Surrogacy and Its Impact on the Surrogate’s Mental Health

*This is a collaborative post on surrogacy and it’s impact on mental health

In 2024, the journal Human Reproduction published the results of the longest study to date on surrogate mothers, conducted approximately 20 years after they participated in surrogacy programs https://www.mother-surrogate.com/. The researchers expected to identify accumulated psychological difficulties. Instead, most participants demonstrated a high level of psychological well-being and stable self-esteem. Many women described surrogacy as a meaningful life experience.

These findings differ noticeably from how surrogacy is often portrayed in the media. Understanding the real picture is important both for women considering participation in a program and for intended parents.

What long-term studies show

Key findings published in Human Reproduction include:

• most surrogate mothers did not show signs of psychological disorders at any stage of observation;
• overall, surrogate mothers scored within the normal range on standardized tests for anxiety and depression;
• twenty years later, participants demonstrated relatively high levels of psychological well-being and a stable positive emotional state;
• many women maintained contact with the families they helped and considered this relationship valuable.

Similar results were reported in a large Canadian sample. A 2019 study that followed participants throughout the entire surrogacy process found that most surrogate mothers described the experience as meaningful and positive, and their relationships with the intended parents as harmonious.

When difficulties arise

Research shows that psychological stress for surrogate mothers may increase in certain situations. Understanding these factors helps ensure timely support.

• The moment of transferring the child. Some surrogate mothers experience short-term emotional reactions when parting with the newborn. Studies suggest that this is usually not related to attachment to the child but rather to the completion of an important life stage.
• Insufficient postnatal support. In several studies, participants noted that after the birth, they sometimes felt a lack of attention from agencies primarily focused on supporting intended parents.
• Isolation in international programs. When the surrogate mother and intended parents live in different countries and have limited contact, overall satisfaction with the program tends to be lower.
• Social stereotypes. Surrogate mothers often encounter simplified assumptions about their motivations, even though research shows that the reasons for participation are diverse and frequently include the desire to help others become parents.

In most modern programs, these factors are considered in advance. For example, in Ukraine, where surrogacy is regulated by law and programs include medical and legal support, special attention is given to communication between the parties and to supporting the surrogate mother throughout the entire process.

Factors that influence a surrogate mother’s well-being

Data collected over the past 20 years highlight several factors consistently associated with positive psychological outcomes for surrogate mothers:

• the quality of the relationship with the intended parents, including involvement, attention, and appreciation;
• psychological preparation before the program begins, including discussing expectations around the transfer of the child;
• support during the postpartum period from the agency or clinic;
• the presence of a supportive family and social environment;
• clear agreements at every stage of the program, without unexpected situations or ambiguity.

The last point reflects a consistent observation in research: surrogate mothers who experienced transparent agreements and clear communication evaluated their experience significantly more positively.

Conclusion

Long-term studies show that with proper support, surrogacy does not increase the risk to a woman’s mental health. Many participants describe the experience as a meaningful part of their lives. At the same time, psychological support should begin during the selection stage and continue after birth, when it is particularly important.