ICES data informs UK policy discussions on the health and wellbeing of surrogates
Despite the growing use of surrogacy, little is known about the health and wellbeing of people who carry pregnancies for others.
Births by gestational carriers, often called surrogates, are becoming increasingly common in Canada and countries around the world. Surrogacy offers a pathway to parenthood for people who are unable to carry a pregnancy themselves. In Canada, the Assisted Human Reproduction Act prohibits paying a surrogate for their services. Despite the growing use of surrogacy, little is known about the health and wellbeing of people who carry pregnancies for others.
As policymakers and healthcare providers seek better evidence to inform care, ICES studies have played an important role in the conversations about the long-term health and psychological outcomes for surrogates.
[S]urrogates have a 30 to 40 per cent higher risk of developing a new-onset mental illness diagnosed during an emergency department visit or hospitalization […]
Evidence grows with access to high-quality data
Using ICES’s extensive population-based health data, researchers generated some of the most comprehensive evidence to date on the physical and mental health outcomes experienced by surrogates during and after pregnancy.
“Gestational carriers play an essential role in supporting families, but we know relatively little about their health experiences,” says Dr. Maria Velez, an ICES scientist and associate professor at McGill University. “As surrogacy became more common, we saw a need to use population-level data to better understand the health outcomes for surrogates and the children born through these pregnancies.”
The first study analyzed 863,017 births in Ontario from 2012 to 2021, including 806 surrogate pregnancies. Findings showed that the rate of severe pregnancy outcomes among surrogates was 7.8 per cent, compared with 4.3 per cent in IVF pregnancies and 2.3 per cent in unassisted pregnancies. Common complications included severe postpartum hemorrhage, pre-eclampsia, and postpartum infections.
Although national guidelines about health eligibility criteria for surrogates exist, Velez says that some criteria may be relatively permissive and that recommendations are not always consistently followed. She emphasizes that surrogates and intended parents should be appropriately counseled on the risks during pregnancy and early postpartum.
Some surrogates also experience postpartum mental health distress after birth. Velez’s second study found that nearly one in five surrogates had a prior mental illness before pregnancy, including some with serious conditions that may have made them ineligible to be a surrogate based on current guidelines.
“Our work further showed that surrogates have a 30 to 40 per cent higher risk of developing a new-onset mental illness diagnosed during an emergency department visit or hospitalization, compared to those with unassisted or IVF pregnancies” says Velez. “This underscores the importance of ensuring timely access to mental health care and support at a very vulnerable time.”
[I]t is important that this evidence from Ontario is considered as policies and practices around surrogacy continue to evolve.
Ontario data shapes international policy conversations
These findings have helped other jurisdictions and professional bodies to consider how to address surrogate health in counselling, clinical care, and policy. Recently, Velez was invited by the United Kingdom Parliamentary Office of Science and Technology (POST) to contribute to a POSTnote briefing to help inform discussions about surrogacy policy and the needs of people who act as surrogates.
Velez contributed as an external expert reviewer, focusing on the section addressing the health and wellbeing of surrogates. Drawing on her expertise and research in this area, she reviewed the evidence for accuracy and impartiality and identified important evidence and sources relevant to the health risks associated with gestational carriage.
“It was very meaningful to see our research contribute to discussions about surrogacy beyond Canada,” says Velez. “There is still limited population-level evidence on the health of surrogates internationally, and it is important that this evidence from Ontario is considered as policies and practices around surrogacy continue to evolve.”
“By shedding light on the health experiences of surrogates, ICES data is helping local, national and international policymakers, clinicians, and health systems better understand how to support this population and ensure their health needs are considered in future policy and care planning.”