In Grace Kao’s book My Body, Their Baby: The Ethics of Surrogacy, she tackles the question of what makes surrogacy ethical and consistent with progressive Christianity. Kao, a professor of theology at the Claremont School of Theology, responds to both feminist critiques that surrogacy exploits women and Christian conservative critiques that it violates family and motherhood. She draws from extensive research on surrogacy and personal experience to come up with an argument and framework that gestational surrogacy aligns with both feminist principles of bodily autonomy and Christian values of caring for others.
We sat down with Kao to explore how Kao became a surrogate for her friends, how her experience inspired her to research the field and write this book, and discuss her vision for bridging the gap between traditional religious values and modern reproductive choices. In our conversation, she shares insights about developing ethical surrogacy arrangements that protect all parties involved while honoring both feminist and Christian principles.
Q. How did you decide to write the book?
A. When I agreed to carry for my friends, it was never with the thought of getting a book deal out of it. I was pregnant again at 40, and this was a surprise to many people, because I already had 2 small kids. I would have these exchanges where they would congratulate me but then I would say “Thanks but I'm actually caring for my friend. This is not a baby for me.” Many women told me, “I could never do that” while others said “I’ve thought about doing it for my sister or friend.” Some questioned whether I could “give up” the baby or what my husband thought. I found there is a lot of interest and misunderstanding about surrogacy and because I have the academic skills to do so, I thought I would commit it to writing about it.
Q. What was your first exposure to surrogacy?
A. I used to watch Friends, the sitcom. There was this one episode in the 90s where one of the main characters, Lisa Kudrow’s character, Phoebe, ends up carrying triplets for her brother in the show. I forget how old I was, maybe I was in college or so but I remember thinking “Oh, that's like a really nice thing.” I didn't think it was odd. I just thought that's really cool. I didn’t know other surrogates. Years later, as someone who’s had easy pregnancies, I said “yes” when a friend who had been struggling with infertility for a decade basically asked.
Q. How much research did you do before you entered into your surrogacy contract and what advice would you have for a potential surrogate who is doing research?
A. I actually did not do very much research before I agreed to be a surrogate. I came to learn that California is the surrogacy capital of the world and also what we needed to do to get a pre-birth parentage order.
One of my biggest sore points is that I didn't fully understand that I had not contracted away my right to decide on things like embryo transfer, how many, or termination. Going forward, I would really want to make sure that surrogates understood that they never actually yield that right, whatever private agreement they might have with IPs.
And while the State of California doesn't require it, a good idea would be to schedule a few meetings between intended parents and the surrogate in the postpartum period. The literature shows that the sudden cutoff can be very painful, not because the surrogate bonds with the child, but because many surrogates form a bond with the IPs. If they had a few meetings already set, they could potentially continue to nurture that relationship because the research shows that continued contact between their baby and intended parents is in the best psychological interests of all involved.
Q. You talked about religious objections to surrogacy in your book. Can you tell us about those?
A. I'm focused in the book on Christian objections, and depending on what religion you're talking about, there will be different ones.
In Judaism, there are cultural and religious pressures, especially in Israel, to continue the family line, to procreate. It's a pronatalist state, and so surrogacy there is heavily subsidized. But to conform with religious requirements , you have to make sure you have an unmarried woman who is a surrogate, and there is this whole approval process by a government committee.
In Islam, it's generally understood as haram (forbidden) for one woman to bear a child for another owing to concerns about adultery and family lineage, though there are differences between Sunni and Shia Muslims and there have been cases of co-wives licitly serving as surrogates. In a Buddhist context, I talk in my book about how some Buddhist surrogates in Thailand understand themselves as creating merit for themselves at the same time as they are performing these good and compassionate deeds for others.
