Psychological well-being, maternal-foetal bonding and experiences of Indian surrogates

Over the past two decades, India has become an international hub of cross-border surrogacy. The extreme economic and cultural differences between international couples seeking surrogacy and the surrogates themselves, clinics compromising health of surrogates for profit, the stigmatisation of surrogacy in India, and the constant surveillance of these women living in a ‘surrogate house’, have raised concerns regarding the potentially negative psychological impact of surrogacy on Indian surrogates. The primary aims of the thesis were (i) to conduct a longitudinal assessment of surrogates’ psychological problems (anxiety, depression and stress) from pregnancy until several months after relinquishing the baby to the intended parents, (ii) to examine the nature of the bond formed between surrogates and the unborn baby and establish whether this prenatal bond contributes to their psychological problems, and (iii) to explore the experiences of surrogates during and post-surrogacy. Fifty surrogates were compared with a matched group of 69 expectant mothers during pregnancy. Of these, 45 surrogates and 49 compairson group of mothers were followed up 4-6 months after the birth. All surrogates were hosting pregnancies for international intended parents and had at least one child of their own. Data were obtained using standardised questionnaires and indepth interviews and were analysed using quantitative and qualitative methods.
Indian surrogates were found to be more depressed than the comparison group of mothers, both during pregnancy and after the birth. However, giving up the newborn did not appear to add to surrogates’ levels of depression. There were no differences between the surrogates and the expectant mothers in anxiety or stress during either phase of the study. The examination of risk factors for psychological problems among the surrogates showed that anticipation of stigma, experiences of social humiliation and receiving insufficient support during pregnancy were associated with higher levels of depression following the birth. With respect to bonding with the unborn child, surrogates experienced lower levels of emotional bonding (e.g. they interacted less, and wondered less about, the foetus), but exhibited higher levels of instrumental bonding (e.g. they adopted better eating habits and avoided unhealthy practices during pregnancy), than women who were carrying their own babies. Contrary to concerns, greater bonding with the unborn child was not associated with increased psychological problems post-relinquishment. All surrogates were able to give up the child. Meeting the intended parents after the birth positively contributed towards surrogates’ satisfaction with relinquishment whereas meeting the baby did not. The qualitative findings on surrogates’ experiences showed that the majority lacked basic medical information regarding surrogacy pregnancy; hid surrogacy from most people; felt positive and supported at the surrogate house; lived in uncertainty regarding whether or not they would be allowed to meet the intended parents and the baby; and did not actually get to meet them. These findings have important implications for policy and practice on surrogacy in the Global South.