The social construction of surrogacy research: An anthropologicalcritique of the psychosocial scholarship on surrogate motherhood

Elly Teman

Science, Technology and Society Center and the Beatrice Bain Research Group, 616 Barrows Hall, University of California, Berkeley, CA 94720, United States

a r t i c l e i n f o

Article history:

Available online 21 June 2008

Keywords:

Surrogate motherhoodSurrogacyInfertilityReproductionGestational carrierGender

a b s t r a c t

This article presents a critical appraisal of the psychosocial empirical research on surrogatemothers,theirmotivationsforenteringintosurrogacyagreementsandtheoutcomeoftheirparticipation.Iapplyasocialconstructionistapproachtowardanalyzingthescholarship,ar-guing that the cultural assumption that ‘‘normal’’ women do not voluntarily become preg-nant with the premeditated intention of relinquishing the child for money, together withthe assumption that ‘‘normal’’ women ‘‘naturally’’ bond with the children theybear, framesmuchof thisresearch.IarguethatthisscholarshiprevealshowWesternassumptions aboutmotherhood and family impact upon scientiﬁc research. In their attempt to research theanomalous phenomenon of surrogacy, these researchers respond to the cultural anxietiesthatthepracticeprovokesbyframingtheirresearchmethodologiesandquestionsinaman-ner that upholds essentialist gendered assumptions about the naturalness and normalnessofmotherhoodandchildbearing.Thisleadstheresearcherstooverlooktheintrinsicvalueof the women’s personal experiences and has implications for social policy.

Introduction

Thevastmajorityofsurrogatemothersdonotbondwiththe babies that they relinquish to the infertile couples thathirethem.Infact,innumbersnowdifﬁculttoignore,anes-timated25,000women

havegivenbirththroughsurrogacyin its contemporary form as a legal, commercial processsince the late 1970s. It is estimated that over 99% of thesewomenwillinglyrelinquishedthechildastheyhadcontrac-tually agreed to do. Less than one-tenth of 1% of surrogacycases end up in court battles (Keen, 2007). Furthermore,the majority of surrogates have reported high satisfactionwith the process and report no psychological problems asa result of relinquishment (Baslington, 2002; Blyth, 1994;Einwohner, 1989; Jadva, Murray, Lycett, MacCallum, &Golombok, 2003; Kleinpeter & Hohman, 2000; Ragone,1994). Most surrogates report that relinquishment of thebaby is a happy event and that they would do surrogacyagain (van den Akker, 2007;Teman, 2006). Longitudinal studies show that these attitudes remain stable over time(van den Akker, 2007;Ciccarelli,1997; Teman, 2006). These ﬁgures, however, are not common knowledge,since most people are not personally acquainted with sur-rogates or families created through surrogacy. Withoutother sources, the public turns to stereotypes that pervadetelevision, ﬁlm and popular journalism.

The popular nar-rative of the surrogate who regrets her decision and triesto reclaim the child to ﬁll this void has little foundation

E-mail address:

mslula@gmail.com

The incidence of surrogacy is impossible to accuratelyestimate due tothe many informal arrangementsthat take place. Shirley Zager, directorof the 23-year-old nonproﬁt Organization of Parents through Surrogacy(OPTS) estimates that surrogates have given birth to 25,000 babies inthe United States since the mid-1970s (Keen, 2007). The Center for Dis-ease Control recorded 1012 gestational surrogacy IVF cycle attempts us-ing non-donor embryos in 2005.

For a discussion on the effect of media coverage on popular opinionsabout surrogacy, seeMarkens (2007). See also a recent opinion piece inthe New York Times (Warner, 2008) addressing the financial desperationof surrogate mothers in India and the 200 plus public comments in re-sponse. Thriller films such asFinal Vendetta (1996)depict psychologicallydisturbed surrogate mothers with ulterior motives terrorizing their com-missioning couples. Dramatic films such asThe Surrogate (1995)depictthe surrogate reneging on the contract.

