrogacy process. Data were retrieved through interviews with fifteen Thai women who had first-hand experience of commercial surrogacy, and thematic analysis was used to interpret the data. Findings showed that the perceptions of 'trust,' 'commitment to obligation,' and 'unacceptable actions' reflected their behaviours exposing risks to detrimental behaviours, disempowerment, and isolation. Understanding these perceptions would be advantageous for health planning programmes or policies in surrogacy practice to promote women's heath as a whole.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
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6
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Rozée V, Unisa S, de La Rochebrochard E. The social paradoxes of commercial surrogacy in developing countries: India before the new law of 2018. BMC WOMENS HEALTH 2020; 20:234. [PMID: 33059640 PMCID: PMC7559454 DOI: 10.1186/s12905-020-01087-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 09/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Commercial surrogacy is a highly controversial issue that leads to heated debates in the feminist literature, especially when surrogacy takes place in developing countries and when it is performed by local women for wealthy international individuals. The objective of this article is to confront common assumptions with the narratives and experiences described by Indian surrogates themselves. METHODS This qualitative study included 33 surrogates interviewed in India (Mumbai, Chennai and New Delhi) who were at different stages of the surrogacy process. They were recruited through five clinics and agencies. This 2-year field study was conducted before the 2018 surrogacy law. RESULTS Surrogates met the criteria fixed by the national guidelines in terms of age and marital and family situation. The commitment to surrogacy had generally been decided with the husband. Its aim was above all to improve the socioeconomic condition of the family. Women described surrogacy as offering better conditions than their previous paid activity. They had clear views on the child and their work. However, they declared that they faced difficulties and social condemnation as surrogacy is associated with extra-marital relationships. They also described a medical process in which they had no autonomy although they did not express complaints. Overall, surrogates did not portray themselves as vulnerable women and victims, but rather as mothers and spouses taking control of their destiny. CONCLUSIONS The reality of surrogacy in India embraces antagonistic features that we analyze in this paper as "paradoxes". First, while women have become surrogates in response to gender constraints as mothers and wives, yet in so doing they have gone against gender norms. Secondly, while surrogacy was socially perceived as dirty work undertaken in order to survive, surrogates used surrogacy as a means to upward mobility for themselves and their children. Finally, while surrogacy was organized to counteract accusations of exploitation, surrogates were under constant domination by the medical system and had no decision-making power in the surrogacy process. This echoes their daily life as women. Although the Indian legal framework has changed, surrogacy still challenges gender norms, particularly in other developing countries where the practice is emerging.
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Affiliation(s)
- Virginie Rozée
- Institut National d'Etudes Démographiques (INED), 9 cours des Humanités, F-93300 Aubervilliers, Paris, France.
| | - Sayeed Unisa
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (INED), 9 cours des Humanités, F-93300 Aubervilliers, Paris, France.,CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
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7
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Attawet J, Wang AY, Farquhar CM, Jordan V, Li Z, Sullivan EA. Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis. HUM FERTIL 2020; 25:217-227. [PMID: 32609023 DOI: 10.1080/14647273.2020.1785643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06-1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10-1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58-69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Cindy M Farquhar
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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8
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Golboni F, Jalali A, Dinmohammadi M, Taghizadeh Z, Nouri P, Salahsoor MR. Iranian model of decision making to use surrogacy: A grounded theory Study. Health Care Women Int 2020; 41:853-865. [PMID: 32357079 DOI: 10.1080/07399332.2020.1758107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Identifying the process of making the decision to use a surrogate mother can create a broad knowledge of this concept. In this grounded theory study, participants were selected through snowball sampling method and obtaining an informed consent, in-depth interviews were conducted face to face and recorded. Then, all the interviews, field notes, and memos were analyzed using Strauss-Corbin 1998 method. Analysis of the statements of the participants boiled down to 487 initial codes, 311 codes, 14 subcategories, and six categories. In the conceptual model of this process, "the hope to have a child" was an influential concept that interacted with other concepts.
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Affiliation(s)
- Farzaneh Golboni
- Dept. of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Jalali
- Substance Abuse Prevention research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadreza Dinmohammadi
- Dept. of Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ziba Taghizadeh
- Dept. of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Parichehr Nouri
- Dept. of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Reza Salahsoor
- Dept. of Anatomy, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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9
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Swanson K, Ayala NK, Barnes RB, Desai N, Miller M, Yee LM. Understanding gestational surrogacy in the United States: a primer for obstetricians and gynecologists. Am J Obstet Gynecol 2020; 222:330-337. [PMID: 31982386 DOI: 10.1016/j.ajog.2020.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/19/2022]
Abstract
As gestational surrogacy (a process by which intended parents contract with a woman to carry a fetus that the intended parents will raise) increases across the United States, it is imperative that obstetrician/gynecologists understand the unique nuances of caring for patients who are gestational surrogates. Gestational surrogacy offers a route to parenthood for individuals and families who may otherwise have limited options. Understanding surrogacy requires multiple ethical considerations about the potential medical and psychosocial effects on gestational surrogates as well as the families built through surrogacy. There is a dearth of research on the subject, particularly in the United States and other countries that practice compensated surrogacy. Here we seek to review the process of gestational surrogacy in the United States, including the legal landscape, current trends in gestational surrogacy use, and what is known about the medical and social effects of this process on all participants. We also aim to highlight the limitations of available data and to identify topics for future research to provide optimal evidence-based and just care for these patients.
