["We are families too": LGBT experiences and demands for access to Surrogacy in Argentina]. / "También somos familias": experiencias y demandas LGBT por el acceso a la gestación por sustitución en Argentina.

Surrogacy (GS) has been established as a means of access to male homoparenting and, despite not being regulated in Argentina, it is negotiated in a "paralegal" scenario. For some time now, LGBT organizations have proposed regulation based on the argument that GS represents the only option available for a male homosexual couple to have a child with a genetic link, albeit with only one of them, and consecutively acknowledge the family ties of both. By means of ethnographic work carried out within the scope of a postgraduate research project, our objective is to ascertain the experiences of male homosexual couples who seek the legitimacy of GS processes and equal access to the healthcare system. With this in mind, we seek a reflection that articulates the construction of public health policies and the claims of sectors of the LGBT movement, focusing on the meanings of the collective experience, on the ways in which these actors organize their family demands, and on the conceptions and practices that articulate these claims with the production of public policies.

La gestación por sustitución (GS) se ha instalado como una vía de acceso a la homoparentalidad masculina y pese a que en Argentina no está reglamentada, se lleva adelante en un escenario "paralegal". Desde hace tiempo, organizaciones LGBT proponen su regulación bajo el argumento de que la GS representa la única opción que tiene una pareja de varones homosexuales de tener un/a hijo/a con lazo genético, aunque sólo con uno de ellos, y reconocer consecutivamente ambos vínculos filiatorios. A través del trabajo etnográfico realizado en el marco de un proyecto de investigación de posgrado, nuestro objetivo es recuperar las experiencias de parejas gays que buscan la legitimidad de los procesos de GS y el acceso igualitario en el sistema de salud. En ello, apuntamos a una reflexión que articula la construcción de políticas públicas en salud y los reclamos de sectores del movimiento LGBT, poniendo el foco en los sentidos de la experiencia colectiva, en los modos en que estos actores organizan sus demandas familiaristas y en las concepciones y prácticas que articulan esos reclamos con la producción de políticas públicas.

Between choices and decisions. Genetics in homoparental families through surrogacy in Argentina. / Entre elecciones y decisiones. La genética en familias homoparentales por gestación por sustitución en Argentina.

Comprehensive access to medically assisted reproduction procedures and techniques in Argentina has been assured by National Law No. 26,862 since 2013. This Law does not include surrogacy procedures, and the lack of specific regulation shifts practices to a paralegal setting. In this context, planned parenthood by male couples through surrogacy is performed through actions that convey demands for access rights and active State policies. For these couples, the argument is that surrogacy is the only option to have a child with a genetic bond with at least one of the two parents and recognize both filiatory bonds. This work results from field work in progress with parents from the Province of Buenos Aires running this practice in Argentina. Based on in-depth interviews, we attempted to rebuild personal experiences and analyze the meanings that the narratives construct regarding their parenting, the biological connections in establishing or defining family relationships, and the importance of genetics in constructing and maintaining affiliations.

En Argentina desde 2013 existe la Ley Nacional 26.862 de acceso integral a los procedimientos y técnicas de reproducción médicamente asistida (TRA). Esta no incluye los procedimientos de gestación por sustitución (GS) y la ausencia de regulación específica mueve las prácticas a un escenario de paralegalidad. En este contexto, las paternidades planificadas por parejas de varones a través de GS se llevan adelante mediante acciones que vehiculizan demandas de derechos de acceso y políticas activas del Estado. Para estas parejas el argumento es que la GS representa la única opción para tener un/a hijo/a con vínculo genético con al menos uno de los dos padres y poder reconocer ambos vínculos filiatorios. El presente trabajo es el resultado de un trabajo de campo en proceso con padres de Buenos Aires que están llevando adelante esta práctica en Argentina. A partir de entrevistas en profundidad intentamos reconstruir las experiencias personales y analizar los sentidos que construyen las narrativas respecto de sus parentalidades, las conexiones biológicas en la creación o definición de los lazos familiares y analizamos la importancia de la genética en la construcción y mantenimiento de vínculos filiatorios.

Gestational Carrier Pregnancies: Legal and Ethical Considerations for Pediatricians.

