America’s Surrogacy Bump: Is Fertility a Blessing to Be Shared?

Pro-life carriers and Christian bioethicists navigate the patchy landscape for assisted reproduction.
America’s Surrogacy Bump: Is Fertility a Blessing to Be Shared?
Image: Malanie Grizzel

Following months of infertility treatments, Meg Watwood cried in joy when her first ultrasound revealed healthy twin babies. At the doctor’s office three years later, when a scan showed she was pregnant with twins again, there was another mom in the room celebrating.

This time, Watwood was carrying the babies for her.

Amid all the waiting, testing, and praying for her own twins, Watwood had developed a deep compassion for families stung by infertility. She felt called to help, so much so that she offered up her womb to two little embryos from a fellow couple struggling to conceive.

Then last year, she did it again for another couple.

Doctors had deemed that hopeful mom-to-be unable to carry a pregnancy after several failed rounds of intrauterine insemination (IUI) and in vitro fertilization (IVF). The couple, a pair of Texas lawyers who shared Watwood’s pro-life convictions, wanted to give the additional viable embryos they had produced a chance. They were connected to Watwood, a Southern Baptist, by a local surrogacy agency.

“God called me to seek out what seemed like unconventional ways to serve others,” said Watwood, now a 39-year-old mother of four. In the surrogacy process, “Some things will be hard … but you’ll be blessed so far beyond what you could even imagine.”

Watwood is part of America’s rapidly growing surrogacy movement. The number of babies born through surrogacy in the United States, though still relatively small, has quadrupled in just over a decade. And despite ethical questions surrounding the practice, demand isn’t slowing.

According to the American Society for Reproductive Medicine, surrogates gave birth to 2,807 babies in 2015, up from 738 in 2004. Nearly all were conceived by IVF and carried by women with no genetic connection, a process called “gestational surrogacy.” (In “traditional surrogacy,” the only option prior to IVF but one rarely used today, the carrier would also be the genetic mother of the baby.)

IVF and surrogacy are becoming more normalized in the US just as other countries have shut down foreign surrogacy enterprises, dual trends that have made the US a top surrogacy destination. High demand for surrogates, who typically earn more than $20,000 per birth, has attracted many evangelical women, who often fit the profile of the “ideal” surrogate and are drawn to the idea of using their fertility to bless others.

But laws and ethical discussions surrounding surrogacy haven’t kept up with the industry’s growth, and pastors and churches appear largely ill-equipped to guide women and couples through the high-stakes decisions involved in third-party reproduction.

A moral and legal patchwork

There is no federal law governing surrogacy. Couples seek out carriers across state lines to navigate the patchwork of laws allowing or banning surrogacy—or, in more than half of the country, a lack of legislation on the issue altogether.

With no agreement over—and sometimes no acknowledgment of—the serious ethical questions that come with new ways of creating and carrying life, neither advocates nor critics see imminent reform ahead for the unregulated surrogacy landscape.

Within the church, even those who share positions against abortion may disagree or simply not have the answers for scenarios that arise with assisted reproduction and surrogacy. But Christians on both sides urgently want their communities to pay more attention to the possibilities and problems emerging as the surrogacy industry continues to expand.

Protestant churches have been largely silent on the issue, said Scott Rae, a Biola University ethicist whose expertise is in assisted reproduction. “Most churches that I’m aware of either have nothing to say or want nothing to say.”

Couples approaching their pastor to discuss surrogacy as an option have often already begun the IVF process, leaving him or her to consider the welfare of the existing embryos even if the pastor would have advised against creating them in the first place. And church leaders have few ready answers for women interested in serving as surrogates; their guidance may vary with the particular situation.

“The pastor is never called to be a medical expert, but he is certainly regarded as a moral expert,” said Paige Comstock Cunningham, the executive director of The Center for Bioethics & Human Dignity at Trinity International University (TIU). “Some of these things are simply not appropriate for the pulpit on a Sunday morning, but they do need to be addressed.”

