Your Mileage May Vary is an advice column offering you a unique framework for thinking through your moral dilemmas. It’s based on value pluralism — the idea that each of us has multiple values that are equally valid but that often conflict with each other. To submit a question, fill out this anonymous form. Here’s this week’s question from a reader, condensed and edited for clarity:
I’m a woman in my 30s and I think I want to have a child, but I have a health condition that makes it harder (not impossible) to get pregnant than for most women. It would also make pregnancy more uncomfortable and physically disfiguring than it is for many pregnant people. It wouldn’t be permanently disabling, but the physical effects would be bad enough that I really don’t want to be pregnant.
I’m fortunate enough that I can probably afford to get a surrogate through a reputable agency. But surrogacy is frowned upon and often considered unethical. Long ago, I knew someone who said she loved the idea of being pregnant and providing gestation as a service to other people, so maybe in theory, it is possible for someone to freely choose to be a surrogate without being coerced by financial need? But even if it could be done ethically, there’s such a stigma around it and I fear being judged by friends and family. There seems to be a sense that there’s something wrong, unnatural, selfish, or unwomanly in wanting to have a biological child but not wanting your own body to be the vessel for it.
Plus, it’s not like I’m the only person in the world for whom pregnancy would suck. I think my experience probably would be worse than average, but pregnancy is just an unpleasant thing overall so I don’t think I can claim it would be so uniquely bad for me that I’m justified in wanting to pay to use someone else’s body. I’d love your help with this.
Dear Really Don’t Want To Be Pregnant,
There are some ethical questions about surrogacy that it’s genuinely worth asking, and some that I don’t want you to devote another second to — so let’s start there.
As you said, there’s a cultural stigma around not wanting to turn your body into a vessel for childbearing — it’s deemed “wrong” or “unwomanly.” But that idea is pure garbage. The idea that there’s some “proper” way to be a woman is a patriarchal construct; anyone who tells you you’re “unwomanly” for not wanting to gestate is reflecting sexist expectations that women’s bodies should be available for reproductive labor.
So to the extent that your fear of being judged is about that, please don’t give it another thought. But of course, there are real moral questions that surrogacy brings up.
I’ll tell you right off the bat that I do think surrogacy can be ethically justifiable in some situations. First, it helps that surrogacy is not one monolithic thing. There’s a big distinction between commercial surrogacy (where you pay someone to carry a baby) and altruistic surrogacy (the unpaid version, where the surrogate carries the baby as a literal labor of love). It’s not easy to find an altruistic surrogate — after all, pregnancy is dangerous business — but I agree with your intuition that if you’re lucky enough to know someone willing to volunteer for the role, opting for that is a good way to avoid most concerns about commodification or exploitation.
Key takeaways
- Unethical surrogacy industries are booming in places like Georgia, Ukraine, and Cyprus. But there’s a moral difference between hiring a surrogate there versus in the US.
- When someone can get pregnant but doesn’t want to for psychological reasons, their case is often deemed “elective.” But a mental health need can also be a medical need.
- “Epistemic injustice” refers to a wrong done to someone specifically in their capacity as a knower. People who say they know they have a mental health need that makes pregnancy too risky often aren’t taken seriously, but that’s starting to change.
Within commercial surrogacy, a second distinction has to do with where the surrogate lives. There’s a moral difference between hiring a surrogate in a developing country and hiring one in, say, the US. In countries like Georgia, for example, surrogacy agencies have been known to recruit at domestic violence shelters — some women see surrogacy as the only way to win financial freedom from an abusive spouse. Ukraine, Cyprus, and several others are also known to have ethically problematic surrogacy industries.
But American surrogates are typically not low-income; they’re usually middle-class white women with husbands and kids of their own, and they have other economic opportunities available to them. The better surrogacy agencies screen out poor women, who are at risk of coercion. That empirical context means there’s less (though not zero) potential for exploitation in the US, compared with international surrogacy.
Another reason I think surrogacy can be ethically justifiable is that for many, many people, the urge to have kids — including ones who are biologically related to them — feels like a need and not just a want.
Many opponents of surrogacy argue that nobody has a “right” to a biological child, so if you can’t or don’t want to be pregnant, too bad. And those opponents are right that nobody has an absolute right to have a baby — otherwise, the state would be obligated to ensure surrogates, egg donors, and sperm donors were made available regardless of their own willingness to participate! But people may still have a qualified right — the kind of right that we generally honor but that can be restricted to protect the interests of others.
When it comes to people who are physically unable to create a biological child — when they have what doctors call a “medical indication” — I think the qualified right to have a kid means that surrogacy can be ethical, provided it meets certain criteria like informed consent.
