When Pope Francis called for a global ban on surrogacy during a foreign policy address last month, non-Catholics, especially those in the United States, may have felt the subject came out of nowhere. Surrogacy is medically and legally regulated in the United States as an intervention recommended by the American Society for Reproductive Medicine for those who do not have the ability to become pregnant or carry a pregnancy to term. But the pope’s concern was beyond the ethics of procreation, as he positioned his pronouncement within the context of a global economy and exploitation.
“A child is always a gift and never the basis of a commercial contract,” Francis said. “At every moment of its existence, human life must be preserved and defended; yet I note with regret, especially in the West, the continued spread of a culture of death, which in the name of a false compassion discards children, the elderly and the sick.”
The pope’s concerns have in mind the multi-million-dollar “fertility tourism” industry, including people from rich countries traveling to countries where they can pay a surrogate less than they would in their home country. It can lead to what researcher Raywat Deonandan called “exploitation of desperation,” wherein women — the research did not include nonbinary people — who do not want to serve as surrogates are lured into participating because they feel they have no better way to make money.
Due to these and other ethical concerns, the practice is illegal in many countries around the world, as well as in some U.S. states. That’s an important context, said Lauren Barbato, executive director of Call To Action, a U.S. Catholic social justice group. She warned against a limited Western view based on rights and privileges, and instead encouraged people to engage with the history and patterns of exploitation across the world.
“We have to remember that we’re a global church,” she said. “He is speaking globally.”
At the same time, Barbato said the Catholic Church has a tendency to make sweeping statements on reproductive issues that ignore life-affirming potential.
“Again, we see a blanket approach similar to contraception and abortion,” Barbato said.
As laws and technology evolve to support assisted reproduction, more aspiring parents are left navigating religious traditions and teachings while trying to build their family. While the pronouncements of the church carry weight and make headlines, Catholics will still make choices for themselves. Catholic groups support abortion, Catholic couples seek in vitro fertilization, and survey research puts the number of Catholics who have used contraception or had an abortion in the same range as the general population.
Surrogacy law and experiences
The remedy for the concerns voiced by the pope, said Judith Hoechst, a Denver-area assisted reproduction lawyer, is better protection for all involved, not a blanket ban.
“There are so many medical reasons for surrogacy,” Hoechst said, speaking from experience, as her second child was carried by a surrogate.
Hoechst has always loved children, she said. Before becoming a lawyer, she was a nurse in pediatric and neonatal intensive care units, as well as pediatric oncology. She worked in several intensive care units while in law school and into her law career, which itself began as an interest in children’s medical rights. But having children of her own proved more challenging. She experienced difficulty conceiving and carrying a full-term pregnancy. After yet another miscarriage, the obstetrician conducting her dilation and curettage procedure damaged the wall of her uterus. The resulting scar tissue would make it almost impossible for an embryo to safely implant. For more than 10 years, Hoechst and her husband continued to unsuccessfully try to have a baby.
All the while, she continued her weekend shifts in the pediatric ICU, where some babies were admitted because of injuries and illness from neglect and abuse. She said she longed to have a baby and give it a safe and loving home, and wondered why God seemed to disagree. Though she was no longer practicing her Catholic faith, Hoechst still retained the sense that God was involved in her efforts to bring new life into the world and felt a growing sense of pain and loss that those efforts hadn’t yielded fruit. Her marriage was strained too, she said, “It’s really tough on a marriage to struggle with infertility.”
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Eventually, Hoechst became pregnant, and the pregnancy went perfectly. However, she herself almost didn’t survive the birth. A hemorrhage from her uterus was so severe that she remembers having an out-of-body experience, hovering over the operating table. Hoechst and her husband named their daughter Grace, because, as her husband said, God had graced their lives with both the newborn, and the survival of her mother. They eventually learned from their doctors, however, that if Grace were to have a sibling, it would have to be with the assistance of a surrogate. Doctors said that Hoechst’s body could not carry another child, without significant risk to her own life and the child’s.
“I didn’t know anything about this area of the law [surrogacy] then,” Hoechst said. The laws vary state by state, and she knew she wanted to find a path that offered the most protections for the surrogate, the baby, and for her and her husband.
