My Body, Their Baby: A Progressive Christian Vision for Surrogacy

MY BODY, THEIR BABY: A Progressive Christian Vision for Surrogacy by Grace Y. Kao. Stanford University Press, 2023. 274 pages. Paperback; $30.00. ISBN: 9781503635975. *Surrogacy has long been understudied, underdiscussed, and even dismissed in Christian circles. Kao courageously begins the conversation by marrying a sophisticated argument, stemming from her expertise in ethics, gender, and sexuality, with her personal experience as a surrogate mother. *Kao considers surrogacy a morally good, supererogatory act. Like adoption, it is a form of reproductive hospitality. It engages certain risks for the greater benefit of the relationships between parents, children, and their community. However, Kao suggests that surrogacy is only morally good when it adheres to several conditions. For instance, the intended parents (IPs) should be in a stable marital or otherwise committed relationship, having already struggled with infertility. The surrogate should have experience with healthy pregnancy and be genetically unrelated to the baby. All three should reside in the same jurisdiction and have a strong relationship. The arrangement must be gestational (that is, the surrogate is not a genetic parent). In addition, it must be altruistic, with all costs covered by insurance and the IPs. *Kao supports her argument with scripture, tradition, reason, and experience. Biblical themes of covenant, vocation, and fidelity ground the relationships between the IPs, surrogate, and prospective child. Kao refers to progressive church traditions that address sexuality, marriage, and family alongside science and technology. Drawing on what she calls "secular sources of knowledge" (p. 5), she consults international human rights, professional medical ethics, and reproductive justice (more below). Her own experience as a surrogate literally fleshes out her primary claim: that the God who long ago ended Hannah's suffering (1 Samuel 1) can today use assisted reproductive technology to do the same. *All of the above are important for understanding Kao's constructive argument: a framework of seven ethical principles that should guide surrogacy relationships. The first two principles concentrate on the pre-surrogacy relationship. The IPs and the surrogate methodically reflect on the known implications of surrogacy. Both individually and collectively, they discern their respective reproductive vocations. Such reflection equips these parties to create a moral covenant of fidelity that precedes any legal contract. This covenant outlines a collective understanding of the nature of the relationships between the IPs, the surrogate, and the child during pregnancy and after birth. It expresses shared values and how decisions will be made about expected, unexpected, and worst-case scenarios. *The next set of principles speaks to the time of active surrogacy. Mutual empathy, care, and stewardship set the tone for discussion and decision making if conflicts arise between competing medical interests or legal rights. Mutual disclosure is promoted over secrecy. *The final principles are public and concentrate on justice from a feminist perspective. Kao entreats us to "trust women" as capable of making reproductive decisions informed by experience (pp. 142-45). This does not mean, she cautions, that each woman will always make right decisions or that "anything goes." Women are entitled to moral agency, and that agency depends, of course, on access to reproductive justice, the subject of Kao's final principle. Drawing attention to the fact that women (and children) are chronically placed in precarious situations, reproductive justice calls for the amendment of reproduction-related laws and policies that adversely affect socially vulnerable people, particularly Black and Hispanic women and same-sex couples. Kao concludes her work by identifying creative ways to tackle surrogacy arrangements that, for one reason or another, stand outside this framework, including transnational and exploitative surrogacy. *Throughout this book, Kao uses her experience to address common concerns. One of interest to me is the expectation that the surrogate will develop a maternal closeness with the baby, despite sharing no genetic relationship. After all, even a prophet presumes this natural bond: "Can a woman forget her nursing child, or show no compassion for the child of her womb?" (Isa. 49:15). *Kao recalls that the bond she has with her own children began not during pregnancy but in the weeks following birth. She anticipated having the same experience in a surrogate pregnancy. She did, and she gave the baby freely to the IPs. Kao augments this personal experience--the basis for her "trust women" principle--with studies that show a majority of surrogates develop affectionate feelings like those of a nanny, but not a maternal bond (pp. 44-47). It would be helpful if she attended to research showing a correlation between the migration of