Professional Documents
Culture Documents
Children of Surrogates
Children of Surrogates
Submitted on July 15, 2013; resubmitted on September 25, 2013; accepted on October 17, 2013
study question: What impact does surrogacy have on the surrogates’ own children?
summary answer: The children of surrogate mothers do not experience any negative consequences as a result of their mother’s decision
to be a surrogate, irrespective of whether or not the surrogate uses her own egg.
study design, size and duration: Participants were recruited as part of a study of the long-term effects of surrogacy for surrogates
and their family members. Data were collected from 36 children of surrogates at a single time point.
participants/materials, setting, methods: Participants whose mother had been a surrogate 5 –15 years prior to interview
and who were aged over 12 years were eligible to take part. Thirty-six participants (14 male and 22 female) aged 12– 25 years were interviewed
(response rate ¼ 52%). Questionnaires assessing psychological health and family functioning were administered.
main results and the role of chance: Forty-four per cent (15) of participants’ mothers had undergone gestational surrogacy,
39% (14) had used their own egg (genetic surrogacy) and 19% (7) had completed both types of surrogacy. Most surrogates’ children (86%, 31) had
a positive view of their mother’s surrogacy. Forty-seven per cent (17) of children were in contact with the surrogacy child and all reported good
relationships with him/her. Forty per cent (14) of children referred to the child as a sibling or half-sibling and this did not differ between genetic and
gestational surrogacy. Most children (89%, 32), reported a positive view of family life, with all enjoying spending time with their mother. Mean
scores on the questionnaire assessments of psychological health and self-esteem were within the normal range and did not differ by surrogacy type.
limitations, reasons for caution: The sample size for this study was relatively small and not all children chose to take part,
therefore their views cannot be known. Nevertheless, this is the first study to assess the experiences of surrogacy from the perspective of the
surrogates’ own children. There may be some bias from the inclusion of siblings from the same family.
wider implications of the findings: Findings of this study show that family relationships within the surrogate’s own family are
good and that the children are not negatively affected as a result of their mother’s decision to be a surrogate. These results are of importance to
counsellors and support groups offering advice to surrogates and intended parents.
study funding, competing interests: This work was supported by the Economic and Social Research Council (grant number
ES/I009221/1). None of the authors has any conflict of interest to declare.
& The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
For Permissions, please email: journals.permissions@oup.com
Children of surrogate mothers 91
fertilization. The implanted embryo is created using either the intended response rate of 66%. Children took part from 23 different families [In 9 fam-
parents’ gametes or donor gametes or a combination of both, and there- ilies, two siblings took part (n ¼ 18) and in 2 families three siblings took part
fore the surrogate and her children are not genetically related to the (n ¼ 6), the remaining 12 participants were from different families]. Sample
resulting child. What little research has been carried out on surrogate characteristics shown in Table I.
A significant association was found between parents’ marital status and
mothers has so far examined their psychological well-being and experi-
surrogacy type (Fishers exact ¼ 0.006). A higher proportion of gestational
ences of surrogacy. These studies have found that most surrogate
surrogates had a married/cohabiting partner (11, 73%) compared with
mothers have positive experiences of surrogacy and do not experience
genetic surrogates (2, 14%) and gestational and genetic surrogates (3,
psychological problems as a result of carrying a child for someone else 43%). There was a significant difference in the number of surrogacies
(Jadva et al., 2003; van den Akker, 2007; Braverman et al., 2012). carried out by the surrogate between the different categories for type of sur-
Compared with other forms of third-party reproduction, surrogacy rogacy (H ¼ 7.348; df ¼ 2, P ¼ 0.025) with genetic surrogates (mean ¼ 4)
families have been found to be more open about their child’s conception. having completed more surrogacies compared with gestational surrogates
Many parents disclose surrogacy to the child by the age of 3 years and (mean ¼ 2; H ¼ 6.202, df ¼ 1, P ¼ 0.013).
remain in contact with the surrogate during the first 10 years of the
Measures child was enough (categorized as either ‘not enough’, ‘about right’ and ‘too
much’).
Psychological well-being
Participants were asked to complete the Rosenberg’s Self-Esteem Scale
(RSES, Rosenberg, 1965) to assess global self-esteem. This 10 item self- Disclosure of surrogacy to the surrogacy child
report questionnaire provides a total score for self-esteem where high Participants aged 18 years or over were asked whether the surrogacy child
scores indicate higher self-esteem and has been validated for use with adoles- knew who their surrogate was (responses were coded as ‘yes’, ‘no’ or
cents (Bagley and Mallick, 2001). The General Health Questionnaire-30 ‘don’t know’). They were also asked whether they felt the child should be
(GHQ-30, Goldberg, 1978) was also completed. The GHQ-30 is a 30 told the identity of their surrogate (responses were coded as ‘yes’, ‘no’, ‘un-
item questionnaire used for detecting minor psychiatric disorders in the certain’, or ‘intended parents’ decision). Their reasons for whether or not the
general population. Both measures are widely used and have good reliability child should be told were also obtained and these responses were tran-
and validity. scribed and later coded and categorized.
Table II Median (interquartile range) scores on Rosenberg’s self-esteem scale, general health questionnaire-30 and FAM III
by surrogacy type.
