Surrogate Motherhood

Conception In The Heart

Helena Ragone

• Publisher: Routledge
• Year: 2019
• Print ISBN:
  9780367289249
• eBook ISBN:
  9781000313659
• Topic: Social Sciences
• Subtopic: Anthropology
• Index: Social Sciences

Surrogate Motherhood: Conception in the Heart is a compelling account written with analytical clarity and remarkable compassion. Helena Ragoné has given long overdue humanity and voice to the actual participants in the surrogate motherhood experience—a heretofore inaccessible population—and the results are fascinating. Anyone interested in fertility, parenting, reproduction, and kinship, or anyone interested in contemporary culture will want to read this book.

1
Surrogate Mother Programs

ON THE UNITED STATES there are currently eight established commercial surrogate mother programs;¹ there are also a number of individuals who arrange surrogate contracts on a free-lance or occasional basis but who cannot be said to direct a program per se. Across the United States couples are now able to contract the services of surrogate mother programs in order to have a child that is biologically related to at least one member of the couple (the father) or, with gestational (in vitro fertilization, rvi ) surrogacy, biologically related to both members of the couple. As little as fifteen years ago a couple in which the wife was infertile was presented with only two choices, to adopt a child or to accept their childlessness. Surrogate motherhood has created a third option for those who are financially able to avail themselves of this choice, the option to have a genetically related child from the moment of her or his birth.² Although some programs have considerably lower operating costs and lower overhead than others, most couples in surrogate mother contracts pay fees that fall within the $28,000 to $45,000 range.

The demand for surrogate motherhood is created largely by a diagnosis of female infertility, although a woman need not be infertile in order to employ a surrogate. Factors contributing to the popularization of surrogate motherhood and other reproductive technologies are both medical and social. In the United States there are reportedly 2 to 3 million infertile couples (OTA 1988:3). A diagnosis of infertility is defined as the "inability of a heterosexual couple to produce a pregnancy after one year of regular intercourse," that is, unprotected intercourse (Stangel 1979:4). The social factors that have contributed to this rise in the rates of infertility and that have resulted in an increase in the demand for reproductive technologies are the trend toward later marriages and the tendency for growing numbers of women to delay having children until later in their reproductive lives.

The programs under consideration in this chapter were selected because they were well established and representative of surrogate mother programs in the United States; included are the Drake, Frick, Harper, Smith, Brookside, Allen, and Wick programs.³ The manner in which a program approaches the surrogacy arrangement is related to several factors: the director's professional background, the director's personal experiences with surrogacy, the program's size, and whether it is an "open" or a "closed" program.

The open programs provide participants with a biographical sketch outlining the motivations of the potential surrogate or couple for pursuing surrogate motherhood (see Appendix A for couple's biographical sketch and Appendix E for surrogate's biographical sketch), and if on the basis of this statement (and a photograph), the parties find themselves compatible with each other, the program formally "matches" them or introduces them to one another, and the director and/or psychologist informs the couple and the surrogate about the tentative match. After an initial meeting (in some programs, the introduction occurs at the program offices; in others, participants meet in a restaurant or another neutral location), the surrogate and the couple then decide if they wish to proceed with the relationship and become formally paired. In the open programs, once paired, they continue to interact throughout the process, that is, insemination, pregnancy, and delivery. In the closed programs, although couples select surrogates from a sheet of biographical data and a photograph provided by the programs; the surrogate does not have the same degree of choice about her couple, and the two parties do not interact with each other, meeting only to finalize the paternity suit and the stepparent adoption once the child is born.

In the older and more established programs (those in operation a minimum of ten years as of 1994), none of the program directors had initially set out to develop a surrogate mother program (then a relatively new concept), and the routes that eventually led them to surrogacy were often circuitous. For example, the director of the Wick program was at one time a surrogate in the Drake program and her dissatisfaction with her experiences there eventually inspired her to open her own program; the director of the Harper program was herself the adoptive mother of a child conceived by a surrogate; and the Brookside director first became involved with surrogacy indirectly through drafting legal contracts for an infertility specialist. Unlike these older and more established programs, many of the newer programs were established by individuals whose backgrounds were in related fields, such as adoption.

