“I felt like someone that sold my child.” These were the words that emotional surrogate mother Tanya Prashad choked out when recounting giving up her surrogate child at birth: a decision that still haunts her a decade later. Years later, on one of her visitations, her child could only muster one question: “Why did you give me away?” The same question haunts hundreds of surrogate children including Brian, who bluntly states "It looks to me like I was bought and sold." 

Tanya’s story is not offered to shun surrogacy in every circumstance: in some instances, surrogacy is necessary, particularly when biological and social considerations leave the prospective parents with no other choice. Surrogacy has blessed many infertile and homosexual couples with children and allowed women to balance motherhood and their career. However, it is clear that surrogacy is fraught with complications. Thus, while surrogacy is necessary in certain cases, its adverse effects on both individuals and society make it undesirable on a large scale. 

Individually, surrogacy adversely affects the birth mother and the child. Due to the sheer number of medicines the mother must take for the embryo to be successfully implanted, any surrogacy is automatically characterized as a high-risk pregnancy, with complications including ovarian hyperstimulation syndrome, blood clots, cancer, and even death. Additionally, many mothers, like Tanya, experience emotional trauma when giving up the child they carried. A 2014 study published in the Iranian Journal of Reproductive Medicine concluded that surrogacy was a high-risk emotional experience and recommended that surrogates receive professional counseling throughout the process, with a 2018 study published in the Journal Human Reproduction finding that surrogates have higher levels of depression both during and after their pregnancy. Moreover, surrogacy has an adverse impact on children: a 2017 study published in the American Society for Reproductive Medicine found that children born through surrogacy are at increased risk for low birth weight, hypertension, and placenta previa, and even worse, a 2014 study from the Journal of Perinatology found a 4-5 times increase in stillbirths from pregnancies conducted through assisted reproductive technologies, including those used in surrogacy.  Furthermore, it is widely acknowledged that children born from surrogacy have problems adjusting especially in adolescence.  A 2012 study from the Journal of Child Psychology and Psychiatry found that children born from surrogacies had higher levels of difficulty in adjusting, even beyond levels found in children conceived from gamete donation, indicating that the lack of a gestational connection between mother and child hinders the child's development, with the study's authors noting that mothers are prone to understating their child's psychological adjustment difficulties  so the difficulties are likely greater than those found in this study. Crucially, the results hold for children who are not aware of their origins, although they are weakened, since mothers who hide their children's origin express distress as a result of guilt, which has a negative impact on the child: an effect amplified if the child knows the true reason. 

It follows that since surrogacy is harmful to the individuals involved that it is harmful at a societal level. However, surrogacy's adverse effect on society exceeds its total individual harm. Proponents of surrogacy argue that surrogacy is a societal benefit because it allows more couples to have children. Furthermore, since these parents go through many extra steps to have children, they are likely more loving, endowing the child with an environment conducive to success. For women, surrogacy also represents a happy medium between career and childbirth, allowing women to have the best of both worlds. By extension, women are free to focus on their careers, allowing them to compete with men, enhancing societal productivity, by freeing up women's time when they are at their peak. Thus, surrogacy represents a potent vehicle for social equality and productivity. Yet, the very fact that society requires this many surrogacies is a cause for concern. Societally, the frequency of surrogacy is a barometer to measure the frequency of the constraints that necessitate surrogacy. Thus, a rapid proliferation in surrogacy would mean that society has a high rate of these constraints such as infertility and a continued penalty on career-oriented women, which would ideally wane as society advances, making surrogacy societally undesirable not as a result of what it causes per se, but of what an increase in surrogacy indicates. A much more desirable outcome would be a decrease in infertility and stronger protections for new mothers, allowing them to balance their career and childbirth, not an increase in these conditions that force couples to turn to surrogacy. 

A possibility overlooked in the previous argument is that medical advances could make surrogacy cheaper and more accessible, resulting in an increase in surrogacies without necessarily meaning an increase in the underlying conditions behind surrogacy. However, extending this argument reveals dangerous implications behind the expansion of surrogacy. If half of the pregnancies in the developed world are through surrogacy, demand would increase, driving up prices and restricting access to surrogacy. Eventually, there wouldn't be enough women available to serve as surrogates, making its growth self-limiting. The only way that surrogacy could continue to grow is by introducing a new supply of women to lower the price, counteracting the lack of available women. Since the scenario specifies that surrogacy’s growth would appear in the developed world, the surrogacy industry could outsource the service, by paying women in developing countries to carry the child. Yet, women in developing countries are often ill-equipped to consider this life-altering decision. HBO correspondent Gianna Toboni discovered that surrogacy companies utilize predatory tactics to recruit women in developing countries, specifically in India. Women are routinely recruited from impoverished areas, directed to sign contracts that they cannot read, much less understand, and forced to spend a year away from home in a facility and undergo a painful and risky Cesarean section delivery to maximize the number of births per day even when not medically necessary. Additionally, doctors often implant multiple embryos to increase the chances of the woman successfully becoming pregnant, without notifying the intended parents. Additional children are often sold into the black market to families from wealthier nations. If not, they are sentenced to a life of human trafficking, slavery, sexual exploitation, and forced marriage unbeknownst to the intended parents.  

Moreover, surrogacy’s globalization and profitability mean that women in developing countries focus more on surrogacy rather than living a normal life and bearing their own children. Surrogacy may leave them too physically and emotionally drained to have their own children, which has dangerous implications for the demographics of developing countries. The number of children in future generations will vastly drop, leaving these countries unable to maintain a robust social safety net to care for the elderly and disadvantaged.

Thus, surrogacy’s harm to both individuals and society renders it undesirable on a large scale. Individually, it physically and emotionally harms the birth mother and the child. Societally, the very need for surrogacy highlights structural biological and social problems that prevent traditional pregnancies, while exploiting the developing world. For every surrogacy, there is a Tanya forced to give up their child, a Brian haunted by his very existence, and two parents with no other choice. On the other side of the globe, women are packed into facilities, coerced into carrying someone else's child, and a host of additional children dismissed as collateral damage, sentenced to a life of subjugation and abuse, all in the service of a billion-dollar industry that degrades individuals and destabilizes society.