in reality. Although true-life materializations of these sce-narios rarely occur, those that do, such as the famousBaby M case,

achievehuge media attention. Stories featur-ing surrogacy in ﬁlms and on television replicate similarplotlines, seldom portraying surrogacy in positive, uncom-plicatedways.Itisnosurprisethatsurveysinvestigatingat-titudes toward surrogacy indicate that the majoritydisapprove of the practice (Edelman, 2004) and that surro-gacyisperceivedastheleastacceptableofthereproductivetechnologies (Ciccarelli & Beckman, 2005).Isuggestthatthispublicuneasinesswiththeideaofsur-rogacy and the meta-narrative that it engenders

of thesurrogatewhoregretsheractionsorrefusestorelinquish

is more illustrative of the cultural anxieties that surrogacyencapsulates than of the actual majority of cases. At thebase of these anxieties is the subversive nature of surro-gacy, which disrupts two traditional conceptions thathave long been comforting to the western world:

family

and

motherhood

. Contractual surrogacy, in which a womanmakes a pre-conception agreement to waive her parentalrights in exchange for payment, calls these basic structuresofsocietyintoquestion.Inanerawhenthetraditionalfam-ily structure is increasingly ‘‘fragmented’’ as divorce ratesrise and alternative family forms flourish, surrogacyrepresents the height of destabilization of long held con-ceptualizations of the family (Markens, 2007). Surrogacyconstructs families through the marketplace, makingthem a matter of choice rather than fate and revealingthat families are social constructs (Rao, 2003).These cultural anxieties provoked by surrogacy in rela-tion to the family are further amplified by those anxietiessurrogacy raises over loss of maternal wholeness as it in-volvesatleastthreepotentialmothers:genetic,gestational,and social. Giving birth to a child for the purpose of relin-quishment also defies mainstream assumptions that iden-tify pregnancy with the birthmother’s commitment to theproject of subsequent lifelong social mothering andthreatens dominant ideologies in many cultures that as-sume an indissoluble mother–child bond. Directly chal-lenging the ‘‘ideology of motherhood’’ (Wearing, 1984),surrogacy reveals that the belief in motherhood as the nat-ural, desired and ultimate goal of all ‘‘normal’’ women issocially constructed.The centrality of motherhoodand familyas basic touch-stones of society make it difficult to accept the repeat find-ing that surrogates are non-psychopathological womenwho are usually happy to relinquish; it would be muchmore comforting to imagine that only unstable, distressed,abnormal womenwould voluntarily relinquish a child theybear to relative strangers. The narrative of the surrogatewho refuses to relinquish therefore seems to play a thera-peutic function, reassuring the public that women do in-stinctively love and cherish their babies and collectivelypromising that the surrogate’s non-normative actions canbe explained by the abnormal circumstances she is in orby her deviant character. Accordingly, surrogates aredepicted in popular representations as financially desper-ate, selfish, peculiar or disturbed.Thisarticlepresentsacriticalappraisalofthepsychosocialresearch on surrogacy. I suggest that the same traditionalWestern assumptions about motherhood and family, andthesameculturalanxietiesthatsurrogacyaffectsmorewidely,have an impact on the research goals, methods and conclu-sions of the scarce empirical scholarship on this topic. Mostoftheseempiricalstudies,withtherareexceptionsofahand-ful of ethnographic accounts (Goslinga-Roy, 2000; Ragone,1994; Roberts,1998; Teman, 2001, 2003a, 2003b), have beenof a psychosocial nature. The psychosocial empirical scholar-shiphasmainlyfocusedonthesurrogatemother,hermotiva-tionsforenteringintotheagreementandtheoutcomeofherparticipation (Aigen,1996;van den Akker, 2003; Baslington, 2002; Blyth, 1994; Braverman & Corson, 1992; Ciccarelli,1997; Einwohner, 1989; Fischer & Gillman, 1991; Franks,1981; Hanafin, 1984; Harrison, 1990; Hohman & Hagan,2001; Jadva et al., 2003; Kanefield, 1999; Kleinpeter &Hohman, 2000;Parker,1983; Resnick,1990; Samama,2002).Mycriticalappraisalofthepsychosocialresearchonsur-rogacy relates to these studies that focus on surrogates asa group rather than critiquing each study individually.This review was conducted as part of a larger longitudinalethnographic study I conducted between 1998 and 2006of the personal experiences of gestational surrogates andintended mothers involved in surrogacy arrangements inIsrael (Teman, 2001, 2003a, 2003b, 2006). The literaturewas identified through reference lists of relevant papersand by searching several databases, including SociologicalAbstracts, Medline, SSCI, Psychinfo, Google Scholar, andDissertation Abstracts. Keywords included surrogate(s),surrogacy, surrogate motherhood, gestational carriers,intended parents, and commissioning parents.While several literature reviews of the psychosocial re-search on surrogacy have appeared recently (see, for in-stance,van den Akker, 2007;Ciccarelli & Beckman, 2005; Edelman, 2004), none of these have applied a critical eye tothe studies overviewed. Using an anthropological perspec-tive, which views the studies themselves as products of cul-ture, I contend that this body of scholarship collectivelyrepresents a cultural text on the norms and values of West-ern culture and reveals how Western cultural assumptionsimpact scientific research. This article identifies the essen-tialist assumptions at the basis of the psychosocial researchonsurrogacy using asocialconstructionist approach (Berger& Luckman,1966) in the critique of the research itself.My argument is that the primary set of assumptions inthe psychosocial research lies at the meeting of two inter-related dimensions of childbirth: its naturalness and itsnormalcy. These concepts, of course, are not applied inmy argument in the essentialist sense, but in the sensethat any departure from them is labeled deviant. Specifi-cally, the cultural assumption that ‘‘normal’’ women donotvoluntarilybecomepregnantwiththepremeditatedin-tention of relinquishing the child for money, together withthe assumption that ‘‘normal’’ women ‘‘naturally’’ bondwith the children they bear, frames much of this research.I contend that these assumptions have led researchersto unconsciously frame their research methodologies andquestions in a manner that upholds mainstream gendered

