Exploring Surrogacy Among Gay Men and as a Theodicy

Danielle Tumminio Hansen has written a marvelous book on surrogacy. I say this as someone who not only has a forthcoming book on this same topic, but also once served as a surrogate for a set of friends. I appreciated the three-part typology she constructs for evaluating this method of collaborative reproduction, where the differences between and among “constructive,” “resistive,” and “injurious” surrogacy arrangements lie in the varying ways the participants “exhibit faith, hope and love toward each other” and insofar as the “overarching cultural values of the system affect their ability to do this” (78).

While I have a few quibbles,1 Tumminio Hansen has captured the experiences of the “surrogacy triad” (the commissioning parents, surrogate mother, and resultant child) quite well. This is likely due to her turning to the social scientific literature on surrogacy and to the Austin, TX-based surrogates who “shared their perspectives and indulged [her] abundant questions” (x). Contrary to widespread misperceptions about surrogate mothers bonding with the developing child in utero and thus experiencing deep pain or even regret at the handover, the author correctly describes these women as not ordinarily seeking recognition as the parents of the child they bore for others, but wanting “validation” for their identity as surro-moms and for the “specific contribution they ma[d]e to the reproductive process” (95). Likewise, contrary to popular beliefs that “altruistic” surrogacies are categorically distinct from “commercial” ones because surro-moms are purportedly driven by love in the former only but financial gain in the latter, Tumminio Hansen correctly acknowledges what four decades of surrogacy research has shown: surrogates who receive financial compensation often report a combination of self- and other-regarding reasons for their service. What’s more, just as many in society recognize that teachers or healthcare providers in the “helping professions” can be “motivated by altruism to do any number of things and still receive payment” without concluding that the remuneration has canceled out their benevolent intentions, so the author wonders—as do I in my own work—why surrogates who are paid to become pregnant for others are held to a different standard (93-94).

While there are other matters I could lift up in this review, I will focus my remaining comments on two substantive points. The first concerns a limitation Tumminio Hansen acknowledges—the heteronormativity of her work. The second concerns my ambivalence about her framing of surrogacy as a theodicy.

“Conceiving Family” Privileges the Experiences of Heterosexual Couples

 No book the length of this one could possibly cover every sub-topic or variety of surrogacy. Given the tremendous diversity in surrogacy customs and laws across the world, the author’s acknowledged limitation of her focus on surrogacy in the U.S. with some references to practices in two other contexts, Israel and India, made sense to me given her desire to offer a context-sensitive, practical theology. Moreover, given the voluminous scholarly and societal attention already devoted to discussing the morality of pregnancy termination, so did Tumminio Hansen’s acknowledged limitation of engaging various ethical issues surrounding abortion only “tangentially,” particularly given her acknowledgment of abortion’s connection to the IVF or third-party reproduction involved in surrogacy, as each practice may lead to “embryos that do not culminate into a freely breathing newborn” (6).

That said, when I came across Tumminio Hansen’s third and final acknowledged limitation, that “many of the examples in this book draw from the use of surrogacy by heterosexual couples because of the book’s emphasis on infertility and reproductive loss as motivators for it,” I couldn’t help but wish she had decided differently (6, emphasis added). Family expansion via surrogacy is an increasingly popular path to parenthood for gay male couples, and some fertility clinics and surrogacy agencies in the U.S. (and elsewhere) accordingly cater to the distinctive needs of their gay clientele, especially when they are foreign intended parents shut out of access to ART and/or adoption in their home jurisdictions.2 in their desires to have children in ways most heterosexual couples will not. In addition, the real or perceived advantage of biogenetic continuity that surrogacy offers will often lead to complex decision-making among gay couples about which of the two intended fathers will also be the genetic one, which is then not uncommonly followed by intrusive personal questions from intimates and strangers alike about their decision—about which one of them is the “real” dad.3

This latter point about genetic fatherhood simultaneously reveals an area of commonality with their straight counterparts: gay couples also experience pressures to conform to the “biological family model,” where “‘family’ means shared blood” and the couple’s recognition as a “family” increases once they are able to have biological children (29-30). For instance, a study of 40 gay men who had recently become fathers through a California-based surrogacy agency found that most experienced both an enhanced sense of self-esteem in finally being able to have both a loving partner and a child with him and “increased recognition of their family unit after having children” from their families, friends, work colleagues and other acquaintances.4 The research also shows some gay men expending considerable effort to produce children in other ways that conform to the “biological family model,” most especially  by arranging for the resultant child to physically resemble both dads. An Australian, interracial couple who selected two egg donors with attributes resembling the (respective) non-genetic father explains the rationale behind their process thusly:

Sami: We decided we wanted to have mix [sic] race children because I’m Asian and Ian’s Caucasian. So my sperm was mixed with a Western girl and Ian’s with Asian girl and then we selected one [embryo] of each and [went] from there.

