Despite it being increasingly commonplace, surrogacy has been the subject of surprisingly few studies. Our project is in fact the only study in the world to be examining family relationships and children’s psychological development in surrogacy families as the children grow up. Forty-two families were originally located through the Office for National Statistics, (who, when the study began, kept a record of everyone who had applied for a parental order) and through COTS, the only surrogacy organisation that existed at that time. All the families were headed by heterosexual couples, and had completed their surrogacy in the UK.
When the children were aged 1, 2, 3, 7, 10 and 14 years, researchers visited each family at home. We collected data on parents’ psychological health, children’s social, emotional and psychological development and the quality of parenting through standardised questionnaires and interviews. For the last three phases of the study we have also been asking parents and children to carry out a play task together which we video record and later code to see how parents and children interact together. At these later ages, with parents’ agreement, we also asked the children’s teachers to complete a questionnaire, which gave us an independent assessment of how the children were doing.
Overall, the findings have been positive, showing that parents who had a child through surrogacy scored highly on measures assessing the quality of parenting, specifically, warmth and sensitivity towards their child. In fact, the earlier phases of the study found that these parents scored better on measures of parenting compared to parents who had conceived their child without any medical intervention. The more positive findings might be explained by the fact that parents who had a child through surrogacy had experienced many years of infertility and thus, when they finally fulfilled their wish of becoming parents, were very involved with their children.
The study also found that children born through surrogacy do not experience psychological problems. When we looked at the data over-time we found that whilst all the children scored within the normal range for psychological health, children born using surrogacy experienced more difficulties at age 7 compared to children born through sperm or egg donation. However, this difference was no longer present at age 10. The temporary difference could be due to a majority of surrogacy children being aware of their birth story (versus a minority of the children born following gamete donation) and thus having to deal with this knowledge at an earlier age. At age 14, we found no differences between children born following surrogacy and the other groups in terms of their well-being, self-esteem, and emotional or behavioural problems. If the birth story had an influence on children’s difficulties at age 7, these did not continue into adolescence.
All the parents in our study intended to tell their child about their surrogacy birth, and many of the parents had done so by the time we visited them at the age of 3 years. Children born through surrogacy showed some understanding of their birth by the age of 7 explaining it using concepts such as ‘broken tummy’. By age 14 years most adolescents were unconcerned about being born through surrogacy, and it was a topic of conversation which rarely came up within their family.
Around two thirds of the parents in our study did not know their surrogate before the surrogacy arrangement; the remaining parents had a family member or a friend who offered to be their surrogate. Many of the families were still in contact with their surrogate. Unsurprisingly, we found that families maintained the most frequent contact with surrogates who had been known to the family prior to the surrogacy arrangement, i.e. those who were family members or friends. Children who were in contact with their surrogate reported that they liked her describing her as ‘nice’ or ‘kind’. Some of the adolescents who were not in contact with their surrogate were curious about her and wanted to know, for example, why she had decided to be a surrogate.
One of our studies has also focused on the experience of UK surrogates over time. This study found that some surrogates experience minor difficulties, such as feeling upset in the weeks following the birth, which gradually declined over the first year. When we went back to see the surrogates a decade later we did not find them to be experiencing any psychological problems. Some surrogates had carried out subsequent surrogacy arrangements either for the same couple or for different couples. Whether or not they continued to stay in close contact with the families depended on the closeness of the relationship they had built with them during the pregnancy.
Overall, findings from this longitudinal study have been reassuring. They show that parents of children born through surrogacy can have positive relationships with them and that the children do not experience psychological problems. The children are now turning 18, and we are preparing to conduct another follow-up with them and their families. The children’s transition to young adulthood promises to be an exciting and important developmental period for us to assess. This cohort will be the first of children born via surrogacy to have been followed throughout their life course from age 1 to age 18 and we very much look forward to visiting the families once again to see how they are now doing.
Dr Vasanti Jadva is a Senior Research Associate and Affiliated Lecturer at the Centre for Family Research, University of Cambridge. Her research examines the psychological well-being of parents and children in families created by IVF, egg donation, sperm donation and surrogacy. She has also studied the experiences of surrogates and gamete donors.
Dr Jadva is currently working with colleagues on a number of different studies which aim to increase understanding of new family arrangements involving non-cohabiting co-parents, transgender parents, elective single fathers and identifiable egg donors.