But your situation is trickier because it’s not impossible for you to get pregnant — it’s more that, for certain reasons, you don’t want to. Typically, your case would be referred to as “elective surrogacy.” Some professionals will refuse to arrange surrogacy if they deem it elective rather than medically indicated.
And yet, doctors are increasingly recognizing that the line between “medically indicated” and “elective” is not so tidy.
While elective surrogacy is often associated with vanity — it brings to mind a celebrity who doesn’t want to be pregnant because she doesn’t want to “mess up” her figure — it’s not like everyone in the elective camp is there for cosmetic reasons.
What about someone who could get pregnant but is deathly afraid of giving birth because she had a traumatic experience — like, say, her best friend dying in childbirth? Or what about someone who’s trans and who physically could carry a pregnancy, but who knows it would cause such gender dysphoria that there’s a risk of serious psychological harm? Shouldn’t a mental health need be considered a type of medical need?
These are not hypothetical experiences — real people have testified to them — but they often haven’t been taken seriously as medical needs. I suspect that these people have endured what the contemporary philosopher Miranda Fricker calls “epistemic injustice.”
Epistemic injustice refers to “a wrong done to someone specifically in their capacity as a knower.” When society denies someone the credibility to assess their own life experience, or discounts an important part of that experience because of a gap in our collective interpretive resources, that can be an example of epistemic injustice. I think people who fall in between medical categories are too often at risk of being wronged in this way, and I don’t want to see that happen to you.
So I want to acknowledge that I don’t know what health condition you’re referring to when you say you have a condition that would “make pregnancy more uncomfortable and physically disfiguring than it is for many pregnant people.” Since I don’t know the details, I’d encourage you to ask yourself: How much more uncomfortable? How much more disfiguring? And how heavy and lasting a toll would that discomfort or disfigurement take on your overall well-being?
Only you can really try to answer that last question, because the same effects can land differently for different people, depending on how well-resourced we are financially, socially, psychologically, and even spiritually.
Once you’ve thought about how big and enduring the risk of harm is to you, try asking yourself this: Is the risk to you so much greater than the risk to a woman of average health that you feel comfortable transferring the risk of pregnancy and childbirth onto her?
Some people will tell you that question is irrelevant. They will say that the only value that matters here is autonomy — yours and the potential surrogate’s — and if you and she both consent to a surrogacy contract, and she is not coerced into it by financial desperation, then that’s that!
But there may be another important value at stake here: justice.
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As far as I can tell, your case is in a gray area — surrogacy is neither obviously “medically indicated” nor obviously “elective” based on the information you shared. If you ask yourself, “Do I think there’s a significant risk that carrying a child would significantly harm me?” and you answer “Yes!” — then some doctors would say surrogacy is medically indicated. But if the answer you feel bubbling up is, “Well…no, not really,” then you may be closer to the “elective” side of the spectrum. And then I think it becomes reasonable to inquire whether it feels fair to ask another woman to take on the considerable risks of pregnancy and childbirth.
You wrote of pregnancy, “I don’t think I can claim it would be so uniquely bad for me that I’m justified in wanting to pay to use someone else’s body.” That suggests that you currently see yourself as more in the elective camp. I urge you to give yourself the space to really interrogate that with an equal measure of honesty and self-compassion. If honesty compels you to say you don’t feel justified in putting someone else’s body in harm’s way in a situation where she otherwise wouldn’t be, then maybe you’ve got your answer.
But if you’re discounting the risk of psychological harm to yourself because you don’t think that “counts” as real need, please know that mental health is just as medically legitimate as physical health. And if you talk to a medical professional about the option of surrogacy, please talk to more than one so you’re less at risk of getting boxed into a category that doesn’t capture you right.
At the end of the day, perhaps none of us can be a perfect interpreter even of ourselves. But you get to be the interpreter-in-chief — with both the power and responsibility that implies.
Bonus: What I’m reading
- This horrifying New York Times Magazine story about the global fertility industry captures why I do think it’s unethical to work with a surrogacy agency in a country like Georgia. These surrogates are not in a position to give informed consent.
- “Is Cognitive Dissonance Actually a Thing?” asked Shayla Love in the New Yorker recently. I now feel cognitive dissonance about all the times I thought I was feeling cognitive dissonance!
- Don’t miss “I’m Kenyan. I Don’t Write Like ChatGPT. ChatGPT Writes Like Me.” This essay by Marcus Olang’, explaining why his writing is often mistaken for AI slop, is both surprising and maddening. Turns out it’s really hard to not write in the Queen’s English when an entire colonial legacy has drilled that style into you from birth.
The post You want a baby. Is it ethical to choose surrogacy? appeared first on Vox.