This case explores the legal and ethical considerations for pediatricians surrounding gestational carrier pregnancies in the United States. Because of high success rates for assisted reproduction, state laws supporting same-sex adoption and surrogacy, and established legal precedents, gestational carrier pregnancies are increasingly common. The case presented involves a gestational carrier in preterm labor at 30 weeks' gestation with malpositioned twins who declines a cesarean delivery. Three commentaries are presented. The first highlights the importance of understanding the ethical implications of gestational carrier pregnancies in prenatal counseling. The second commentary emphasizes the pregnant person's right to autonomy and bodily integrity, and discusses considerations in surrogacy pregnancies, including the authority to authorize a cesarean delivery, valid informed consent, and decision-making for neonates. The third commentary discusses autonomy, emphasizing the importance of contracts in surrogacy pregnancies, and suggests that, in the case of a conflict between the gestational carrier and the intended parent(s), the gestational carrier's preference should be decisive regarding medical care during pregnancy. These discussions highlight key concepts for ethically informed and family-centered care in gestational carrier pregnancies and deliveries.

Surrogates' experience during the COVID-19 pandemic: mental health, social support, and relationship with intended parents.

PURPOSE: To examine surrogates' mental health, social support, and relationship with intended parents (IPs) during the COVID-19 pandemic from March 2020 to February 2022. METHODS: Data were collected between April 29, 2022 and July 31, 2022, at an academic IVF center in Canada using an 85-item online anonymous cross-sectional survey that included three standardized scales measuring mental health (PHQ-4), loneliness, and social support. Eligible surrogates actively involved in surrogacy during the study period received email invitations. RESULTS: The response rate was 50.3% (338/672); 320 submitted surveys were analyzed. Two-thirds (65%) of respondents experienced mental health concerns during the pandemic and were significantly less comfortable about seeking mental health support than those without concerns. Nonetheless, 64% were highly satisfied with their surrogacy experience; 80% received a high level of support from their IPs, and 90% reported a good relationship with them. The final hierarchical regression model identified five significant predictors, explaining 39.4% of the variance in PHQ-4 scores: a prior mental health history, COVID-19 impact on personal life, surrogacy satisfaction, loneliness, and social support. CONCLUSIONS: COVID-19 created an unprecedented challenge to surrogacy care, increasing surrogates' risk of experiencing mental health symptoms. Our data show that IP support and the surrogate-IP relationship were fundamentals to surrogacy satisfaction. The findings are relevant to fertility and mental health practitioners in identifying surrogates who are more susceptible to mental health challenges. Fertility clinics should ensure adequate psychological screening of surrogate candidates and proactively offer mental health support services.

A relational investigation of Israeli gay fathers' experiences of surrogacy, early parenthood, and mental health in the context of the COVID-19 pandemic.

Perinatal distress affects approximately 10% of fathers, but little is known about how gay fathers experience the challenges surrounding childbirth and early parenting of a child. This study explored gay fathers' experiences of having a baby via transnational surrogacy, raising that baby as a gay parent, and the context of the COVID-19 pandemic. In-depth qualitative interviews were conducted with 15 Israeli men to understand their experiences of surrogacy and early parenthood, focusing on the impact on their mental health and the relational factors involved. Secondary narrative analysis revealed that fathers constructed surrogacy as a perilous quest that required strong intentionality to undertake. The first year of parenthood was conceptualised alternately as a joyful experience and/or one that challenged fathers' identities and mental health. A relational framework was applied to better conceptualise the fathers' narratives, revealing that actual connections-and the potentials for links-considerably shaped experiences of surrogacy, perinatal distress and recovery. Implications for research and policy are discussed.

subrogación en series: una narrativa sobre la metafísica del embarazo / Surrogacy in Series: A Narrative on the Metaphysics of Pregnancy

Se analizan dos series que, con diferencia de quince años, abordan el tema de la maternidad subrogada: Shameless y Little fires everywhere, con el foco en las cuestiones bioéticas y sociales involucradas en ellas. A partir de los relatos de apego entre la gestante y la persona nacida o por nacer, se pone a prueba el concepto de "metafísica del embarazo", tal como lo trabaja Suki Finn, ofreciendo un escenario novedoso para un tema complejo y controvertido

Two series are analyzed that, with a difference of fifteen years, address the issue of surrogate motherhood: Shameless and Little fires everywhere, with a focus on the bioethical and social issues involved in them. From the stories of attachment between the pregnant woman and the person born or unborn, the concept of "metaphysics of pregnancy" is examined, as Suki Finn works, offering a novel scenario for a complex and controversial issue

Higher Levels of Postnatal Depressive Symptomatology, Post-Traumatic Growth, and Life Satisfaction among Gay Fathers through Surrogacy in Comparison to Heterosexual Fathers: A Study in Israel in Times of COVID-19.