Ian: We…wanted our children to reflect our backgrounds . . . . We wanted them to have not only exposure to and experience with each of our cultures, but we also wanted them to physically reflect them as well so when they look to us they’ll see part of themselves in each of us.5

A different path some have called the “gold standard” and pursued by actors/husbands Neil Patrick Harris (among others) involves selecting one egg donor, fertilizing half with one partner’s sperm and the other half with the other partner’s, and then transferring two embryos at a time (the “best quality” from each). If both embryos implant and eventuate in live births, the twins would be biological half-siblings (due to use of the same egg donor) with both partners becoming fathers genetically related to their children at the same.6 as a first choice—as something allowing for biogenetic continuity as well as greater legal certainty of parentage in some contexts over what would be the case if they were to pursue adoption or an informal arrangement with a single woman or lesbian couple.7 Gay couples, in short, usually do not have the “traumas of reproductive loss and of infertility” that Tumminio Hansen aptly describes most heterosexual couples must first put to rest (38). What’s more, the research shows that this absence of reproductive trauma can often lead to smoother relations between surrogates and gay male intended parents in contrast to surrogates and intended mothers, particularly when the infertile women have unresolved feelings of loss, sadness, jealousy, or even “womb envy” and thus may experience more ambivalence and potentially more power struggles with their surrogates. As evident among surrogacy discussion boards I frequented when I served as a surro-mom for my friends, some “repeat” surrogates expressly prefer to work with gay male couples over straight ones for this very reason alone. In ways I expand upon in my own work, heterosexual couples who turn to ART or adoption to become parents have something to learn from queer couples since the latter have been managing the presence of third-parties in reproduction or family-building since the beginning of same-sex headed families.

Surrogacy as a Theodicy?

 Pivoting now to the second matter, I confess to feeling ambivalent about Tumminio Hansen’s characterization of surrogacy in terms of a theodicy. Granted, I understood and appreciated the various roles intended parents or society-at-large have cast surrogate mothers in: as “social heroes,” as “allies” to the involuntary childless couples who have long struggled with infertility, and even as social deviants or the “antithesis of culturally normative views of womanhood” for their willingness to “carry the baby of a man who is not her husband” and then relinquish the baby at journey’s end (39). In their “social hero” or “ally” role, I can appreciate how a woman who agrees to become pregnant for an infertile couple can indeed be the “curative to the reproductive trauma experienced by the intended parents” (40). As the surrogacy literature and my own experience confirms, I can also appreciate how surrogates “often become the embodiment of hope for those who experience infertility and reproductive loss” (142). But to accordingly cast surrogate mothers as the “embodiment of a successful theodicy” insofar as it is appropriate to frame “infertility or reproductive loss… in terms of theodicy” and accordingly view surrogates as persons capable of “address[ing] this particular problem of evil directly”? (40, 142). And to suggest that the “children birthed through surrogates may function as a theodicy solution for the parents” (102, emphasis added)? Despite Tumminio Hansen’s intentions to emphasize the way surrogates help intended parents “rewrite the ending of their reproductive story that seems impossible to write, allowing those individuals to restore a sense of agency in the process,” I fear that introducing theodicy language into her analysis will perpetuate biblical notions that fertility and infertility are matters of God’s will, not potential human control. The long biblical tradition of linking intact or restored fertility as a reward for righteousness and infertility (or “barrenness”) as a possible sign of divine disfavor, punishment for sin, or even test of their faithfulness in my judgment should be put to rest.

This is to say I am much more comfortable thinking of infertility as a medical problem than a theological one. I do, of course, appreciate how many Christians today still seek to theologize about the agony of their infertility. My friend and colleague, feminist Catholic thinker Gina Messina, among others, is tempted to curse God for her infertility and has published about drawing comfort from stories of “biblical foremothers who shared her barren state” when personally identifying with Sarai’s anguish and bitterness, Rachel’s envy, and Hannah’s hope in her years long struggle with infertility.8 I appreciate how crying out to God in prayer and supplication is compatible with persons also exploring medical and ART services in response to involuntary childlessness. But to conceptualize surrogacy as a theodicy is to place involuntary childlessness in a larger place than I am prepared to accept. And that’s probably because I do not believe the experience of infertility “should” be the type of thing that leads someone to question either the existence or goodness of God—and yet I acknowledge that for many, the painful experience of infertility nonetheless does lead to such questions.

I am, to be sure, quite comfortable with other ways Tumminio theologizes about surrogacy: about, for example, the surrogate’s freely expressed generosity mirroring the  “freely offered generosity of a God who shared God’s self in creation, in the life of Jesus, and through continued commitment to human flourishing” (74). Based on my own research of “repeat” surrogates, I’m even comfortable conceptualizing surrogacy as a “vocation,” believing that some women have a particular “charism” to perform a service that many others simply cannot. But, at least on my reading, framing conception in terms of theodicy might provide some justification to various theologies that chalk up infertility to a facile notion of “God’s will.”

In her latest TIME article, “The Hard Truth About My Surrogacy Journey,” an excerpt from her latest book, You Got Something Stronger, actor Gabrielle Union tells the long-awaited story of her struggles of love, loss, and surrogacy.1 When the title first popped up in my daily news notifications, I took a deep sigh because I knew even before reading that Union would force me to confront some hard truths about my journey of conceiving family as a single Black woman and pre-tenure academic. Like most Black women, Union’s love story is complicated. I remember all too well the numerous gossip columns and sensational paparazzi reports of her partner and former NBA champion Dwayne Wade conceiving a child with another woman just before the couple married less than a decade ago. I heard of Union’s numerous challenges with miscarriages and reproductive technologies through the celebrity rumor mill. I watched Union embody this gut-wrenching narrative and play the part of a Black professional woman surviving infertility on BET’s Being Mary Jane with soul-stirring scenes that felt more real than a made-up television drama. I celebrated Union and Wade on the birth of their daughter, Kaavia James Wade, with no signs of Union physically pregnant days or months before her Instagram debut. I could only imagine that Union made or accepted a hard choice of surrogacy as a final option to actualize her dreams of family. If Union, a Black woman like me, though worlds apart economically, could choose surrogacy, then maybe, if necessary, I could too.

