Surrogacy — where a woman carries a child for another couple, usually for money — is on the rise. While there’s not a lot of hard data, multiple sources confirm a big uptick in couples seeking surrogates. California attorney Stephanie Caballero, who specializes in creating contracts for intended parents and surrogates, sees the growth firsthand. She has handled more than 200 cases through August alone. “Surrogacy is becoming more common and accepted than ever before, Caballero says. “My caseload is up 40% from last year.”
The United States is one of the few countries in the world that allows legal, paid surrogacy — along with India, Ukraine, Mexico and Thailand. So, while we often read about Americans going abroad to adopt children and seek surrogates, floods of international couples are also coming to the States, drawn to our high standards of care and relatively lax laws.
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Lisa Wilkins and Kristen White are psychologists who operate Tiny Treasures Surrogacy, a company that matches surrogates with intended parents. They’ve got offices in Massachusetts, New York, and California, but work with couples throughout the country and around the world. Wilkins, who started in the third-party reproduction business with egg donation in 2002 and launched the surrogacy wing last year, says she’s seen the practice expand drastically and become much more normalized. Wilkins and White spoke to Refinery29 about the business, laws, and matchmaking process around outsourcing childbirth.
How do you hire women to become surrogates?
Lisa Wilkins: We don’t hire surrogates. We recruit them. They are women usually aged 21-39. Surrogates have all given birth to one child, and they need to be raising a child. They are drug-free, abstain from drinking, and have no history of medical complications during pregnancy. They can’t be taking psychotropic medication or any drugs that would impact pregnancy.
Lisa Wilkins: We don’t hire surrogates. We recruit them. They are women usually aged 21-39. Surrogates have all given birth to one child, and they need to be raising a child. They are drug-free, abstain from drinking, and have no history of medical complications during pregnancy. They can’t be taking psychotropic medication or any drugs that would impact pregnancy.
Other than making sure they’re healthy, do you look at their lifestyle?
LW: Yes — surrogates need to have a certain BMI — and no history of criminal convictions. Their financial stability is assessed; they can’t be on government assistance. There’s a general assessment of salary — what are they using the money for? We make sure they can take time off work — if they work — for appointments. They can’t have had tattoos, blood transfusions, or piercings for a certain period prior to becoming a surrogate.
LW: Yes — surrogates need to have a certain BMI — and no history of criminal convictions. Their financial stability is assessed; they can’t be on government assistance. There’s a general assessment of salary — what are they using the money for? We make sure they can take time off work — if they work — for appointments. They can’t have had tattoos, blood transfusions, or piercings for a certain period prior to becoming a surrogate.
How much are the surrogates paid?
LW: Compensation varies, but the average is low- to mid-$20,000s.
Kristen White: For the first time; it goes up with experience to about $40,000 for the very experienced. It’s easily a year of the woman's time.
LW: Compensation varies, but the average is low- to mid-$20,000s.
Kristen White: For the first time; it goes up with experience to about $40,000 for the very experienced. It’s easily a year of the woman's time.
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Some claim using surrogates is predatory — what would you say?
LW: Dollar signs come up a lot, but that tends not to be the most relevant. From my own feminist perspective, to assume that a woman isn't able to make this decision for herself feels anti-feminist. If a woman is carefully assessed, to assume that it's predatory seems unreasonable. It’s a complex relationship between human beings, but whether its more complex than other human relationships, I don’t know.
LW: Dollar signs come up a lot, but that tends not to be the most relevant. From my own feminist perspective, to assume that a woman isn't able to make this decision for herself feels anti-feminist. If a woman is carefully assessed, to assume that it's predatory seems unreasonable. It’s a complex relationship between human beings, but whether its more complex than other human relationships, I don’t know.
What kind of people end up as surrogates?
KW: The best surrogates have an altruistic motivation. They want to do something important with their lives. When we receive inquiries from women, it becomes clear quickly when the motivation is financial. What’s great about the screening process being long is that those people can’t hang in with the length of the evaluation and are weeded out almost naturally.