Baby M was born to surrogate Mary Beth Whitehead, who refused torelinquish her to the contracting couple, William and Elizabeth Stern. ANew Jersey courtroom later gave Stern legal custody.

E. Teman / Social Science & Medicine 67 (2008) 1104–1112

1105

assumptions about the naturalness and normalness of motherhood and childbearing and to overlook the facevalue of the women’s personal experiences. Instead, theyexplain the non-naturalness of the surrogates’ choicesand reactions by positing psychological mechanisms of de-nial, deception, and anticipatory detachment, resolvingsurrogacy’s anomalous connotations by using scientiﬁcmethods to try to authoritatively prove that women whowillingly relinquish a child in surrogacy are not ‘‘normal’’or suffer severe consequences. Consequently, I suggestthat we can learn more from the literature on surrogacyabout the centrality of these concepts in Western cultureandtheireffectontheresearchers’essentialistassumptionsthanwecanaboutthesurrogatesthemselves.Inthefollow-ing, I identify three main themes that emerge from thisliterature.

Assumption 1: surrogates are not ‘‘normal’’ women

The psychosocial literature has a tendency to frame thestudy of surrogacy in such a way that it presupposes thatthe surrogate possesses personality traits which deﬁneher as psychologically aberrant. Given the assumptionthat ‘‘normal’’ women are ‘‘naturally’’ predisposed towardkeeping the children they bear, most of the psychologicalresearchers attempt to isolate explanatory factors thatmight account for the surrogates’ unnatural choice in relin-quishing the child by determining what makes the surro-gate population different from ‘‘normal’’ women. Often,deviance is implied in the way the researchers formulatethe questions themselves.For instance, in her article ‘‘Who becomes a surrogate?Personality Characteristics,’’Einwohner (1989:126)asks:‘‘W