fetal stem cells to the pregnant woman's body, particularly, in relation to her brain and to her sense of attachment or bonding.1 *Some of Kao's principles are informed by experiences that were not ideal. She did not anticipate all the complications that would arise. For instance, Kao struggled with the IPs' refusal of preimplantation genetic testing, and their delay in determining whether Kao would breastfeed or express colostrum and milk for bottle feeding. Such experiences give her clearance to make strong recommendations on these subjects. They also humanize the text. *Kao's description of ethical surrogacy is detailed and reinforced by numerous studies and resources. Even so, there remain some ethical concerns she might speak to more thoroughly. Many pertain to the presumptions on which her argument rests. She views the following as morally permissible: (a) conception that is not the result of sexual intercourse; (b) IVF, including the discarding of unused embryos (Kao relies on her denomination's stance rather than offering her own sustained ethical defense; see pp. 93-94); (c) risks associated with IVF pregnancy, including preterm birth, placenta previa, and others; (d) embryonic risks associated with preimplantation and prenatal genetic testing; (e) abortion when it is "in [the pregnant person's] or their fetus's best interests" (p. 75); and (f) the conception and parenting of children by same-sex couples. As these matters polarize the church, it would be helpful to have more fulsome explanations of Kao's foundational beliefs and rationale for calling them morally permissible. *Kao acknowledges the concern about the dynamic between environmental sustainability and the human population. Unfortunately, she discusses only the narrow view of antinatalism, claiming that no one should be forced to have fewer or no children (pp. 88-89). More could be said about how a growing population can maintain sustainable lifestyles. *Kao's argument for reproductive justice would be strengthened if greater attention were paid to broader social and economic injustices. Is surrogacy a responsible use of money in a world with parentless children? Kao defends the financial burdens and emotional toll of surrogacy as being on par with those of adoption (p. 80). Insisting that infertile people are not morally obligated to adopt, she maintains that surrogacy serves the public good by fulfilling the human vocation and right to have children (p. 149). This is tenable. However, reproductive justice, as Kao describes it, offers no alternative for parentless children. The named right of adults to have children competes with the unnamed right of children to have parents--a competition that ended unhappily for Sarai, Abram, Hagar, and Ishmael (Genesis 16, 17, and 21). *I continue to wonder about Kao's attention to the rights of adults when I read the title, My Body, Their Baby. Does the comma mark a clear separation of the surrogate and the baby? Kao supports this interpretation by reminding the reader that some pregnant women do not experience a maternal bond. And even when a bond exists, the fetus receives no genetic material from the surrogate, making them two separate entities (pp. 63-64). However, Kao fails to cite available research on DNA exchange or epigenetic effects--research that blurs where "my body" ends and "their baby" begins.2 *The title also fails to show the tension in the book between Kao's feminist approach that stresses personal agency ("trust women") and the social support she needed to live out her decision to be a surrogate. Strong relationships with the IPs and the child were necessary. Her household had to adapt, as well. Kao's spouse underwent medical and psychological testing, along with mandated periods of sexual abstinence. He took on additional household and parenting responsibilities, and regularly administered Kao's estrogen injections because of her fear of needles. Kao's children, too, were told about what their mother was undergoing. They were able to accommodate her need for ample rest while knowing they were not going to have another sibling. As the book ended, Kao and her family regularly visited with the parents and child--a "cousin" to her children. Kao's body was essential for surrogacy, but surrogacy was a shared experience. *As a Christian ethicist and mother of two, I found Kao's work compelling. Scripture does not provide clear moral instruction on the complex matter of surrogacy. It does witness to the importance of community as a place of nourishment and care. Kao admits so herself: "Surrogacy can serve as a metaphor for a deep truth of our Christian tradition--the caring and rearing of children was always intended to be a communal affair, not simply the task of the parents alone" (p. 100). This is a theological and ethical idea worth pondering. *Notes *1For example, Mario Valerio Tartagni and Alessandra Graziottin, "The Love-Shaper: Role of the Foetus in Modulating Mother-Child Attachment through Stem Cell Migration