Content Warning: This section of the guide includes discussion of ableism.

Surrogacy is the process whereby someone agrees to carry a pregnancy for another individual or couple after conceiving through in vitro fertilization. The Surrogate Mother focuses on a “traditional” surrogacy whereby the surrogate mother’s own eggs are fertilized by the intended father’s sperm (or that of a donor). In these cases, the surrogate mother is biologically related to the child. The alternative to traditional surrogacy is gestational or host surrogacy, whereby an already fertilized egg is implanted in the surrogate mother. In gestational surrogacies, the intended mother (or donor of the egg) is the baby’s biological mother.

McFadden’s novel shows how surrogacy can offer hope to individuals who are unable to conceive naturally. However, the conflict between Abby and Monica reflects the complex ethical, legal, and social considerations that make surrogacy a highly debated topic. Surrogacy agreements can be highly contentious since they involve balancing the rights and well-being of the surrogate, the intended parents, and the child. A lack of federal laws regulating the practice further complicates surrogacy agreements in the United States. Surrogacy laws vary widely by state, creating uncertainty about who is legally recognized as the child’s parent.

Surrogacy disputes can arise if the surrogate changes their mind, and a key consideration in all agreements is informed consent. This means that the surrogate fully understands and agrees to the process without undue pressure. One of the first contested surrogacy cases in the US, the “Baby M” case, highlighted the complexities of informed consent. Mary Beth Whitehead willingly agreed to be a traditional surrogate for William and Elizabeth Stern in exchange for $10,000. However, after giving birth, she refused to give up custody, and a legal battle ensued. The New Jersey Supreme Court ultimately invalidated the surrogacy contract while awarding custody to the Sterns, citing the child’s best interests.​ Nevertheless, Whitehead’s claim that she did not fully understand the psychological impact of giving up the baby highlights how the emotional bond that may develop between the surrogate and the baby can complicate the handover process. Consequently, a surrogate may agree to a contract without fully comprehending the emotional ramifications.

Surrogacy agreements can also go awry if the intended parent(s) decide not to accept the child. In the 2014 “Baby Gammy” case, an Australian couple, David Farnell and Wenyu Li, made a gestational surrogacy agreement with a Thai surrogate mother, Pattaramon Chanbua. Chanbua became pregnant with twins, but when it was discovered that the male twin had Down syndrome, the Australian couple only wanted Gammy’s sister, Pipah. Consequently, Chanbua raised Gammy, although she was not genetically related to him.

This case caused international outrage, highlighting how commercial surrogacy can exploit economically disadvantaged women, turning their bodies and reproductive capacity into commodities for wealthier individuals or couples. Furthermore, the failure of the Australian couple to honor the original agreement also raised concerns that surrogacy arrangements risk treating children as returnable goods based on perceived desirability or health. As a result of the Baby Gammy case, commercial surrogacy became illegal in Thailand.