The Physical and Emotional Risks of Surrogacy

The Physical and Emotional Risks of Surrogacy

    

        Surrogacy is a method of assisted reproduction where a woman carries and delivers a child for another individual or couple. While this process can be life-changing for intended parents, it carries significant physical and emotional implications for the surrogate. These risks are often underrepresented in public discussions but are crucial for a full understanding of the surrogacy experience. This article explores the physical and emotional risks that surrogates may face, along with the ethical, psychological, and societal dimensions that accompany this complex journey.

1.Primary types of surrogacy

 Before diving into the risks, it's important to recognize the two primary types of surrogacy:

Traditional Surrogacy: The surrogate uses her own egg, making her the biological mother of the child. This method is now rare due to legal and emotional complications.

Gestational Surrogacy: The surrogate has no genetic link to the baby; the embryo is created via IVF using the intended parents’ or donors’ genetic material.

Most modern surrogacy arrangements are gestational, but both types involve significant physical and emotional demands.

2. Physical Risks of Surrogacy

a. Health Risks from Fertility Medications

To prepare for embryo transfer, surrogates must take hormone medications such as estrogen and progesterone. These medications carry side effects such as:

Mood swings

Headaches

Bloating and nausea

Breast tenderness

Fatigue

In rare cases, women may experience Ovarian Hyperstimulation Syndrome (OHSS), a condition that causes swollen, painful ovaries and fluid retention.

b. Complications from Embryo Transfer and IVF

Embryo transfer through IVF is not always successful on the first attempt. Multiple transfer attempts can increase physical strain. Risks include:

Mild bleeding or cramping

Infection

Failure of embryo implantation, necessitating further cycles

Anesthesia-related complications during procedures

c. Risks During Pregnancy

Even in healthy women, pregnancy involves potential complications. Surrogates may face:

Gestational diabetes

Pre-eclampsia (high blood pressure and organ damage)

Placenta previa or abruption

Preterm labor

Cesarean section (which carries surgical risks)

Moreover, because surrogates are often carrying babies for older or infertile parents, multiple embryo transfers may be used, increasing the chances of multiple pregnancies, which carry higher risks of:

Premature birth

Low birth weight

Miscarriage

Higher maternal strain

d. Long-Term Reproductive Health

While most surrogates recover well, repeated pregnancies can lead to long-term issues such as:

Uterine scarring

Increased risk in future pregnancies

Postpartum complications like hemorrhage or infection

3. Emotional and Psychological Risks

a. Attachment and Bonding Issues

Even in gestational surrogacy, surrogates carry the baby for nine months. They feel the baby grow, kick, and move. After delivery, handing over the baby—even if they are not genetically related—can trigger emotional trauma.

Some women report feelings of loss, emptiness, or even postpartum depression. These reactions may intensify if the surrogate has limited support or counseling.

b. Social and Family Pressure

Surrogates might face judgment or misunderstanding from:

Extended family

Friends or neighbors

Religious communities

Some women feel isolated or stigmatized, especially in cultures where surrogacy is taboo.

c. Emotional Exploitation

In commercial surrogacy—especially in economically disadvantaged settings—women may feel pressured to participate due to financial need. In such cases, the emotional burden can be amplified by a sense of coercion.

Even in altruistic arrangements, surrogates may agree to help a relative or friend, leading to guilt if the process becomes emotionally taxing or goes wrong.

d. Psychological Impact of Failed Pregnancy

If the pregnancy ends in miscarriage or stillbirth, surrogates may face intense grief and guilt, especially if the intended parents have been emotionally or financially invested. This psychological toll can have long-term effects on their mental health.

4. Ethical and Legal Concerns

a. Consent and Autonomy

Surrogates must give informed consent, but in practice, they may not fully understand the risks or feel empowered to say no. Agencies or intended parents may underplay the complications involved.

b. Medical Decision-Making

If medical complications arise during pregnancy, questions about who gets to make critical decisions—the surrogate or the intended parents—can create legal and emotional turmoil.

For example, if doctors recommend termination of pregnancy due to fetal abnormality, the surrogate’s personal beliefs might clash with the intended parents’ wishes.

c. Lack of Postpartum Support

After birth, surrogates often receive minimal psychological support. They may struggle with feelings of abandonment or emotional fatigue. In some countries, there are no regulations mandating postnatal care for surrogates, leaving them vulnerable.

5. Cultural and Societal Context

In developing countries, commercial surrogacy has sparked widespread ethical debate. Women from poor backgrounds may agree to surrogacy as a form of economic survival. While this may seem like a financial opportunity, the imbalance of power between surrogate and intended parents raises concerns about exploitation.

In contrast, in wealthier nations, the process is often highly regulated. Still, emotional risks persist even when the surrogate enters the agreement willingly and with full knowledge.

6. Impact on Surrogate's Family

Surrogacy affects not just the woman, but also her partner, children, and family. Challenges include:

Disruption of family dynamics

Partner discomfort with the physical intimacy of pregnancy not related to their own child

Children’s confusion over the surrogate baby

Household responsibilities during pregnancy

Partners may also worry about complications, both physical and emotional, affecting their relationship.

7. Managing Risks: Counseling and Support

To minimize harm, the following support systems are critical:

a. Pre-Surrogacy Counseling

Surrogates should undergo psychological screening and receive counseling about:

Physical risks

Emotional toll

Legal rights and obligations

b. Ongoing Psychological Support

Regular access to a mental health professional throughout the process can help surrogates process complex emotions and cope with stress.

c. Ethical Medical Practices

Clinics and agencies should:

Ensure informed consent

Provide full disclosure of medical risks

Avoid coercion or financial manipulation

Offer postpartum care and follow-up

 Conclusion

While surrogacy offers a path to parenthood for many hopeful families, it is essential not to overlook the physical and emotional challenges faced by the surrogate. These women take on significant risks—health-wise and psychologically—and deserve informed, respectful treatment, robust legal protection, and continued emotional support. A truly ethical surrogacy arrangement must prioritize the well-being of all parties involved, especially the woman who brings new life into the world on behalf of others.