In my book, I'm focusing on Christian objections, and I would say that we can divide those as objections from the left and objections from the right. Objections from the right have to do with the “queerness” of inviting a third person into a husband-wife scenario and the IVF process creating thousands of embryos. If you hold a pro-life, life-begins-at-conception view, then you are really distraught about all those embryos that are never going to be brought to full term. There's also concern about choosing reproductive technology to expand your family instead of adoption. The Catholic version of the objection is about separating sex from reproduction - the Catholic Church teaches that even if you're doing artificial insemination by husband into his own wife, that is illicit because you are never to separate sex from reproduction. That's why you can't use artificial contraception, you can’t engage in same-sex sexual activity, you can’t masturbate, you can’t have an abortion – all of those activities separate conjugal union (sex) from procreation (reproduction)
Now from the left, what I do in the book is try to show that there's a gap, meaning there are mainline Protestant denominations who in the past several years/decades have approved marriage equality. You can be a gay minister, you can be a same-sex couple in a legal marriage, and they've also approved the conscientious use of IVF for infertile couples in addition to adoption. So it's not so much that there are objections, but they have yet to resolve the issue about surrogacy, and at that point the concerns from the left mirror the concerns that secular folk, like secular feminists, have about surrogacy - about whether the practice is exploitative, whether IPs are just instrumentalizing and commodifying woman's bodies, that type of thing.
Q. Are the Biblical examples of surrogacy good arguments in support of modern surrogacy?
A. No. The Biblical models of surrogacy are actually pretty horrific, because they always involve older, more powerful women orchestrating relationships with their husband and their likely younger, more fertile “handmaids” or slaves. I’m talking about the stories of Sarah and Hagar (with Abraham, Ishmael and Isaac), or the co-wives of Jacob (Leah and Rachel and their “surrogates” Bilhah and Zilpah), or Naomi with Ruth and Boaz. These are all examples of traditional surrogacy. With the possible exception of the Ruth-Naomi-Boaz story, we would consider all of these today as non-consensual situations, because you cannot truly consent if you're someone's slave being told you have to have sex with someone else’s husband to bear a child for his wife.
So yes, absolutely, the Biblical models are awful, and there is not very much to be learned from them except to read them as cautionary tales for surrogacy practices today.
Q. You talked about feminist reactions, what is your response to feminist arguments?
A. I'll start with two things. First, I think the asymmetry is strange. The asymmetry here is that secular and progressive Christian feminists have united and converged on the right of a woman or pregnancy-capable person to decide whether to continue a pregnancy or terminate it. There is universal agreement that's a good thing, again, not on the conservative side, but among feminists. However, they have not come to agreement on the good and right of a pregnancy-capable person to undertake a pregnancy for someone else.
Somehow, it's okay to say ‘I'm going to continue my pregnancy, or I'm going to end it,’ but they get all concerned if you say ‘I'm going to undertake a pregnancy for someone else.’ I think that asymmetry undermines the larger claim about trusting women, about trusting that they know what they are and are not capable of, what they can and cannot handle, and respecting their autonomy, decision-making, and integrity. That's point number one.
Point number two is that there is a widespread racialized understanding that it's rich white people going to Laos, Thailand, and India, etc. commissioning poor brown, yellow, and black bodies. In that image, the assumption is that those women don't know what they're doing, they're just tragic figures being duped or mesmerized by the money. That's problematic from a post-colonial perspective, but it's also problematic when you look at the actual studies and research. Women who get paid to become pregnant for others report a mixture of motives: many want the money – yes – but they also want to help others, they care about their maternal identity, and they want to help others become parents, too.
If you're going to argue that poverty prevents surrogates in other countries from providing full and free consent, then you're technically committed to saying they can't consent to anything. They can't consent to work in a garment factory, to do custodial work, to do other care work, or anything. And then you have to wonder why critics are singling out surrogacy as an exploitative practice and not these other industries.
Q. In the past, opponents of surrogacy pointed out a surrogate was paid below minimum wage and that could be exploitative. Now that surrogate compensation has risen, sometimes to $50,000 or more, the argument has become that surrogates are making too much money, and and it’s too much of an incentive for women to become surrogates?
A. All you have to do is watch reality TV to know what role financial inducements can play. If the incentive is too great, sometimes people will minimize risks, physical or psychological, they might be rushed into the process.
