IN THE WANING WEEKS OF my third pregnancy, when my shape even under billowy summer dresses served as a telltale sign of my condition, I could no longer run into an acquaintance, colleague, or student without having an exchange that would go something like this:
“Wow, Grace [or Dr. Kao]—I didn’t know you were expecting! When are you due?”
“Congrats! Do you know what you’re having?”
“Thanks! Yes, it’s a girl. But here’s the thing—I’m actually carrying my friends’ baby, not my own.”
The eyes of whomever I was talking to would usually then widen with shock. After all, I was forty years old at that time and a married, middle-class Taiwanese American tenured professor with two kids—hardly the stereotype of someone who bears children for others. How my conversation partners would then respond would vary.
Most would pay me some sort of compliment: “How generous of you!” “That’s amazing!” “What a gift!” Others would struggle to process what they’d just heard—“You mean you’re a surrogate?” Through their indirect questions, I could tell most were also curious whether the baby was genetically mine or how my unusual arrangement with my friends even came to be.
Many of my women interlocutors would first register surprise like the others and then imaginatively place themselves in a parallel situation. They would blurt out “Wow, I could never do that” before narrating how difficult their pregnancy, labor and delivery, or postpartum experiences had been or why they couldn’t imagine undergoing all that it takes to bring a child into the world for someone else.
Through these exchanges, I even came to learn something I hadn’t known previously—how surrogacy had been a live option for others. Four women took the occasion of my pregnancy to disclose to me that they, too, had once contemplated carrying a child for a loved one, but ultimately didn’t go through with it for one reason or another. Two others reacted in a way suggesting they had at least considered surrogacy in their long road to parenthood. A good friend with a school-aged child and a sad history of miscarriages reacted to my news in partial jest: “Grace, I didn’t know you were available!” One of my oldest son’s coaches exclaimed “Why couldn’t we have met four years ago when we needed you?” before recounting the ordeal his wife and he had endured of several rounds of in vitro fertilization (IVF) and several miscarriages before adopting their daughter overseas.
My visibly pregnant body and one-sentence mention of my carrying a baby for my friends had been enough to induct me into a society I had scarcely known existed. It was a world where fertility problems were freely told and shared and where people found themselves strangely moved—even flooded with tears—upon hearing scant details about our story. Years later while researching this book, I came to understand that these reactions were par for the course. In the words of Elizabeth Kane, America’s first contractually paid surrogate mother: “Infertility isn’t exactly cocktail party talk, but as soon as anyone finds out the details of my pregnancy, they feel free to tell me the most intimate . . . details of their lives.”
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I know from personal experience and my work as an ethicist that surrogacy as a way of bringing children into the world is not something the public feels indifferent about. Some people marvel at what modern medicine makes possible while others are aghast at this use of science to “play God.” Some people lavish praise on persons like me who become pregnant for others out of a desire to help them while other people feel pity and revulsion for anyone who would perform such metaphorical and literal labor for money. Some people sympathize with couples who cannot bear children of their own while others judge them for hiring surrogates to endure significant health risks on their behalf, when in those critics’ minds, such couples should “just adopt.”
While statistically the least common and most contested method of family expansion,\ surrogacy is nonetheless on the rise. Singles and couples who are involuntarily childless, facing secondary infertility (i.e., they cannot become pregnant or carry to term after previously giving birth), or in a same-sex relationship are increasingly commissioning others to bear children for them while many nations across the world are clamping down on the practice. But what explains this escalating usage and why are opponents agitating for tougher regulations or even total prohibitions on what critics have derisively called “outsourcing” pregnancy? How do surrogates like me actually feel about birthing babies for others and how do they and the children they bear ultimately fare?
With My Body, Their Baby, I help readers sort through these and other questions while advancing the moral permissibility—even moral good—of this reproductive technique when conducted under certain parameters. I intersperse reflections on the time I spent carrying and delivering a child for my friends, Katie and Steven, with the research amassed on other families expanded by “collaborative reproduction” to offer readers something more than an academic treatise on a contested topic. In the following pages, I offer my firsthand account and scholarly assessment of surrogate motherhood for anyone who has ever struggled with infertility, pondered what it would be like to hand over a baby to someone else to raise, or attempted to sort out the moral parameters of this “brave new world” of reproductive medicine.
