Surrogacy
Biblical Basis
Technical & Medical Basis
Pastoral Application
“Now Sarai, Abram’s wife, had borne him no children. She had a female Egyptian servant whose name was Hagar. And Sarai said to Abram, ‘Behold now, the Lord has prevented me from bearing children. Go in to my servant; it may be that I shall obtain children by her.’ And Abram listened to the voice of Sarai.”
—Genesis 16:1-2 ESV
Understanding Surrogacy Through Scripture
Biblical Basis
Sarah and Abraham as an Example
From the earliest pages of the Bible, we encounter a story that mirrors the modern practice of surrogacy. Faced with infertility, Sarah (formally Sarai) and Abraham (formally Abram) devised a plan to obtain a child through Sarah’s servant Hagar. Their choice was understandable: God had promised Abraham descendants as numerous as the stars, yet Sarah’s womb remained closed. The solution Sarah devised, however, fractured her marriage by:
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- going outside of the exclusivity of one man and one woman,
- exploiting Hagar as a mere means to their goal of having children, and
- introducing bitter and ongoing strife into Abraham’s family.
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It is not uncommon for advocates of modern surrogacy to point to Abraham and Sarah as an example that it is a Biblical practice, yet this reading misses the entire point of the story. Of course, Abraham and Sarah did not hire Hagar as a surrogate (where the human embryo is implanted into a third, and usually unrelated, woman). Hagar was Sarah’s servant, and as was common in that time, Sarah gave Hagar to Abraham as a concubine to bear him children. Still, the difference is only one of degree and not kind with modern day surrogacy practices. In both cases, a third person enters the exclusive bond of marriage. In both cases, a woman—often of a lower socioeconomic class and lower financial means—is reduced to her capacity to bear children for another couple. And in both cases, the natural bond between mother and child is intentionally disrupted or reassigned in order to satisfy the desires of others.
Thus, the Bible does not give us this account as a model to imitate, but as a warning about what happens when humans try to control their fertility outside of God’s good design for the “package deal” of marriage, sex, and procreation.
The Bible and Procreation
The Biblical vision of procreation is deeply relational. In Genesis 1:27-28, God blesses humanity with the gift of fruitfulness within the context of male-female union: “So God created man in his own image, . . . male and female he created them. And God blessed them. And God said to them, ‘Be fruitful and multiply and fill the earth.’” Procreation is thus given as a blessing tied to the one-flesh union of husband and wife. The command to be fruitful is not a mandate to produce children at all costs, but a blessing that flows from the covenantal relationship of marriage. It is not a process that can be outsourced to another.
Indeed, marriage is an exclusive, lifelong, and covenantal union between one man and one woman. And, as the Book of Common Prayer describes it, marriage is for the four-fold purpose of procreation, protection from sin, mutual pleasure and companionship, and building Christ’s kingdom on earth through the church, family, and society.
Sexual union, likewise, is both unitive and inherently oriented toward life, with marriage providing the exclusive covenantal context in which this union rightly flourishes. Taken together, it is within this one-flesh union of marriage that God unites sex and procreation as distinct and interconnected parts of the Bible’s package deal of marriage, sex, and procreation.
The "Package Deal"
For some people reading this, it may seem self-explanatory: Marriage is between one man and one woman, sex is for marriage alone (Ex 20:14; Matt 5:28; 1 Cor 6:18; 1 Cor 7:2-3; Gal 5:19; Eph 5:3; 1 Thess 4:3; Heb 13:4) and as a result of that children–unless otherwise prevented or absent due to infertility–naturally occur within this context. Or another way of putting it, you either get all three or you get none.
This pattern of the package deal occurs throughout the Old and New Testament. In Psalm 127 and 128, the psalmist describes children within the context of marriage as a fruitful vine from one’s wife and arrows in the hands of a mighty warrior. Mark 10:7-9 reiterates Genesis 2:24 and adds that “what therefore God has joined together, let not man separate” emphasizing a unified vision of marriage. Even in Luke 20:27-40, Jesus describes marriage with the expectation of children, and concludes that this is a temporal reality, in the eternal and bodily resurrection men and women will be like the angels who “neither marry nor are given in marriage” (v. 35), thus implying that neither sex nor additional children will be present either.
