Altruistic surrogacy
A slippery slope
This is a guest post by Bernd Ahrbeck and Marion Felder.
Surrogacy is prohibited in Germany. It has long been assumed that children need protecting from tensions between their genetic inheritance, their particular genesis and their subsequent life experiences. Knowing one’s origin is a fundamental psychological need: the search for one’s roots, for belonging and connection, accompanies people throughout their lives. Ambiguous motherhood, in contrast, places a burden on psychological development and later identity formation. Biographical gaps are difficult to bear, especially when they are brought about deliberately. For this reason, German law unambiguously defends the best interests of the child.
However, the FDP (Freie Demokratische Partei), a liberal party which is a member of the current German government, is seeking to change the country’s surrogacy laws. The FDP argues, ‘If those affected cannot have a child by other means, they can be helped by surrogacy and the surrogate mother wants to help purely out of charity, the state has no right to prevent this happiness.’ It considers an unfulfilled desire to have children to be a serious restriction on life that does not have to be accepted. The state or government, the FDP argues, has ‘no right’ to stand in the way of people becoming parents, even if the consequences for the child could be serious. Altruistic surrogacy, it claims, is an ‘act of charity’ which should take place free from economic, social and psychological constraints.
But differentiating between commercial and altruistic surrogacy is not as easy as it may seem at first glance. Every surrogate mother accepts physical risks and puts herself in a psychologically delicate position. Even an altruistic surrogate mother is subject to high expectations and the problems that arise from this are diverse and complex. They concern the surrogate mother’s inner relationship with (her) child and with the client, for example if the child does not turn out as desired, or is ill or disabled, as well as her relationship with others including, potentially, her own children.
The FDP states that:
Legalizing altruistic surrogacy in Germany would ultimately benefit everyone. The intended children who are born into clear circumstances, the intended parents and the surrogate mothers who are allowed to help in a self-determined way.
But some have questioned whether everyone really does benefit from such arrangements. One argument is that, ‘From the child’s perspective, surrogacy can never be “altruistic” because it is not in the child’s best interests to be separated from the birth mother after birth’.
Surrogacy and pregnancy
Pregnancy marks a profound turning point in a woman’s life. This makes it fundamentally different from other life events. Physical and psychological developments go hand in hand. On the biological side, major transformations occur: organs and bodily functions readjust, individual areas of the brain change in volume and activity, for example in the prefrontal and temporal cortex. Psychologically, for example, the capacity for empathy grows and self-awareness changes.
As a result of pregnancy, the inner world is reshaped in a way that can no longer be reversed, regardless of whether the child is actually born, lost or aborted. The intense preoccupation with oneself and the life to come represents a psychological milestone that relates equally to the present and the future. Early fantasies, fears, longings and desires can be activated, and decisive life events and inner conflicts can flare up again. Depending on how they are dealt with, the experience may be characterized by joy and confidence or doubt and sometimes even despair. The expectant child can occupy very different positions in the mother’s psychological framework due to the wishes and expectations it is supposed to fulfill and the dangers it represents. Individual expectations inevitably arise.
Pregnant women’s thoughts are often focused on the future: How will their child develop? What will their relationship with the child be like? Few things in life last as long as the bond with one’s own child. From the very beginning, the child is embedded in a triangular space, in the relationship between father, mother and child, with shared or separate ideas about the future. This basic psychological constellation is anthropologically predetermined and no one can escape it. Whether the child is raised by both parents together is irrelevant.
Commercial surrogacy turns a human being into the object of a sales contract. This objectification is a blow to the social structure of a society of free and equal individuals. In effect, two parties become involved in a contract: a mother and a child. Money determines the nature of the relationship with the client, and the abrupt separation after birth is just one indicator of this, albeit a particularly obvious one. The child no longer belongs to the mother in the truest sense of the word, it has become ‘motherless’.