As someone who identifies as a feminist and progressive Christian, I have also written My Body, Their Baby in a way that especially engages those who are feminist but not necessarily Christian, those who are Christian but not necessarily feminist, and those who, like me, claim both sets of identities and commitments.
Feminists have long been divided on surrogacy. Some welcome it and other assisted reproductive technology (ART) for allowing individuals to exert more control over their own fertility and thus exercise greater bodily autonomy. Others oppose the practice for exploiting, commodifying, and objectifying women’s bodies and/or children: they liken paying women to bear children for others to reproductive prostitution, human trafficking, or both. Some feminists also worry about surrogacy’s implications for the abortion debate and potential to exacerbate tensions between and among persons of different races or social classes. Other feminists believe these dangers to be exaggerated and resent the paternalism they detect in critics’ assumptions that women cannot—or should not—be trusted to make their own informed decisions about their own reproductive lives, be it to terminate a pregnancy or to undertake one for someone else. What is clearly in dispute is whether surrogacy as a social practice is good or bad for women (and others capable of pregnancy) overall and is therein compatible with, or contrary to, the central aims of the feminist movement.
Christians likewise do not hold one unified position on surrogacy, just as they differ among themselves on many other social issues. Catholics in conformity with the Magisterium, the teaching authority of the Catholic Church, condemn all practices separating the unitive from the procreative ends of marriage (i.e., that detach sex from reproduction) in contravention of the natural law. Many conservative evangelical Protestants and Orthodox Christians appeal more to the Bible than to reason or nature to ground similar protests against surrogacy for the all-too-common destruction of embryos during the IVF process typically involved and for deviating too far from their understanding of the biblical ideal of a heterosexual married couple bearing children together as the fruit of conjugal love. Progressive mainline Protestants, however, generally respond more favorably to advancements in reproductive medicine for providing an additional pathway beyond adoption for infertile married couples to still realize one of the three traditional goods of marriage: offspring (bonum prolis). To wit: several mainline Protestant denominations, including my ecclesial home—the Presbyterian Church (U.S.A.)—have endorsed the responsible use of IVF and other ART while urging caution and further study on surrogacy.
The central argument of My Body, Their Baby is that surrogacy need not betray core feminist or progressive Christian ideals when pursued under certain conditions. Against opponents of ART who extol the moral superiority of adoption or lament surrogacy’s division of motherhood into its component parts, I show how collaborative reproduction can be an ethically justified way of bringing children into the world if the members of any arrangement proceed justly with great care. But beyond simply parrying popular objections, I offer a positive vision where surrogacy could be a thing of beauty and advance certain commitments progressive Christians already profess as holding, including a view of children as a traditional good or end of marriage for those who have discerned a vocation to parenthood, the removal of barriers for same-sex couples to head families as per the logic of “marriage equality,” and respect for the conscientious decisions persons capable of pregnancy make about reproductive matters affecting their own bodies and families.
As a work of Christian ethics, this book offers a positive vision and framework of seven principles for surrogacy to protect the well-being of all members involved that are grounded upon the four traditional sources of Christian ethics: Scripture, tradition, reason or secular sources of knowledge, and experience. More specifically, my account builds upon selected biblical themes and concepts, including covenant, vocation, and fidelity, and from traditions of progressive Christianity, including several mainline Protestant denominational positions on sex, marriage, family, and science and technology. The reason or secular sources of knowledge I turn to include international human rights; professional medical societies’ ethics committee opinions on assisted reproduction; and the reproductive justice framework which was founded by Black activists in the mid-1990s and developed further by a broader coalition of women of color when they judged the reigning “pro-choice” platform insufficiently attentive to their realities. Finally, the experiences I draw upon include my having jointly brought a baby girl to life with my friends and the reproductive journeys of other “surrogacy triads” as documented in the ethnographic and social scientific literature: other persons who have become pregnant for others, other parents who have opted for this method of ART after considering all possible avenues to parenthood, and the surrogate-born children themselves.
