Can a baby be a gift? Or is surrogacy always a transaction?

When a woman wants to procreate, despite the potentially dangerous challenges this poses, the urge is primitive and all-consuming. It has to be, or we’d all be childless cat ladies. Out. Of. Rational. Choice.

I hate to be all doom and gloom about something as seemingly natural as childbirth, but childbirth ain’t the natural fairytale it’s cracked up to be. If you’re new to my blog, let me catch you up: having a baby is hard core and leaves scars, and that’s when it goes well. Look, I was a homebirth midwife, and I had 2 of my babies at home, so I’m well aware that fundamentally we are designed to survive without too much/any intervention. But still: there will be blood, sweat and tears. We emerge very much scathed.

So. Growing a baby is a defiant act of love and selflessness. Doing so for someone else is next-level self- sacrifice. I truly, from the bottom of my heart, respect a woman who would do that for a beloved friend/sister. Just as I would be in absolute awe of someone who gave up a kidney to save a loved one.

But.

Were I to become a surrogate for my sister or best friend, I’d be consenting to this of my own free will. I’d be doing this out of pure love,and I’d gladly do it for free because there’s just no way you can put a price on what I’d be giving her. If I gave up a kidney for a loved one, it’d be the same deal. I wouldn’t expect financial renumeration. The recipient has to believe they won’t be perpetually in debt to me otherwise it’s not really a gift, more a transaction. It’s a fine line, I know that, but we have to try to recognise it and toe it.

Being healthy albeit properly middle-aged I could, conceivably, do either (not my eggs, obvs, they’re out of date) of these selfless things purely for kicks, altruism at it’s purest, just for the kudos. I’d be a kind of fairy godmother. To be clear, I’m not keen on either. I know too much. I’m not that brave.

Sadly, not everyone who needs a birth mother for their baby knows someone who could altruistically lend their womb. If I had been in this position, I know I’d have been desperate. I’m hugely aware of how lucky I was to have had my very-much-wanted children. (And yes, I did know what to expect, I was already a midwife; yes, it’s inexplicable). That’s why I so want to believe in kind strangers doing this to help another woman in return for basic costs. We know that some women do, so what’s the problem?

The problem is that surrogacy is a big business. It’s a business that, by definition, treats women as commodities. Usually the poorer women.  According to Hannah Harrison (Ten Ways Surrogacy is Like Prostitution, September 20, 2018)

“Surrogacy agencies not only exploit poor women, but also rely on exploiting ‘altruism’. Women are told that by becoming a ‘surrogate’ they’re doing something good and generous, helping those in ‘need’ of a baby. They aren’t informed to consider the potential health risks and the emotional trauma that will occur when the baby is taken.”

Every time I sit a couple down to explain what’s likely to happen for the birth of their child, they visibly cringe. I’m doing my best to make it sound tolerable but even so, it’s mostly not good news. But forewarned is forearmed, right? I keep telling them that at least they’ll have their baby. Surrogate mothers won’t even have that. Unless, of course, the baby is deemed imperfect and the so-called intended parents no longer want it, because they paid (a great deal of money) for a perfect baby. Then the surrogate, who was already in a financially precarious situation, has herself an extra mouth to feed. I guess she could abandon the child but if she is altruistic enough to have hosted this child from conception through to birth, she probably wouldn’t consider that.

Human reproduction relies 99.99% on the human female. I made that number up, not gonna lie, but seriously, are you going to argue with me? This is our super power, but also our curse. Society can’t function if we don’t take care of producing and nurturing the next generation. Since it’d be impossible to put a price on this labour, mostly because it would be far too expensive,  we like to pretend it’s not work. As Kerala Goodkin (Oct 16th 2025) puts it:

“Capitalism’s answer, of course, is to pay as little as possible for care work when we have to and nothing at all if we can. In order to pull this off, capitalism positions care work as unskilled labor more naturally suited to women, whether or not women also engage in paid labor. The end result? We devalue the vital work of caregiving, and we devalue women’s time.”

We are led to believe it’s easy and natural and destiny. Thus, when we are initiated into the circle of motherhood (not discussed by Dante, he couldn’t have known about that circle) we swear an unspoken oath of silence paid for with tea and toast. So we don’t tell our sisters and daughters the whole truth. Sex education consists of diagrams. We talk of destiny. Ignorance is bliss. We idolise those lucky women who make it look easy and they feature on magazine covers three days post birth looking glamorous. Most NDAs will buy a woman’s silence for lots of money but this one we seem to enter unwittingly. I can’t explain it. Even nowadays when we try to warn others using the socials, we end up speaking into echochambers. Only the iniated can hear us. The uninitiated who mostly don’t stumble upon our warnings in their feeds, only hear ungrateful moaning myrtles when they do, and they scroll past undeterred.  Society needs us to use our power though, or else society collapses.

