US Surrogates’ Motivations and Satisfaction – A key to read the social context

The Social Context for Surrogates’ Motivations and Satisfaction” (2014) is an article written by Zsuzsa Berend, sociologist of UCLA.

Berend starts this article talking about one of the persistent surrogacy fears related to surrogacy; what about if the surrogate, who carries for the IP, regrets her decision when the process is completed? (Teman, 2008) As I’ve already shown in a previous blogpost “My Bun, Her Oven” An Anthropological Review, how Elly Teman has analyzed why the large portion of the thoughts express a sense of discomfort with surrogacy. In sum: gestational surrogacy (GS) reveals the strong cultural assumption in Western society that women “naturally” develop instinctive bonds and love with the babies in their bellies, and they won’t give the babies away unless they are desperate, forced, or out of their minds.

Berend article
Within the substantial literature on surrogacy that has analyzed this practice for over 20 years, there are just few longer-term data results on it. On the Reproductive BioMedicine Online, Imrie and Jadva (2014) have published a long-term study on surrogates ‘experiences. This research has found that most of the surrogates were satisfied with the relationship they had with the intended parents (IPs) and have shown no regrets for their journey as surrogates. (I will discuss about it in the future).

Berend has conducted a decennial research on surromomonline (SMO), one of the largest US surrogacy support website until the early 2000s. She has analyzed how US surrogates collectively defined their experience, reading which kind of expectations they had about their journey. The sociologist, noticed that there has been a change throughout the years: in the early 2000s, surrogates expressed the desired for an ongoing friendship with the intended parents. While, over time, surrogates have presented a different representation of the relationships with the IPS. In some cases, they did not have any contact after the delivery or have reported to feel abandoned by the IPs. Berend found that the surrogates constructed some social explanations to describe why the parents acted in the way the acted. Such as, the parents wanted to bond with the newborn or simply because they were new busy parents.

This paper is interesting because Berend suggests to keep separated the meaning of the relationship from the meaning of satisfaction. She explained that meanings are social, while satisfactions are personal feelings that involve individual interpretations of different experiences. In general, the degree of the satisfaction is related to our expectations. What does it mean being satisfied and how can we understand when and if we are satisfied? Berend said that we make a kind of comparison with our previous experience, referring to a range of practical expectations constructed on our prior knowledge. Following her thoughts, if these expectations are satisfied, we feel satisfied. As Berend asks: “[…] how do we know what to expect in new social relationships such as surrogacy?” (2014:399). Within surrogacy, satisfaction is harder to define, because it is the outcome of an intricate set of evaluation about what the relationship could be and what in concrete is.

US surrogates of SMO blog discussed about the relationship with the IPs, emphasizing that surrogacy doesn’t mean having new friends; it is more to help someone to create their own family. Related to that, there were a lot of advice for avoiding having high expectations about the relationship the surrogates could have with the IPs, during before and after the birth. In literature (Berend,2016; Teman, 2010), the most common way to stay in touch are: some periodical emails, some pictures exchanged through social media and, less often, some presents sent between them. What does it mean to stay in touch and how to stay in touch? I will analyze the meaning of that during my research.

Often surrogacy is a hybrid of contractual and gift relationship, and gifts and relationships are not terminated in the same way that contractual relations are.” (2014:400).

Berend continues her article paying attention to the other main question of the study: the surrogates’ motivations. What are the reasons why some women become surrogates? In their research, Imrie and Jadva found that most answers were, wanting to help a couple and the pleasure of being pregnant. These were similar answers that other researchers received in other cultural contexts. The most popular motivations find in literature are the payment, the desire to help a childless couple and the enjoyment of the pregnancy. For more information, I suggest to read this article.

References
Berend Z., 2016, The Online World of Surrogacy, Berghahn Books, New York – Oxford.
Carries J., 1991, Gift, commodities, and social relations: a maussian view of exchange. Sociol. Forum 6, 119 -136.

Imrie S. and Jadva V., 2014, The Long-term experiences of surrogates: relationship and contact with surrogacy families in genetic and gestational surrogacy arrangements. Reprod. Biomed.

Teman E., 2008, The Social Construction of Surrogacy research: An Anthropological critique of the psychological scholarship on surrogate motherhood. Doc Sci. Med. 67, 1104-1112.

Teman, E., 2010. Birthing a Mother. The Surrogate Body and the Pregnant Self, The University of California Press, Berkeley, CA.

“My Bun, Her Oven”, an Anthropological Review

The anthropologist Elly Teman has conducted a field-based research about gestational surrogacy (GS) in Israel between 1998 and 2006, interviewing and observing the interactions between surrogates and intended mothers. “My Bun, Her Oven” is just one of the several publications she has written in this field.