The one salient feature that unites all program directors is their publicly stated and personally held conviction that they are performing a much needed and valued service for society, an exuberant attitude that has also been observed among physicians and staff at IVF clinics {Bonnicksen 1989:27). The Brookside director's response to seeing a couple pick up their child for the first time is very typical: "Isn't this great? Such wonderful people.... I love what I do." Directors as a whole tend to be charismatic and enthusiastic about their work, considering it almost a mission or calling rather than a profession. When I initially began my research, I could not help but note the persuasiveness and dedication of directors and staff and their sense of commitment to the task of alleviating the pain and despair couples experience as a result of their infertility.

What follows are what I have loosely referred to as the industry's guidelines. These guidelines can be understood as at times tacitly agreed upon and at other times expressly agreed upon criteria to which the programs subscribe and to which they theoretically adhere. The guidelines are the product of the industry as a whole, developed and refined over the past several years in response to negative publicity such as that generated by the coverage of the Baby M case; other guidelines have been formulated for in-house use by individual directors over time, through trial and error.

Although there is a national organization of surrogate mother programs, which has annual meetings attended by some program directors (other directors attend infrequently, if at all), the surrogate industry as a whole tends to be somewhat rivalrous and factionalized. All the established program directors are acquainted, and quite often they have been formerly in one another's employ. Competition permeates the industry; there are numerous examples of animosity between directors, which makes it extremely unlikely that all the program directors will appear at the same event at a given time. One of the greatest sources of discord among the directors appears to be the belief that she or he is running the superior program. In confidence, some directors are more willing than others to discuss the shortcomings of other programs and their directors, but in public a concerted effort is made by all to maintain a united front. This is especially true when a politically charged issue such as the Baby M case arises or when there is a legal challenge to surrogacy such as the legislative effort to ban surrogacy in California in 1989.

Surrogate Program Guidelines

The guidelines created by the industry are of two types, which can best be understood as being either extra- or inter-program. Extra-program guidelines were primarily designed as a public relations strategy, to protect the industry from potential negative publicity by averting situations that might be perceived as immoral, exploitative, or transgressive, with certain of these guidelines serving both an extra- and an inter-program function. An example of the dual function of a guideline is the purported refusal of programs to accept a surrogate who is currently receiving public assistance. As the director of the Wick framed the issue, "It's a shame I can't accept them; I lose a lot of really great gals," a sentiment shared by most program directors. Here the extra-program strategy for not accepting women on public assistance stems from the fear that doing so would create the impression that these women are being exploited by upper-middle-class couples and that their reasons for wanting to become surrogates are solely financial, that they are essentially selling a child. However, the inter-program guideline, which is designed to provide programs and directors with baseline criteria in the selection of candidates for surrogacy and which seeks to develop a protocol that will result in increased efficiency, recommends rejecting a woman on public assistance because of the possibility that she may, because of financial need, deny her feelings about parting with the child, a potentially disastrous situation.

Lists of extra-program and inter-program guidelines follow; it should, however, be noted that these guidelines are unwritten and unenforceable and that a program's stated public policy may differ, at times radically, from its actual practice. It was during the course of conducting research that I recognized that program directors consistently referred to several procedures used for selecting surrogates and operating a program, for example, physiological and psychological screening of surrogates, the sponsoring of surrogate support groups, and post-birth program directives. I began to compile a list of these guidelines as they were presented to me informally during the course of this project.

Extra-Program Guidelines

1. Couples should be asked to provide medical proof of their infertility.
2. Only heterosexual, married couples should be permitted the option of participating in the surrogate mother program.
3. Unmarried heterosexual women or men should not be permitted to engage the services of a surrogate.
4. Lesbians, lesbian couples, gay men, or gay male couples should not be permitted to engage the services of a surrogate.
5. Women who are receiving public assistance should not be permitted to become surrogate mothers.
6. [In the open programs], surrogates should be paid a monthly fee once pregnant rather than a single sum after the child has been born.

Guidelines 1 through 5 are primarily designed to avert potentially controversial situations that may cast a negative light on surrogacy. A concerted effort is made by programs to create the image and ultimately foster the belief that surrogate motherhood is not socially deviant and that it need not have negative or deleterious consequences for any of the parties involved or for society as a whole, that is, if surrogates are properly screened and guidelines for both surrogates' and couples' behavior are made explicit. One of the principal means by which to accomplish this objective is to permit only those individuals who have historically been regarded as the "traditional family" to participate; thus lesbians, gay men, and unmarried heterosexual women or men are, in theory, barred from participation. Several directors informed me in private that their decision to permit only married heterosexual couples has less to do with their own personal convictions than it does with the belief that the industry must reject policies that anti-surrogacy groups could potentially use to turn public and legislative opinion against them.