Perhaps the most direct Biblical witness to this vision appears in Malachi 2:15, where the prophet reminds Israel, “Did he not make them one, with a portion of the Spirit in their union? And what was the one God seeking? Godly offspring. So guard yourselves in your spirit, and let none of you be faithless to the wife of your youth.” Here the Bible clearly describes the fruitful nature of marriage, faithfulness to one’s wife (i.e., sex within marriage alone and with one’s spouse), and for what purpose? Godly offspring.
Marriage, sex, and children are not separate goods or projects to optimize or pursue in isolation. They form a single, integrated reality that reflects God’s relational nature, his vision for fruitfulness, and the groundwork for human flourishing in marriage and family.
Surrogacy directly violates this Biblical package deal by inserting a third person into the procreative act. Even if no sexual contact occurs between the intended father and the surrogate, the surrogate’s body becomes part of the process by which husband and wife attempt to bear a child. This fractures the exclusivity of the marital bond. In essence, what Abraham and Sarah attempted with Hagar is repeated in high-tech form. It is the same concern that we explore in the section on “donor” egg and sperm, which is another example bringing a third person into the process of conception, thus violating the exclusivity of marriage.
Throughout the Old Testament, God repeatedly warns his people against turning to fertility cults or pagan rituals in their attempts to secure children. Israel’s worship of Baal and Asherah often centered on manipulating fertility through ritual acts, sacrifices, and temple prostitution. These practices were condemned not only because they involved idolatry but because they exploited women and children. Deuteronomy 18:10-14 forbids practices that hurt children for religious gain, and Ephesians 5:3 warns against any sexual immorality among God’s people.
The Maternal Bond
The maternal bond is also a central Biblical theme. The womb is consistently depicted as a place of divine activity. Job acknowledges that God “knit me together with bones and sinews” (Job 10:11). The psalmist testifies, “You knitted me together in my mother’s womb” (Ps. 139:13). Jeremiah was called by God before he was formed (Jer. 1:5), and John the Baptist leapt in Elizabeth’s womb at the presence of Christ (Luke 1:41-44). These passages affirm that gestation establishes a profound and God-ordained relationship between mother and child. A surrogacy contract may attempt to redefine that bond, but the Bible testifies that the womb is not a neutral vessel. It is the sacred place where God forms and knows his children and establishes an intimate bond between husband and wife and mother and child.
The Biblical call to protect the vulnerable further challenges surrogacy. The prophets repeatedly call Israel to defend the widow, the orphan, and the poor (Is. 1:17; Amos 5:24). James describes pure religion as visiting “orphans and widows in their affliction” (Jas. 1:27). Surrogacy arrangements often involve women of limited financial means who rent their bodies out of economic necessity. To exploit financial desperation to fulfill the desires of wealthier parents is contrary to the Biblical command to protect the weak. Pope Francis of the Roman Catholic Church captured this truth when he declared surrogacy a “grave violation of the dignity of the woman and the child, based on the exploitation of situations of the mother’s material needs.” Likewise, the European Parliament was right to classify commercial surrogacy as a form of human trafficking.
The Biblical story consistently affirms that children are a gift, not a right. They are blessings to be received, not products to be procured. Surrogacy turns this order upside down, making children the objects of contracts, women the means of production, and marriage a negotiable boundary. The church must therefore speak with clarity and compassion: Surrogacy, like Sarah’s scheme with Hagar, arises from a longing for life but leads to division and distortion. Only by entrusting our fertility to God’s sovereign care can we honor both his design and the dignity of every child and mother.
The Biblical story consistently affirms that children are a gift, not a right. They are blessings to be received, not products to be procured. Surrogacy turns this order upside down, making children the objects of contracts, women the means of production, and marriage a negotiable boundary.