In Conceiving Family: A Practical Theology of Surrogacy and Self, feminist practical theologian Danielle Tumminio Hansen identifies the majority profile of intended parents who can access surrogacy belong to the upper-middle or upper class and are often white. Hansen writes to this audience to think theologically about surrogacy “as a metaphor for the enactment of power in the United States”(2) and to examine “how human beings use the resources available to them in order to write a narrative that transforms pain into joy” (2). For many, conceiving a family is the ultimate test of faith. Hansen argues, “surrogacy is rarely one’s preferred ending to the reproductive story; rather, it is more often the last chance to reconstruct a story of loss as a story of gain, a story of conceded hope as one of hope restored” (2). As a subject for practical theology, Hansen explores the integration of the practice of choosing surrogacy with faith as a way of interrogating the theological claims of self in community. 

Chapter One addresses human reproduction and the construction of the self through three characteristics: body, desire, and agency. Hansen’s starting point for theological anthropology is Genesis 1:27 and the enduring challenge to articulate what it means to be made in the image of God, especially when tied to the subsequent divine command in Genesis 1:28 to be “fruitful and multiply.” Theological anthropology, a locus in Christian theology that attends to the relationship of God, self, and community, raises these questions: How does reproduction determine assumptions and values about what it means to be human or experience human fulfillment? Does God call humans to reproduce? Does reproduction equate to humanity’s right standing with God? Is reproduction the primary pathway for the salvation of the human species? Whatever the responses to these questions, Hansen frames infertility or the inability to reproduce as an early factor of human suffering beginning in Genesis and narrated throughout the Hebrew Bible and New Testament. Infertility poses critical theological questions about the problem of the body when humans are unable to create new life. While the biblical stories do not suggest infertility as a sign to identify one as less than human, Hansen characterizes a utilitarian valuing within some Christian traditions of certain bodies over others because of their abilities to reproduce.

Chapter Two outlines the cultural construction of surrogacy in the modern context of the United States, India, and Israel. Hansen focuses on the United States “because it is the country with the highest annual usage of third-party reproduction and because it executes surrogacy in ways that make it distinct from other nations” (3). According to data cited by Hansen, the average American surrogate is a “working class, white, Christian, twenty-seven-year-old high school graduate, married with three children” (40). These women likely have no intention of making their families larger and “view surrogacy as a calling or vocation” with “an interest to help infertile couples procreate” (40). While money holds power in settling the business contract between the surrogate and intended parents, the value is much higher as the surrogate produces life and plays an indelible role in the child’s origins. On the other end, the average profile of the intended parents in the U.S. are usually highly educated couples whose annual income exceeds $100,000. The class power differential exists because “intended parents have money to pay for surrogacy; surrogates are usually not affluent enough to hire a surrogate themselves” (42). The contemporary U.S. surrogate also possesses the power to leverage her fertility, womb, and connection to the child as a “source of benevolence or exploitation” with the intended parents (45). 

Surrogacy is big business that constructs transactional relationships between all parties involved: intended parents, surrogates, healthcare professionals, fertility agencies, and corporations. The role of surrogacy agencies and programs function to mediate transactions between the parties and “mitigate the relational difficulty” (42). Union recounts her introduction to the surrogate marketplace to find a surrogate. 

For weeks, I went down a rabbit hole of books, surrogacy message boards and conversations with our fertility agency. At the top of the surrogate food chain were married, white, American women who have their own kids. The belief is that if they are married, they have a built-in support system, and if they have more than one child, there’s proof they can do the job. On the message boards, people can be anonymous, so they rank surrogates by race. I got the sense a lot of white families-to-be were more comfortable with brown people as surrogates—Latina and South Asian—who were often classified as ‘breeders.’ Now, I am Black, and I am used to hearing how people speak of women of color, but this was some Handmaid’s Tale sh-t.2

As a result of the luxury costs of assisted reproduction, including navigating the problem of the legality of surrogacy across states, Hansen describes some intended parents from the U.S. as having shifted their search for surrogates to nations like India or Israel where the surrogacy laws are less rigid, and the total cost of a surrogate is significantly lower than the United States. For cases in India, Hansen illuminates the image of today’s surrogate as a poor, nonwhite woman desperate to make ends meet who settles for surrogacy as an enduring hope to secure the future of her struggling family—though often this hope is never materialized. For cases in Israel, surrogates serve a different function for some U.S Jewish families to perpetuate both their lineage and faith.

Chapter Three returns to the biblical story of the infertility of the Hebrew wife Sarah and the exploitation of the Egyptian slave-girl Hagar that spawned a life-denying conflict between the slaveholder and the enslaved. Hansen identifies Sarah, Hagar, and Abraham’s reproductive journey narrated in Genesis as “the most developed representation of surrogacy in the Bible” (63). Hansen is sympathetic to the victimization of Sarah in biblical antiquity by the cultural, patriarchal constructions that reduced women to reproduction and the limited, available reproductive technologies that narrowed Sarah’s choices. Hansen laments that perhaps the Sarah and Hagar controversy could have been eliminated if such “preconditions” were radically different (62). 