Teman pic
Elly Teman starts her article by paying attention to the social answer that surrogacy in general receives, saying that the large portion of the thoughts express a sense of discomfort with surrogacy. As she wrote, gestational surrogacy is challenging some of our most deeply conceptual categories, introducing an ambiguity in the concept of motherhood (Teman, 2010), and causing a more visible fragmentation of it – biological motherhood, genetic motherhood and social motherhood (Ragonè, 1994). At the same time, GS reveals the strong cultural assumption in Western society that women “naturally” develop instinctive bonds and love with the babies in their bellies, and they won’t give the babies away unless they are desperate, forced, or out of their minds. For this reason, as Teman has written, surrogacy has been read and treated like a “cultural anomaly”.

news pic

Also, the cases reported in the news help relieve our cultural anxieties about surrogacy. It helps us to prove that our believes are rights and that woman really wants love and take care of the baby she was carrying. We ignore that the large majority of surrogates does not hesitate to relinquish the baby and are happy of it (as reported in the article, out of 25.000 surrogacy births in the US, no more than 30 cases have reached a courtroom).  If the large part of the population believe that mothers have a “natural motherhood instinct” that conduct her to love and feel the baby, in this frame, it is easy to understand why a woman who says “I am not the mother, I am just the oven”, can be seen strange to people, assuming that surrogates are alienated from their bodies.

The article continues introducing the thoughts of one of the most influential anthropologist of the last half-century, Mary Douglas. She taught us that there are many ways to manage the “anomalies” and to protect our categories; in other words, there are many ways to bring back the order caused from a cultural practice that has introduced a change in our system, what most of the people see like an anomaly. The most common answers are: fully banning them, avoiding them from imagining it ever existed or using the anomaly ritually or symbolically to find a way to incorporate it within the accepted cultural values.

Teman has used the category introduced by Mary Douglas to read the experience of the subjects involved in her research. In “My Bun, Her Oven” she has shown how these women tried to resolve the anomaly introduced by the surrogacy, using the meanings she collected during her fieldwork. For examples, surrogates used many strategies to distance themselves from the so called “surro-baby”, using the genetic disconnection for distancing themselves from the title of mother. At the same time, the intended mothers wanted to take this “title”, wanting to be recognized as the only Mother, publicly and privately. How? They participated in many of the symbolical actions that common mothers do: reading pregnancy books, accompanying the surrogate to every doctor appointment since the delivery. In other words, they were experiencing the pregnancy from the “outside”, acting they were pregnant too.

As Teman has shown in this article, both Israeli intended mothers and surrogates used some symbols and rituals to describe their surrogacy’s experiences. With their stories and thoughts surrogates and intended mothers are slowly deconstructing the ideological idea of motherhood, showing other different meanings related to that.

As Teman suggested anthropologists provide insights starting from the ways people involved in the practice give meanings to their actions (2010:33).
During my research, I will use Temas’s article to understand and read the way in which surrogates often describe the relation with the baby they are carrying. Below one example collected during the fieldwork:

S.: “You know, it is hard to explain what I think about it. Maybe it sounds weird, but I don’t feel any maternal bond with the surro-baby I am carrying. I know he is not my child because we don’t have any genetic connection […]

S.(Encino, 11/02/17).

 

References
Ragonè H., 1994, Surrogate Motherhood: Conception in the Heart. Boulder, CO: Westview.

Teman E., 2010, “My Bun, Her Oven”, Anthropology Now, vol.2 n. 2.

 

“What Egg Donation is All About”. An Interview with Leslie, Medical assistant & Senior Egg Donor Coordinator at WFI

Leslie began her journey at the Western Fertility Institute as an intern in April, last year. Throughout the process she became a Medical Assistant in April, and a Senior Egg Donor Program Coordinator. As Leslie said, she had a “very big teacher, Quiana”. She was taught about fertility and surrogacy during her internship; before that, she never thought about working in this field.

A medical assistant helps nurses and doctors, and has several other functions. Leslie spends most of her time doing blood work. As she said, taking blood is not just a routine job: “I am kind of a confidant for surrogates and egg donors. I try to construct a personal relationship with them. I know their journey, their troubles, their history…”.

blood

She continuously follows the journey of the egg donors. Leslie is by their side for all the steps of the procedure. There are many reasons why a woman enters in the egg donation process. As Leslie pointed out: “Whatever the reason why a woman is making this act, she needs to be informed more about the process of the egg donation. She is giving a part of herself away, it is a part of them”. She makes sure they are informed of the possible connections that egg donation can construct.

As she explained to me, every donor receives a different protocol. In general, the medication that a donor has to follow takes about 10 days. Every 1 or 2 days, the donor has to make a blood analysis at WFI in order to see if the follicles are growing (2mm each day). When the eggs are “ready”, the egg retrieval occurs. At WFI they are performed every Wednesday and Friday. The whole procedure takes about 2 hours: 30 minutes to prepare the patient for the surgery, 15 minutes for the retrieval itself, and the time left for the recovery. “We wait until the patient feels comfortable, we control the situation and make sure everything is fine”. Leslie follows donors throughout all the journey.

test tube

She works also with the surrogates, but the relationships she constructs with them are quite different. If a donor is going to WFI every 2 days, the surrogates spend less time at the clinic. The relationship that Leslie is building with the donors is more intense because they spend more time together talking about egg donation, the medications, but also about the everyday life. She said that probably this connection she feels is related with the age and the experience that the patient has. In comparison to the donors, the surrogate already knows what a pregnancy is, they know what to expect from it. “They had experienced the gestation, so they know what will happen to their body. Yes, they ask a lot of question about the medication, and in general, about all the medical procedures. I make sure donors understand what egg donation is all about. I make donors understand the procedure. I try to explain to them all the information I know; it is a way to keep them more involved. They can trust us. They become basically family with us”.

