Study question: How does the psychological well-being and prenatal bonding of Indian surrogates differ from a comparison group of mothers?

Summary answer: Surrogates had higher levels of depression during pregnancy and post-birth, displayed lower emotional connection with the unborn baby, and greater care towards the healthy growth of the foetus, than the comparison group of mothers.

What is already known: Studies in the West have found that surrogates do not suffer long-term psychological harm. One study has shown that surrogates bond less with the foetus than expectant mothers.

Study, design, size, duration: This study uses a prospective, longitudinal and cross-sectional design. Surrogates and a matched group of expectant mothers were seen twice, during 4-9 months of pregnancy and 4-6 months after the birth.

Participants/materials, setting, methods: Semi-structured interviews and standardized questionnaires were administered to 50 surrogates and 69 expectant mothers during pregnancy and 45 surrogates and 49 expectant mothers post-birth. All gestational surrogates were hosting pregnancies for international intended parents.

Main results and the role of chance: Surrogates had higher levels of depression compared to the comparison group of mothers, during pregnancy and post-birth (p < 0.02). Low social support during pregnancy, hiding surrogacy, and criticism from others were found to be predictive of higher depression in surrogates post-birth (p < 0.05). Regarding prenatal bonding, surrogates interacted less with and thought less about the foetus but adopted better eating habits and were more likely to avoid unhealthy practices during pregnancy, than expectant mothers (p < 0.05). No associations were found between greater prenatal bonding and greater psychological distress during pregnancy or after relinquishment.

Limitations, reasons for caution: All surrogates were recruited from one clinic in Mumbai, and thus the representativeness of this sample is not known. Also, the possibility of socially desirable responding from surrogates cannot be ruled out.

Wider implications of the findings: As this is the first study of the psychological well-being of surrogates in low-income countries, the findings have important policy implications. Providing support and counselling to surrogates, especially during pregnancy, may alleviate some of the psychological problems faced by surrogates.