Guideline 6, concerning the use of monthly payments at the open programs, is designed to avert the perception that surrogates are being paid for a product, a baby, rather than for a service, namely, pregnancy. This strategy is not unlike that employed with adoption whereby the birth mother's living expenses may be paid for by the adopting couple although the couple is forbidden by law to pay for the baby. However, this and other guidelines are not followed by all the programs: The Drake and Harper programs continue to pay their surrogates the full sum after the child has been born in spite of the open programs' recommendations.

As previously mentioned, in the Brookside, Allen, and Wick programs, these guidelines are primarily designed for the purpose of creating good public relations, and they are sometimes ignored. Certain programs have long-term goals for the industry as a whole, whereas other, more shortsighted, programs often ignore the effects of their practices on the industry as a whole and, in particular, on its future, in the interest of making an immediate profit. That practice causes a degree of dissension among programs. I learned, for example, of an instance in which a woman on public assistance was accepted as a surrogate and of the somewhat dubious practice of accepting a couple in which the wife was not infertile. Programs will, however, go to extraordinary lengths to guard against the possibility that information such as this will be made public, because of the very real fear that anti-surrogacy organizations might make use of it in their efforts to ban the practice of surrogacy.

Inter-Program Guidelines

1. All potential surrogates should undergo a series of psychological tests, for example, the Minnesota Multiphasic Personality Inventory, as well as medical screening, including HIV testing and hormonal tests.
2. Surrogates should have had and kept at least one child in order to ensure that they are both biologically and emotionally "proven."
3. Surrogates in open programs should attend semi-monthly or monthly support-group meetings; in some programs, attendance is mandatory.
4. Life and medical insurance should be provided to the surrogate if she is not covered by either her own policy or her husband's policy.
5. The surrogate should not be given information as to the financial status of her couple in order to avoid a situation in which the surrogate withholds the child in an effort to receive additional financial reimbursement.
6. Adoptive couples are not screened, that is, they are not subject to any psychological testing in any of the programs since programs maintain that it is the couple's right, as it is the right of all adults, to become parents.
7. No formal counseling services are offered to the couples, but they are afforded twenty-four-hour access to either the program director or the psychologist.
8. All programs advise couples and surrogates to terminate their relationship once the child is born, although photographs and cards for the holidays are considered appropriate in both open and closed programs.
9. [In the open programs], couples are encouraged to tell their child about its birth origins.

There are further differences in the application of the above criteria between open and closed programs; for example, the closed programs do not usually offer their surrogates counseling services since closed programs generally draw surrogates from all over the United States and it is therefore impossible for the surrogates to meet as a group. For example, a closed program such as the Drake program has an administrative assistant phone its surrogates monthly to assess their progress rather than seeing them in person. It appears that closed programs are less concerned with providing surrogates psychological support and reinforcement than open programs are, and in general closed programs tend to view the process as more a business contract than a social and business contract.

One of the few unchallenged beliefs shared by all programs is that these couples have as much right to be parents as anyone else; because of this assumption, none of the progr...

Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• Dedication
• Contents
• List of Tables and Figures
• Acknowledgments
• Introduction
• 1. Surrogate Mother Programs
• 2. Surrogate Mothers
• 3. Fathers and Adoptive Mothers
• 4. Surrogate Motherhood and American Kinship
• APPENDIX A Couple's Biographical Sketch for Surrogate Mother
• APPENDIX B Contract
• APPENDIX C Phone Intake Form and Letter to Prospective Surrogate
• APPENDIX D Detailed Application Form for Surrogate Mothers
• APPENDIX E Biographical Sketches of Potential Surrogates
• APPENDIX F Surrogate Mother's Biographical Sketch for Couple
• APPENDIX G Genetic Screening Information Sheet and Questionnaire
• APPENDIX H Phone Intake Form for Prospective Parents
• APPENDIX I Prospective Parents Questionnaire
• APPENDIX J Egg Donor Program
• APPENDIX K Handling of Semen Specimen and Insemination Instructions
• Notes
• References
• About the Book and Author
• Index