I think we have to accept that yes, money might change the equation. The problem I have, though, is the ‘therefore.’ Some people might say, ‘and therefore this is why we should not allow for it. We shouldn't allow for any compensation.’
But what I've seen is that prohibition just drives the practice underground. The UK is very interesting. Technically, you cannot run surrogacy as a commercial enterprise. You can't advertise your services, you can't put out an ad, but you can offer compensation. So far the courts have allowed something like 15,000 GBP, but in many cases, people are still paying under the table and not officially registering.
There are all sorts of issues when the paperwork isn't done properly, and one reason people aren't doing the paperwork properly is because they don't want to get caught giving more compensation than they think the courts will allow. And this can pose problems down the road about legal custody and inheritance rights. I've become a bit of a realist about prohibition, it does not actually help to stop the practice, but simply drive it underground.
Q. Your book is written from a progressive Protestant perspective, can you explain the how it differs from mainline and evangelical Protestant thinking?
A. “Progressive” is sometimes a word that people use interchangeably with "liberal," but "liberal" has a certain kind of connotation, too. The mainline Protestant denominations (Lutheran, Presbyterian, Episcopalian, Methodist, etc.) actually connect to specific institutional and church forms.
"Progressive Christian" is not something that is strictly bounded. For instance, I would say there are progressive Christians who are Catholics or there could be progressive Christians who technically go to an evangelical church. The reason I call it a progressive Christian vision is because I'm not starting from square one. I'm already starting from a set of commitments. For example, I support same-sex marriage and same-sex parenting. I'm not debating whether it's okay to use reproductive technology, because many mainline and a number of progressives will agree to that.
I say very clearly in my book, if you don't start with my premises "it's okay to be gay, it's okay to separate sex from reproduction" then there's nothing I've written in the book that will persuade you, because you will fundamentally reject my premises. I'm sure you know that Pope Francis has been speaking up about surrogacy. And even though I've written an op-ed in response, we just have completely different starting premises. My book can't really engage him or the Catholic Church where they’re at
Q. What if someone is an evangelical Christian and is considering surrogacy (believe in reproductive rights or or gay marriage), what can they take away from your book?
A. About evangelicals: There are left-leaning, centrists, and right-leaning ones. Many evangelicals, just like many Catholics in conformity with the Catholic Church, will say life begins at conception. This is why they're anti-abortion. What I've found is that evangelicals, more so than Catholics, are supportive of IVF. This is why after the fall of Roe v. Wade, many states with trigger laws on abortion have been carving out exceptions for IVF. They have moral squeamishness about abortion, but many of them actually do and believe in IVF even though they have likely contributed to the death or destruction of embryos. Catholics are more consistent on the issue. Once you start with “you can't separate sex from reproduction,” you never get to the problem of “what about these embryos?” I think number one, evangelicals have to come to terms with the fact that if they are going to do this (gestational surrogacy or IVF), they may be complicit in the death and destruction of embryos.
Now, there are some evangelicals who offer advice contrary to ACOG. They basically say just fertilize one egg at a time—go through one cycle, then try to fertilize one egg and see if that one takes, because they're trying to be consistent. That's not a best practice medically. The other thing I talk about, although this gets us a little bit outside of surrogacy, is that some evangelical Christians are doing what they call "embryo adoption" where they are transferring surplus, cryopreserved embryos (leftover from others’ IVF cycles) because they want to give them a chance for life. Ultimately, I'm not going to start my argument with "is it okay to separate sex from reproduction?" I'm just starting from where many progressive Christians already are.
Q. Your book talks largely altruistic or unpaid surrogacy journeys. What ethical guidelines do you believe should apply in compensated journeys?
A. I begin with unpaid surrogacy as a starting point, along with other baseline assumptions such as gestational surrogacy taking place within one legal jurisdiction, to establish my initial argument.
In Chapter 6, I specifically address what happens when these assumptions change—when surrogacy involves compensation, crosses borders, or is traditional rather than gestational. I propose seven ethical norms for surrogate arrangements. When parameters change, such as when arrangements cross jurisdictional boundaries or involve compensation, additional ethical considerations arise.