In relation to the surrogate mother, all that counts is her reproductive performance. This is measured on the basis of external criteria: a child must be born intact and flawless, as stipulated in the contract or risk it not being accepted and not receiving payment. The situation of Indian surrogate mothers has been described as follows: ‘They are supposed to see themselves as disciplined birth workers: The goal of the work is solely to physically optimize the child to be delivered.’ Care is therefore taken to ensure that the women remain healthy. Anything else jeopardizes the business model, for example if the child is born with a disability, the client can, in many countries, insist on an abortion, known in technical jargon as ‘a reduction’. This also applies to a twin pregnancy if only one child is wanted.
The massive health risks that surrogate mothers expose themselves to, that go far beyond the normal risks associated with pregnancy, are often overlooked. They include: multiple pregnancies, hypertensive pregnancy disorders, and greater likelihood of gestational diabetes and pre-eclampsia. The egg donor is also at risk of various physical harms, such as hormone overstimulation, tissue damage during retrieval or the failure to reproduce eggs.
An Israeli study sheds light on the social and psychological experience of surrogate mothers. ‘None of the surrogate mothers reported an emotional bond with the foetus during pregnancy and with the child after birth,’ it notes, identification with the developing child is avoided, physical changes must remain without inner meaning. The surrogate mothers interviewed reported, for example, that they do not touch their belly. Parts of their own body thus become alien to them. They distance themselves mentally from what is happening to them biologically. The bodily connection between nature and culture is to be severed. This requires a tough struggle with oneself, because no one can escape the psychological impact of biological changes no matter how much they might wish to do so. In order to escape this conflict, or to make it at least halfway bearable, considerable defensive efforts are required. In order to preserve one’s own self, the body is fragmented and depersonalized to guard against imposing affects and fantasies. Anyone who, like these surrogate mothers, is reduced to a working body and only appears as a rented birthing machine, has taken on a potentially psychologically damaging task.
Neglected suffering
In much of the psychological and socio-educational literature dealing with new family forms, surrogacy is largely uncommented on alongside other forms of reproduction. It does not occupy a special position. Above all, the dramatic situation in which commercial surrogate mothers find themselves receives little attention. Their fate is often ignored. Concerns, if they exist, are rarely raised. But idyllic descriptions that try to portray surrogacy as a win-win situation for everyone involved cannot hide the fact that the child is also given a heavy burden to bear. The relationship with its mother, i.e. the surrogate mother, is an extremely unusual one for the reasons already mentioned. Even in psychoanalytic writings, surrogacy is only mentioned sporadically. And when it is, it is least often about the surrogate mothers themselves. The focus is usually on the new parents and their child, their wishes, fantasies, but also the conflicts that arise when coping with the special reproduction process.
It is all too obvious what a considerable potential for conflict arises for the surrogate mothers and how explosive the associated ethical questions are. Psychoanalysis should face up to this, both with regard to patients seeking help and to the whole complex of issues. However, some psychoanalysts place surrogacy in a broad emancipation movement, which includes the depathologization of homosexuality. In their view, the possibility of marriage (“marriage for all”) legitimizes the desire of homosexual couples to have children.
The diversity of today’s lifestyles means that motherhood and parentage need to be reconsidered. Although the conditions suffered by surrogate mothers in poor countries are strongly condemned, the phenomenon itself is not called into question. A ban on surrogacy is viewed as historically outdated and just as counterproductive as other previous bans. With regard to altruistic surrogacy, it is stated that the desire for pregnancy does not necessarily have to go hand in hand with the desire for motherhood. The cards could be reshuffled to favour self-determination. The legal situation is decisive and psychoanalysis must follow it. But this robs psychoanalysis of its socio-critical potential.
One thing should be clear: if altruistic surrogacy is permitted, important obstacles that still stand in the way of commercial surrogacy will be removed. It will then only be a matter of time before commercial surrogacy is also legalized.
Bernd Ahrbeck is professor of psychoanalytical paedagogy at International Psychoanalytical University, Berlin, Germany. He is an educational scientist, psychologist and teaching psychoanalyst.
Marion Felder is professor of inclusion and rehabilitation at University of Applied Sciences, Koblenz, Germany. She is currently head of the social work programme.