The Genesis account reveals Sarah offered Hagar to Abraham and coerced Hagar to conceive and birth a child to realize the family’s dream. Hansen asserts, “The slave thereby functioned as a solution to the mistress’s inability to enact reproductive agency and provided a way for her to repair what was perceived as a bodily defect because she could use the slave’s body as a proxy for her own” (63). Hansen raises the womanist theology of Delores Williams in Sisters In the Wilderness: The Challenge of Womanist God-talk as a source for explicating the “negative value” or the problem of surrogacy (66). Williams interprets Hagar as a slave-surrogate coerced to conceive a child by the intended slaveholding parents Abraham and Sarah; thus, Hagar faces entrapment in a multi-traumatic predicament of “slavery, poverty, ethnicity, sexual and economic exploitation, surrogacy, rape, domestic violence, homelessness, motherhood, single-parenting and radical encounters with God.”3 What is at stake in the Hagar, Sarah, and Abraham biblical saga is cultural and theological. The birth of a child for Sarah and Abraham represented the fulfillment of a divine promise. Hansen interprets Sarah’s actions as “at the very least comprehensible” as she exercises agency and follows a predictable maneuver to provide for herself and her family (17). For Hansen, Sarah is both victimized by her culture and oppressive to Hagar in the same breath.

I assert that Hansen and Williams have unique concerns about the theology of surrogacy, which may highlight the distinctiveness between feminist and womanist theologies. Hansen interprets the theology of Sarah, a woman of privilege who uses any means necessary – the body of Hagar— to navigate cultural and theological preconditions and support herself and her family. Sarah exerts agency to manifest a divine promise by oppressing and denying the agency of another woman of lower social status. Hansen argues that Sarah and contemporary women (primarily white) in the twenty-first century share a similar reproductive struggle and a defining question: “to what ends will I go to create the child that I am supposed to have?” (66) In contradistinction, Williams interprets the narrative by reading Hagar as a slave surrogate who is left to suffer a forced impregnation and cast into the wilderness to survive a hostile world with a rejected son. Williams coined surrogacy as the distinctive marker of Black women’s oppression in America. Hagar’s story, in particular, resonates with the African American woman who survived the brutal exploitation of her body as an object of production (labor), property, and reproduction for more than four hundred years of U.S. chattel slavery; suffered the role of a nurturing domestic for the available use of white families throughout the antebellum and postbellum; experienced the reality of parenting and single mothering at a young age; and remains victimized by the never-ending cycle of multi-dimensional oppression that keeps her in the wilderness and on the underside of humanity. Williams traces the brutality of U.S. chattel slavery and racial segregation that fortified the sexual and economic exploitation of Black women to fulfill the comforts and fantasies of white families, which can never be erased from any conversation of the American dream or U.S. history. Whereas God does not provide immediate liberation to Hagar, Williams contends Hagar exercises agency “to liberate herself from oppressive power structures” in Genesis 16 and works with the divine to survive in the wilderness in Genesis 21.4

Hansen adopts the story of Hagar to propose three distinctions of surrogacy: constructive, resistive, and injurious. First, constructive surrogacy affirms the subjective agency of the surrogate to achieve the desired outcome she intends with the support of her community. Hansen envisions the constructive surrogate as an “ally” who “is freely using the privilege and power that she possesses—in this case, her reproductive privilege—in the service of those who lack it motivated by faith, hope, and love” (74). There is no point in Hagar’s story where constructive surrogacy is present or possible. Second, resistive surrogacy maintains the surrogate’s agency to choose her path while recognizing the missing systemic support to uphold her desires. Hansen notes the experiences of primarily Indian surrogates with less than favorable conditions from corporate and communal stakeholders who make demands on their bodies while ignoring their wishes. Hagar exercising freedom and agency through resistance (e.g., Hagar on the run in Genesis 16) represents resistive surrogacy that subverts the power structures that seek to stifle her survival. Third, injurious surrogacy denies the agency of the surrogate and traps her with no opportunity to satisfy her basic needs. Hansen interprets Hagar as objectified, silenced, and raped without her consent, marking an injurious surrogacy with Sarah and Abraham. 

I wonder whether constructive surrogacy is possible from Hansen’s constructions, given the power relations in play. What circumstances make constructive surrogacy conceivable for both the surrogate and the intended parents? Like Hagar, surrogacy for nonwhite women can never be understood outside power relations; there is no exterior to this power dynamic. The conditions of surrogacy will likely never be favorable for Black women, mainly because of the numerous health disparities facing expectant Black women and the alarming U.S. maternal mortality rates that suggest Black women are three times more likely to die in childbirth than white women. Moreover, Hansen’s proposed distinctions of surrogacy fail to attend adequately to the ethical roles and responsibilities of the intended parents in these scenarios. Intended parents like Sarah and Abraham play a significant part in moving from constructive to injurious surrogacy.