This study aimed to explore the psychological welfare, as indicated by postnatal depressive symptomatology, life satisfaction, and posttraumatic growth (growth after contending with stressful birth events), of Israeli gay fathers through surrogacy in comparison to heterosexual fathers. For that purpose, a sample of 167 Israeli fathers (M = 35.6, SD = 4.4) was recruited (68 identified as gay fathers through surrogacy and 99 as heterosexual fathers). Participants completed questionnaires assessing their postnatal depressive symptomatology, life satisfaction, and sense of posttraumatic growth after becoming fathers. Results indicated that gay fathers through surrogacy reported higher levels of life satisfaction and posttraumatic growth than heterosexual fathers. Yet, gay fathers also reported higher levels of postnatal depressive symptomatology than heterosexual fathers when life satisfaction or posttraumatic growth values were low or medium. The findings were interpreted in light of the hardships associated with cross-border surrogacy and the psychological outcomes associated with succeeding to become fathers after contending with them. The study contributes to the limited literature on postnatal depressive symptomatology and posttraumatic growth among gay fathers through surrogacy and provides clinicians and policymakers with relevant information on the psychological strengths and potential difficulties associated with cross-border surrogacy among gay fathers.

The psychological impact of surrogacy on the families of gestational surrogates: implications for clinical practice.

OBJECTIVE: To examine the psychological impact of gestational surrogacy on surrogates' families. BACKGROUND: ASRM practice committee guidelines recommend that psychological counseling prior to surrogacy include consideration of a surrogate's own family, but there has been little research to help guide mental health professionals (MHPs) providing implications counseling. METHODS: Fifty-nine family members from 16 surrogate families were recruited and data were collected on family relationships, child psychological well-being, and family experiences of surrogacy. Family members filled out a series of questionnaires based on their age and role in the family system. RESULTS: Participants included 16 surrogates (28 surrogate pregnancies) with an average time since first surrogate pregnancy = 2.93 years (range = 0-8 years). Overall, families of surrogates are functioning well across a number of psychological domains. There were some differences between surrogates and spouses regarding their perceptions of their children's experience. A small number of children reported negative emotions about surrogacy and more research is needed to identify which children may be at risk. Children reported surrogacy having a positive impact on their lives and endorsed both pride and excitement about their mother being a surrogate. CONCLUSIONS: There has been limited data to inform MHPs tasked with implications counseling prior to surrogacy in offering guidance to surrogates' family members to help prepare them for the experience. This data can be used by MHPs providing implications counseling to help facilitate discussions about the potential impact of surrogacy tohelp ensure positive psychological outcomes for surrogates and their family members.

Medical and mental health implications of gestational surrogacy.

Gestational surrogacy in the United States has quadrupled since 1999, but to date, only a few states explicitly permit compensated gestational surrogacy. Current legal prohibitions are often influenced by outdated and stereotyped understandings of surrogacy. It is increasingly important to understand the current literature about the medical and mental health impacts of surrogacy and how state legislatures have addressed compensated gestational surrogacy in recent years. Based on this review, we found no evidence of substantial adverse medical or psychological outcomes among women who are gestational carriers or among the children they give birth to. The literature suggests that gestational surrogacy is a safe and increasingly popular option for families as long as rigorous screening and medical, psychological, and social supports are equitably provided. As states move to responsibly legalize and regulate gestational surrogacy, there is a continued need for further longitudinal studies on the health and psychological outcomes of gestational surrogacy.

The Role of Religion and Spirituality in Conceptualizing Reproductive Loss: Clinical Implications of the Narratives of Gestational Surrogates in the USA.

Reproductive losses experienced by gestational surrogates, who do not share a genetic connection to the child they are carrying, may not be acknowledged or treated as compassionately as women who lose their "own" pregnancies. In-depth, semi-structured interviews were conducted with 17 gestational surrogates from diverse religious backgrounds. Grounded theory analysis of data included line-by-line coding, and emergent themes were identified. The results suggest that understanding and utilizing the religious/spiritual beliefs of a gestational surrogate may be one way for health professionals to provide implications counseling prior to surrogacy and also as a means to help process and grieve losses that may occur within surrogacy.

The social paradoxes of commercial surrogacy in developing countries: India before the new law of 2018.

