Many health issues arise for the surrogate mother.  A major issue is how much control a physician can exercise over a surrogate mother.  For example, is she obligated to change her current living style?  How often does she need to have vaginal ultra-sounds or amniocentesis?  An important question to consider is if and when she should be allowed to terminate a pregnancy.  In general, this decision would be free of the complicating factors of STDs, as physician will ensure that the pre-embryo is free of viruses such as human immune-deficiency virus (HIV), cytomegalovirus (CMV), and hepatitis B&C viruses (HBC and HCV).  These viruses could compromise the health of the surrogate mother and that of the newborn.  In this section, we will focus more on the psychological effects of surrogacy. 

Mental Health

Although there is a lack of scientific proof, many psychologists, psychiatrists, and developmental biologists believe there is a special tie that develops between a pregnant mother and a child in her uterus.  A study done in Japan that was designed to evaluate the maternal-fetal relationship found no significant correlation between the maternal-fetal attachment and depression. Additional research has shown that surrogate mothers are less attached to the fetus, which is most likely due to encouragement by their agency to feel detachment toward the fetus during pregnancy.   Although many surrogate mothers admit to feeling sorrow and distress when relinquishing the child, they also felt a sense of happiness and satisfaction for the new parents of the baby. In this study, the intended mother was more anxious than the surrogate mother, but overall they were found to share comparable stable psychological characteristics.  This study also reassures the fact that many surrogate mothers are capable of feeling a lack of anxiety and flat responses towards the baby and pregnancy, which suggests their psychological state may not lead to peri-natal or surrogate arrangement complications. 

Another important factor of mental health is the relevant familial and spousal support of women in surrogacy arrangements.  In one study done in the UK by the Center for Human Reproductive Sciences, psychologists found that the intended, genetic mother had more support from the important people in her life. For surrogate mothers in stable relationships, social support from husbands and partners was more negative than the corresponding support from husband/partners of intended mothers.   Weaker social support received by surrogates suggests that counseling should be provided to surrogate mothers after their pregnancy to monitor their longer term welfare. 

This study also emphasizes the social stigma attached to surrogacy. Additionally, two studies that investigated attitudes towards surrogacy in the US and Canada found similar results.  One study in Canada found that three-quarters of 5,000 women of reproductive age disapproved of surrogacy.  Similarly, a smaller study in the US showed the majority of the 400 people randomly surveyed were against surrogacy.   Unfortunately, societal attitudes towards surrogacy have been highly stigmatized by a few exceptional cases such as the 1986 Baby M case.  In this complicated legal case, the surrogate mother, Mary Beth Whitehead, violated the surrogacy contract by refusing to give up the child to Elizabeth and Howard Stern.  However, such cases are extremely rare.  Although findings show surrogate mothers rarely suffer from extreme psychological distress when relinquishing the child, surrogacy still affects the mental health of these women.  In societies where surrogacy is stigmatized, it is important to provide these women with support both during and after the pregnancy. 

Honjo et al.  “Antenatal Depression and Maternal-Fetal Attachment.”  Psychopathology, 2003, 36:304-311. 

Olga B.A. van den Akker.  “Psychological trait and state characteristics, social support and attitudes to the surrogate pregnancy and baby.”  Human Reproduction: 22:8, pp. 2297-2295.  <>


Edelmann R. Surrogacy: the psychological issues. J Reprod Inf Psychol (2004) 22:123–136.<>


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