P-499 Long term psychological health of gestational surrogates in a low-income setting: five years after birth
Authors: Lamba N , Jadva V 
Published: July 2024

Abstract

Study question
How does psychological health and experiences of surrogates in a cross-border commercial surrogacy setting change from pregnancy, 4-6 months, and five years post-birth?

Summary answer
Longitudinally surrogates’ psychological health did not significantly change. Majority had still not met the parents, continued hiding surrogacy, and reported mixed feelings for the child.

What is known already
Commercial surrogacy was banned in India in 2017 due to concerns related to exploitation and psychological harm. Power differentials between surrogates and intending parents and commercialization raised concerns regarding the psychological health of surrogates in low-income settings. Post the ban, surrogacy hotspots moved to countries like Mexico and Georgia embroiled in similar practices. There is however no academic literature on long-term psychological health of surrogates from low-income settings. Previous research showed that surrogacy pregnancy and prenatal attachment did not significantly contribute psychological harm post-birth. Instead, socio-cultural practices related to support during pregnancy and stigma increased depression scores post-birth.

Study design, size, duration
The fieldwork was administered in Mumbai, India, where international cross-border, gestational, and commercial surrogacy was being practiced. Data was collected over three phases: 1) during pregnancy 2) 4-6 months post-birth and 3) 5-6 years after surrogacy. Being a mixed-method design, findings include quantitative data on psychological health of surrogates from all three phases and qualitative data from phase 3 of the research. The study spans from 2014 to 2021.

Participants/materials, setting, methods
In-depth semi-structured interviews and standardized questionnaires (anxiety, depression, stress scale) were administered to 50 surrogates during pregnancy, 45 surrogates 4-6 months post-birth, and 19 surrogates 5-6 years post-birth. In phase III, mothers also responded to the perceived social support scale. Interviews included questions related to narratives and feelings about the baby, intending parents, surrogate hostel, fertility clinic, potential financial gain, perceptions of stigma, and the new law banning surrogacy. Fieldwork was administered at the clinic.

Main results and the role of chance
Three one-way repeated measures ANOVA were administered which showed that anxiety, depression, and stress of surrogates did not significantly differ over the three time-points, suggesting that practicing surrogacy did not significantly contribute to psychological harm. It is important to note that financial gain did not significantly improve their psychological over time. Non-parametric tests also did not show significant differences. Mean scores show a downward trend for anxiety and depression, but an upward trend for stress.
The perceived social support scale showed that participants received support from family and significant other and least support from friends. However, support from family positively correlated with the stress scores of surrogates. Perhaps an overwhelming involvement of family adds to stress.
Most surrogates were not in touch with friends from the surrogate hostel. Majority reported still thinking about the baby frequently, had mixed feelings, and were still hiding surrogacy. Most of them had not met the parents and child, did not know if intending parents should disclose to the child about surrogacy. Majority did not appreciate the new law and wouldn’t consider becoming surrogates without a payment.
Prenatal bonding from phase 1 did not have any relationship with psychological health observed in phase 3.

Limitations, reasons for caution
The study’s sample size raises generalizability concerns. Diminishing sample sizes and potential social bias may affect robustness. Limited psychological measures and homogeneity assumptions suggest a need for caution in interpreting results.

Wider implications of the findings
This is the first longitudinal study on surrogate mothers from low-income settings practicing commercial surrogacy. Findings advocate policy reassessment, enduring support structures for surrogates, educational initiatives for transparency, international collaboration on best practices, and future research exploring cultural nuances and the perspectives of intending parents in cross-border commercial surrogacy.

Trial registration number
N/A