Last year, former Arizona congressman Trent Franks—a Republican, pro-life Baptist—resigned following allegations that he had asked female staffers if they would serve as surrogates for him and his wife, who had struggled with infertility.

The news launched a bigger conversation among evangelicals over whether gestational surrogacy was even a moral option in the first place—a debate that rarely makes its way into the national pro-life conversation.

Together,  Meg Watwood, Melissa O’Hare, and Gayle Garrett— founder of Surrogate Solutions— have given  birth to 16  children, including 7 as surrogates.
Image: Melanie Grizzel

Together, Meg Watwood, Melissa O’Hare, and Gayle Garrett— founder of Surrogate Solutions— have given birth to 16 children, including 7 as surrogates.

A Christian heart for surrogacy

A bubbly mom with a social work degree, Watwood knew how bittersweet the surrogacy process would be for the women whose babies she carried. After years of expenses and treatments, the intended mother had a baby on the way—except Watwood was the one who would deal with the morning sickness, bust out the maternity jeans, feel the first little kicks, and ultimately go through the pain of labor.

Watwood saw herself as part of a bigger plan for these couples and their little ones. When the mother of her most recent surrogate baby teared up in the delivery room, she said to her, “This is almost over. You are going to praise God that you didn’t get pregnant those four years . . . because you’re fixing to meet this baby that God has for you. You’re going to be grateful for all of the nos he gave you that led up to this yes.”

The demands of surrogacy—emotional, physical, and spiritual—go well beyond what gets written up in surrogacy contracts. Watwood said she worried more about her surrogate babies than her own, avoiding medication, caffeine, and as many other risk factors as possible to ensure a healthy outcome.

A friend and fellow surrogate, Melissa O’Hare, was admitted to the hospital to give birth to her surrogate baby at the same time as Watwood. She felt the pressure, too. “I’m so glad I have a peace about this being God’s plan,” O’Hare said. “I don’t know how non-Christians do this.”

Watwood and O’Hare worked with an agency called Surrogate Solutions, one of dozens of networks in the US that recruit surrogates. Candidates are typically active women in their 20s and 30s with at least one kid of their own and a solid financial background. They can’t smoke, do drugs, or take antidepressants and must pass a psychological review. And they must live in a state where surrogacy is legal.

New Jersey has long known the risk of surrogacy-gone-wrong since its courts handled the first surrogacy dispute in the US. In the 1986 “Baby M” case, the surrogate (and genetic mother) famously fought for custody, forcing the intended parents to sue for the rights to their baby.

New Jersey, along with states like Washington and Indiana, will not enforce commercial surrogacy contracts. New York, Arizona, and Michigan prohibit all contracted surrogacy arrangements.

Jurisdictions with restrictions deem the practice “injurious to the public” or “contrary to public policy,” because such agreements, according to some lawmakers, amount to “baby-selling,” which is illegal.

Meanwhile, favorable laws in places like California and Texas provide a relatively smooth legal process for commercial surrogacy if everything goes right.

The industry is unregulated, so every agency has its own approaches and standards. “The compatibility factor is huge,” said Gayle Garrett, director of Surrogate Solutions, which oversees 55 births a year through gestational surrogacy.

Most agencies recognize that pregnancy is not a compartmentalized side task and ask that a surrogate’s spouse agree to support her through the process. Demographics like Christian stay-at-home moms and military wives, with big hearts and a deep appreciation for family, prove to be a good fit for the job.

Garrett, a Christian who studied nursing at Oral Roberts University and founded the agency over a decade ago, first carried babies as a surrogate for a couple in Europe, where commercial surrogacy is largely illegal. From her experience, she learned that the relationship between carrier and intended parents “helps make the process easier all the way around.”

Surrogate moms and parents also have to be on the same page about two of the touchiest social issues: marriage (whom they’re having the baby for) and abortion (whether they will end the pregnancy under any circumstances). Agencies can help both sides enter into agreements designed to avert worst-case scenarios, such as surrogates fighting to keep a baby found to have a genetic condition or surrogates refusing to hand over a baby upon learning the parents are gay.