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Affiliation(s)
- Kate Swanson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California San Francisco, San Francisco, CA.
| | - Nina K Ayala
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Brown University, Providence, RI
| | - Randall B Barnes
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology & Infertility, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nidhi Desai
- Desai & Miller Adoption and Reproductive Technology Law, Chicago, IL
| | - Marcy Miller
- Desai & Miller Adoption and Reproductive Technology Law, Chicago, IL
| | - Lynn M Yee
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Rozée V, Unisa S, de La Rochebrochard E. Sociodemographic characteristics of 96 Indian surrogates: Are they disadvantaged compared with the general population? PLoS One 2019; 14:e0214097. [PMID: 30908500 PMCID: PMC6433248 DOI: 10.1371/journal.pone.0214097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/06/2019] [Indexed: 11/18/2022] Open
Abstract
Commercial surrogacy in emerging countries such as India is often associated with exploitation of vulnerable women, the assumption being that it is performed by poor and uneducated women for rich intended parents. However, the hypothesis that surrogates are poor women has rarely been confronted with field data. The objective was to compare the socioeconomic characteristics of Indian surrogates interviewed in social studies with those of Indian women in the general population in order to provide preliminary data on whether surrogates have a specific profile and are indeed disadvantaged compared with their counterparts. The study analyzes the data from four cross-sectional studies carried out in India among surrogates between 2006 and 2014. Surrogates were recruited through clinics, agencies and agents. Data were collected during face-to-face interviews. The resulting convenience sample included 96 Indian surrogates. Their sociodemographic characteristics were compared with those of the general population extracted from Indian national surveys. The surrogates interviewed had their first child at a younger age than women in the general population, but they tended to have a smaller family. Their social situation tended to be better than that of the general population in terms of education, employment and family income. These results provide first empirical evidence moderating the common assumption that Indian surrogates are the poorest and least educated women. This does not mean, however, that exploitation does not exist. More studies are needed to confirm these results and to explore the issue in new international destinations for surrogacy.
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Affiliation(s)
- Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
| | - Sayeed Unisa
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Kremlin-Bicêtre, France
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11
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Carr SV. Surrogacy and ethics in women with cancer. Best Pract Res Clin Obstet Gynaecol 2018; 55:117-127. [PMID: 30553717 DOI: 10.1016/j.bpobgyn.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
Women diagnosed with gynaecological cancer may face unwanted loss of fertility as well as all the other life-changing issues with which cancer and its treatments are associated. The decision to harvest and store gametes has to be made before commencement of treatment, and advances in these techniques have made this successful. Fertility sparing therefore must be discussed and offered at an early stage post diagnosis. Surrogacy is currently an evidence-based method of assisted reproduction, with mainly desirable outcomes for the commissioning mother, surrogate and child, without impacting on the cancer treatment and long-term survival. Surrogacy is therefore ethical as long as the autonomous rights of both the commissioning mother and gestational carrier are equally observed, they both have equal legal protection and due attention is paid to the short- and long-term welfare of any resulting offspring.
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Affiliation(s)
- Susan V Carr
- Faculty of Medicine, University of Melbourne, Parkville, Australia.
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13
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Abstract
This review analyzes the emerging literature on reproductive tourism through a metaphorical “reproscope,” focusing largely on cross-border egg donation and surrogacy as the prime areas of contemporary anthropological investigation. While acknowledging that reproductive travel is not new, this article recognizes that there has been an increased volume of such travel over the past couple of decades. It provides an overview of the major areas of anthropological investigation into these transnational phenomena, globalization, stratification, exploitation, race, nationalism, religion, biopower, and bioethics. I propose that these areas of investigation may provide key indications about the preoccupations of anthropology today. Namely, what kind of discipline does anthropology imagine itself to be?
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Affiliation(s)
- Michal Rachel Nahman
- Department of Health and Social Sciences, University of the West of England, Bristol, Frenchay Campus, Bristol, BS16 1QY, United Kingdom
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14
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Reddy S, Patel T. “There are many eggs in my body”: medical markets and commodified bodies in India. Glob Bioeth 2015. [DOI: 10.1080/11287462.2015.1112625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Arvidsson A, Johnsdotter S, Essén B. Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy. PLoS One 2015; 10:e0126518. [PMID: 25955178 PMCID: PMC4425515 DOI: 10.1371/journal.pone.0126518] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/03/2015] [Indexed: 11/19/2022] Open
Abstract
Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.
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Affiliation(s)
- Anna Arvidsson
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Sara Johnsdotter
- Department of Health and Welfare Studies, Malmö University, Malmö, Sweden
| | - Birgitta Essén
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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Essén B, Johnsdotter S. Transnational surrogacy - reproductive rights for whom? Acta Obstet Gynecol Scand 2015; 94:449-50. [DOI: 10.1111/aogs.12636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Birgitta Essén
- International Maternal and Child Health; Department of Women's and Children's Health/IMCH; Uppsala University; Uppsala Sweden
| | - Sara Johnsdotter
- Medical Anthropology; Faculty of Health and Society; Malmö University; Malmö Sweden
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