Technical & Medical Basis
Surrogacy from a medical and technical perspective
Surrogacy is a form of third-party reproduction in which a woman agrees to carry and deliver a child for another person or couple. While advocates often present surrogacy as a compassionate solution to infertility or a creative pathway to parenthood, the practice involves complex medical procedures, significant risks for both the surrogate and the child, and a deeply unsettling legal framework. To understand the ethical challenges posed by surrogacy, it is necessary first to examine the medical definitions, processes, and health consequences that accompany it.
Definitions and Modes of Surrogacy
Surrogacy is generally classified in two ways: by mode, traditional or gestational; and by transaction type, altruistic or commercial.
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- In traditional surrogacy, the surrogate is also the biological mother of the child. She provides her own egg, which is fertilized by the sperm of the intended father, either through artificial insemination or in vitro fertilization (IVF). This form of surrogacy was more common in the early years of the reproductive technology industry, but it has largely fallen out of favor due to legal complications and the obvious ethical concern that the woman is simultaneously the mother and contractual party over the child. Most States either prohibit traditional surrogacy or decline to enforce such contracts.
- In gestational surrogacy, which has become the dominant form, the surrogate carries an embryo created through IVF. The embryo may come from the intended parents’ gametes or from donated eggs and sperm from third parties. In this arrangement, the surrogate has no primary genetic connection to the child, which is often used as justification for viewing her as a “carrier” rather than a mother. However, as will be seen, the biological reality of pregnancy resists such a reduction.
The transaction type further distinguishes arrangements.
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- In altruistic surrogacy, the surrogate does not receive compensation beyond reimbursement for medical expenses, maternity clothes, or lost wages. Despite its name, altruistic surrogacy can still amount to thousands of dollars in reimbursements, making the distinction somewhat misleading. In the United States, altruistic surrogacy makes up less than 2 percent of cases.
- By contrast, commercial surrogacy involves significant financial compensation. Total costs for intended parents can range from $100,000 to $200,000, with the surrogate herself receiving $25,000 to $75,000 on average.¹ Commercial gestational surrogacy is by far the most prevalent arrangement, particularly in the United States, which has become a global hub for this practice due to its permissive state-level laws and lack of federal oversight.
Commercial surrogacy costs can range from $100,000-200,000.
Medical Process
The surrogacy process almost always begins with IVF. Eggs are retrieved from the intended mother or from a donor, fertilized in a laboratory with sperm from the intended father or a donor, and grown in the fertility clinic until the human embryos develop over the course of a few days to a week. These embryos are then transferred into the uterus of the surrogate-mother. Often multiple embryos are created, raising questions about the fate of unused embryos, which may be adopted, frozen indefinitely, discarded, or selectively destroyed.
Before implantation, surrogates undergo hormonal preparation to make their uterine lining receptive to the embryos. This involves high doses of synthetic hormones, including estrogen and progesterone. After transfer, the surrogate is monitored through ultrasounds, bloodwork, and other procedures to confirm implantation and track embryonic development. Throughout the pregnancy, her medical care is typically directed not only by her physician but also by the contractual obligations outlined with the intended parents.
It is also important to keep in mind that in the United States, there are no legal limits on how many human embryos can be transferred at one time. The American Society for Reproductive Medicine—the largest fertility organization governing the industry—formally recommends that no more than three human embryos be implanted, with a strong preference for single embryo, and yet these guidelines are not legally binding. When multiple human embryos are transferred, or if twins develop from a single human embryo, the intended parents may demand that the surrogate-mother undergo selective abortion to kill one or more of the babies.
These contracts often specify what the surrogate may or may not do during pregnancy. They may restrict her diet, require abstinence from certain physical activities, and sometimes dictate sexual behavior with her spouse. Many contracts specify if the surrogate-mother will have a natural or C-section birth and contain selective reduction clauses. These clauses permit the intended parents to request an abortion of one or more babies conceived by the surrogate for any reason. If the surrogate resists, she may face financial penalties or legal action for breaching her contract. Sadly, these are not hypothetical concerns. In recent years, many high-profile stories have emerged where intended parents requested—and surrogates refused—to abort the child due to health concerns related to disease or preterm birth.
