When does a mother truly become a mother?
Join us as you delve into part 1 of a 3-part blog series written by our Head of Ethics, Kay Read. This series was written in response to the debate on whether surrogates should be defined as ‘Mothers’. Kay speaks both as our Head of Ethics and as a surrogate herself and the series explores many aspects of the debate on in-utero bonding and how important it is to have the surrogates voice at the centre of this debate.
As Head of Ethics for a global surrogacy agency—setting the standard for ethical best practices—and as a surrogate myself, I am no stranger to criticism about the work we do and the role I play in family building. Where surrogacy exists, so too do counterarguments, misconceptions, and outright attacks. I get it. Reproductive choices, especially those involving women’s bodies, are always contentious. Over time, I’ve built resilience, grounded in the beauty of the families we help create and the pride I have in surrogates.
Yet, some comments still hit a nerve. During a recent BBC interview ahead of a surrogacy debate show, a reporter confided, “I just don’t know where I stand on the maternal-foetal bond. I want to believe it doesn’t matter, but something tells me it does.” I instinctively responded that two opposing beliefs can coexist—I deeply value the bond between a pregnant person and their baby, yet I also believe early childhood development is shaped more by primary caregivers than by gestation alone. It was a balanced response, but it left me reflecting: how can we move beyond speculation to deeper, evidence-based discussion? How can we put an end to the fixation on surrogates being the mother?
And here lies the problem—so much of reproductive health, especially anything concerning women’s bodies, is under-researched and therefore resides in speculation and debate rather than in evidence. In August 2023, Imperial College London reported that only 2% of medical research funding is spent on pregnancy, childbirth, and female reproductive health (1). This lack of investment fuels misinformation, speculation, and debate, leaving us without conclusive longitudinal study data to answer many of the questions that impact issues of body politics.
The BBC debate aired without a surrogate’s voice, featuring instead an anti-surrogacy campaigner and an intended parent. The anti-surrogacy campaigner argued that “surrogates are not surrogates, they are the mothers,” citing epigenetics as proof. She framed surrogacy as “taking babies away from their mothers.” My blood boiled. Sitting voiceless in a debate that centres on our bodies is infuriating. Surrogates deserve to be heard—not spoken for or about without a voice.
As a surrogate, I’m often asked if I’ll be “okay with giving up my baby” to its parents—a question that reflects the assumption that I consider the baby I’m carrying as mine and that I consider my role to be that of surrogate mother. This perspective overlooks my intentional and altruistic call to be a surrogate and, quite frankly, insults my bodily autonomy and decision-making!
Maternal-Foetal Bond in Surrogacy
I recognise that for a gestation that is intended to lead to a lifelong maternal role, there is a deep connection between the mother and her unborn child. However, research indicates that surrogates often experience a different type of attachment to the foetus compared to intended mothers. A study found that surrogates had lower emotional attachment to the foetus, suggesting that the gestational bond does not equate to traditional maternal attachment (2). Lower emotional attachment does not equate to no attachment, but I strongly believe in the psychological intelligence of surrogates to differentiate between helpful gestational attachment, in which they care for the unborn child through positive health and wellbeing, and emotional attachment that is associated with the baby belonging to them. Essentially, and this is not a huge cognitive leap to make, I think compassionate, altruistic people are capable of looking after something that doesn’t belong to them and that they are capable of doing that well.
Child Development and Primary Caregivers
Extensive research underscores the critical role of primary caregivers in shaping a child’s psychological development—not just in their presence (and yes, this is a deliberate counter to the anti-surrogacy campaigner’s epigenetics argument), but in the tangible, measurable impact that compassionate, nurturing care has on a genetic level. Studies have shown that variations in maternal care can lead to divergent developmental trajectories in offspring, affecting neuroendocrine function and behavioural phenotypes (3).
Research indicates that the quality of maternal caregiving not only impacts children’s development but can also result in heritable changes in gene expression, influencing emotional regulation, stress response, and cognitive outcomes (4). This evidence challenges the idea that gestation alone defines parental influence, it challenges the idea that parenthood and in-utero growth have to be one and the same and it highlights that postnatal caregiving plays a far greater role in a child’s well-being than their in-utero experience alone.
Secure attachments with caregivers are foundational for healthy emotional and social growth, and isn’t it this, after all that we are dominantly concerned with? The American Psychological Association emphasises that parents and caregivers serve as essential partners in the prevention and treatment of children’s mental health issues (5).
We look forward to sharing more thoughts on the role and definition of the surrogate in the second part of our blog series which will be coming out soon. Please use the references provided for further reading on this important topic.
References:
- Imperial College London. (2023). Female reproductive health research funding statistics.
Retrieved from https://www.imperial.ac.uk - Jadva, V., Murray, C., Lycett, E., MacCallum, F., & Golombok, S. (2003). Surrogacy: The experiences of surrogate mothers. Human Reproduction, 18(10), 2196–2204.
Retrieved from https://academic.oup.com/humrep/article/18/10/2196/635870 - Meaney, M. J. (2010). Epigenetics and the Biological Definition of Gene × Environment Interactions.Child Development, 81(1), 41–79.
Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4783284 - Moog, N. K., et al. (2018). Intergenerational Effect of Maternal Care on Child Brain Development and Function. Nature Neuroscience, 21, 567–574.
Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC6381851 - American Psychological Association. (n.d.). Parents and Caregivers: Partners in Children’s Healthy Development.
Retrieved from https://www.apa.org/topics/families/parents-caregivers-kids-healthy-development
