Recently, in an interview with ET, reality TV actress Kim Kardashian-West talked about the third child she will soon be welcoming into her family. After giving birth to a daughter and son with her husband, Kanye West, she wanted to give her children more siblings. But getting pregnant the third time around was more difficult than she expected.
That’s because Kardashian-West has a condition called placenta accreta, which caused difficulties in her first two pregnancies and made a third pregnancy unlikely. "Having more kids is definitely going to be a struggle," Kim shared on the show, "Keeping Up With the Kardashians," announcing in March that she was going to try surgery on her uterus as a last attempt. "I've gone through so much with really bad deliveries that the doctors don't feel like it's safe for me to conceive again myself," she said. "This surgery is really the one last thing I can try."
According to the National Institutes of Health, in the United States alone, 11% of women and 7% of men have experienced fertility problems, often causing crushing disappointment for couples hoping to grow their family.
Ultimately, Kardashian-West decided to pursue her next pregnancy by hiring a surrogate. In the recent ET interview, she described the experience as not exactly what she expected: "Anyone that says or thinks [surrogacy] is just the easy way out is just completely wrong. I think it is so much harder to go through it this way." She went on to explain that she did not feel as in control as she did when she carried her two prior pregnancies.
While parents who hire surrogates, like Kardashian-West, certainly face difficulties, surrogacy can also bring unexpected challenges for the surrogate mothers that are too often overlooked. We all know the female body experiences numerous changes when pregnant, both physical and mental, thanks or no thanks to the hormones that bring about the miracle of life. So, like any mother, surrogate moms bond with the child in their wombs, and often experience emotional pain when detached from their child after birth—even if they knew and intended all along to give up the child to the intended parents. A 2014 qualitative study on the experiences of eight surrogate mothers published the Iranian Journal of Reproductive Medicine, revealed surrogate moms experience significant emotional attachment to the children they carry. Researchers concluded, "surrogacy pregnancy should be considered as a high-risk emotional experience because many surrogate mothers may face negative experiences."
Furthermore, surrogate moms face increased pregnancy risks that come with carrying multiple embryos, which are often used to ensure success. Multiple births come with an increased risk of Caesarian sections and longer hospital stays, according to the British Journal of Medicine, as well as gestational diabetes, fetal growth restriction, pre-eclampsia, and premature birth. The drug, Lupron, which is used to transfer embryos, has also been documented to put surrogate women at risk for increased intracranial pressure.
In part due to the challenges surrogates face, Jennifer Lahl at the Center for Bioethics and Culture Network created the documentary, Breeders: A Subclass of Women. Lahl says the American Society for Reproductive Medicine reported a 30% increase in surrogate births between 2004 and 2006, for a total of 1,059 live births in 2006, the most recent year for which it could provide data. After hearing the experiences of surrogate moms who shared their stories in the documentary, Lahl believes, "surrogacy is another form of the commodification of women’s bodies...and degrades a pregnancy to a service and a baby to a product."
Lahl told me via email that many of the women she has interviewed say they feel "devastated" afterward. When surrogates have pregnancy-related health complications, Lahl notes, the intended parents complain about the extra costs and having to pay their surrogates who miss work, and some surrogates feel little empathy for their well-being. Lahl explained:
They feel as if they have been hired to do a job, and that job is a paid breeder. One surrogate, who almost died due to high-risk pregnancy complications, was told that it was her fault and was accused of doing it on purpose to make more money.
Lahl adds that several surrogates she has met with have been "diagnosed with post-traumatic stress disorder afterward, making it hard for them to get back to their pre-surrogacy health."
Adding to their physical and emotional stress, surrogate moms sometimes also experience exploitation at the hands of the agencies facilitating the transfer or by the intended parents. Some former surrogates say they’ve been left with a hefty financial burden due to parents who do not pay medical payments in full, or agencies that do not defend them when a conflict arises.
This happened to a five-time surrogate mom from South Dakota, Kelly, who shared her story this past March at the United Nations Commission on the Status of Women. Kelly signed up to be a surrogate hoping to help infertile couples, but after the intended parents of one of her surrogacies took the child and left her with thousands of dollars in unpaid medical bills, her view on the practice changed. "If it sounds too good to be true, it most likely is," she said. "Both my international couples were through an agency….Two international couples exploited me, lied to me, and have caused me so much suffering and heartache."
How do the children fare, though? Four years ago, a report conducted by the University of Cambridge and published in the Journal of Child Psychology and Psychiatry received some buzz after suggesting surrogate children face increased emotional risks. Researchers led by professor Susan Golombok found that children who were not gestationally carried by the mother who ended up raising them faced increased psychological adjustment difficulties including depression, around seven years old. However, a 2016 study, also led by Golombok, found that by age 14, children do not show significant adjustment problems, suggesting the bumpy emotional ride for children born of surrogates may smooth out over time.
So is the surrogacy option worth the risks—both for the women struggling with infertility who want to grow their families and for the women willing to provide their bodies and their time to carry a child for someone else? As surrogacy is relied upon by more women in the United States each year, including Kardashian-West, now is a good time to be asking this question, which requires looking more closely at the challenges that come with it. Currently, the United States does not have any federal law regulating surrogacy, and state laws vary greatly. There is room for laws to become more consistent, as well as a need for more research on the effects of surrogacy on women and their children.
Mary Rose Somarriba is a writer and contributing editor for Verily Magazine.
Editor's Note: The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.