Mandatory (M)othering: An Exploration of British Surrogates’ Healthcare Experiences

In this blog Dr Zaina Mahmoud outlines the focus of her chapter, ‘Mandatory (M)othering: An Exploration of British Surrogates’ Healthcare Experiences.’ Zaina is a lecturer in law at the University of Liverpool.

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Between 2008 and 2024, there has been a 600% increase in the number of babies born through surrogacy to UK intended parents. Surrogacy refers to an arrangement where a person (the surrogate) agrees to gestate for the intended parent(s) who raise the child. This form of assisted reproduction remains contested, despite its growing prevalence in the UK. Chapter 8 of Narratives of Consent and Reproductive Subjects seeks to amplify the voices and choices of those at the heart of the process: surrogates. Too often, surrogates are portrayed passively: either vulnerable women in need of protection or altruistic angels whose motivations are romanticised. In either case, their agency is obscured.

Frustrated by prevailing legal and medical framings, this chapter focuses on surrogates’ healthcare experiences in the UK, drawing on in-depth interviews with 14 British surrogates sharing their narratives of resilience, frustration, and hope. This chapter reveals how the law’s insistence on (mis)recognising surrogates as “mothers” goes beyond a semantic issue, with real and tangible consequences for their treatment in healthcare settings. Indeed, it highlights the indignity of being called “mum” repeatedly in NHS maternity care settings, despite clear birth plans and repeated corrections. Surrogates’ (m)othering coupled with a healthcare system ill-equipped to handle non-normative reproductive arrangements gave rise to epistemic injustice, referring to injustice arising when individuals are wronged in their capacity as knowers. This epistemic injustice manifested in multiple ways: through the dismissal of surrogates’ embodied knowledge during labour, the questioning of their motivations during counselling, and the hurdles that rendered their consent a mere formality. The chapter also explores hermeneutical injustice, referring to surrogates lacking the conceptual resources to make sense of their experiences, in a context in which healthcare providers struggled to accommodate surrogacy within standardised protocols, often defaulting to assumptions.

Surrogacy straddles the public and private healthcare sectors in the UK, and this chapter reveals how this hybrid model creates a fragmented experience for surrogates, who navigate two very different systems with little continuity of care. Fertility treatment typically occurs in private clinics, while pregnancy and birth are managed within the NHS. In private clinics, surrogates often feel like secondary patients—present but peripheral. Their consent is frequently overshadowed by the commercial interests of the clinic and intended parents’ desires. This chapter captures the nuance of a surrogate’s experience in a fertility clinic where her consent is sidelined in favour of the intended parents’. When accessing antenatal and intrapartum care through the NHS, they are treated as mothers by default, without recognition of the unique nature of their pregnancies.

This chapter comes at a critical moment: the Law Commissions’ recent proposals for surrogacy reform in the UK signal growing recognition of the need for change. Legal reform must be informed by empirical evidence and grounded in the lived realities of those it seeks to regulate. This chapter offers a detailed and nuanced account of how surrogates navigate the public and private healthcare sectors in the UK. It is a key resource for policymakers, healthcare providers, legal professionals, and those interested in reproductive justice, especially for those interested in the ongoing efforts to reform surrogacy regulation.