Risks
Medical Risks for Surrogates
Although surrogacy is often portrayed as a routine procedure, it carries significant risks for the women involved. Indeed, recent research shows that surrogacy pregnancies are more high risk on average than either IVF-only or natural conception pregnancies.²
A 2024 population-based study of nearly one million singleton births in Ontario, Canada, compared outcomes across natural conception, IVF pregnancies, and surrogate pregnancies.³ Surrogates experienced a 7.1 percent rate of severe maternal morbidity, compared to 4.6 percent for IVF pregnancies, and 2.4 percent for natural conceptions. Severe maternal morbidity refers to life-threatening complications such as organ failure, hemorrhage, or sepsis.
The same study found that surrogates were more likely to suffer hypertensive disorders of pregnancy, which are the leading cause of maternal and fetal morbidity worldwide. Hypertensive disorders affected 13.9 percent of surrogate pregnancies, compared to 11.6 percent of IVF pregnancies, and 6.6 percent of natural pregnancies. Postpartum hemorrhage, another life-threatening complication, occurred in 13.9 percent of surrogate pregnancies, compared to 10.5 percent in IVF pregnancies and only 5.7 percent in natural conceptions.
Other studies corroborate these findings. Bioethicist Jennifer Lahl’s research has shown that surrogate pregnancies are up to three times more likely to result in cesarean delivery and five times more likely to deliver preterm. These outcomes increase risks not only for the surrogate but also for the child.4
Recovery for surrogates is also complicated by the emotional dimension of separation. Because they are often unable to breastfeed or bond with the child after birth, surrogates lose the natural oxytocin release that supports healing and protects against postpartum depression. Many studies show slower physical recovery and heightened risk of mood disorders following delivery.
Biological Bonds in Pregnancy
Even when the surrogate has no genetic connection to the child, modern science affirms that pregnancy establishes an enduring biological relationship. A process known as fetal microchimerism shows how DNA cells pass between the mother and child during pregnancy. These cells have been found in the brains, livers, and hearts of women long after giving birth. In some cases, they have aided in wound healing or organ regeneration. One striking example documented fetal cells, from a prior abortion, helping rebuild a woman’s liver more than twenty years after her pregnancy.
This discovery undermines the claim that surrogates are mere “carriers.” Even without full biological motherhood, the child leaves a permanent biological imprint on the surrogate’s body.
Risks for Children
Beyond physical outcomes, there are significant concerns about the psychological effect of maternal separation. From the child’s perspective, the surrogate is his or her mother: her voice, amniotic fluid, and temperament are the only world the child has ever known. Indeed, when babies at birth root toward their mother’s breast, it is not merely because they are hungry but because a woman’s amniotic fluid and her initial breast milk bear the same scent and taste—the only familiar thing to the child at birth. Even if the child’s biological mother is in the room, the surrogate-mother is the only mother the child knows.
Immediate separation at birth disrupts this bond. Research on maternal separation, including studies of adoptees, indicates that early loss of maternal connection can leave lasting marks on brain development and emotional health.5 Many adoptees describe this as a “primal wound”—a deep sense of loss and abandonment that can manifest as depression, anxiety, and difficulties with attachment later in life. Surrogacy, unlike adoption, may intentionally create this wound from the outset because separation is a built-in feature of the contract. While it may sound like a crass comparison, even puppies are kept with their mother for six-to-eight weeks before families can adopt them. The same cannot be said of children born from surrogacy agreements. When the intended parents are two men, as is often the case, this injustice of separating the mother becomes all the more pronounced.
Legal and Regulatory Structures
The regulatory landscape of surrogacy varies dramatically worldwide. Most developed nations—including France, Germany, Italy, Canada, Australia, Spain, and the United Kingdom—ban commercial surrogacy outright, citing the risks of exploitation and commodification. Some permit altruistic surrogacy but regulate it closely to ensure the absence of financial gain.
The United States, by contrast, is one of the most permissive nations in the world. There is no federal law governing surrogacy, no system of oversight, and no central database tracking the number of contracts. Regulation occurs entirely at the state level. States such as California and New York have enacted laws that actively promote commercial surrogacy, with California in particular serving as an international hub for foreign nationals seeking to hire American surrogates. By contrast, only Louisiana and Nebraska explicitly prohibit or refuse to enforce commercial surrogacy contracts. Most states remain permissive or neutral, allowing contracts to proceed with little scrutiny.