As women we know this. This should empower us to demand better conditions. Instead we are offered a pedestal where we can bask in the glory of having taken one for the team.  Society makes the pedestal very appealing: look, you will be fed (after your husband). You’ll be gorgeously attired in very small and uncomfortable clothes (that your husband finds attractive).  Housed like a princess (but you are the entire unpaid staff). You will not work (for money). You will still be envied (if you post the correct photos). But perhaps it’s just a fiendishly clever way to divide and conquer. Each mother on her lonely pedestal, each believing that, having fulfilled her so-called destiny, she ought to be happy and grateful.

Only Daughter knows better than to believe all this societal claptrap. She doesn’t want children. Mostly because she can’t think of anything more horrendous than childbirth. She’s a midwife’s daughter and she knows too much! But what if she decides to outsource the pregnancy? Should she be allowed to use another woman’s body? After all, if my daughter could freeze her eggs (or buy some) and hire a womb, she could focus on her career and basically live like a man. And I still get to be a granny. Eventually.  But can it ever be ok to rent a uterus from a woman whose only source of income is her body?”As career feminists have proven, handing off undervalued care work to underpaid laborers does nothing to advance the feminist cause. And in practice, trying to “do it all” means nothing we do is ever enough.” Kerala Goodkin 0ct 16th 2025

I’m just asking… because I suspect we only get to hear the rose tinted version of surrogacy, the feel-good stories from the true altruists. These women are amazing, but they are well educated, well-informed, highly articulate and have a mega pedestal upon which to bask in their genuine good deed, and a commensurate platform from which to broadcast it. They are NOT victims. Like any decent fairy godmother, they used their superpowers to do good.  But that doesn’t mean most surrogates (who have no voice) aren’t.  Both things can be true. Just like someone who gives a kidney to save a loved-one’s life isn’t a victim. But a poor man who needed cash and ‘willingly’ sold a kidney to raise funds… obviously that’s illegal because commodifying organs is wrong, no matter how rich the would-be recipient might be.

Being an egg donor is another contentious issue. On the face of it, it’s no big deal. I see many women who’ve had IVF so they had their eggs harvested for the procedure, and it seems safe as houses. But I know that they very rarely get more than 10 eggs per cycle. Not so for commercial egg donors. They are often targeted for their looks and IQ thanks to clever advertising on university campuses, capitalising on their student debt, their sense of altruism and good old-fashioned flattery (you wouldn’t be chosen if you weren’t smart and gorgeous). These young woman know they won’t get any money if they dare complain of signs of ovarian hyperstimulation. Which is when their ovaries are artificially fired up to produce dozens of eggs – leaving them prone to dangerous complications. Most of them will be fine, but some really aren’t. Perhaps the risks are explained to them, but it isn’t informed consent if you need the cash. If the one-sided (not yours) contract you signed has you in a bit of a pickle.

Thing is, you can always find an articulate, privileged, altruistic woman to defend surrogacy, egg donation, even sex work. After all, her body, her choice, right? I’m torn here, because clearly I believe in choice. I even like the thought that women have ways to make some cash in ways that men cannot due to biology. I’m all in favour of altruism. Hosting a baby that another woman couldn’t have had is an amazing act of love, and I’m very well placed to know how magical a gift it is. But I’m equally well placed to know what can go wrong. I am trained and regularly updated in the art of obtaining true informed consent, but this merely highlights how difficult it is to obtain at the best of times. There’s never enough time to explain the risks. Even for a routine 12 week scan, which everyone unthinkingly accepts, most women have no idea what they are consenting to, namely way too much information about possible foetal abnormalities which they will struggle to process. Or, a routine blood test might reveal that she has a life-limiting STI. Once you know, you can never un-know. I’m sorry to say I don’t dwell too much on these outcomes when I offer these tests.  I ought to, but I don’t have time.

I’d go so far as to say that truly informed consent is actually quite rare, mostly because people hear what they want to hear. I see this all the time. I’m guilty of it too. If you are happily pregnant, you’re kinda assuming you’re going to ace this so you’re not listening, welcome to the club, good luck. If you’re about to get pregnant because you need the money, you will need to believe that the risks I’m telling you about will not apply to you. If you need a surrogate you will need to believe she is choosing this freely because she kind. And that she’ll be fine. Of course, when the surrogate can’t afford to see the risks and the intended parents are blinded by their understandable longing for a child, there’s always room for a middle man who can reconcile the two. For a fee.

And when you hear that debate (Woman’s Hour, 16th October 2025) between the altruistic surrogate with the home counties accent which signals her wand-waving status (kudos to her, she’s amazing), and the pesky radical feminist who speaks for the thousands of voiceless, choiceless, but still selfless and incredible surrogates from less affluent countries (and has the actual stats on the true costs of surrogacy), you still tend to side with the former. Because pregnancy is natural, right? And women are kind. And you’d do it if your sister asked. Wouldn’t you?