The Unheard Voices of Surrogate Mothers

The woodecut of an woman growing a plant
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Grow up by Shachnas Aghayeva

Surrogacy is the most complex aspect of assisted reproductive technologies (ART), in which three parties – including the surrogate mother – are involved. Instead of the intended commercial gestational surrogacy is legal (Law on Health Protection 1997). A surrogate can enter a contract only with a heterosexual couple, assuming the couple is able to document that they have been married or cohabitating for at least one year. The first baby conceived through surrogacy in Georgia was born in 2007. Since then, the number of surrogacy agencies and clinics offering assisted reproductive technologies has grown and Georgia is becoming a hotspot for transnational surrogacy.parent(s), it is the surrogate mother who consents to pregnancy since the remaining parties are unable to do so due to medical or other reasons. Georgia is among the few countries worldwide where

The first time I met Ani, she was 24 years old and planning to become a surrogate mother for the second time.[1] As a researcher interested in surrogacy issues, I wanted to understand the reasons behind her decision. Ani was wondering why I was curious about her story.[2] When she asked me, I hesitated a little and then answered diligently, “Because hearing your voice is important.”

The first case of a child born through a surrogate mother was documented in the early 1980s in the USA;[3] yet, this medical procedure still causes controversy and necessitates a rethinking of the concepts of body, motherhood, and family. In most countries surrogacy is illegal, and the law is based on the argument that this phenomenon contributes to the commodification of women and children, devaluing human life and reproductive capacities. In some countries, only altruistic surrogacy is allowed, which involves a surrogate mother helping a couple or a single woman and only receiving reasonable compensation for medical and other expenses (e.g., Canada, Greece, Israel, the Netherlands, UK). In contrast, given the economic situation in Georgia, it is unsurprising that getting paid for surrogacy is important for Ani and others involved in the process. Georgia is one of the few countries (like Ukraine, Russia and some US States) where the current law allows both types of surrogacy. As the Georgian Law on Health Protection states, “In vitro fertilisation shall be allowed (a) to treat infertility, if there is a risk of transmitting a genetic disease from parent to child, using the gametes or embryo of the couple or a donor, if written consent has been obtained from the couple; (b) if a woman does not have a uterus, by transferring the embryo obtained as a result of fertilisation to the uterus of another woman (‘surrogate mother’) and growing it there. Obtaining written consent from the couple shall be obligatory”.[4]

In Georgia, the first surrogate child was born in 2007.[5] Since then, interest in surrogacy, as well as the number of surrogacy agencies and clinics offering assisted reproductive technologies have grown each year, currently amounting to approximately 20 clinics. [6] In Georgia, only gestational surrogacy is allowed, which, according to current medical views, excludes any biological connection between the surrogate mother and child.[7] A contract with a surrogate can be entered into by a heterosexual couple who can document that they have been married or cohabitating for at least one year. [8] According to doctors and lawyers in the field, surrogacy is largely unregulated in Georgia because current legislation says nothing about the criteria for selecting a surrogate mother, the number of embryos that can be implanted, the number of children that can be obtained through surrogacy, or the upper age limit for potential parents.[9] At present, homosexual couples and single women in Georgia cannot use surrogacy services. In contrast, the current liberal legal framework provides maximum flexibility to married heterosexual couples. Despite the scarcity of the law, it does clearly state that in the case of childbirth, the donors or the surrogate mothers do not have the “right to be recognized as parents,” pleasing potential parents who, according to studies, worry about the surrogate mother changing her mind and deciding to keep the child (Blyth 1995). [10] In addition to the law, agencies and clinics require that potential surrogate mothers have their own child/children. Women who already have children are less expected to develop feelings for the surrogate newborn or pose a problem to the intended parents. Additionally, having had a child confirms the reproductive potential of the surrogate mother and previous experiences with pregnancy and childbirth become a reason to consider her agreement to go through with the process better thought-out. To self-regulate, clinics and agencies also set a proper age range of approximately between 21-38 years for surrogate mothers.

Generally, the economic standing of Georgian couples rarely allows them to think about surrogacy. Despite its pro-natalist stance, the state does not cover in vitro procedures, let alone the more expensive process of surrogacy. Consequently, the growing number of agencies and clinics can be better attributed to rising demands from foreign couples who try to make their dreams come true by avoiding legal restrictions in their own countries. According to the interviews conducted with representatives of agencies and clinics, foreign couples are from different countries where the legal framework does not give them access to desired services.[11] Their interest in Georgia is due to several reasons: prices are affordable compared to other countries,[12] Georgian birth certificates recognize the couple as parents as soon as the child is born, local clinics have a high success rate, and intermediaries speak the languages ​​necessary to communicate with foreign couples.