In a high-profile example last fall, the Supreme Court declined to hear what would have been its first-ever surrogacy case, a petition from a California surrogate who refused to abort two of the triplets she carried for a 51-year-old single man in Georgia, babies conceived with his sperm and donor eggs.

After having the babies, Melissa Cook sued for custody, alleging that the man who hired her, Chester Shannon Moore Jr., was unfit to raise them. Moore said he was not in financial or physical shape to care for three babies when he had tried to convince her to “reduce” the pregnancy. Lower courts did not grant her custody, even as she drew support from the Family Research Council as well as certain feminist advocates.

“If you’re doing it for the money—don’t,” said Meg Watwood, who sees surrogacy as a calling. “You’ll be disappointed and disillusioned when realizing what a long nine months it is, with all of the pain and suffering that goes along with pregnancy.”
Image: Melanie Grizzel

“If you’re doing it for the money—don’t,” said Meg Watwood, who sees surrogacy as a calling. “You’ll be disappointed and disillusioned when realizing what a long nine months it is, with all of the pain and suffering that goes along with pregnancy.”

Christian surrogates like Watwood avoid the possibility of such a scenario by making their preferences clear from the start and only meeting with couples who share their views. “I’m not comfortable under any circumstances having an abortion,” she said. It means “you just might have to wait a little longer for intended parents to select you.”

Garrett said her agency has had “very, very few” disagreements between intended parents and surrogates—and no litigation come up. “We’ve not ever had an instance where a surrogate was asked to terminate a pregnancy.”

In most states where surrogacy is commonly practiced, surrogacy agreements are not necessarily binding: Intended parents don’t have much say over the baby before it’s born, and surrogates cannot claim rights to it after.

“In the state of Texas, even if the surrogate says, ‘Sure, I’ll terminate a pregnancy if you want me to,’ when it comes right down to it, Texas law looks at that surrogate as this is her body, and she makes the final decision,” Garrett said. “Legally she has the right to say no, even though she signed a contract with the couple.”

My babies, not my belly

As a young Christian mom, Jenna Miller was an unusual client for surrogacy. She never imagined having another woman carry her children. She also never imagined suffering heart failure at 24 and hearing her doctor issue what felt like a death blow to her family dreams: “You shouldn’t have any more kids.”

Eager to add to their family of three, Jenna and her husband, Mark, looked into adoption—many Christians’ instinctual recommendation for couples who can’t conceive—only to have the process stalled by her health issues. Agencies weren’t eager to place a child with her due to her heart condition (which she now manages through medication).

Eventually, Miller contacted Surrogate Solutions in suburban Dallas, having seen the agency featured in a local family magazine. She felt God finally opening doors for them, particularly with the surrogate they were matched with: a pastor’s wife who became a close friend and “the most godly woman I know.” She prayed for them and their baby every day.

“Our prayer life got real serious,” Miller said. “Once you get into surrogacy and IVF, there’s just an amount of faith that has to go into that.”

Miller was eating breakfast at Shipley’s Do-Nuts when she learned that the first of their prayers had been answered: The surrogate texted a picture of a positive pregnancy test. The good news continued at the ultrasound and then months later when their son Ryan, now four, was born.

The Millers—then in their 20s, the youngest clients ever for Surrogate Solutions—went on to work with the same surrogate, Jennifer Nelson, to carry their remaining embryos. With each IVF process, they transferred two of their four total embryos and ended up with one healthy baby at the end of both rounds. Their daughter Faith was born in 2016.

As Christians who believe life begins at conception, they had to think ahead about the possibilities for the embryos generated in the process. Options like selective reduction, when doctors plant several embryos and terminate higher multiples, or disposing of extra embryos violate many believers’ pro-life convictions.