BACKGROUND: Commercial surrogacy is a highly controversial issue that leads to heated debates in the feminist literature, especially when surrogacy takes place in developing countries and when it is performed by local women for wealthy international individuals. The objective of this article is to confront common assumptions with the narratives and experiences described by Indian surrogates themselves. METHODS: This qualitative study included 33 surrogates interviewed in India (Mumbai, Chennai and New Delhi) who were at different stages of the surrogacy process. They were recruited through five clinics and agencies. This 2-year field study was conducted before the 2018 surrogacy law. RESULTS: Surrogates met the criteria fixed by the national guidelines in terms of age and marital and family situation. The commitment to surrogacy had generally been decided with the husband. Its aim was above all to improve the socioeconomic condition of the family. Women described surrogacy as offering better conditions than their previous paid activity. They had clear views on the child and their work. However, they declared that they faced difficulties and social condemnation as surrogacy is associated with extra-marital relationships. They also described a medical process in which they had no autonomy although they did not express complaints. Overall, surrogates did not portray themselves as vulnerable women and victims, but rather as mothers and spouses taking control of their destiny. CONCLUSIONS: The reality of surrogacy in India embraces antagonistic features that we analyze in this paper as "paradoxes". First, while women have become surrogates in response to gender constraints as mothers and wives, yet in so doing they have gone against gender norms. Secondly, while surrogacy was socially perceived as dirty work undertaken in order to survive, surrogates used surrogacy as a means to upward mobility for themselves and their children. Finally, while surrogacy was organized to counteract accusations of exploitation, surrogates were under constant domination by the medical system and had no decision-making power in the surrogacy process. This echoes their daily life as women. Although the Indian legal framework has changed, surrogacy still challenges gender norms, particularly in other developing countries where the practice is emerging.

Iranian model of decision making to use surrogacy: A grounded theory Study.

Identifying the process of making the decision to use a surrogate mother can create a broad knowledge of this concept. In this grounded theory study, participants were selected through snowball sampling method and obtaining an informed consent, in-depth interviews were conducted face to face and recorded. Then, all the interviews, field notes, and memos were analyzed using Strauss-Corbin 1998 method. Analysis of the statements of the participants boiled down to 487 initial codes, 311 codes, 14 subcategories, and six categories. In the conceptual model of this process, "the hope to have a child" was an influential concept that interacted with other concepts.

Selecting the optimal gestational carrier: medical, reproductive, and ethical considerations.

The goals of a gestational surrogacy relationship are to have a healthy baby for the intended parents while maintaining the medical and psychological well-being of the gestational carrier. A successful gestational surrogacy relationship will result also in good psychosocial outcomes for the gestational carrier, intended parents, and child. Finding a gestational carrier who will achieve these goals would be the ideal. This article focuses on key medical, reproductive, and ethical considerations to optimize clinical outcomes in gestational carrier cycles. Recommendations from available clinical guidelines regarding gestational surrogacy are reviewed, along with updates from current literature.

Psychological assessment of gestational carrier candidates: current approaches, challenges, and future considerations.

The role of a mental health professional (MHP) in the psychological assessment of gestational carrier (GC) candidates has evolved over time, with clinical practices well established in the United States. Current ASRM guidelines recommend that all GC candidates undergo a psychosocial consultation and psychological testing (where deemed appropriate). Practice standards are relatively consistent among mental health disciplines, with assessments typically involving a clinical interview and the administration of a single, objective, self-report personality inventory. Although recent studies have established normative data for GCs, there has been little research into which assessment protocols are best suited to answer the referral questions of interest. Current challenges for MHPs placed in a gate-keeping role include providing a thorough screening using measures that typically yield defensive profiles that make them difficult to interpret. Research is emerging that suggests that using a multimethod approach in the psychological assessment of GCs may yield a more comprehensive psychological profile of GC candidates. This could allow MHPs to determine psychological appropriateness with more confidence and contribute additional data to be used in pre-surrogacy counseling. Assessing the psychological appropriateness of a woman to serve as a GC is a complex process, and there are a multitude of factors that must be considered, not the least of which are the psychological well-being of a potential GC, her partner, and her children throughout the process and beyond.

Postdelivery adjustment of gestational carriers, intended parents, and their children.

Surrogacy raises a number of concerns about the psychological adjustment of the surrogate, the parents, and the child. Despite surrogacy becoming more common, research into the postdelivery psychological adjustment of the individuals involved has lagged far behind. This review examines research on the psychological adjustment of surrogates and their children. It then presents findings from studies assessing parents' psychological health and parent-child relationships, and children's adjustment within families formed through surrogacy. Finally, it examines how children born through surrogacy feel about their birth and toward their surrogate. Overall, studies have shown good psychological outcomes for surrogates, parents, and children, but research is still very limited, particularly in relation to the geographical location of the research, the ages of the children studied, and the lack of longitudinal projects. Different forms of surrogacy now exist under the umbrella term of "surrogacy." There is now greater diversity in terms of who is using surrogacy, their motivations for using it, whose gametes are used for the pregnancy, and how a surrogacy arrangement is managed. There is therefore a need for future studies to examine the consequences of these different forms of surrogacy on the postdelivery psychological health of surrogates, surrogacy parents, and their children.

