Document Type : Original Article
Authors
- . Marjan Goli
- . Shahnaz Kohan 1
- . Seiied Mahdi Ahmadi Oloonabadi 2
- . Ziba Farajzadegan 3
- . Zeinab Heidari 4
1 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Fertility and Infertility Center, Isfahan, Iran
3 Professor, faculty of Nursing and Midwifery, Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Assistant Professor of Midwifery and Reproductive Health Department, Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Surrogacy has become an alternative family formation option for women who are
unable to carry a pregnancy. There is no comprehensive care program despite the different nature of
this pregnancy. The present study aimed to develop a reproductive health‑care program for surrogate
mothers within the cultural and social context of Iran.
MATERIALS AND METHODS: In the present sequential exploratory mixed methods study, first
through a qualitative approach surrogate mothers, care providers, and policy makers of reproductive
health services were selected purposefully. Data were collected by using the in‑depth semi‑structured
interviews and analyzed. A care program draft was designed by integrating results of the qualitative
study and reviewing the literature and guidelines, then appropriateness of each proposed care was
assessed by a two‑Rounds Delphi technique (RAM), and the final reproductive health‑care program
for surrogate mothers was developed.
RESULTS: The surrogate mothers’ reproductive health needs were summarized in four main
categories: surrogate mothers’ extra care, educational training, psychological support, and protecting
against surrogacy`s social and familial consequences. The reproductive health‑care program for
surrogate mothers were developed in four sections: prepregnancy health screenings and legal
counseling; special care during embryo transfer until pregnancy confirmation; psychological support
and prenatal care of surrogacy until delivery and follow‑up postpartum care.
CONCLUSION: Women face many challenges in surrogacy and need special care such as legal
counseling, reproductive health care, and psychological support. Implementation of this care program
seems to help improve the reproductive health of these mothers.
Keywords
motherhood regulation in South American countries: Pointing
to a need for an international legal framework. BMC Pregnancy
Childbirth 2019;19:46.
2. Odunvbun WO, Oziga DV, Oyeye LO, Ojeogwu CL. Pattern of
infertility among infertile couple in a secondary health facility
in Delta State, South South Nigeria. Trop J Obstet Gynaecol
2018;35:244‑8.
3. Berek JS. Berek and Novak’s Gynecology,Philladelphia, Lippincott
Williams and Wilkins; 2019.
4. WangAY, Dill SK, BowmanM, SullivanEA. Gestational surrogacy
in Australia 2004‑2011: Treatment, pregnancy and birth outcomes.
Aust N Z J Obstet Gynaecol 2016;56:255‑9.
5. Tremellen K, Everingham S. For love or money? Australian
attitudes to financially compensated (commercial) surrogacy.
Aust N Z J Obstet Gynaecol 2016;56:558‑63.
6. Murugappan G, Farland LV, Missmer SA, Correia KF,
Anchan RM, Ginsburg ES. Gestational carrier in assisted
reproductive technology. Fertil Steril 2018;109:420‑8.
7. Burrell C. Surrogacy legislation remains complex and
unsatisfactory. BJOG 2018;125:353.
8. Zandi M, Vanaki Z, Shiva M, Mohammadi E. Nine centuries
waiting: The experiences of Iranians surrogacy commissioning
mothers. Iran J Nurs Midwifery Res 2014;19:224‑32.
9. Perkins KM, Boulet SL, Jamieson DJ, Kissin DM; National Assisted
Reproductive Technology Surveillance System (NASS) Group.
Trends and outcomes of gestational surrogacy in the United
States. Fertil Steril 2016;106:435‑42.e2.
10. Arvidsson A, Vauquline P, Johnsdotter S, Essén B. Surrogate
mother – Praiseworthy or stigmatized: A qualitative study on
perceptions of surrogacy in Assam, India. Glob Health Action
2017;10:1-10.
11. Burrell C, Edozien LC. Surrogacy in modern obstetric practice.
Semin Fetal Neonatal Med. 2014 Oct;19(5):272-8.
12. Dar S, Lazer T, Swanson S, Silverman J, Wasser C, Moskovtsev SI,
et al. Assisted reproduction involving gestational surrogacy: An
analysis of the medical, psychosocial and legal issues: Experience
from a large surrogacy program. Hum Reprod 2015;30:345‑52.
13. Goli M, Farajzadegan Z, Heidari Z, Kohan S. Reproductive and
sexual health of surrogate mothers, developing a care program:
A protocol for mixed methods study. Reprod Health 2019;16:23.
14. Basger BJ, Chen TF, Moles RJ. Validation of prescribing
appropriateness criteria for older Australians using the RAND/
UCLA appropriateness method. BMJ Open 2012;2:e001431.
15. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24:105‑12.
16. Sadeghi H, Yazdkhasti B, Malekahmadi H, Abdellahi A.
Phenomenological experience of the surrogate mothers in renting
wombs. Woman Fam Stud 2013;1:135‑53.
17. Ghasemzadeh N, Salehi SM, Faramarzi‑Razini F. Breast milk as
the forgotten ethical right in surrogacy and suggestions for its
recognition: Islamic perspective, Iranian experience. Iran J Pediatr
2017;27:4.
18. Shojaee KK, Davati A, Hadavand S, Bahrami M. Knowledge
and attitude of patients about the use of surrogacy as treatment
method of infertile couples – Mostafa Khomeini hospital in 2016.
Iran J Obstet Gynecol Infertil 2017;20:31‑42.
19. White PM. Hidden from view: Canadian gestational surrogacy
practices and outcomes, 2001‑2012. Reprod Health Matters
2016;24:205‑17.
20. Pizitz TD, McCullaugh J, Rabin A. Do women who choose
to become surrogate mothers have different psychological
profiles compared to a normative female sample? Women Birth
2013;26:e15‑20.
21. Klock SC, Covington SN. Results of the Minnesota multiphasic
personality inventory‑2 among gestational surrogacy candidates.
Int J Gynaecol Obstet 2015;130:257‑60.
22. Ahmari Tehran H, Tashi S, Mehran N, Eskandari N,
Dadkhah Tehrani T. Emotional experiences in surrogate mothers:
A qualitative study. Iran J Reprod Med 2014;12:471‑80.
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