In most cases, the surrogate’s name never appears on the birth certificate. Legally speaking, the only distinction between a legitimate commercial surrogacy agreement and baby-selling (which is illegal under federal law) is the timing of the contract. If the contract is signed before conception, it is viewed as legitimate; if after, it may be considered child trafficking. For this reason, the New Jersey supreme court, the United Nations, and other governing entities have declared surrogacy a form of illicit baby selling.
Pastoral Application
Surrogacy is never only a medical or legal question. It is also deeply pastoral because it touches on some of the most painful and intimate realities of human life: infertility, longing for children, disappointment with the body’s limitations, and cultural pressure to pursue every possible technological solution. For pastors, it is important to be prepared to help intended parents navigate their desire to hire a surrogate and also to help congregants who are considering working as a surrogate think biblically about this issue.
The Church’s Witness
The church must bear public witness against surrogacy. In 2024, the Vatican’s Dignitas Infinita listed surrogacy alongside abortion, euthanasia, and human trafficking as violations of human dignity. Pope Francis has called surrogacy “deplorable,” noting that “a child is always a gift and never the basis of a commercial contract.” Protestants should not need papal authority to reach the same conclusion. The Bible itself commands us to protect children and women from exploitation, to honor marriage as exclusive, and to receive children as gifts rather than rights.
Yet few Protestant congregations speak clearly about surrogacy. Sermons and teachings often address abortion but rarely address reproductive technologies. Pastors must fill this silence with biblical instruction lest Christians uncritically adopt surrogacy as “just another way” to have children.
Surrogacy tempts Christians with the promise of children, but it achieves this promise by breaking apart what God joined together. It divides marriage, sex, and procreation; it exploits women; it commodifies children; and it manufactures children who will lose their connection with their gestational mother at birth for the sake of the desires of adults. Yes, the desire for a child is good and natural, but as explored in the section on IVF, good desires and good ends (the birth of a child) do not justify any means necessary.
The church must therefore say with one voice: children are gifts, not the content of contracts; women are image bearers, not nameless vessels; marriage is a covenant, not an interchangeable arrangement. Surrogacy may be culturally celebrated, but it is biblically untenable. Our calling is to proclaim God’s good design for marriage, sex, and procreation, to protect the vulnerable, and to bear witness to the God who gives life as a gift.
Surrogacy Compared to Adoption
It is not uncommon for someone to reply and say, “Isn’t surrogacy just another form of adoption? Aren’t Christians some of the leaders in domestic and international adoption? Why not support surrogacy too?” This may seem like a compelling line of reasoning, but it fails to account for crucial differences between adoption and surrogacy.
Adoption, for example, is an act of charity toward a child who has suffered the loss of his or her biological parents due to death, abuse, or other circumstances. Some adoptions are open where the biological and adoptive parents remain close and involved in the life of a child. Other adoptions are closed where a relationship isn’t possible or desired. In either case, parents adopt a child as an act of mercy to provide the child with the next best opportunity to be raised by a mother and father who love them. Moreover, adoption laws are carefully constructed so that adoptive parents never directly pay the birth mother for a child. Finally, adoption laws in the United States are oriented toward the well-being and best interest of the child. That is why caseworkers conduct extensive background checks, home visits, and application interviews to ensure, to the best of their ability, that the child goes to a family where they are most likely to flourish.
Surrogacy, by contrast, is the intentional creation of a child for the purpose of separating the child from his or her gestational mother, and potentially a biological parent, through egg and sperm donation. Instead of lovingly stepping into the gap to address a deep loss, surrogacy creates the very grounds for that loss to occur. Likewise, the basis of commercial surrogacy agreements rests on the expectation that a surrogate will receive a lucrative amount of compensation for conceiving, carrying, and birthing a child. Finally, no federal law governs surrogacy, and state laws governing surrogacy only require two primary protections: that the intended parents have enough money to fulfill their contractual agreement, and that the surrogate-mother be over the age of twenty-one, have had a successful pregnancy previously, and undergo a psychological evaluation. Proper protections such as a parental background check, home visit, caseworker interviews, or assessments determining the best interest of the child are not legally required.