hat kind of woman

is willing to conceive a child bya man not her husband, carry it within her and feel itmove, go through the effort and pain of delivery, andthen give it to relative strangers for love and care?’’ Thequestion itself implies a form of sexual deviance, of con-ceiving a child in adulterous relations. It suggests the ma-ternal deviance of relinquishing a child she ‘‘feels’’ to‘‘relative strangers,’’ and it assumes the skewed perceptionof a woman who would make such an ‘‘effort’’ and volun-tarily undergo ‘‘the pain of delivery’’ from apparently irra-tional motivations.Studies that aim to sketch a typical surrogate profile notonly assume that they will find abnormal personality char-acteristics among the surrogate population, but they alsoconstruct methodologies that are influenced by this as-sumption. Some studies use standard psychological diag-nostic tests to locate psychopathology among surrogates.These studies date back to 1981, whenFranks (1981:1379)tested 10 surrogates for psychopathology and found thathe could find ‘‘no specific profiles or patterns in thesewomen other than routine trends

the composite MMPIprofile was not notable; all scores were within one stan-dard deviation of normal.’’ He was left to conclude, reluc-tantly, that ‘‘little psychopathology could be detected’’and that surrogates have ‘‘relatively normal personalities.’’After Franks failed to locate psychopathological traits,otherresearchersattemptedmoresophisticatedmethodol-ogies. A number of studies have tried to comparesurrogates to control groups of non-surrogates byadminis-tering the same diagnostic tests to both populations. Dis-sertations in psychology byHanafin (1984), Resnick(1990), and a study byFischer and Gillman (1991)all used this method, while more recent studies have appliedalternative methodologies for the purpose of locating theassumed psychopathological traits that prior studies havemissed. For instance,van den Akker (2003)andJadva et al. (2003)administered standardized questionnaires tosurrogates, andSamama (2002)attempted to locate signsthat might differentiate surrogates from ‘‘normal’’ womenthrough content analysis of qualitative interviews.Some of these studies try to identify differences be-tween surrogates and ‘‘normal’’ women in terms of moral-ity.Resnick (1990:109), for instance, reports findings thatsurrogates are non-conformists, less affected by social pre-scriptions and sanctions than are other women.Kleinpeterand Hohman (2000:968)measured ‘‘normal personalitytraits’’ in 15 surrogates, reporting that surrogates ‘‘differedfrom the general population on nine personality traits.’’They suggest that surrogates are individuals who are ‘‘lessconscientious’’ or ‘‘less rigid’’ in their ‘‘application of moralstandards.’’Finally, some assessments of surrogate normality focusonthepredispositionofthispopulationtowardattachmentand bonding. This approach relies on bonding theory (Con-don & Corkindale, 1997), specifically on the assumptionthat ‘‘normal’’ women form close, loving attachments totheir children in utero and immediately after birth. Al-though anthropologists have long contested the culturallyconstructed nature of bonding theory (Ivry, forthcoming;Scheper-Hughes,1992; Weiss, 1994), mother–infant bond-ing is still understood in these psychological studies to bea universal, natural, innate process that occurs in allwomenunlessthere issomepsychologicalfactorinhibitingthe process, such as depression, or lack of social support(Condon & Corkindale,1997).Such surrogacy studies hypothesize that the ability tofunction as a surrogate may indicate some type of inabilityto bond or to form secure attachments (Ciccarelli, 1997:2).Hanafin (1984)attempted to assess the ways that surro-gates cope with separation and with making attachmentsby testing them for ‘‘separation anxiety’’ and ‘‘emotionalempathy,’’ among other signs.Resnick (1990)tested surro-gates with the Attachment History Questionnaire, hypoth-esizing that surrogates would score lower than the controlgroup on attachment scales. Although she found nodifference in attachment between surrogates and non-surrogates, she claims that her findings did support hernext hypothesis: that surrogates were less nurturing of their own biological children living with them than thecontrol group was.To my knowledge, none of the studies have successfullylocated any ‘‘abnormal’’ personality traits among surro-gates, yet continuous attempts have been made to proveotherwise over more than 20 years. Surrogates are repeat-edly found in these studies, asEinwohner (1989)reported,to be ‘‘intelligent, self-aware, stable adults.’’ Far from psy-chopathological, Einwohner described the surrogates inher study as ‘‘down to earth, practical, decent people,’’who were ‘‘optimistic’’ and ‘‘not worriers.’’Baslington

E. Teman / Social Science & Medicine 67 (2008) 1104–1112

1106