When pregnancy is a job: Surrogacy in policy and practice

By April Hovav

Is pregnancy work? What if you’re a surrogate and carrying a pregnancy for someone else? Is it degrading or exploitative to pay women to carry and birth a child for someone else? These are some of the questions that policymakers around the world are grappling with as they decide how to legislate surrogacy.

Surrogacy is either illegal or unrecognized in most of the world[i] with only a few countries actually allowing surrogates to be paid.[ii] While some laws allow for limited forms of compensation (e.g. for lost wages, time, and maternity clothes), they ban direct payment for surrogacy. The overall message is that surrogacy is not a job.

India, once an international hotspot for paid surrogacy, recently joined the list of countries that only allows “altruistic” surrogacy whereby women cannot be paid for being a surrogate.[iii] At the same time, legislators in Canada are considering moving in the opposite direction. They are debating whether or not to amend the Assisted Human Reproduction Act to allow intended parents to pay surrogate mothers, which is prohibited under the current law.[iv]

But is the line between altruistic and commercial (paid) surrogacy really that clear-cut? Restrictions against paying surrogates are often premised on the idea that paying a woman to carry and birth a child is degrading, exploitative, or otherwise immoral. These allegations are especially strong when the women hired to be surrogate mothers live in countries that are more impoverished than the countries from which the intended parents come to hire them.

As a social scientist, I wanted to know how people involved in transnational commercial surrogacy arrangements deal with accusations that surrogacy is exploitative and how this narrative shapes the way they handle the financial aspects of surrogacy. I interviewed and observed more than 100 different participants in the Mexican surrogacy industry, including local surrogate mothers, the mostly foreign intended parents who hire them, and the staff at the surrogacy agencies that match surrogates with intended parents.

I found that people involved in the surrogacy industry were also reluctant to call surrogacy a job. For example, Katrina, a woman working at the Mexican branch of an international surrogacy agency, told me that surrogates should view surrogacy as “a voluntary contribution to help a couple create a family, not as a job.” Similarly, Hugo, the manager of the Mexico branch of another surrogacy agency, explained, “In the end what we want to do is to create families, we’re not encouraging people to make themselves rich by renting their wombs.”


These statements are examples of what I call an altruism/commercialism dichotomy, a framing of altruism as contradictory to and in tension with profit, market logics, and commodification.  In my article, I show how this dichotomous thinking makes the surrogacy process seem morally acceptable while simultaneously leading surrogate mothers to earn less. I found that intended parents preferred to hire surrogates that they perceived as financially stable in order to avoid being accused of exploiting a poor woman. In turn, surrogacy agency staff either rejected or re-oriented potential surrogate mothers who indicated that they were interested in becoming surrogates for monetary reasons. For example, Carla told me that she was first interested in being a surrogate for the money but after talking to a surrogacy agency, she learned to see it as an altruistic act. I also found that surrogate mothers were discouraged from negotiating their wages because doing so was seen as a sign that a woman had chosen to be a surrogate for the “wrong reasons.”

Why does this matter? On a practical level, the assertion that surrogacy is not a job may lead surrogate mothers to be paid less than they would be paid if they were able to negotiate their wages. In a broader sense, this is an issue of gender inequality.

Fertility doctors, surrogacy agencies, and family law attorneys are also in the business of creating families but no one is saying that they shouldn’t get paid. No one would argue that being a doctor isn’t a job; even if the doctor’s entire practice is based on helping infertile couples have children. But carrying a fetus to term and giving birth (which we call labor!) isn’t seen as a job.

Researchers have argued that traditionally female occupations, like caretaker, teacher, and nurse, are relatively low-paid because they are seen an extension of women’s “natural role” as mothers and caregivers.[v] [vi] While there are many reasons to be concerned about the welfare of surrogate mothers and to regulate the surrogacy industry, we should be weary of couching critiques of surrogacy in terms of an altruism/ commercialism dichotomy. The narrative that surrogacy isn’t or shouldn’t be a job reinforces the idea women’s reproductive labor isn’t “real work.”

[i] http://www.un.org/en/ga/search/view_doc.asp?symbol=A/HRC/37/60


[ii] Ibid.

[iii] https://www.businessinsider.in/india-moves-to-ban-commercial-surrogacy/articleshow/67171236.cms

[iv] https://www.bbc.com/news/world-us-canada-44243920; https://globalnews.ca/news/4599925/surrogate-regulations-canada-compensation/

[v] Heyes, Anthony. 2005. The economics of vocation or “why is a badly paid nurse

a good nurse?” Journal of Health Economics 24 (3): 561-69.

Nelson, Julia. 1999. Of markets and martyrs: Is it OK to pay well for care? Feminist Economics 5 (3): 43-59.

Nelson, Julie, and Paula England. 2002. Feminist philosophies of love and work. Hypatia 17 (2): 1-18.

England, Paula. 2005. “Emerging theories of care work.” Annual Review of Sociolology 31: 381-399.

Folbre Nancy. 2001. The Invisible Heart: Economics and Family Values. New York: New Press.


April Hovav is a doctoral candidate in sociology and gender studies at the University of Southern California. Her research examines the social impact of reproductive and genetic technologies.


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