Gestational surrogacy: medical, psychosocial, and legal considerations.

Gestational surrogacy can provide an effective family-building method for women whose uterus is absent or dysfunctional and with contraindications to pregnancy, single men, and same-sex male couples. Over the past 30 years, gestational surrogacy cases have represented a growing percentage of third-party reproduction cases, both in the United States and internationally. The following series of articles provides a summary of current topics in optimizing GS arrangements. They focus on medical and psychological screening; psychosocial adjustment of carriers, children, and their families; legal considerations with precedent-setting cases that every clinician should know; and an international overview of cross-border surrogacy.

A comparison of sociodemographic and psychological characteristics among intended parents, surrogates, and partners involved in Australian altruistic surrogacy arrangements.

OBJECTIVE: To characterize the sociodemographic and psychological profiles of participant groups involved in altruistic surrogacy in Australia. DESIGN: Cross-sectional study. SETTING: Single psychological practice in Sydney, Australia. PATIENT(S): Six hundred and two individuals involved in 160 altruistic surrogacy arrangements: 143 intended mothers, 175 intended fathers (including 17 same-sex intended father couples), 160 surrogates, and 124 surrogate partners. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Responses to a presurrogacy sociodemographic assessment counseling protocol and the Personality Assessment Inventory (PAI). RESULT(S): The surrogates were primarily sisters, sisters-in-law, mothers (48.6%), or other extended family or friends (46.3%) of the intended parents. Most participants resided in residential postcode areas within the highest socioeconomic status quintile; however, intended mothers were more likely than surrogates to live in the most advantaged residential areas, to be younger and be more educated, and to be employed in professional occupations. Most participant psychological profiles were normal. A statistically significantly elevated PAI Somatic Complaints-Health Concerns subscale for intended mothers was observed compared with other participant groups. The higher PAI Warmth scale scores of intended mothers and surrogates were statistically significantly different from their respective partners, although not different from each other. CONCLUSION(S): Sociodemographic and some psychological differences between participant groups were observed that warrant exploration in pretreatment surrogacy counseling. Importantly, the higher scores on the PAI Warmth scale exhibited by intended mothers and surrogates in the context of close family and friendship relationships are likely to serve as protective mechanisms for the altruistic surrogacy outcome.

Surrogacy relationships: a critical interpretative review.

Based on a critical interpretative review of existing qualitative research investigating accounts of 'lived experience' of surrogates and intended parents from a relational perspective, this article proposes a typology of surrogacy arrangements. The review is based on the analysis of 39 articles, which belong to a range of different disciplines (mostly sociology, social psychology, anthropology, ethnology, and gender studies). The number of interviews in each study range from as few as seven to over one hundred. Countries covered include Australia, Canada, Greece, India, Iran, Israel, Italy, Mexico, Norway, Russia, Sweden, UK, Ukraine, and the USA. Most studies focus only on surrogacy practices in one country (although often with intended parents from other countries), and some include several countries (e.g. interviewees from several countries or fieldwork in different field-sites). The proposed typology goes beyond the division between altruistic versus commercial, and traditional versus gestational surrogacy, in order to inform further research and to contribute to bioethical and policy debates on surrogacy in a transnational context. Four types of relations are identifiable: open, restricted, structured, and enmeshed. The criteria which influence these relationships are: the frequency and character of contact pre- and post-birth; expectations of both parties; the type of exchange involved in surrogacy arrangements; and cultural, legal, and economic contexts. The theoretical contribution of the article is to further the development of a relational justice approach to surrogacy.

Understanding gestational surrogacy in the United States: a primer for obstetricians and gynecologists.

As gestational surrogacy (a process by which intended parents contract with a woman to carry a fetus that the intended parents will raise) increases across the United States, it is imperative that obstetrician/gynecologists understand the unique nuances of caring for patients who are gestational surrogates. Gestational surrogacy offers a route to parenthood for individuals and families who may otherwise have limited options. Understanding surrogacy requires multiple ethical considerations about the potential medical and psychosocial effects on gestational surrogates as well as the families built through surrogacy. There is a dearth of research on the subject, particularly in the United States and other countries that practice compensated surrogacy. Here we seek to review the process of gestational surrogacy in the United States, including the legal landscape, current trends in gestational surrogacy use, and what is known about the medical and social effects of this process on all participants. We also aim to highlight the limitations of available data and to identify topics for future research to provide optimal evidence-based and just care for these patients.