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How many is too many in surrogacy? Who is thinking about the children?

14 June 2021
By Dr Marilyn Crawshaw and Professor Olga van den Akker
Marilyn Crawshaw is an Honorary Fellow at the University of York UK. Olga van den Akker is Professor of Health Psychology at Middlesex University, London, UK. Both are members of PROGAR.
Appeared in BioNews 1099

A recent report of a millionaire couple, the Ozturks, who had 20 babies through surrogacy makes for disturbing reading. It highlights what can happen in the absence of universally agreed, child-focused laws to regulate the growing world of surrogacy. 

As surrogacy is more costly than any other form of family building it is available only to those who can afford it. The Ozturks are a good example: they appear to have no medical reason to turn to surrogacy but instead outsourced the task of creating babies to multiple surrogates simply because they could. They employ 16 live-in nannies, indicating the care of the children is also outsourced. 

The surrogacy agency involved was said to be happy to help them achieve their 'dream of a big family'. The media accounts say nothing about the paramountcy of the welfare of these children or the welfare of the surrogates involved. 

The concerns, in this case, are manifold. The majority of these babies were born in the space of one year, and need to develop ongoing attachments with a constant caregiver. The 16 nannies are unlikely to stay in the job for the duration of these children's childhood into adulthood, leaving them with the difficulties of developing repeated new attachments. 

This is not an isolated case. A young, single Japanese man – also a millionaire – commissioned numerous surrogates (and, presumably, egg donors) to have as many babies as possible who were then also looked after by nannies. Mr Shigeta fathered 13 surrogate babies in Thailand, and aimed to produce 1000 babies at a rate of 10-15 a year (see BioNews 939). His motivation was to have enough children to vote for him in the future when he may want to run for election. Clearly, this is not only morally and ethically dubious, it is potentially dangerous for any of them who do not comply. Such cases are likely to continue to occur.

There are a number of reasons why such practices raise ethical concerns. None of these children will benefit from sufficient one-to-one care from the parent(s). For this reason alone, it will be difficult if not impossible to adequately address their psychological well-being or social and emotional development. Additionally, and importantly, it is the parents' responsibility to manage their surrogate-born child(ren)'s individual needs in relation to their (genetic and) gestational origins. This includes helping them understand their 'story' and allowing them to apply their own meaning to it as they grow and develop.  

Emerging research documents that donor-conceived people (research specific to surrogate-born people is still lacking, given their greater recency) can face complex challenges in navigating contact with large numbers of donor relatives. And the rapid growth in direct-to-consumer DNA testing suggests that more and more surrogate-born people will be tracing, or being traced by, genetic relatives. With cross-border arrangements, these experiences could be further complicated by different cultures and languages.

While it might be tempting to think that challenges are confined to extreme cases, we suggest it can be unhelpful to portray other surrogacy practices as always problem-free and/or driven solely by altruism. Where human relationships and feelings are involved, the picture is invariably more nuanced and will anyway unfold dynamically over lifespans. 

Given that families formed through surrogacy involve at least one 'outside' party in their family origins story, there is value in seeking potentially transferable messages from donor conception (DC) and adoption. Some DC parents struggle with openness in part because DC, unlike adoption, can still evoke social disapproval. This may explain why some parents through surrogacy (whose social approval is increasing) are more open about the surrogate than the donor, where one is used, leaving their child believing the surrogate is their genetic parent and heightening risks associated with later disclosure about the donor. Meetings between adoptive parents and birth relatives have become more commonplace and valued, suggesting the same might be true for intended parents (IPs) and donors or surrogates.  

Finally, accounts from DC people make clear their belief in their right to full information about their origins. Where births are registered by IPs, this invariably restricts such a right by leaving the formal decision about disclosure solely with the IPs. Recently published International Social Services 'Verona principles for the protection of the rights of children born through surrogacy' state that birth registries should record full information about a child's legal, gestational and genetic parentage (though not on the birth certificate itself).

Further, we argue that the release of such information should not await a child reaching legal majority and birth certificates (for all children not just surrogate-born) should make clear that additional information may be available, and is accessible by the person concerned. 

Countries have different birth registration practices, different welfare and medical safeguards and the UN has highlighted the risks of trafficking babies and surrogates. Like their peers, surrogate-born children need a stable, open caregiving environment. Thorough safeguarding and risk assessments are necessary, good quality preparation of prospective parents needs to be in place, and families need ongoing support. Having access to a lot of money is no guarantee!  

SOURCES & REFERENCES
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