Chapter Four provides a thick description of the cultural misorientations and corporate sins that alienate the intended parents, surrogates, and surrogate children from themselves, the communities to which they belong, and their relationships to the divine. Historical and contemporary constructs of the nuclear family as the normative model with two parents and biological children who live together in a single-family home strangles different possibilities for emerging and evolving families. Not all families are the same; neither do they need to be. Hansen identifies ways surrogate families have unique vulnerabilities and needs for dependency because of infertility, which may require new family arrangements. Chapter Five lays bare Hansen’s constructive vision for “consonant dependency care” that proffers broader family structures to welcome and include surrogates as equal members of the family. Williams argues there is nothing redemptive in surrogacy because of its exploitation, whether coerced or voluntary. Hansen maintains God desires human flourishing and “surrogacy, at its best, manifests the kind of flourishing God wishes for humanity” (142). The question remains: is the God of Hagar and the God of Sarah synonymous?

Conceiving Family is not written for Union or me, though Union and Wade belong to the upper class with greater access to surrogacy and chose a white surrogate couple to birth their daughter. It is not written for queer or trans couples facing oppressive theologies and restrictive legal policies that disavow any possibility for conceiving or raising children. This book is written for the majority—white upper-middle to upper-class heterosexual couples—who have experienced infertility or reproductive loss and choose third-party assistance as a last hope. Hansen rightly captures that the concept of family may mean “something different in nonwhite America than it does in white America” and even more so for “classes that cannot afford surrogates” (5). Surrogacy as a practice of faith is worth analyzing theologically because of its complex linkage to multiple systems of power in contemporary society. I appreciate Hansen’s examination of the practical theology of surrogacy and self as a solid introduction and conversation starter for students, scholars, and religious leaders to engage the relationships of God, self, and community amid unequal dynamics of power (7). Conceiving Family brings into closer view ways dreams fulfilled for some may mean nightmares for others, which is indeed a hard truth in the context of U.S. power relations and the tragic dramas retold in our biblical stories.

Danielle Tumminio Hansen posits surrogacy as a potential successful ending to a traumatic narrative of reproductive loss within the lives of intended parents. Reproductive loss can be a traumatic experience for some people, although it is worth noting, as Tumminio Hansen does, that not all reproductive losses are traumatic. Trauma has many and varied definitions, often related to concepts of power and powerlessness, the experience of being overwhelmed where ordinary adaptations to life are no longer sufficient, or missed encounters with death. Given the slipperiness of the definitions, it is perhaps more useful to consider the characteristics of a traumatic experience—the loss of bodily integrity, the rupture in language and cognition such that it is difficult—often nigh on impossible—to speak of and thus understand what has happened to you, and ruptures in time as the traumatic past continues to invade the present.1  

I know this first-hand. In my twenties, I experienced a series of reproductive losses. Each of these reproductive losses ruptured my bodily integrity. My body contained death within it. I lost blood. I lost consciousness. I lost a fallopian tube. My body was opened up surgically. In my second experience of an ectopic pregnancy, I encountered death as I was rushed into the operating room for life-saving surgery. As I recovered physically after these experiences, my body no longer felt like a safe, impenetrable, invulnerable space. I became afraid of what my body could and could not do. I was terrified of getting pregnant again. I was terrified I would never get pregnant again. My bodily integrity was ruptured. 

I had no desire but crucially no ability to talk about what had happened to me. I did not have the right words to articulate my feelings and my experiences. In fact, I struggled to remember quite what had happened. I could not remember the before-time, the joy of discovering I was pregnant. I could not piece together the sequence of events for each reproductive loss. Furthermore, I could not understand why this kept happening to me. It was unfathomable and felt inconsistent with everything I thought I believed about God and about being a person of faith. My language and my cognition were ruptured. 

Finally, my experience of time ruptured. I experienced flashbacks and nightmares for many years as the past experiences—of being in hospital, of discovering I was losing another pregnancy—continued to haunt me. These past experiences continued to try make their presence felt in the present. I also felt trapped in some kind of limbo state. Having always wanted to have children and being convinced that was the next step in my life, I suddenly found myself floundering and encountering a future that potentially looked very different from the one I had imagined in the past. Similarly, each time I became pregnant, I found myself imagining a future with that child. Who would it look like? What school would it go to? What gender would it be? What would it be like to raise this child? Each reproductive loss rendered that future impossible.2 

Suffice to say, these experiences were traumatic for me. I am intrigued, therefore, by the idea of surrogacy as a potential opportunity for post-traumatic remaking of the self. This language of post-traumatic remaking is mine rather than Tumminio Hansen’s. She prefers to talk about surrogacy, in this sense, as an opportunity in which intended parents (i.e. those who will go home with the newborn child) get to write an acceptable and happy ending to their reproductive narrative. Hansen uses the language of post-traumatic remaking within her analysis as she talks about the potential surrogacy has to offer the intended parents a sense of redemption as their identity as parents is enfleshed and the birth of a child offers opportunity for the restoration of relationships within the family and in the wider society. All of which, of course, helps to reconstruct and complete the reproductive narrative within this family. 

As one who works primarily in trauma theology, with a keen interest in reproductive loss as a site of theological discourse, I want to focus here on what is missing in this presentation of surrogacy as a mode of post-traumatic remaking. It is significant that Tumminio Hansen has particularly focused in her book on the heterosexual couple who could potentially have conceived through sexual intercourse but, for whatever reason, cannot and so turn to surrogacy. In contrast, same-sex couples and single people would be far less likely to expect to reproduce in this manner and so are less likely (but not completely unlikely) to have experienced traumatic reproductive losses in their past. The focus on the heterosexual couple and their journey into surrogacy that is likely to be characterised by repeated attempts to get pregnant, puts the embodied experience here at a primacy. The absence in this mode of post-traumatic remaking, at least in the way Tumminio Hansen has outlined it, is the body.