LW: Having done egg donation longer than surrogacy, I’ve found that you’re much more likely to find egg donors who are initially financially motivated than surrogates. I often get this gut feeling when I sit with surrogates who would be a good fit for this process. The other thing is that they love being pregnant.
KW: The best surrogates have an altruistic motivation. They want to do something important with their lives. When we receive inquiries from women, it becomes clear quickly when the motivation is financial. What’s great about the screening process being long is that those people can’t hang in with the length of the evaluation and are weeded out almost naturally.
LW: Having done egg donation longer than surrogacy, I’ve found that you’re much more likely to find egg donors who are initially financially motivated than surrogates. I often get this gut feeling when I sit with surrogates who would be a good fit for this process. The other thing is that they love being pregnant.
What kind of people come to you looking for surrogates — is it mostly gay couples?
LW: Yes, we’ve fallen into working more with gay couples.
KW: We’ve had an influx of international gay fathers in the surrogacy program.
LW: Yes, we’ve fallen into working more with gay couples.
KW: We’ve had an influx of international gay fathers in the surrogacy program.
How do you match couples with surrogates?
LW: Intended parents and surrogates complete applications, and then we conduct extensive interviews to make sure they’re a good fit. It’s important to look at what type of relationship the intended parents want with the surrogate and vice versa. Some intended parents want to have a very close relationship to their surrogate, others want distance. The little research that has been done on the impact of surrogacy has shown that that relationship is one of the most important factors predicting how the surrogate will feel afterwards. That’s really important to us.
LW: Intended parents and surrogates complete applications, and then we conduct extensive interviews to make sure they’re a good fit. It’s important to look at what type of relationship the intended parents want with the surrogate and vice versa. Some intended parents want to have a very close relationship to their surrogate, others want distance. The little research that has been done on the impact of surrogacy has shown that that relationship is one of the most important factors predicting how the surrogate will feel afterwards. That’s really important to us.
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Do surrogates ever remain in the lives of the new parents or the children?
LW: That’s not unusual. We’ve found that a lot of gay male couples in particular are interested in having the gestational surrogate involved in the family’s life, so there is a woman figure. I’ve seen it vary a lot. Sometimes, the interaction is limited to exchanging photos on birthdays or holidays.
LW: That’s not unusual. We’ve found that a lot of gay male couples in particular are interested in having the gestational surrogate involved in the family’s life, so there is a woman figure. I’ve seen it vary a lot. Sometimes, the interaction is limited to exchanging photos on birthdays or holidays.
What are the major difficulties that come up when facilitating a surrogate/intended parent relationship?
LW: Important factors to assess include how surrogates feel about fetal termination in case of fetal anomaly, or if there is a multiple pregnancy and a reduction is needed. How many embryos does the surrogate feel comfortable carrying? Singles, twins, triplets. Parents and surrogates need to be on the same page with those matters.
KW: Another important consideration is how many IVF cycles is the surrogate willing to try? We’re not always successful the first time.
LW: Usually the magic number is three. But this is not always agreed upon.
LW: Important factors to assess include how surrogates feel about fetal termination in case of fetal anomaly, or if there is a multiple pregnancy and a reduction is needed. How many embryos does the surrogate feel comfortable carrying? Singles, twins, triplets. Parents and surrogates need to be on the same page with those matters.
KW: Another important consideration is how many IVF cycles is the surrogate willing to try? We’re not always successful the first time.
LW: Usually the magic number is three. But this is not always agreed upon.
How do you deal with surrogates who are uncomfortable with aborting or refuse it?
LW: Surrogates who oppose terminating pregnancies are harder to match. We prefer to work with surrogates who allow intended parents to make that choice. We let folks know that we’re dealing with human beings here. People have their feelings, and they change their minds. For example, one wonderful woman who wanted to be a surrogate told us, “Whatever the intended parents want, I’m comfortable,” and said that it would be up to the parents to terminate in the case of fetal anomalies. But, she also told me about her daughter who had disabilities. And, after we spoke, I ascertained that this might be really hard for her. We were able to talk through it, though, and she didn’t end up becoming a surrogate for that couple.
