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Infertility and Assisted Reproduction

Surrogacy and Gestational Care

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Gestational surrogates are the first to intentionally assist beyond conception with creation of babies never— even potentially— for themselves. Does this constitute reproductive prostitution? Some feminists believe that a surrogate acts with free agency— she can use her body as she chooses to— while others think that to conceive a pregnancy for others willing to pay (an estimated minimum fee of sixty-five thousand dollars) for the service inevitably involves coercion. While the lump sum of money received seems large given that the surrogate isn’t officially working, the hourly wage, especially if the surrogate undergoes numerous IVF cycles before even becoming pregnant, might not seem quite so impressive.

The Whitehead case pushed the burgeoning industry surrounding surrogate arrangement -- agencies and lawyers and doctors -- to codify as many aspects of the process as possible. A profile of those women most apt to choose to be surrogates and perform the task well emerged: religious, fairly traditional married women (“stay-at-home moms”) with moderate incomes who had enjoyed successful pregnancies and believed they were done bearing their own children. These women were less enticed by money than a calling to help others. Using a third party’s donor eggs --  the intended mother’s or another’s -- became routine. Along with more rigorous psychological testing of surrogates, strict contracts were drafted, detailing health behaviors and the maximum number of fetuses that would be carried. The language favored those procuring babies: gestational surrogates were not birth mothers as Kane called herself, nor even surrogate mothers; instead the current term entirely skirts the word “mother.” Legislation passed in some key states like California, where a large percentage of surrogate arrangements occur, that bypasses the birthing woman’s name ever appearing on the birth certificate, legally erasing her role. In states where the birthing mother’s name appears on the original birth certificate, the intended parents can go to court and receive a second birth certificate with their names rather than hers.

The image of perfected motherhood --  the sort spread out along glossy magazine pages depicting every celebrity mom on the planet -- encourages entitlement for privileged women to share biological ties to their babies. Adoption, perhaps always cast as a second place option to “natural” parenthood, has fallen even lower because technologies promise “positive” results. If part of perfectionism is the ability to control a situation so it goes according to plan, the surrogate arrangement appeals, given that few details are left to chance.

In their book The Mommy Myth Susan Douglas and Meredith Michaels point out that when fifty-two year old television personality Joan Lunden obtained a surrogate so she and her younger husband could have twins the only thing larger than her disposable income was her “sense of entitlement.” Of Lunden's babies they write, “If you can't have them yourself, you can buy them.”

Celebrities, perhaps fearful of tabloid innuendo, have come forward with their stories. In addition to Lunden, soap opera star Deirdre Hall and model Cheryl Tiegs made public— on People magazine covers— their surrogate arrangements. According to Meredith Michaels, the media attempts to assimilate the surrogate arrangement by employing “the narrative of the miracle” and by “playing up a fantasy about a sisterhood between the surrogate and this powerful, privileged celebrity. There is an implication that surrogate and privileged mom are going to have such a strong bond that they raise the child or children together, which of course, could not be further from the truth.”

To gear up for her second round of family (she has three grown daughters) Lunden launched a media blitz. In deference to sisterhood, she posed on the cover of People with arms encircling her very pregnant salt-of-the-earth surrogate. Lunden’s much younger husband had never had children before. Sharing her story to “help others,” for all of her openness, Lunden refused -- and continues to refuse -- during an interview in Ladies Home Journal that featured her and her year-old twins -- to reveal whether her own eggs or those of a donor were used. “I do that for all the other people who are calling and writing me now, wanting to do this. I don’t want them to feel they can’t achieve what we have if they can’t produce their own eggs. I want everybody to understand that however they make their families doesn’t make any difference. It’s about parenting. It’s about having these children. If they can use their own egg and sperm, fantastic. And if one of them isn’t viable, then get a donor. I don’t want anyone to feel their way isn’t right.” Given Lunden’s smugness, it’s abundantly clear that if she’d used her own eggs, she would share this as further proof of her unique youthfulness compared to other women her age. Also over fifty, Tiegs was questioned heavily by the media when she claimed that her eggs were used because so many doctors have disputed this as likely.

