These answers have been provided by psychologist Seema K Terangpi. Psychologist on staff at Ethical Surrogacy International.
1. Do surrogates receive psychological testing?
As per our mandate we do screen our surrogates before we enroll them for the program.
2. What are the components of your psychological screening? (in the U.S. it is generally a face to face meeting with a fertility psychologist and an MMPI )
At ESI the surrogates undergo 3 rounds of counseling session with the Counselor
First, there is a telephone interview, then a skype and finally a face to face interview at the clinic.
After the final interview, doctors proceed with medical examinations.
3. What are you looking for when you screen a surrogate?
As mental health professionals we have a responsibility to protect children psychologically where possible.
They must be married and have at least one child that she has given birth to and parented. They must have no history of mental illness or criminal record.
India Surrogates need to have an intellectual ability to do abstract thinking, conceptualizing and retain a lot of information. It is important that we assess their coping mechanisms, defense and resiliency especially under duress as becoming a surrogate can come with particular stress. It is vital that a surrogate have the ability to thinking independently, as well as take care of herself to protect herself from exploitation.
Another very important factor lies within her personal support system, resources available to her and more recently it is becoming increasingly important that her family is involved as a key support. Her husband beliefs and thinking can be very critical in understanding how she came to the decision to become a surrogate and how she will be supported during the process. If they have minimal resources and an inability to utilize her support this can be indicative of a person who will need an increased level of case management. Looking at her family and children, how she plans to tell them, if the children have undergone any life trauma will all be taken into consideration in order for surrogacy to proceed safely.
4. What can you tell about the GS from your evaluation?
There are 3 main things we hope to understand from the evaluation. Is the gestational carrier (GC) fit psychologically. Does she have the emotional commitment and family support, and lastly, is the GC comfortable with the financial arrangements.
5. After psychological screening, what percentages are accepted into program, what percentage turned away?
Approximately 50% of those evaluated are accepted into the program.
6. What are some psychological reasons why a surrogate would be turned away?
Reasons for a surrogate not being able to enter the program would be based on findings of our psych evaluation; are there medical and/or mental instabilities. Also, surrogates may be reluctant to tell her children the truth about becoming a surrogate if this is the case then it is often best not to accept her.
7. Do you meet with or assess the support of the surrogate’s spouse and family?
The Counselor meets with the surrogate and spouse/family to explain every minute detail of the program, financial transactions etc
8. Do you feel that the psychological screening for India surrogates is similar in quality to screening in the U.S.?
Definitely, India being a country that has legal surrogacy program is also well equipped to screen and give the best surrogates to help complete a family for those in need.
9. In the U.S. there is an emotional bond that is generally nurtured between the surrogate and the IPs.. most surrogates find this one of the very rewarding aspects of surrogacy.. How is this different in India? What is the rewarding aspect for the surrogates? (It’s okay if its purely financial, we’d rather you be honest in this answer)
There are 2 types of IPs;
- One that would like to meet the surrogate and build emotional bond since she would be carrying their child
- While the other just wants the baby and have nothing to do with the surrogate.The surrogates in India are concerned about the finances, since most come with a need of different kind i.e. hospitalization, children’s education, debts
10. Please address the American concern of Indian surrogates living away from their families for the duration of the pregnancy (obviously this is foreign notion to some).
The ESI counselor explains the following:
- Surrogates are told clearly that they would have to stay in the surrogate home for 9 months during the pregnancy.
- Children and Spouse will be allowed to visit the surrogate in the surrogate house during the pregnancy
- Surrogate home would have rules and regulations that she would have to follow for the benefit of her and the child i.e. sleep, outings and food timings etc.
- On conception routine medical check ups will be done by Doctors and in case of any medical emergencies the surrogate will be admitted in the hospital.
11. Do surrogates receive counseling during the course of the pregnancy?
Surrogates have access to skype, chat via phone with a staffed psychologist whenever necessary? They discuss topics that concern them about their pregnancy or actual personal issues that arise during pregnancy. Often they are dealing with the initial fear/concerns of embarking on surrogacy which can be overwhelming, and talking with a psychologist can help in making the process better for them
11.Do you find it necessary?
Yes, it’s a good way to motivate the surrogates to eat and stay healthy and to remind them that we are there as a team to support/ accept them without any stigma or discrimination, which they fear so much about.
12. What issue(s) if any do you see with GSs during the pregnancy?
There are not as many issues if we have the GCs together. Having the GC’s in an environment where they are experiencing the same process together is critical. Together they can share the experience and support eachother. In the hostel they are offered activities to improve skills. We can ensure there food intact is appropriate and that they have the necessary family support and interactions to avoid issues.
13. Have you ever had any issues where the surrogate had problems ‘giving up’ the baby?
This is unlikely to occur, since it’s not an open adoption program and things have been clearly explained on the start of the program with the Surrogate and spouse signing in on consent forms.
14. What else can you tell Americans (or IPs travelling from different parts of the world) to do surrogacy in India to reassure them that their surrogate will be psychologically sound?
By reassuring the IP’s that you have a rigorous screening process we are allaying a few fears that come along when another person is carrying your child. There are two priorities at play here; to ensure well being of Surro and provide IP’s with confidence in their choice of surrogate Both are important with ESI as part of the Helsinki Declaration of Human rights the welfare of the GC and as a responsible agency that ensures the welfare of the child. Below are key factors to ensure the well being of the surrogate and child.
- Welfare of the GC (WOGC)- At the time of screening we ensure that the GC is fit to be pregnant and has no absolute or relative contraindication for getting pregnant both medically and psychologically. When selected ESI does not do any medical activity which can put the life or health of the GC in jeopardy this is as per the Helsinki Declaration.
- Welfare of the Child (WOC)- At the time of screening of the IP’s ESI ensures that the IP are supportive and caring parents and for which our Counselor interviews the parents or has an independent counselor from the home country of the IP send us a report. This is as per the HFEA guidelines in UK and ESI being accredited to Bourn Hall Clinic UK has to follow this procedure.
- Further once the GC is pregnant the pregnancy care will be as per the guidelines of VA , USA and this ensures the child receives the best treatment that US offers.
- GC is also housed in a hostel to ensure that the child is not compromised medically by the GC not taking the right food, right exercise and is not exposed to any harmful pollutants.
- The final stage of Delivery of the child is as per the US VA guidelines
- The child has access to the finest level of neonatal care available anywhere in the world
- The legal documentation ensures that the child will not be detained or become stateless
- In case of abandonment by the IP of their child ESI has developed an abandonment insurance policy which ensures that in case IP abandons the child , the child will be placed in adoption with sufficient money for raising the child in India