For the GHQ-30 a non-significant trend was found indicating differ- In terms of enjoyment of family, 36% (13) were coded as experiencing ‘a
ences in median scores between the three groups (H ¼ 5.229, df ¼ 2, great deal’ of enjoyment, 47% (17) as ‘quite a lot’ of enjoyment, with the
P ¼ 0.07). As shown in Table I, the median score was higher for children remaining 17% (6) coded as ‘some’ enjoyment. None of the surrogates’
of surrogates who had carried out both types of surrogacy in comparison children were coded as having no enjoyment of their family.
to those who had carried out genetic or gestational surrogacy. An exam- For surrogates’ children’s relationships with their mother and father,
ination of the individual scores on the GHQ-30 showed that none of the Table III shows that the majority of participants reported sharing interests
children of gestational surrogates and genetic surrogates scored above with their parents and enjoyed spending time with them. Fishers exact
the threshold of 5. Seven per cent (2) of surrogates’ children (both of tests revealed no association between interview ratings of family relation-
whom had mothers who had carried out both types of surrogacy) ships and type of surrogacy.
scored above the threshold of 5 indicating a 50% likelihood of having a
psychiatric condition.
Feelings about handing over the
Family relationships surrogacy child
Contact with the surrogacy child, intended the child did not know and 53% (8) said they did not know whether the
mother and intended father child had been told. In terms of whether they felt the child should be told
about their surrogacy birth, 53% (8) said the child should be told, 27% (4)
Just under half (47%, 17) of the surrogates’ children were in contact with
felt uncertain, 7% (1) said the child should not be told and 14% (2) said it
the surrogacy child and 44% (16) were in contact with the intended
was up to the parents.
mother and intended father. All of the surrogates’ children who were
Reasons for telling included ‘medical reasons’ (2); ‘the child having a
in contact with the surrogacy child maintained face to face contact with
right to know’ (4); ‘the child would know who their mother is’ (1); ‘the
him/her and all reported a positive relationship with them. Frequency
child would not be here otherwise’ (1); ‘Trust, so that there is nothing to
of current contact with the surrogacy child and intended parents
hide’ (1) and one was unsure of a reason (note, some gave more than one
shown in Table V. No significant associations were found for frequency
reason). The reason given for not telling was that it would ‘complicate life’.
of contact and type of surrogacy. In terms of whether children were in
touch with any other surrogacy children, 67% (24) of participants were
in touch with at least one of the surrogacy children that their mother Children’s views on mother’s involvement in
had carried. surrogacy
Table V Frequency of contact with the surrogacy child, intended mother and intended father.
able to do that for you and help you through it then it’s something that’s com- family functioning. Some differences were found on measures of family
passionate really. (Child of a gestational surrogate) functioning between children of genetic and gestational surrogates, indi-
cating children of gestational surrogates to have better relationships with
An example of a neutral or ambivalent response was:
their fathers and better perceptions of family life than children of genetic
Um, I don’t have a problem with it, if mum wants to do it that’s her preroga- surrogates. However, it is important to note that most of the children of
tive. (Child of a genetic surrogate) genetic surrogates had experienced parental separation which could help
explain this finding. It is not possible to determine whether genetic sur-
Thirty-nine per cent (14) of the surrogates’ children mentioned factors
rogacy caused these parental separations as the present study was not
that were difficult during the surrogacy. These responses were later
designed to address this. However, the rates of parental separation
coded into the categories seen in Table VI. Sixty-nine per cent (25) of sur-
are not overly high when compared with UK norms where 42% of mar-
rogates’ children mentioned what they thought were the rewarding
riages are likely to end in divorce (Office for National Statistics, 2012).
aspects of surrogacy and 19% (7) mentioned factors that would have
Some of the surrogates were in cohabiting relationships which have
made surrogacy easier for them and these are shown in Table IV. The
higher rates of separation than marital relationships (Kiernan (1999). Fur-
way in which the surrogates’ children referred to the surrogacy child
a
Total 13 12 7 32
Some participants gave more than one response.
96 Jadva and Imrie
important to note that just over half of the children mentioned that they the same responses suggesting that children within the same family can
were not in touch with the child, and some were unaware whether the have different experiences of surrogacy. Despite the limitations of the
child had been told about their surrogacy origins and the identity of sample the findings provide new insight into the experiences of surrogacy
their surrogate. However, most of the children who were not in for children whose mothers act as surrogates.
contact with the surrogacy child were happy with this decision. This is
likely to be a reflection of the way in which the surrogate feels about
contact with the intended parents (and surrogacy child) as some surro-
Acknowledgements
gates make a mutual decision with the intended parents not to remain in We are grateful to all the participants who took part in this research. We
contact following the birth of the child (Jadva et al., 2003). wish to thank Surrogacy UK, COTS, CARE Fertility Manchester and
No clear patterns were found in the way terminology was being used Bourn Hall Clinic for their help in recruiting participants to this study.
by children of surrogates who were genetically related to the surrogacy
child, and those who were not. That is, the terms related to familial rela-
tionships such as ‘half-brother’ or ‘half-sibling’ were being used by surro- Authors’ roles