Sadly, the result is that men or couples who would have likely failed an adoption screening have been able to procure children through surrogacy—including, in the last few years alone, a man who is a registered sex offender, a man arrested for the creation and distribution of child pornography, and a YouTube star known for making many perverted and obscene sexual comments about minors.
“What If We Have Already Used a Surrogate? Now What?”
As pastors and lay leaders provide guidance for couples and women considering surrogacy, it is also important to be prepared for cases when a couple has already had a child through surrogacy.
Here are a few sample questions a pastor or leader could begin with:
- How do you feel about this decision now?
- How did you feel about the decision at the time?
- Tell me more about your story:
- What led you to pursue surrogacy? Was it medical necessity, infertility, or another reason?
- Was the arrangement altruistic or commercial?
- Was the surrogate genetically related to the child (traditional surrogacy) or the gestational carrier?
- How was the child conceived (own gametes, donor egg, donor sperm)?
- What was the relationship with the surrogate? Are you still in contact with her?
- Were any embryos created and left frozen, donated, or destroyed?
- How do you feel about the decision now?
- Have you told the child? What was his/her response?
Of course, no matter how the child was conceived or brought into the world, they bear the image of God and inherent worth and dignity. The child’s life is a gift, and God’s mercy and grace extends into all aspects of our lives. It will be important for the pastor or lay leader to help the couple process when to tell the child and how to give children space to process it. They likely love their parents very much and are grateful to be alive, yet they may grieve or have serious reservations about the process used. They may also want to learn more about their gestational mother too. Moreover, it is important to provide the best biblical support as the child navigates the resulting emotional or psychological pain that may accompany this relationship.
When is the Right Time to Tell a Child?
So, when is the right time to tell a child? Here, the wisdom of adoption counseling is helpful. It will be important to seek a qualified counselor to navigate when to begin telling the child and how to do so in age-appropriate ways. This should be done with a warm affirmation from the parents to the child. Something such as, “We longed for you. We prayed for you. God made you, and you are his good gift to us.” As the child grows, the details can be filled in gently, affirming that even where adults may have made choices outside God’s perfect design, God’s hand was not absent. He is the Redeemer of all things, including our family stories.
Key Citations and References
Comprehensive Reference List
- https://www.circlesurrogacy.com/post/surrogacy-costs-breakdown#:~:text=In%20the%20United%20States%2C%20a%20full%20gestational%20surrogacy,insurance%2C%20legal%20services%2C%20surrogate%20compensation%2C%20and%20agency%20support.
- Matsuzaki, Shinya, Aaron D. Masjedi, Satoko Matsuzaki, et al. “Obstetric Characteristics and Outcomes of Gestational Carrier Pregnancies: A Systematic Review and Meta-Analysis.” JAMA Network Open 7, no. 7 (July 23, 2024): e2422634. DOI: 10.1001/jamanetworkopen.2024.22634. PMID: 39042408
- Velez, Maria P., Marina Ivanova, Jonas Shellenberger, Jessica Pudwell, and Joel G. Ray. “Severe Maternal and Neonatal Morbidity Among Gestational Carriers: A Cohort Study.” Annals of Internal Medicine 177, no. 11 (November 2024): 1482–1488. DOI: 10.7326/M24-0417. PMID: 39312777.
- Lahl, Jennifer, Kallie Fell, Kate Bassett, Frances H. Broghammer, and William M. Briggs. “A Comparison of American Women’s Experiences with Both Gestational Surrogate Pregnancies and Spontaneous Pregnancies.” Dignity: A Journal of Analysis of Exploitation and Violence 7, no. 3 (2022): Article 1. https://doi.org/10.23860/dignity.2022.07.03.01
- Verrier, Nancy N. The Primal Wound: Understanding the Adopted Child. Gateway Press, 1993. Verrier’s foundational book argues that a “primal wound” develops when a mother and child are separated by adoption shortly after childbirth.