This fourth source of moral wisdom—experience—is a connecting point between Christian ethics and feminist methodology. I argue for certain kinds of lived experiences, namely those of former surrogates like me and of others who have had at least one pregnancy resulting in a live birth (a common prerequisite for surrogate motherhood), to be regarded as “epistemically transformative” and thus carry greater normative weight in applied ethical debates involving pregnancy, including any pregnancies undertaken for others. The point in surfacing my and other surrogates’ experiences as studied in the social scientific research is to call upon anyone ambivalent about or opposed to the practice to actually listen to the stories of those who have entered into these reproductive agreements with others. I also mine the perspectives of persons not always at the forefront of discussions about family formation—same-sex couples—with an eye for showing why surrogacy for an increasing number is their first choice (in contrast to it nearly always being the last resort for infertile heterosexual couples) and how queer families have always had to involve someone outside of their marriage or committed partnership to become parents: a known or unidentified gamete donor, a surrogate, or a birth mother in an adoption scenario. It is my hope the witness of queer families will give readers a more expansive—and thus accurate—understanding of surrogacy while simultaneously being of special interest to all couples exploring alternative paths to parenthood when natural conception is foreclosed to them. May my friends’ and my experiences and those of others disrupt persistent myths about the practice, including widespread fears that any given surrogate’s post-birth handover of the child will be emotionally distressing because all pregnant women via the maternal instinct will have grown attached to the life developing inside of them.
Today, many persons among the general public beyond self-identified feminists or Christians are grappling with what to make of the social practice of prospective parents commissioning a third party to bear their child. When I ask my students what comes to mind when they think of surrogacy, just as many rattle off celebrities who have proudly announced the birth of their surrogate-born babies—singer Elton John! model Tyra Banks! actress Nicole Kidman! reality TV star Kim Kardashian! broadcast journalist Anderson Cooper!—as they describe dystopian nightmares of an underclass of “breeders” gestating the offspring of the elite, such as in novelist Margaret Atwood’s The Handmaid’s Tale (1985) and the book’s adaptation into an award-winning TV show on a popular streaming service. Decades ago in the 1980s, the public struggled with the then-new reality of “test-tube babies,” though in vitro fertilization has long since been medically, if not socially, normalized in many quarters as the estimated eight million people in the world born through IVF since the first IVF-conceived baby, Louise Joy Brown, was born on July 25, 1978, in Great Britain attests. Will surrogacy, which requires IVF in the preponderance of cases, follow a similar trajectory of moving from widespread controversy to measured acceptance and increased usage? While that is an empirical question, the more pertinent one for ethics is whether it should. In My Body, Their Baby, I respond with a conditional “yes.”
The argument of my book proceeds in steps. To assist readers, I begin with a primer: I explain surrogacy’s logistics in chapter 1 while contextualizing my own surrogate motherhood in California against the wider landscape of surrogacy customs, trends, and laws across the globe. To clear the conceptual underbrush for my constructive vision and framework for the practice, I discuss in the next two chapters what about surrogacy most troubles three discrete but overlapping sets of commentators—feminists, Christians, and members of the general public—while also connecting their concerns to my loved ones’ reservations about my carrying and delivering my friends’ baby girl. I also fold in key findings from the scholarly literature on families expanded by collaborative reproduction so readers can better grasp what surrogacy is like and thus judge for themselves which of those fears are substantiated by the data—and which are not. Where relevant, I also compare surrogacy throughout this book to other morally laden social practices: I show how premeditatively birthing babies for others is both similar to and different from placing children for adoption, having an abortion, donating or selling body parts (namely, gametes, live organs, hair, blood, plasma, breastmilk), negotiating and signing a prenuptial agreement, or partaking in other labor involving physical and psychosocial risks, including sex work.
The constructive heart of My Body, Their Baby lies in the next section of the book. In chapter 4, I argue for the practice’s moral permissibility—and even beauty—when willing persons extend reproductive hospitality to couples who long for a child but lack a suitable uterus between them to birth one into the world. Because there are different types of surrogacy arrangements, I first clarify the conditions surrounding the type initially under consideration, including the surrogacy being gestational (not traditional), altruistic (not commercial), and intrastate (not cross-border). I spend the remainder of the chapter describing how the four traditional sources of Christian ethics bear upon my argument and then connect my vision with extant progressive Christian ideals. Finally, I provide in chapter 5 a framework of seven norms and principles to guide members of surrogacy triads in their discernment and relationships with one another and the general public in their posture toward the arrangements of others. These are (1) discernment without haste, (2) covenant before contract, (3) empathy, care, and stewardship, (4) medical self-determination, (5) disclosure, not secrecy, (6) “trust women,” and (7) social justice.