“I’d like to see significantly better education so people know what they’re getting into before they go down these roads,” said Rae at Biola. “We tell couples, ‘If you don’t have the stomach for implanting every embryo you create in the lab, then don’t go down this road to begin with.’ ”

Rae does see potential improvements and areas of hope in the practice of gestational surrogacy, including IVF options that work alongside a natural cycle to minimize hormones taken and only fertilize a single egg at a time. The rise of egg freezing over embryo freezing also gives Christian couples more options.

“I can’t tell you how many people have called me, and they’ve got twins, but they’ve also got six embryos left in storage,” he said. “I tell them, ‘Those are your children,’ as much as the bouncing baby boys or girls left in their arms.”

Altogether, the IVF and surrogacy process can run at least $80,000, but the Millers agreed that the outcome was worth whatever costs, inconvenient treatments, and awkward conversations they had to endure to get there.

Intended parents end up having to explain that even though they’re expecting, it won’t be Mom giving birth (my baby, not my belly), just like surrogates like Watwood have to clarify to family, friends, and curious strangers that the little one inside them belongs to someone else (my belly, not my baby).

There are even kids’ books, like The Kangaroo Pouch and The Very Kind Koala, to explain this setup to siblings or surrogates’ children. But opponents to surrogacy worry that such metaphors—as well as another common one, “our bun, her oven”—oversimplify the relationship between a woman and the child inside her.

“Since in most surrogacy arrangements it’s not a genetic contribution, some people think that that makes it more morally neutral or acceptable. I think that’s viewing the surrogate in a way that is a stretch,” said Rae, who co-authored the book Outside the Womb: Moral Guidance for Assisted Reproduction.

“They view the surrogate as this human incubator or prenatal babysitter, which I don’t think does justice to what we know takes place in the womb and how formative the gestational environment is to the development of the child.”

Christian bioethicists raise concerns over the commodification of women, women’s bodies, and women’s reproduction (worries also shared by some feminists) as well as the long-term impact on children born via surrogacy. Cunningham at TIU points to research on maternal-fetal bonding, including hormones during pregnancy and the baby’s senses as a newborn, as a crucial question for commercial surrogacy.

“Is the gestational surrogate going to intentionally not bond with the child, knowing that she’s not going to be the mother? There could be harm or at least some loss or deprivation to the growing child if the mother’s intentionally not bonding emotionally,” she said. “But if she intentionally bonds with the child, there is going to be some harm or loss at birth when she’s separated from the baby.”

Watwood and other surrogates said that knowing how much the intended parents wanted a baby helped them from ever seeing the child as “theirs.” “People worry so much about how much you would bond with a surrogate baby when it’s in the womb, then giving it away would be so painful,” she said. “God protects your heart in such a way that it never ever felt like my baby. It was not emotional to give the baby to its parents.”

O’Hare, 34, still has keepsakes from her first surrogacy in 2015. Despite concerns about hormone treatments duringanother surrogaCY last year, She still felt it was “part of God’s plan” and “what I was meant to do.”
Image: Melanie Grizzel

O’Hare, 34, still has keepsakes from her first surrogacy in 2015. Despite concerns about hormone treatments duringanother surrogaCY last year, She still felt it was “part of God’s plan” and “what I was meant to do.”

The biblical side of bioethics

If avoiding an abortion seems like an obvious issue for Christians considering surrogacy, Jennifer Lahl sees even more complex concerns. An activist and president of The Center for Bioethics and Culture Network, Lahl has featured several women scarred by surrogacy in documentaries designed to show a different side of assisted reproduction.

Heather became a surrogate in her 20s, which helped her provide for her family while staying home to raise her own two kids. Her first surrogacy experience was so smooth—birthing healthy twins for a happy couple she met online—that she continued offering her services.

Heather, who is only identified by first name in Lahl’s 2014 film Breeders, learned the process is much more painful when the babies aren’t healthy. When ultrasounds revealed signs of abnormalities or birth defects, she said the mothers-to-be would flee the room, leaving her alone to bear the bad news. In one case, the parents asked her to terminate at 21 weeks a baby with a brain condition. She refused.