LW: Surrogates who oppose terminating pregnancies are harder to match. We prefer to work with surrogates who allow intended parents to make that choice. We let folks know that we’re dealing with human beings here. People have their feelings, and they change their minds. For example, one wonderful woman who wanted to be a surrogate told us, “Whatever the intended parents want, I’m comfortable,” and said that it would be up to the parents to terminate in the case of fetal anomalies. But, she also told me about her daughter who had disabilities. And, after we spoke, I ascertained that this might be really hard for her. We were able to talk through it, though, and she didn’t end up becoming a surrogate for that couple.
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What common psychological issues come up?
LW: There’s the “my body your baby/my baby your body” issue. It’s the intended parents’ baby and the surrogate’s body. I like to talk about prenatal care preferences in advance. Do the intended parents have any strong preferences?
LW: There’s the “my body your baby/my baby your body” issue. It’s the intended parents’ baby and the surrogate’s body. I like to talk about prenatal care preferences in advance. Do the intended parents have any strong preferences?
Is what to eat in the contract?
LW: During matching, we touch on the dietary stuff. I use the example with surrogates and parents: ‘We don’t want the surrogate eating a slice of pizza and the intended parents to see and be aghast that she’s eating pizza while pregnant.' We make sure everyone is on the same page up front.
LW: During matching, we touch on the dietary stuff. I use the example with surrogates and parents: ‘We don’t want the surrogate eating a slice of pizza and the intended parents to see and be aghast that she’s eating pizza while pregnant.' We make sure everyone is on the same page up front.
Do you find that a surrogate will feel a connection to the child she’s carrying, even though it’s not genetically hers?
KW: Imagine what an intimate relationship it is for that surrogate to carry that fetus for all of that time. Ideally, we hope there is an attachment — and a warmth and a connection between surrogates and babies, and that’s not problematic.
LW: [The surrogate’s] connected in that she’s carried the child, but when assessing surrogates, if you speak with someone who uses terms like ‘my baby’ or ‘my child,’ that’s a red flag.
KW: Imagine what an intimate relationship it is for that surrogate to carry that fetus for all of that time. Ideally, we hope there is an attachment — and a warmth and a connection between surrogates and babies, and that’s not problematic.
LW: [The surrogate’s] connected in that she’s carried the child, but when assessing surrogates, if you speak with someone who uses terms like ‘my baby’ or ‘my child,’ that’s a red flag.
How do controversies around surrogacy — like the recent events where an Australian couple reportedly abandoned a baby born to their surrogate because he had Down syndrome — affect what you do?
KW: Human beings do unbelievable, sometimes awful things. Surrogacy is not exempt. People are temporarily hesitant about flying after a plane crash, but then people fly again. The desire to have a family is so visceral and important, if the technology is available and you can find a way to do it that matches with your own compass, morally and ethically, you go forward.
KW: Human beings do unbelievable, sometimes awful things. Surrogacy is not exempt. People are temporarily hesitant about flying after a plane crash, but then people fly again. The desire to have a family is so visceral and important, if the technology is available and you can find a way to do it that matches with your own compass, morally and ethically, you go forward.
What’s the best part of your job?
KW: It’s especially rewarding to help families who were devastated by the inability to have a child, or who have experienced loss, or gay fathers who may have once thought they’d never be able to become parents.
LW: We build families. Quite literally. We now have clients whose children are seven, eight, nine years old. Unique people are in the world because of us.
KW: It’s especially rewarding to help families who were devastated by the inability to have a child, or who have experienced loss, or gay fathers who may have once thought they’d never be able to become parents.
LW: We build families. Quite literally. We now have clients whose children are seven, eight, nine years old. Unique people are in the world because of us.
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