Reconnecting with one’s body—learning to trust it again and retraining the body to regain control over the hyper-alertness that comes with the trauma experience—is a key element of post-traumatic remaking. Given that within surrogacy, the physical experience of being pregnant is out-sourced, is other-bodied, and given that, for many people who experience reproductive losses, their desire is not just to have a child but also to have a successful pregnancy, I query the extent to which surrogacy alone can provide the necessary elements for post-traumatic remaking. 

Throughout her book, Tumminio Hansen emphasises the significance of the physical and biological for intended parents. Surrogacy is preferable to adoption not just because of the cost implications.3 Surrogacy is often considered to be preferable to adoption because, as Tumminio Hansen notes, cultural systems perpetuate assumptions around “certain connotations of ‘family,’ and the patriarchal desire to perpetuate one’s genes to the point that perpetuation becomes idolatry.” (81) The connotations of family that are preferable are those of the nuclear family in which biological relationships are at play between parents and children. The physicality and biological drive inherent within surrogacy are significant, particularly given the disembodied nature of the resulting pregnancy. Disembodied to the intended parents; not, of course, to the surrogate. 

Tumminio Hansen notes the various ways in which intended parents might try to overcome the disembodied nature of this pregnancy through the wearing of fake pregnancy bellies, the refusal to tell children born of surrogates about their origins, and high level of investment in the physical health of the surrogate. As she indicates, this investment in the physical health of the surrogate can be taken to extremes as in the case in pre-2017 Indian surrogacy arrangements in which the control of the life of the surrogate is largely submitted to the healthcare professionals overseeing the pregnancy with controls over who the surrogate sees, what she eats, where she lives and how she spends her time (50–52). These strategies reinforce the absence of the body and, paradoxically, its persistent presence, within the experience of surrogacy for the intended parents. 

What potential is there within surrogacy, therefore, for this bodily element of post-traumatic remaking to be addressed? In keeping with Hansen’s argument, I want to resist cultural assumptions about the significance of genetics in producing family and strategies of understanding surrogacy that reduce the surrogate to an object rather than a subject. I will not argue, for example, that ultimately holding one’s own flesh and blood in the form of a new born child is a sufficient embodied element to this remaking. Nor will I argue that attending every ante-natal appointment with one’s surrogate, physically touching the surrogate’s belly, or being present at the birth, is a sufficient embodied element either, as it reduces the surrogate to physical object rather than subject. 

Finding ways of attending to one’s own body in the process of post-traumatic remaking can be difficult. Serene Jones highlights the ways in which she had to turn outside the Christian tradition to find the “liturgies of the flesh”—breathwork, yoga, acupuncture, massage—that ultimately helped her to reconnect to her flesh and through her flesh to those around her.4 I have explored the contribution that sacramental rituals of anointing and the Eucharist might make to post-traumatic remaking.5 But in this regard, if it is surrogacy itself that is the mode of post-traumatic remaking on offer here—the surrogate as the embodiment of a successful theology in whose body is help the cure to the reproductive trauma of the intended parents (40)—then the primary way in which the bodies of those who have been traumatised through reproductive losses can be reconnected with and retrained, is through the embodied nurture that creates a familial bond.

It is important to note that I am not referring only to care for a newborn child who bears the same genetics as the intended parents. In this sense, there is perhaps little difference between the surrogacy experience and adopting a child. It is, in this case, the embodiment of nurture, care, and love that helps to retrain and reconnect with the body in the aftermath of reproductive loss. An embodied response that might manifest across a lifetime of nurture, care, and love for this child regardless of whether any particular biology is shared between parents and child. As Susannah Cornwall notes in her work on adoption: “In some sense, all children, even those born to and brought up by their biological parents, need to be ‘adopted’ into their own families.”6 No child is born “knowing” their genealogy or the legacy of their family; rather, all children are “adopted” into such family narratives. Cornwall goes on to argue that the ways in which all families are made, complicate notions of generativity. Both Cornwall and Tumminio Hansen offer an expanded view of what might make a family, rejecting any sense of biological inevitability as the only or primary marker and highlighting the ways in which cultural imperatives have influenced the kinds of reproductive stories we are able to successfully narrate. 

Regardless of the way in which a child enters a family—through unassisted conception, through assistive technologies, through surrogacy, through adoption—the new parent(s) have an opportunity to integrate that child into their family narrative. This legacy is dependent upon family story rather than family genes. This integration is an embodied experience in which the child is nurtured by the bodies of those around her. Not by feeding at the breast but rather through the ways in which these bodies around her perform the imago Dei seeking out her flourishing in concrete circumstances and actions throughout her life.7 As Tumminio Hansen notes, there may be a variety of people who perform such modes of being in the child’s life, potentially extending our understanding of family beyond biology even further. 

Tumminio Hansen notes that the cultural misorientation of these assumptions that privilege one form of family and type of generativity over another, can also impact on the ways in which those traumatised by reproductive loss process their trauma. If one cannot picture any other kind of successful family save one in which children are biologically related to their parents, then the traumatised person will necessarily be limited in the ways in which they can construct the ending of their trauma narrative. 