Of course, surrogacy is entangled with notions of gender, social inequality, family, and inheritance, as well as medical, governmental, and religious regulations. It is important to investigate the motives and tactics of all actors who engage in the global reproductive market as they continue to live in their local spatial and temporal fields, negotiating between medical innovation and their traditional cultural scripts that often frame surrogacy as a “cultural anomaly”.[13]

The experiences of social inequality are imprinted in the life stories of surrogate mothers like dried flowers placed in an herbarium. Ani, like many other surrogate mothers, married young, hoping to escape a difficult childhood. Due to her new family’s traditional views, Ani could not continue her studies, the marriage turned out to be unsuccessful, and today, she must handle the difficulties of life as a single mother. Overcoming such obstacles becomes even more unimaginable when individuals also face harsh preconditions. Without a school diploma, thinking about university is futile. With precarious working conditions, it becomes impossible to repay any accumulated debt. The stories of surrogate mothers in Georgia show the insufficiency of the country’s social support systems or a complete lack thereof.

Though there are cases of couples negotiating with a potential surrogate mother without an intermediary agency, more often, this process is regulated by agencies that deal with surrogacy and donation. Agency representatives understand the danger of women being used by husbands or partners for economic gain. So, during the initial interview, they try to get the clearest, most detailed picture possible concerning the candidate’s motivations. Agencies also actively cooperate with clinics. These are normative spaces, where proper/non-proper bodies and bodily practices, and their usefulness/uselessness are defined. The surrogacy contract details guidelines for the surrogate mother to follow before and during pregnancy. For example, she must take medication in an orderly manner, is forbidden from consuming alcohol or drugs, and may not be allowed to have sexual intercourse, even with her husband.

Women who wish to become surrogate mothers must also take part in physical, as well as discursive preparations. Throughout their lives, women have been told that the nine months of pregnancy are very important and that it is natural for them to love and think of the baby as their child even before it is born. In contrast, discourse about surrogacy no longer focuses on the emotional connection that can be formed during pregnancy. This period is relayed as part of a temporary, minor, medical supervision and not as the fundamental stage of motherhood. Surrogate mothers are accustomed to activating defense mechanisms. They deliberately do not look at the ultrasound screen and may avoid seeing the newborn. Lia, who is supposed to give birth any day now, chooses this tactic:

“I do not even want to see them, to tell you the truth, because I do not want the image to be stuck in my mind” (Lia, 39).

Though the lack of a biological bond is very important for surrogate mothers, they still pay close attention to the connection between them and the child/children. They reminisce about how they talked to the fetus, ensured its safety, and knit socks for the future newborn.

On the tenth day, foremilk was already coming from my breasts, imagine. And they were assuring me that the pregnancy was artificially created for the body in such a way that it should not have this intense psychological response. They were even surprised that I loved the children” (Nini, 27).

According to the clinics and surrogacy agencies, the level of awareness about modern reproductive technologies has more or less increased, but surrogacy remains a stigmatized practice in Georgia to this day. It is very rare for a surrogate mother to talk openly about her own experiences. To avoid negative responses, surrogate mothers mostly try to disguise and cover up the whole process. In Georgia, there are no established mechanisms that would help surrogate mothers with self-empowerment, nor circles where they could share experiences or motivational books that would make it easier for them to cope with various difficulties. There are frequent cases when surrogate mothers change their place of residence and thus avoid revealing their secret. Ani, recalling later months of her pregnancy, says that she had found an alternative explanation for those around her who were curious:

“I claimed that I had some sort of a hormonal problem and had gained weight because of it” (Ani, 24).

Conversations with surrogates show that their reasoning is very pragmatic. What can actually be done with the expected payment? What will 12, 15, or 18 thousand dollars be enough for? To repay bank debts? To mortgage an apartment? To gain a new skill? Nini says that it is very difficult to achieve desired goals with the salary received:

I could not do anything much, to tell you the truth, except that I bought necessary items. This was a laptop that the children need constantly. They are always told in school to research everything. I bought bicycles for them, very basic, for 250 GEL each, a drop in the ocean but they dreamed of them and deserved them. I trained to become a nail specialist and bought all the necessary equipment, materials, etc.” (Nini, 27).

Many surrogate mothers think that the pay should be higher and find it especially unfair that the amount for a pregnancy with twins is only increased by 1500-2000 dollars. In most cases, most of the received amount is used to pay off debts. With the remaining money, surrogates try to do something valuable or decide to keep it in the bank, hoping to add more money later - the cause for Ani’s deliberation about a second surrogacy.

“I have motivation - to buy an apartment for me and my child, at least a small, one-room apartment, this is my motivation” (Ani, 24).