I asked Leslie her favorite aspect of her job, she mentioned: “My favorite part is connecting with people. I love helping people with their journey. I am part of their story, I am helping them to create a family”.

Sonia, a 3rd Party Coordinator: A Liaison Between Different Subjects

Sonia is the first employee of Western Fertility Institute that I have interviewed. I entered her office while she was filling out some documents for a gay couple. With 20 years of experience in the medical field, she mentioned she did not have any idea the extent the fertility industry had grown and the number of people that were becoming a part of it.

Sonia is currently a 3rd party coordinator at the Western Fertility Institute.
As a coordinator, Sonia wears many hats. She works with a vast variety of different people including, intended parent(s), egg donor and surrogates. She doesn’t just interact with them, she becomes the liaison between different figures within and out of WFI.  

foto so

She follows and takes care about different aspects of the pathway, from the first match between parties throughout the journey and delivery. Communication is one of the important skills she needs to manage during the months. Every part of the process is separated from one another, but everything is interconnected, like in a puzzle. Anxiety, anticipation, timing, waiting, joy and happiness are just some of the emotions she has to balance with each patient she is working with.

Every story is different; every patient has their own reason why they’re here. Sometimes the IPs keep the surrogate updated. Sometimes not. I have to work and make sure that everything is going well, for all the parties involved in the process.”

I asked Sonia, what is it that she loves most about her job, she replied: “My favorite part is when the Intended Parents get the news they are having a baby”.

Comments on Berend’s interview: Money, Contract & Relationship

With the interview with sociologist Zsuzsa Berend of UCLA, we have touched the heart of some thematic nodes that are often at the center of numerous debates. In this new article, I briefly comment the aspects I found most interesting and useful for my research.
The most common type of surrogacy in the United States is gestational surrogacy – GS (Perkins KM, Boulet SL, Jamieson DJ, Kissin MD, 2016), that it has been practiced for three decades (Twine 2015). Is money the most relevant resource in the surrogacy experiences? To try to answer this common question, I would like to focus my attention on 3 different aspects: money, the contract and the relationship.

1. Money
Money is seen as something that gives more power to those who possess it and guarantees them to acquire a privileged position within the surrogacy pathway. In other words, who owns the money is seen as the one who has advantages over those who enter in the circuit and have a lower economic position than the intended parents. Quite on the contrary, Berend (2016) decade-long ethnographic research on US surrogates has revealed that surrogates (mostly married, white, middle-class women) discuss their choices, resources and voice their opinions about agencies, clinics, and practices. Her findings show how surrogates define choice and resources in a way that contradict the “taken-for-granted” notions about vulnerability and the role of money within the arrangement of surrogacy. Berend talking about money: “Obviously, it is a resource because people that don’t have the money can’t probably start the surrogacy process, but also people with money cannot even end up with a baby if the surrogate doesn’t put her resources, her generosity, her fertility and all the other skills that they are so proud of, into providing the baby for this couple”. Money clearly is not the only resource in these exchanges.

2. Contract
As Berend (Ibidem) has pointed out during the years, “the contract became more and more sophisticated”. How the surrogates see the contract? Following the answer of Berend “They don’t think of this as something that people force on them, they very much want to understand what contracts entail and act to have their own contract”. But one of the most fascinating points she found is that the surrogates saw the contract like the basis of a social relationship with the intended parents (IPs), like the test of a character and the compatibility.

3. Relationship
In this view, the contract plays an important role, not only for legal purposes, but because it became clue of the future relationship and communication. The Surrogates desire to transform the surrogacy journey into a mutual gift-giving relationship, during the contract phases, allows the ability for both parties to understand the type of relationship they will have and the type of people they will be dealing with.
I think these 3 aspects play an important role during the surrogacy pathway. This is why I’ve decide to focus my attention on them during the first part of my fieldwork.

 

References
Berend. Z. (2016). The Online World of Surrogacy, New York: Berghahn Books.

Twine, F. W., (2015), Outsourcing the Womb:Race, Class, and Gestational Surrogacy in a Global Market. Second Edition. New York and London: Routledge.

Perkins KM., Boulet SL., Jamieson DJ, Kissin DM., (2016), National Assisted Reproductive Technology Surveillance System (NASS) Group. Trends and Outcomes of gestational surrogacy in The United States, Fertility and Sterility: 106; 435-42 e 2.