I note two things in conclusion here. The first is that some (if not most) trauma narratives may never end. No birth of a child, no matter how longed for, wipes away the trauma of reproductive loss (just as the resurrection does not do away with the crucifixion). The trauma survivor may find ways to flourish and survive but the trauma rarely just disappears. And the second is that if this is the case, then the church has a responsibility to foster and encourage a variety of ways in which family might be conceived. It must find a balance between honouring biological families without giving them primacy over all other kinds of families. This requires a multiplicity of generativity narratives that resists the cultural misorientation Tumminio Hansen has, quite rightly, demonstrated as “sinful” in her text. 

Danielle Tumminio Hansen has written a probing book, one that has prompted me to consider the practice of surrogacy in new ways. Prior to reading Conceiving Family, I regarded surrogacy as a primarily exploitative enterprise that, as Dolores Williams argues, invariably participates in the legacy of objectification of the bodies of poor women and women of color. Without sacrificing a concern for justice, Hansen offers the possibility of regarding surrogacy as a vocational practice that, at its best, directs our vision toward a more expansive understanding of family. Williams’s critique continues to capture my pessimism about the capacity of a society steeped in market capitalism and white supremacy with almost no social safety net and profound wealth and healthcare disparities to create the conditions necessary for the practice of surrogacy to develop in a just and humanizing way. Nevertheless, I applaud the nuance, care, and meticulous interdisciplinary analysis that Hansen has brought to the consideration of surrogacy from a practical-theological perspective. 

I approached this book, and all conversations surrounding birth, motherhood, and reproductive trauma, primarily through the lens of my own prior work on prenatal loss. I’ve examined how the lack of attention to pregnancy loss in Catholic theology and ritual has consequences for the ways that we understand not only reproductive loss, but also pregnancy, childbirth, and women’s bodily experiences more broadly. The three interconnected areas of reflection I will offer in what follows all emerge from the inner conversation Conceiving Family provoked about the question of surrogacy, the phenomenon of miscarriage, and, inevitably, my own experiences of motherhood and loss. 

First, after reading Conceiving Family, I was left with questions about the limits of narratives of selfhood, agency, and control as they relate to reproduction. As Hansen explains, many of the would-be parents who seek to have a child through surrogacy do so in the wake of reproductive trauma—infertility, miscarriage, stillbirth, and other negative outcomes. Part of what makes such experiences traumatic is the loss of agency involved (20). A miscarriage, for example, is an experience of consummate helplessness. There is nothing that can be done: no way to stop the bleeding, no medicine or procedure or intervention that would set things back on their course. Most of the time, the cause of the loss remains a mystery. The urge to grasp for explanations, most of which involve significant degrees of self-blame, is in many ways an attempt to reclaim a semblance of agency within a situation rife with wrenching ambiguities. Of course it wasn’t the glass of champagne consumed at the Christmas party before the pregnancy was known that caused the miscarriage—but supposing that it might have been is in some ways less terrifying than the alternative realization that the things we most desire in life lie just beyond our control. 

I wonder, then, how a theological engagement with surrogacy might both foreground questions of agency and self-construction, as Conceiving Family does, and at the same time resist the myth of control that distorts American cultural attitudes toward fertility and conception more broadly. Infertility and pregnancy loss are jarring in themselves. Yet the trauma they provoke is magnified because they so deeply defy these cultural expectations of control. Reproductive loss speaks a kind of aching truth about the human condition. Rather than introducing anomalous vulnerability into the otherwise straightforward process of reproduction, such sufferings reveal the fragility that always already haunts the possibility of birth. For this reason, I found myself wondering about the ways in which these vulnerabilities persist within and beyond even the most healthy and fruitful surrogacy relationships. Fertility is always a condition with an asterisk next to it: it’s temporary and capricious, ebbing and flowing and sometimes receding without warning. I wonder what happens, for example, when the surrogate herself experiences the loss of a pregnancy—a situation that, while outside of the norm, can’t be entirely uncommon. What becomes, then, of the relationship between the intended parents and the surrogate? In this case, the surrogate’s ostensibly “functioning womb” has become yet another site of loss for the intended parents, and now for herself as well (41). Can this yet-wider circle of grief open up to accompaniment? Or is there an uncomfortable sense that the terms of a contract have been violated, albeit in ways beyond anyone’s control? Is the surrogate compensated as she would have been had the baby been born alive, her labor now spent shepherding a loss that both is and is not her own? I raise these questions as a way of asking whether the act of welcoming a surrogate into the childbearing relationship should be seen not first and foremost as a solution to a problem but, fundamentally, as a relationship of what Hansen terms “connected vulnerability” (122).  Yet to be genuinely loving, this recognition of vulnerability must go beyond shared dependency and the mutual indebtedness that comes from inter-reliance. It seems that the more we are able to resist an overly efficacious, mechanistic understanding of the surrogate’s role in this expanded notion of family, the more successfully we might refuse the exchange-relationship paradigm that lurks dangerously close to this sort of arrangement.

My second area of inquiry is about the relationship between self-construction and intersubjectivity. Here, I will begin with a story from my own life. I suffered three miscarriages before ultimately giving birth to three daughters. Women’s experiences of miscarriage differ in many ways. Mine was was one of devastation. During the miscarriage years, I had equated future healing with the birth of a living child. I felt sure that finally having a baby would assuage my grief and redeem the losses I’d suffered. Yet when that hoped-for day finally came, and the weeks and months that followed, I realized with surprise that the sting of loss remained. The place these losses occupied in my life gradually evolved, but it has never disappeared. In retrospect, what felt at the time like a surprising revelation now seems obvious to me. Good and bad aren’t a math equation, where each unit of joy cancels out each unit of grief and you only feel the difference. These momentary lives and in-between deaths continue to exert their own sort of agency, even in seasons of consolation. 

