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Experience and psychological well-being of surrogates

Vasanti Jadva surrogacy
In the UK, there are 2 types of surrogacy that are practiced. And the way to distinguish between them is whether or not the surrogate uses her egg. So you would have traditional surrogacy that it is sometimes called, there are other terms used as well. In traditional surrogacy it is the surrogate’s egg that is used. And in gestational surrogacy it is usually the intending parent’s gametes although it could be a donor egg or donor sperm as well. So we have been carrying out a number of different studies at the centre. And we have been looking at the experiences of the surrogates and also of the intended parents to have the child through surrogacy.
In terms of the study of intended parents we’ve actually been following up the children now from when they were 1 till the age of 14. So we followed them up from quite some time now. In terms of our research on surrogates we’ve actually been doing a longitudinal study of surrogates. We first saw the surrogates a year after the birth of the surrogacy child. And we then followed them up 10 years afterwards. And we are interested in their psychological well-being, whether or not they are in contact with the intended parents and the surrogacy child. And we are also interested in whether or not they’ve done any subsequent surrogacy pregnancies and whether or not that was any different.
In terms of the psychological well-being of surrogates we’ve actually found that the psychological well-being of surrogates is absolutely fine. They have no problems 10 years after the births. And we also find that is regardless of whether or not they are traditional surrogates, so whether or not they use their egg, or whether they are gestational surrogates. So we find very few differences between these two types of surrogacy’s. In fact, one of the things we did find in the later study was that some women were doing both types of surrogacy. So whereas previously we had thought that women only did either traditional surrogacy or either gestational surrogacy, we actually found that some women did both.
In the UK surrogates can only help British intended parents. So they are unable to help foreign intended parents. So all the arrangements are in the UK. And actually that is quite important because what it means is that they have the opportunity to remain in quite close contact with the intended parents. And actually we did find that in some cases that was the case. So some intended parents and surrogates had formed very close relationships during the surrogacy, which are actually sustained over time. One of the things we did find is that surrogates tended to maintain different types of contact and different frequency of contact with the different intended parents that they had helped.
So, what appears to be happening is whether or not they are in contact depends upon the strength of the relationship that they form with different people rather than the surrogacy in and of itself. One of the things we found was that some surrogates were actually doing multiple surrogacy’s whereby they helped more than one couple. And this maybe because they’ve got to know other couples during the surrogacy and they are part of a surrogacy organization for example, and surrogates can do as many as 5, 6, maybe even 7 surrogacy pregnancies. And the other reason why that may be is because in the UK there is a perceived shortage of surrogates. There aren’t enough women coming forward to be surrogates.
So it is not really surprising therefore that the same women are doing them again and again. And in fact that may be leading some intended parents to go abroad for surrogacy. Unfortunately we don’t know the numbers of people going abroad. There is no exact figures available. And that is partly because people who go abroad may not always get the legal parentage by applying for a parental order. So there is no real record kept of how many pregnancies are happening in this way. We know much less about what happens when people go abroad for surrogacy. We know that surrogacy is practiced in different ways in different countries. Say for example if you are going to the U.S.
you will go through a surrogacy agency who will manage the entire process for you. This is in contrast to going somewhere, for example, like India where the relationship is with the clinic and it is the clinic that will manage the surrogacy for you. So for example, in the U.S. you will have a relationship with the surrogate if you wanted to and the surrogate can in some cases remain in contact with the intended parents. In India it is much less likely that the surrogate would even be in contact with the intended parents or would even meet the intended parents.
So where you go for surrogacy is likely to have an impact on not only the experience of the surrogacy itself but also for subsequent years as well, whether or not the child has information about the surrogate and whether or not the child will ever know who the surrogate was. We don’t know how important it is for children to know who their surrogate was. Certainly from our UK studies we found that for some children they do know who their surrogate is and in other cases they don’t. But that remains to be seen, we need more research really to find out what the experiences are for intended parents who do go abroad for surrogacy.
Because surrogacy is practiced so differently in different countries it is really important that research is carried out in these individual countries to see what surrogacy is like for the surrogates who are doing it. It is very possible that the experiences will be different for surrogates given that the practice of surrogacy and the legal framework around surrogacy does differ so widely. We know much less, for example, about the psychological well-being of surrogates in India. There have been only a handful of studies of surrogates in America for example. And we know much less about surrogates In other countries too.
So I think it is really important to do more research to find out what it is, and in what way does surrogacy impact on the individual women who are acting as surrogates in these countries. But currently we don’t know as much as we should do. There are a number of factors that might impact on how a surrogates experiences surrogacy and on her psychological well-being too. So for example support during pregnancy may be something that affects her psychological well-being, possibly seeing the child following the birth may also have a negative or positive impact on the surrogate. Other factors that might be important, obviously, her psychological well-being prior to the surrogacy.
And also possibly whether or not her expectations of surrogacy are fulfilled or not. In our sample of surrogates in the UK we found that most of them actually felt very positive about their experience of surrogacy. There were a few cases where they didn’t feel as positive. And that tended to be when their expectations weren’t met. So for example, if they had at the time of the surrogacy decided that they would maintain contact with the intended parents, but then contact had been stopped by the intended parents, that’s when they felt a little bit disappointed about the surrogacy outcome for them.

Dr Vasanti Jadva is a Cambridge psychologist, specialising in research examining the psychological well-being of parents and children in families created by IVF, egg donation, sperm donation and surrogacy.

In this interview, Dr Jadva first describes different types of surrogacies – traditional surrogacy, where the surrogate uses her own egg, and gestational surrogacy, where the surrogate is implanted with an embryo unrelated to her.

Dr Jadva then describes research done on the experiences of intending parents and surrogates. These are long-term follow-up studies, where it is possible to see the outcomes years after the event.

In terms of experiences, she discusses factors like attaining a Parental Order for the new-born (when a court assigns the legal parental responsibility for the child, to the exclusion of everyone else, including the surrogate), the role of surrogacy agencies, the impact of surrogate child knowing about the surrogate, and the challenge of repeat surrogacies.

In terms of psychological well-being, Dr Jadva found that surrogates usually do well psychologically, regardless of whether the surrogate child is genetically linked to the surrogate or not.

Finally, she elaborates on the structure and quality of the relationship between intended parents and the surrogates in the UK, USA and India, and emphasises the need for more research on experiences of surrogates and intended parents.

For your discussion: Imagine yourself in the role of the surrogate. What do you think would be the most difficult parts of the contract? What would you like to see put in place in order to make the situation better?

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