Surrogacy and the COVID-19 vaccine — a UK perspective

It is reported that surrogacy agencies in the USA have been so overwhelmed by requests for unvaccinated surrogates that it has now become a new matching criterion that the agencies use when placing surrogates to work with intended parents. 

The anxiety around the potential harm the vaccine can do to a baby in the womb has led to surrogacy contracts being amended to ensure that intended parents can make medical decisions for the surrogate, and in some cases has led to the breakdown of surrogacy teams who cannot agree on whether to vaccinate or not.

The UK surrogacy community has reacted in a much gentler manner to the COVID-19 vaccine, due in part to the vastly different way that surrogacy works here.  Surrogacy in the UK is altruistic and there are no enforceable contracts. Intended parents cannot enforce their own opinions of medical care on to their surrogate. The surrogate retains the right to always make her own medical choices.  

But how does this work practically when it is the surrogate's body, but the intended parents baby?

When looking for a surrogate the intended parents can choose not to work with a surrogate that is unvaccinated – this is called a dealbreaker. It is an issue that either party feels cannot be compromised on, and both intended parents and surrogates must discuss these dealbreakers before trying to get pregnant. Prior to trying to conceive, the agreement whether to vaccinate or not certainly takes into account both parties' opinions and can certainly result in a team deciding not to work together if their views differ.

However, when a team is already pregnant, and the surrogate is offered a vaccination, discussions can become much harder. Whilst surrogates want to include their intended parents in the decision, the surrogate has autonomy over her own body, and ultimately the decision is up to her.  

One pregnant surrogate said 'personally, I wouldn't risk it for my own baby, even if the intended parents supported it, and I wouldn't risk it for this baby either. If I was really high risk for health or work, then I'd possibly consider it.'

At SurrogacyUK if a surrogate and her intended parents disagree on whether to have the vaccination, they are provided with information and guidance from all official sources and are encouraged to speak openly about their concerns. Even if a consensus cannot be reached, this openness results in a better understanding of both parties' opinions, so at least they can be assured that everyone is acting in what they personally believe is in the best interests of the child.

Up until recently, little was known about the effects the vaccine would have on a pregnancy, and surrogates have been cautious, not knowing if their decision to vaccinate or not would cause harm.

One team stated 'although we are all very strongly pro-vaccination, and agreed to have all vaccinations offered to us, the thought of possibly harming our much-wanted baby by having the vaccination felt too risky and we all agreed that our surrogate would give birth before vaccinating. With hindsight, we may have decided differently but we made the best choice we could with the information we had'.

As the guidance has been updated it has had an impact on the decisions that teams are making and has resulted in more surrogates being reassured that having the vaccination is not harmful to either themselves or the baby. A recent study, published in Obstetrics & Gynaecology adds to the growing literature in support of the safety of the COVID-19 vaccination during pregnancy. (See BioNews 1095.)

A current surrogate stated 'I'd have it, the guidance was updated to say pregnant women should have it when offered. I trust the science to have the flu/whooping cough jab while pregnant so would trust this too.'

In most cases, surrogates have discussed it with their intended parents at length and in direct contrast to reports from the USA, have followed the official guidance, and have overwhelmingly opted to be vaccinated.

One surrogate described how she and her intended parents came to the decision to vaccinate together. 'I'll definitely be having it as soon as I'm offered. I have done my research and so have my intended parents. One intended parent works in the field. I wouldn't take any risks for my own baby, or my intended parent's baby. It's a much bigger risk to be unvaccinated and get COVID-19, than to have the vaccine'.

The unique way that surrogacy works in the UK has certainly impacted how COVID-19 vaccinations have been handled by all parties.  

Whilst the decision whether to vaccinate or not can be emotive the intended parent's respect for a surrogate's body and choice is at the forefront of the decision-making process. Because UK surrogacy is based on trust rather than a transactional and contractual process, the willingness to see it from each other's viewpoint, ensures that even if a compromise cannot be found, it doesn't negatively impact the ongoing relationship.