In my final chapter, I critically assess different kinds of surrogacies where not all of these simplifying conditions obtain, such as when there is financial payment above expenses (profit), the interaction of two or more sets of laws due to the surrogate and intended parents residing in different jurisdictions, and/or the involvement of a surrogate’s genetic (not just gestational) contribution. I then describe the challenges these more ethically and sometimes logistically complex arrangements raise before recommending ways to structure them to meet the moral baseline. Both in this chapter and in my opening primer, I seek to correct popular, but overly simplistic, characterizations about the practice, such as fears that surrogacy when racially understood is mostly a matter of white intended parents hiring women of color or from the Global South or that transnational surrogacy is mostly a matter of “reproductive tourists” looking to save money by traveling overseas to cheaper destinations.
Five disclaimers are now in order about how I will proceed in the remainder of the book.
First, when discussing a couple’s possible use of the sperm or eggs of an unknown genetic parent to create embryo(s) to be transferred into their surrogate, I will use the terminology of “non-identified” donation or “non-identified” donors. Though it is much more common for ordinary people to speak and write about “anonymous” sperm or egg donation and “anonymous” sperm or egg donors, several medical societies have encouraged this “transition in language” to reflect our emerging global reality of a decrease in anonymity. There has not only been a rise of direct-to-consumer DNA testing and their large ancestry databases exposing long-held family secrets, but also an uptick in bans on anonymous gamete donation across the world, including in one state in the U.S. starting in 2025—Colorado.
Second, I will commonly refer to persons who can undergo a pregnancy or donate eggs as “women,” follow convention in calling such persons gestational or genetic “mothers,” and use “she/her/hers” pronouns when describing them. I do so because at the time of this writing, there are no published cases of surrogates who have not identified as women and because popular and scholarly objections to surrogacy are often couched in the language of protecting vulnerable women and children from harm. Still, readers should know that some persons who can either become pregnant or donate their eggs (apart from surrogacy) do not identify as women but as men or transgender men and thus use different pronouns (he/him/his/they/their/theirs) and different referents (father or parent). Because there is wisdom in beginning to alter our gendered ways of thinking, talking, or writing about surrogates in advance of the reality of trans or nonbinary persons bearing children for others, I will also vary my usage and make references to pregnant persons (not just women) as well.
Third, I mostly write about intended parents (IPs) in the plural while acknowledging that a minority who commission others to bear their children are not coupled but single. I remember watching news coverage about Latin popstar Ricky Martin becoming a father for the first time to his surrogate-born twin boys while he was reportedly single. Someone my nephew looks up to, the soccer superstar Cristiano Ronaldo, also became a father for the first time to his surrogate-born son and years later to his surrogate-born twins while he was reportedly single before later having more children with his girlfriend. Still, my reference to plural, not singular, IPs is connected to the empirical reality that the majority of persons who turn to surrogates are romantically partnered with an intention to co-parent. It is also supported by my assumption in my progressive Christian vision and framework for surrogacy that the parents-to-be are in a marital or otherwise committed relationship.
