From Shah Rukh Khan and Gauri Khan (AbRam) to Aamir Khan and Kiran Rao (Azad), Tusshar Kapoor (Laksshya), and Priyanka Chopra and Nick Jonas (Malti Marie), several celebrities have turned to surrogacy to build their families. As public awareness grows and stigma fades, surrogacy has become a more accepted reproductive option, especially in cases where medical complications prevent women from carrying a pregnancy themselves.
However, a new study has added an important dimension to this evolving narrative. Published in JAMA Network Open, the landmark research by McGill University and the Institute for Clinical Evaluative Sciences (ICES), Canada, reveals that surrogacy may carry a higher risk of mental health challenges for gestational carriers — commonly known as surrogates.
Study at a glance
The study analysed an extensive dataset of 7,67,406 pregnancies in Ontario, Canada, between 2012 and 2021. It found that women who carry a pregnancy for others are significantly more likely to develop new-onset mental health conditions during or after pregnancy compared to women who conceive either naturally or via IVF. “Pregnancy is not just a biological process, it’s deeply emotional,” says Dr Sumina Reddy, fertility consultant and director at Fertilica IVF & Women Care, Hyderabad. “For surrogates, the journey comes with added psychological layers. Even if there is no genetic link to the baby, they still undergo all the hormonal, physical, and emotional changes that pregnancy brings,” she adds.
Diagnosed conditions ranged from mood and anxiety disorders to psychosis, substance use, and self-harm. Alarmingly, many diagnoses were made in emergency or inpatient settings, pointing to delayed support and crisis-level interventions.
“Surrogates face a higher likelihood of developing mental health issues compared to women who carry their own children,” notes Dr Sarada Vani N, senior consultant in Obstetrics and Gynaecology, and high-risk pregnancy specialist at Yashoda Hospitals, Hyderabad. “Mood and anxiety disorders were most common, and the median time from conception to diagnosis was around two and a half years. This shows how some issues may emerge long after the pregnancy ends,” she notes.
The doctor adds that surrogates who previously experienced mental health issues were particularly vulnerable. Even when compared to women who conceived without assistance but no longer lived with their child a year after birth, surrogates showed elevated risks, hinting at a grief-like experience akin to that seen in adoption or foster care.
Screening gap
While the study excluded women with known prior mental health conditions, nearly one in five surrogates still had a history of such issues — highlighting a worrying disconnect between policy and practice. “This gap between what the guidelines mandate and what actually happens on the ground is troubling,” says Dr Sumina, adding, “Psychological screening needs to go beyond formalities. It should involve in-depth evaluations by trained professionals, not just checklists. If a woman is agreeing to surrogacy due to financial distress or emotional pressure, those factors must be carefully examined.”
Implications for India’s surrogacy law
India’s Surrogacy (Regulation) Act, 2021 permits only altruistic surrogacy and mandates psychological and medical evaluations. It also restricts eligibility to women aged 25–35 who have previously given birth. While Dr Sumina supports the spirit of the law, she believes the implementation needs to be more rigorous. “This study should serve as a wake-up call. Are we truly evaluating these women across all centres? Are we offering them consistent mental healthcare after childbirth or are they forgotten once the baby is handed over?” asks Dr Sumina.
At Fertilica, postnatal mental health check-ins are a standard part of surrogate care. “But this shouldn’t be the exception, it should be the norm,” she stresses, adding, “Support shouldn’t stop at discharge, it should extend through the full postnatal year.”
Crucially, the study does not question the value of surrogacy itself. It underscores the need for a more empathetic, holistic approach to care. “Surrogacy is a courageous and generous act,” says Dr Sumina, adding, “As a society, we must ensure that these women are supported not just physically, but emotionally — before, during, and long after the baby is born.”
Note on limitations
While groundbreaking, the study isn’t without caveats. Only 758 surrogates were included, and the research relied on administrative health data — which may not capture subtler emotional challenges or undiagnosed conditions. Still, the statistical significance of the findings offers a strong case for deeper inquiry and enhanced safeguards.