I describe this experience in order to situate a question that emerged for me about parental self-construction and the subjectivity of the child—the one whose hoped-for ingression into the world is the impetus for the surrogacy relationship. Hansen explores the mutual dependency (and thus the connected vulnerability) that exists between parents and child. While we typically think of the infant as the dependent party in the relationship, in fact, Hansen contends, parents are equally dependent on the infant for the construction of their parental identities:

That parental identity is not something they could procure for themselves but rather one that must be procured through the existence of another human being entrusted to their care, such that they are dependent on the child for the creation of it. In this way, the infant directly addresses the desire of each adult to be a parent and transforms the self of the parent into the self that the parent wants to realize (125).

I wonder if attending even more thoroughly to the subjectivity of the infant would deepen reflection about the question of mutuality in the parent-infant-surrogate relationship. Behind the lingering sting of loss I felt, I now realize, was a recognition that it was not simply that my previous attempts to achieve maternal identity had failed, and now at last they had succeeded. It was true that I had been transformed into a mother—the birth of this child had accomplished, or at least set in motion, that particular act of self-construction. I had become a mother to Nora, but there were also the mothers I’d never be, the mother to any one of the babies I’d lost. Pieces of the story I’d previously regarded as static—pregnancy, motherhood, a baby—were all fundamentally intersubjective realities. I wasn’t a mother—I was her mother; a different child would have made me a different mother. I didn’t long for a baby; I longed for this baby, just as I’d longed for each of the babies I’d lost. I still bristle when I hear a child born after miscarriage described as a “rainbow baby,” a colloquialism that has migrated from the blogosphere to the mainstream within the past decade. To me, the term feels like a reduction of the infant to the function that it serves within the parents’ story, as though the birth of one baby somehow redeems the loss of the last one.

Of course, the infant’s role in the familial relationship goes beyond function, beyond parental identity work and the fulfillment of desire (a point on which Hansen undoubtedly agrees). What defines all loving relationships is non-instrumentality, the defiance of the exchange paradigm. Of course, as Hansen notes, no relationship can be healthy if the parties involved do not uphold the subjectivity and agency of the other. But in the final place, a parent’s love for her child isn’t about who the child’s existence enables her to become. The parent loves the infant because the infant exists. I suppose that this is the challenge of surrogacy in general: it plays on the human tendency to instrumentalize human relationships to desired ends, so it takes a particularly robust set of safeguards and dispositions and cultural conditions to ensure that the surrogate is treated as a full subject rather than an object. By contrasting the practice of surrogacy in various global and religious contexts, Chapter 2 of Conceiving Family demonstrates this point vividly. I wonder how a more robust consideration of the selfhood and agency of the infant could make the book’s ultimate vision—a deeper and more expansive notion of family—even more radical and humanizing. 

This point also relates to my previous one. In many ways, the newborn becomes the ultimate symbol of the limits of parental agency and control. Whereas the modern parenting complex would have new moms and dads believe that breastfeeding and co-sleeping and homemade baby food and the right preschool will make our children into the kind of people we always imagined they’d be, so much of who a child is and becomes lies utterly beyond our control. I’ll never forget the first time my oldest daughter started humming a song I’d never taught her. Where did she learn that? What else did she know? Barely old enough to walk, she was already a world unto herself. In her world, she was the protagonist and I was a supporting character, if a particularly ubiquitous one. Any sense of selfhood I constructed as a parent had to contend with the recognition that the one upon whose existence this parental self-construction depended—the child, this child—was an Other, a subject, a world unto herself. It was her agency, her selfhood, that would most challenge my own self-construction, calling me to become not the mother I always wanted to be but a different kind of mother entirely, one only she could make me. I love her to the extent that I allow the reality of who she is to supplant the image of who I imagined she’d be—and, in turn, who I imagined I’d be.

My final question is about ritual and community. In both the religious and secular spheres, we lack rituals through which to mourn reproductive loss. We have liturgies and traditions and familial social scripts to turn to when marking life’s clear beginnings and endings. Yet no comparable rituals—religious or secular—accompany parents in those more hidden, ambiguous experiences of death-before-life.1 Ritual is important because it offers a template for weaving a single story into the anthology of a community. A ritual speaks in the language of a community, saying to those who mourn, we have been here before. Come: let us show you what to do. Without a socially recognized way of drawing such losses into a larger communal story, the pain of loss is compounded by isolation, loneliness, questions of meaning, and an aching sense that one’s grief is illegible to her community. I have often considered how ecclesial communities might offer better liturgical care for women and families suffering from miscarriage and other forms of reproductive loss. Conceiving Family has broadened my reflection even further. Calling readers beyond the myopic self-sufficiency myth at the root of emphases on the nuclear family, Hansen evocatively enjoins us to consider the mutual care and connection that are part of any birth: “All reproduction could rightly be termed ‘assisted’” (100). In view of this point, I wonder what it would look like to expand our liturgical and ritual imaginations to encompass an even fuller understanding of the relationships that make a family, including surrogacy, adoption, and other experiences that speak to this more capacious vision.