With the guidance of the fertility clinic, they met a woman in California — considered a “surrogacy-friendly” state, with statutes protecting all parties — who felt that being a surrogate gave her a meaningful way to help people while her husband was serving in the military and her own family was complete.
“There’s nothing more loving, selfless or precious than a woman sharing her uterus with someone who doesn’t have a uterus or whose body cannot carry a pregnancy,” Hoechst said.
Broader Catholic concerns
It’s here where Barbato sees a broader goal in the pope’s call for a ban on surrogacy. The Catholic Church, she said, has gone to great lengths to outline the rules of reproductive activity, based on a desire to preserve a certain kind of family and regulate sex within that family structure. For instance, when offering guidance to Catholics using reproductive technology that requires intrauterine insemination, the church has very specific instructions for how to “licitly obtain” sperm, instructing couples toward normal intercourse rather than masturbation.
“I think they’re worried that [forms of procreation besides normal intercourse] could form a whole new social order,” Barbato said.
Like the surrogacy statement, these instructions are often presented as a desire to protect life, which Catholic tradition maintains begins at conception. But Barbato said it’s difficult to separate that from the fear of radical changes to the institution of family if reproduction can happen without a heterosexual couple having sex.
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It’s more difficult to accept the ostensible reasoning of the church when the technologies in question are part of an effort to create life, not end it, she added. When it comes to the surrogate’s participation in the process, altruistic goals tend to sit better with most Catholics, Barbato said, while the financial aspect — especially the idea that a woman would serve as a surrogate strictly for compensation — draws more hesitation.
But those who have participated in the process say they don’t see financial compensation and interpersonal care as mutually exclusive.
Hoechst and her husband met the surrogate and her family, and their surrogate traveled twice to Colorado to meet the reproductive care team at the fertility clinic to go through comprehensive medical and mental health screening, and months later, for embryo transfer. Their surrogate stayed in their home both times she traveled to Colorado, even bringing her toddler with her on her first trip. The whole experience, Hoechst said, was highly personal, and she remains in touch with their surrogate each passing year since their son’s birth, usually for Mother’s Day, their son’s birthday, and the Christmas holidays, to thank her for the life of their son. Their surrogate went on to be a surrogate twice more, including for a same-sex couple.
Going into the surrogacy process, Hoechst said, she hadn’t known anything about surrogacy or reproductive law, but on the recommendation of her fertility physician, she changed the direction of her law practice from medical negligence to assisted reproductive technology. Through her work with RESOLVE: The National Infertility Association, she also tracks and advocates for pro-surrogacy and infertility legislation. While her practice covers many different kinds of reproductive issues, Hoechst said the majority of her reproductive legal matters involve surrogacy.
Considering the ethics
In his OB-GYN practice, Eric Widra sees many religious patients considering surrogacy, alongside other ethically debated reproductive technologies, such as in vitro fertilization and sperm donation.
“I counsel patients regularly about the intersection between their religious beliefs and the technologies available,” he said.
Widra sees the pope’s concern, and acknowledged that “there absolutely is exploitation and bad economics,” especially in global contexts. “That doesn’t make it bad for everybody, everywhere, all the time.”
Widra said he wouldn’t describe most situations he’s seen as commercialized, even if surrogates are paid. He said most surrogates see themselves altruistically, and hopeful parents want to offer as much support as possible, including payment.
“Yes [surrogates] need to be compensated. It’s a huge amount of time, energy, and risk,” Widra said. “But it’s not transactional.”
Barbato said that people of faith can consider the pope’s warning alongside the knowledge that the technologies “facilitate the creation of new life, not destroy it.”
“Consider altruistic surrogacy or make sure that your surrogate is being paid justly and has access to maternal healthcare, and remember that even though this is ‘work’ for the surrogate, there may be an emotional component to it,” she said in an email. “For reproductive technologies in general, consider the different procedures and treatments and decide which ones are best for you and not for the pope!”
Bekah McNeel is a freelance journalist living in San Antonio. She reports on the intersection of faith and early childhood for Sojourners. This was originally published by Sojourners.