Regarding compensation, I argue that payment doesn't negate altruistic motives. If we assumed it did, we'd have to apply the same logic to firefighters, nurses, and teachers—claiming they only work for money or that their receipt of money cancels out their desire to help others, which isn't accurate. People can have multiple motivations.
Q. Should surrogacy be restricted to IPs who have a medical need for it?
It's important to distinguish between ethical guidelines from a progressive Christian commitment and legal regulations. In my book, I focused on the IPs’ medical necessity as a condition to get the progressive Christian argument off the ground (note: medical necessity here would be defined as a lack of a suitable uterus, so two gay men wanting to become parents through surrogacy would meet this requirement), but I understand why people might seek surrogacy for other reasons as well. In short, there might be many reasons for the law to protect or allow for arrangements outside of what I think progressive Christianity could support.
Q. If a surrogate lives in a state with restrictive abortion laws—where she cannot terminate the pregnancy after approximately 6 weeks, except under very limited circumstances or not at all—what ethical concerns do you have about this situation?
A. Given that earlier, I had said one of my regrets is that I didn't fully understand that I didn't sign away termination or embryo transfer rights, that's exactly part of the serious consideration a surrogate needs to take. If I get pregnant, how difficult is it to seek an abortion if needed? Almost every state has some sort of escape clause, if it's a life-or-death situation, they'll allow for an abortion. But if you dig deeper, we now have heard several cases where women were miscarrying or seeking an abortion but were denied care because hospitals were not yet ready to intervene. And in some of the most tragic cases, this delayed care led to the woman’s death. So that's absolutely a very, very serious risk! This might be reason enough for someone to say, “No, I don't want to take this risk. Because if I'm not allowed to terminate, or if I have to be at this dangerous stage of medical failure before I can seek intervention, it's not worth it.”
Q. Your use of surrogate mother or surromom might disturb some in this field who believe the surrogate should not reference motherhood, can you explain why you chose that term and would you use a different term in compensated surrogacy?
A. I talk about this in the preface, because I know, medically, the term they would use for me is "gestational carrier." It's funny because there are academics who are offended by that term. They think "carrier" eliminates the agency and personhood of the surrogate.
I decided to use "surromom" and "surrogate mother" because that's how women identify themselves. If you read surrogacy online discussion boards, Facebook groups, or look at the ethnographic literature, they don't have a problem using the word "mom." In saying that, they accept what's called "maternal multiplicity." If I'm a surromom, it doesn't mean that I'm the mother of my friend's child—it just means I served one of many maternal roles.
As a side note, I made a comment before about how my contract had all these weird clauses about how I promised not to form an intention to bond with the baby. They're so worried that even if the surrogate is carrying the child, she's going to naturally want to keep it. I think that's where the offense comes from. People are so worried it's not going to work out in the end that they're trying to create controlling language. I understand the legal and medical reasons why certain terms like “gestational carrier” or “surrogate mother” are used. But looking at the research and how these terms are actually being used by surrogates themselves, I didn't have a problem with using “surromom.”
Conclusion
My Body, Their Baby is a unique book that takes the deepest dive into the ethics and theology of surrogacy we know of from the unique perspective of a former surrogate. Kao takes the arguments of opponents of surrogacy seriously, and with the support of much published research, presents a framework of surrogacy that will appeal to progressive Christians and feminists. It is a must read for anyone who works in the surrogacy field who wants to understand how to not just defend surrogacy arrangements from moral objections but make arguments that surrogacy is a social and Christian virtue. As voices against surrogacy grow, it may be important for supporters of surrogacy to find persuasive arguments, that makes Kao’s book all the more a timely read.
We at Tsong Law Group enjoyed reading this book as an intellectual exercise and change of pace. As fellows of the Academy of Adoption & Assisted Reproduction Attorneys (AAAA) and the Academy of California Adoption-ART Lawyers (ACAL), Tsong Law Group brings extensive expertise to the practice of surrogacy law. Our three-years running Super Lawyers are licensed in California, New York, Illinois, Washington, Oklahoma, and Arizona. Contact us now.
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