Fourth, I will regard the terms “surrogate mother” or “surrogate” to mean anyone who agrees in advance to carry and deliver a baby for someone else to raise, regardless of their genetic relation (or lack thereof) to that child. I do so not only to follow social convention, but also because those who perform these maternal functions for others frequently self-identify as surrogates, surrogate mothers, or more colloquially as “surro-moms” or even “surros.” Still, readers should know that this terminology is contested in some quarters. As I will unpack further in chapter 2, some radical feminists criticize it for obfuscating exactly who is doing the substituting: they contend that a woman who gestates and births a child for someone else has done everything thus far a mother at that stage in the child’s life could have done, which is why she should be regarded as the real (not substitute) mother while the person who intends to raise the child thereafter should be viewed as the (true) surrogate. Without malice, persons in the medical community sometimes restrict “surrogate mother” to refer only to a “traditional surrogate”—a woman who is the gestational and genetic mother of a child intended for others. They thus use “gestational carrier” to describe a woman like me who has borne or will bear a genetically unrelated child for someone else. Others in the medical community might also call a woman or trans man in a queer couple who undergoes “reciprocal IVF” and gestates the resultant embryo formed by their partner’s oocytes and sperm (from a third party) a “gestational carrier” since, from a medical point of view, they must undergo the same IVF and heterologous embryo transfer process as gestational surrogates must to become pregnant. For the purposes of this book, however, I will not be considering them “surrogate mothers” because they would not be gestating a baby for someone else—they would be carrying and delivering a child for themselves (they and their spouse or partner) to raise in their newly expanded family.
Fifth and finally, my personal experience as a surrogate is inextricably connected to my friends’ (Katie and Steven’s) struggle to become first-time parents and my family of four’s ongoing relationships with their happy family of three. There are portions of our shared story, however, that I am not at liberty to tell. In the pages that follow, I narrate key moments of our journey as I have lived and reflected upon them without speaking for my friends. I also omit some details about our collaborative reproduction to preserve their and their child’s privacy as befitting a book entitled My Body, Their Baby.
1. Elizabeth Kane, Birth Mother: The Story of America’s First Legal Surrogate Mother (San Diego, CA: Harcourt Brace Jovanovich, 1988), 124.
2. Five surveys in the U.S. since the 1980s show “most people do not approve of surrogacy, finding it the least acceptable route” to parenthood. See Heather Jacobson, Labor of Love: Gestational Surrogacy and the Work of Making Babies (New Brunswick, NJ: Rutgers University Press, 2016), 46. While a 2015 YouGov poll found a majority approve of surrogacy (71%), 50% believe couples who cannot conceive a child on their own should adopt, and only 15% say they should use a surrogate. See Peter Moore, “Americans Want Biological Children but Prefer Adoption to Surrogacy,” YouGov America, Dec 2, 2015
3. I will use pseudonyms throughout to protect the anonymity of the intended parents of the child I bore.
4. This term generally refers to a medically-assisted scenario where a child is born with the biological help of a third party: a gamete donor, a surrogate, and/or a couple who has donated their leftover embryo(s) to the parent(s).
5. See L. A. Paul, Transformative Experiences (New York: Oxford University Press, 2014) and Fiona Woollard, “Mother Knows Best: Pregnancy, Applied Ethics, and Epistemically Transformative Experiences,” Journal of Applied Philosophy 38.1 (2021): 155–171.
6. See The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology, “Guidance Regarding Gamete and Embryo Donation,” Fertility and Sterility 115.6 (2021): 1395–1410 at 1396 and Alex Pearlman, “Gamete Donor Anonymity Is a Myth: Q&A with Seema Mohapatra,” Digital Symposium on Consuming Genetics: Ethical and Legal Considerations of New Technologies, May 23, 2019. For the Colorado “Donor-Conceived Persons and Families of Donor-Conceived Persons Protection Act,” see Sam Tabachnik, “Colorado Becomes the First State to Ban Anonymous Sperm and Egg Donations,” Denver Post, Jun 1, 2022
7. See Damien W. Riggs, “Transgender Men’s Self-Representations of Bearing Children Post-Transition,” in Who’s Your Daddy? And Other Writings on Queer Parenting, ed. Rachel Epstein, 62–71 (Toronto, Canada: Sumach Press, 2009), and K. J. Surkan, “That Fat Man Is Giving Birth: Gender Identity, Reproduction and the Pregnant Body,” in Natal Signs: Cultural Representations of Pregnancy, Birth and Parenting, ed. Nadya Burton, 58–72 (Bradford, Ontario, Canada: Demeter Press, 2015).
9. Reciprocal IVF is an ART process that allows both female partners in a couple to participate biologically in their child’s birth. One partner’s eggs are retrieved and then fertilized with sperm from a known or non-identified donor. At least one resultant embryo is then transferred to the other partner for gestation and, eventually, childbirth if the embryo implants.