The culmination of the pregnancy is emotional for all parties. The traditional bond between mother and child takes on a new image in this case. Interviews with intended parents show that the moment the child is born, they try to take over and somehow compensate for the months when the baby/babies were growing in the surrogate’s womb. After childbirth, most clinics are reluctant to allow the surrogate mother to keep a connection with the newborn, even to breastfeed the baby, which, according to surrogate mothers, is excessive caution. Surrogate mothers are frustrated that society still associates handing over the baby with selling your child:

“That stereotype is also very prevalent, when they think, how are you going to let go of your child?! It is not your child, you know, you know from the beginning that it is not” (Eka, 28). Postpartum is also accompanied by ambivalent emotions. Distancing from the child leaves the surrogate mother with feelings of both relief and emptiness: “I had a moment of sadness, internally, for a split second, thinking oh, I won’t be pregnant... oh, and they are taking the child away. And then, when I saw the girl’s emotions... She almost fell, crying, laughing, letting everything out at once when she saw the baby outside of the operating room. That’s when I realized that I had done something very amazing and that not only should I not worry for a second but be happy for the rest of my life” (Nini, 27).

Surrogate mothers decide to engage in this process precisely because they are mothers themselves and need material support for their children. As 28-year-old Eka says:

“One day, I finally got to the point when I knew that I had to do something to give my child a better life. I wasn’t getting anywhere with just my job. I realized it was a risk, but I also had nothing to lose. There was no other option, so I just took the leap.”

Conversations with surrogate mothers show that women have two main options before making the decision: surrogacy or migration. Because of their own children, women find it difficult to imagine leaving the country, knowing that going abroad means a long separation from them. Often, surrogacy seems like the only choice.

It is frequently argued that all surrogate mothers are oppressed, voiceless, and without agency, but we must remember that when we try to merge people into theoretical categories, there is always the danger of devaluing individual experiences. Researchers walk on the edge of this boundary. When speaking to surrogate mothers, along with the scarcity of social support and underdeveloped public services, it is impossible not to see strength in their stories of struggle. We should not view surrogates simply as victims because they are also agents.

You are very strong!” I say to Ani with eyes wide, listening to her life story. “We are mothers, after all. All mothers are strong. All mothers are strong to some extent, I think,” she replies with a smile.

 

 

[1] Interviewees’ names are intentionally changed to protect their anonymity.

[2] Interviews were conducted in the frame of an ongoing research project – “Surrogacy as Networked Phenomenon: the study of key actors and their interrelations”. The project is financially supported by the Shota Rustaveli National Science Foundation through a research grant (FR-19-7478). I am enormously grateful to all the participants who agreed to be interviewed and shared their experiences.

[3] Utian, W. H., Goldfarb, J. M., Kiwi, R., Sheean, L. A., Auld, H., & Lisbona, H. (1989). Preliminary experience with in vitro fertilization-surrogate gestational pregnancy. Fertility and Sterility, 52(4), 633–638. doi:10.1016/s0015-0282(16)60977-9

[4] See Georgia’s Law on Health Care, Article 143.2.

[5] See the website of the ReproART clinic: https://reproart.ge/reproduqciuli-klinika/

[7] During gestational surrogacy, an embryo - created from the egg of a biological mother or a donor - is implanted into the surrogate mothers uterus.

[8] See the Order of Georgias Minister of Justice on Approval of the Procedures for Civil Registration, №18, 31 January 2012, Tbilisi, Article 19: https://matsne.gov.ge/ka/document/view/1572063?publication=0

[9] The most extreme example of lax regulations is the case of the millionaire Turkish businessman - Galip Ozturk and his wife, Kristina Öztürk (@batumi_mama) who are planning to have 105 children through surrogacy. The couple lives in Batumi, Georgia (a city on the coast of the Black Sea).

The Sun (26 Jul 2021 )“KID YOU NOT Dad who had 21 surrogate babies in a YEAR already had 9 kids with ex & his eldest is a decade older than his wife”, https://www.thesun.co.uk/fabulous/15674309/dad-21-surrogate-babies-year-9-kids-ex/

[10] See Georgias Law on Health Care, Articles 141, 143, 144.

[11] Couples come from Turkey, China, Israel, UK, Germany, Spain and other countries.

[12] For comparison, see the webpages of Georgian and American Surrogacy Centers:

Israeli IVF, Donation and Surrogacy Center BIRTH in Batumi, https://birthbatumi.com/?page_id=7199&lang=ka

“Price of US Surrogacy”, https://fertilitycenterlv.com/diagnosis-treatment-care/price-us-surrogacy/

[13] This concept is used by Elly Teman in her book “Birthing a Mother: The surrogate body and the pregnant self”. University of California Press, 2010.