“The dad told me I was going to ‘suffer spiritual consequences’ for not obeying their decision,” Heather said. “I thought, ‘How cruel. I have to live with my own spiritual consequences too, and for me, the good Lord decides who lives and dies—not me.’ ”

The parents ultimately kept the baby, but reluctantly. The mom wasn’t present for the delivery.

The subjects of Lahl’s documentaries typify the litany of concerns she has about the entire process: the creation of babies in a lab rather than the marital bed, the financial differential between parent and surrogate (or the pressure for family members to serve as a surrogate “altruistically”), the health risks involved with necessary hormonal treatments, the psychological and relational impact on children when they learn they were conceived through donor egg or sperm, and the booming industry built around “selling hope and selling babies” rather than accepting the physical limitations of our bodies. “That’s the work of a fallen world,” she said.

With 1 in 6 couples facing infertility, the questions of whether to intervene, keep trying, or let go of a dream are not hypotheticals for people in the pews. The hyper-focus on the nuclear family in some evangelical circles doesn’t make the journey easier. But once couples reach the point of assisted reproduction—IVF, surrogacy, and even donor contributions—they often focus more on outcome than ethics.

“The reason a lot of couples aren’t interested [in ethical considerations] is their desperation to have a child,” said Rae at Biola, who has spent years counseling couples through infertility and believes that pastors should be more direct about assisted reproduction.

Pastors with concerns over IVF and surrogacy are put in a tough position, he acknowledges. Advising parents against these options can be a “buzzkill” for weary couples who have been holding out to find a way to start their families. If they speak up against embryo creation and third-party contributions to procreation, they likely will end up offending parents who have already gone down that path to conceive.

Miller said that even as she and her husband felt led to surrogacy, the prospect of undergoing IVF raised new questions and gray areas that required them to turn to their pastor.

Mark and Jenna Miller had daughter Kaylee in 2009, then used a surrogate to have their two youngest children.
Image: Melanie Grizzel

Mark and Jenna Miller had daughter Kaylee in 2009, then used a surrogate to have their two youngest children.

“I know that it was the first time anyone had approached him about wanting someone else to carry their baby and the IVF process,” said Miller, a Baylor University graduate who attends Brazos Meadows Baptist Church outside Waco, Texas. “There was that piece of him just reassuring us that he knows we value life and we believe life starts at conception. We had no doubt that we needed to guard the embryos.”

“We were looking for support and guidance from him,” the 34-year-old said. “If he had some reasoning for not having us move forward, we wanted to hear that.”

While commercial surrogacy may be a 21st-century phenomenon, Scripture warns of the inherent tensions in carrying a baby for another. Consider the fallout surrounding Sarah and her maid, Hagar, and Rachel and her maid, Bilhah.

It’s difficult to know how common surrogacy was in the ancient world, according to M. Daniel Carroll R., professor of Old Testament at Wheaton College. The stories don’t condone the practice, either; Sarah’s deteriorating relationship with Hagar and Rachel and Leah’s childbearing jealousies reveal their lack of faith.

“You don’t get a sense that this is some kind of consensual, contractual piece,” he said. “The arrangement was very different” than today’s surrogacy.

If Protestant churches have been largely silent about assisted reproduction, the Roman Catholic Church has adopted a more explicit position against the practice (although some Catholic leaders say it still isn’t given the level of pastoral care it deserves).

“Because of the dignity of the child and of marriage, and because of the uniqueness of the mother-child relationship, participation in contracts or arrangements for surrogate motherhood is not permitted,” according to the United States Conference of Catholic Bishops. “Moreover, the commercialization of such surrogacy denigrates the dignity of women, especially the poor.”

The church also declared IVF immoral because it violates human dignity and the marriage union.