Despite the fact that Kane and Whitehead did not help celebrities, the number of people able to afford surrogates remains small. Few people will come face to face with this issue. Yet, images of celebrities with their surrogate-born babies (and miraculously old eggs) confirm for all women dealing with infertility that a means to have one's “own” baby should somehow exist.

No cut and dried answers

This glossy image offered up by the “celebrity mom” feeds into American society’s current baby making obsession. A recent issue of Good Housekeeping flouted actress Courtney Cox on its cover with a story inside about celebrities who overcame infertility. Many of those actresses kept their struggles private until they triumphed with a “precious miracle.” Never mentioned were actresses who continue to confront infertility. Michaels believes that Lunden represents the most egregious end of this spectrum. “‘Why should I be denied?’ people are asking, as if having a biological baby is a basic, inchoate right. Globally, to put so many resources and so much effort into a single child makes no sense.”

“While there was a knee-jerk response among feminists that reproductive technologies were bad for women,” Michaels recalls, “that was too simplistic.” Reproductive technologies run a wide gambit. Activists have long worried that singling out later abortions would compromise the right for all abortions. Similarly, feminists feared that to question surrogacy might compromise other, more simple interventions. Some feminists are among those reaching for help from technology in their personal struggles with infertility, making it even harder to raise pointed questions about its ramifications. Michaels says, “There’s this faux feminist argument about choice that you are expanding women’s choices, but this notion doesn’t take into account the perversion of some of these choices. If left untended, these so-called choices make pregnancy and family into commodities.” Marlene Fried, activist, professor and co-author (with Loretta Ross, Jael Silliman and Elena R. Gutierrez) of the book Undivided Rights: Women of Color Organizing for Reproductive Justice also warns against overly simplistic responses to these complex questions. “Who would you find to regulate these technologies?”

The increasing precariousness of abortion access over the past quarter century has squelched feminists’ abilities to examine other reproductive health matters freely. Fried says, “Given abortion rights’ minimal security, it’s hard to look at reproductive technology without potentially jeopardizing those tenuous rights.” Yet, to keep abortion entirely out of the infertility equation is impossible. Infertility drugs and IVF elevate the risk of multiple pregnancy. Medical reduction, a euphemistic term for abortion, is a doctor-sanctioned procedure involving dissolution of one or more fetuses from a multiple pregnancy. These reductions occur for a range of reasons, from birth defects in one fetus to the fact that carrying three or more fetuses greatly increases the risk of premature delivery and sometimes compromises the health of the pregnant woman.

It cannot be disputed that extreme reproductive technologies raise the risk of devastating losses surrounding pregnancy and that the costs -- in terms of dollars, emotional and physical health -- are potentially enormous. A very short list includes a sharp rise in complications for premature babies, a direct result of the exponential rise in multiple pregnancies and the enormous toll infertility treatments takes upon women and their partners, sometimes regardless of whether they end up with a child or children or not. The myriad ways that others can now be involved in the creation of children opens the door for potentially complicated connections between strangers never before imagined. There are countless happy stories of the ways reproductive technologies have created families or assisted people in having healthier children. No cut and dried answer exists now that what’s possible and what might be possible in the future has rendered simple answers obsolete. Technology, moving at warp speeds, cannot be slowed, so we need to slow ourselves down in order to disentangle our questions and concerns from the enticing momentum of “progress.”

What seems clear in the meantime: a woman’s right not to have a baby is intricately linked to her right to try to have a baby or to help someone else to have a baby. To lose the right of one side of this equation is to threaten the loss of the other side. Sometimes, this might create uneasy alliances. At this juncture uneasiness may be called for— even welcome.

Written by Sarah Werthan Buttenwieser.
Last revised February 2005.
Special thanks to the
Mothers Movement Online for permission to repost this article.

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