“In America, we have a tendency to think that we can solve all problems with the right ‘technology,’ ” said John M. Haas, president of the National Catholic Bioethics Center. “But children are not engendered by technology or produced by an industry. Children should arise from an act of love between a husband and wife, in cooperation with God. No human being can ‘create’ the image of God.”

Jennifer Nelson (left) gave birth to the Millers’ son Ryan in 2013 and daughter Faith in 2016. Nelson has become “like one of our family friends,” Jenna said.
Image: Melanie Grizzel

Jennifer Nelson (left) gave birth to the Millers’ son Ryan in 2013 and daughter Faith in 2016. Nelson has become “like one of our family friends,” Jenna said.

When Kristel Acevedo, a Christian speaker and blogger based in Miami, decided to serve as a surrogate in 2015, she faced pushback from her Catholic family, particularly an outspoken aunt.

“It did make me pause and think, but the way I saw it, if God wants this person to be born, they’re going to be born,” said Acevedo, who carried a baby for a married couple from Europe who suffered infertility after cancer. “I don’t like the idea of embryos getting discarded or destroyed, but I was more concerned about what happens once they’re inserted in my uterus.”

Once her belly began to grow, Acevedo had all sorts of awkward conversations. People asked how much she was getting paid and suggested she was doing it for the money (paying off debt was a motivation, but not her primary one). Onlookers remarked about how selfless she must be and how they “could never do it.” The mom of two is writing a book about her experience.

“Prayer is No. 1. You have to seek God and see how he answers you, then get as educated as possible,” she said. “It does get very complicated …. Surrogacy can be presented as sunshine and rainbows, but it’s not.”

Surrogacy’s future in America

In recent years, surrogacy agencies have seen more applications from couples outside the country as the United States emerges as the go-to place for finding a surrogate.

Most of Western Europe either prohibits all forms of surrogacy or allows only altruistic surrogacy, where mothers aren’t compensated. The European Parliament condemned the practice in 2015, saying it “undermines the human dignity of the woman.”

And multiple Asian countries, such as Thailand and India, once marketed as destinations for less-expensive surrogates have banned international commercial surrogacy or are considering banning it, with concerns about dishonest payment practices and mistreatment of surrogates.

Between IVF, surrogacy, and the accompanying travel, parents can expect to pay well into the six figures to have a baby in the US, around $200,000 on the high end. Surrogates themselves typically get $20,000–$60,000 of that. Many make their way from Europe as well as China for American surrogates.

In California, one of the country’s most “surrogate-friendly” states, “we have fertility clinics that market themselves as a destination: ‘Come get a baby and then see Disneyland,’ ” Lahl said. One agency in San Diego reported that 80 percent of its clientele is international.

Beyond the foreign market, more infertile couples are considering surrogacy an option, as are gay couples and single parents.

Hollywood has done much to bring attention to assisted reproduction, with stars like Kim Kardashian and Jimmy Fallon turning to surrogacy. Celebrity gossip magazines follow the tension and drama that inevitably arise from such high-profile surrogacy arrangements.

Surrogacy has also made its way into movies like Baby Mama, in which uptight Tina Fey and wild Amy Poehler prove a difficult match for the process. And the most haunting portrayal of surrogacy comes through the book-turned-Emmy-winning-TV-show The Handmaid’s Tale, which depicts a dystopian future with an underclass of forced surrogates.

“Hollywood gives us a great jumping-off point for thinking through ethical questions because it comes in the form of a story, a narrative,” Cunningham said. “That can communicate something so much more powerfully than going through statements of propositional truth.”

But, Christian ethicists say, in the teachings of Scripture and the practice of church community, believers have an even more powerful mechanism for guidance. The church has a role to play in directing Christians—not just on questions of medical ethics and individual procedures but also on the deeper underlying issue of the powerful and sometimes unfulfilled longing to conceive and bear children.

“We’re not talking about how fragile our reproductive bodies are,” Lahl said. “What happens when babies don’t come?”

Kate Shellnutt is associate online editor at Christianity Today.

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