I love TV. I really do, and I can usually find something that I appreciate or like about almost every genre of TV. So, when Netflix released ‘The Surrogacy,’ I was excited to watch what I was expecting to be another incredible Netflix original series, especially on a topic that I am extremely interested and invested in. While I am currently pursuing surrogacy, it is only in the United States. I have never considered Mexico as a place to work with an agency, largely because I am still relatively new to living in Stockholm, and navigating Sweden is enough in terms of international logistics. I didn’t want to add another country that is foreign to me to this already complicated process. Also, as a physician trained in the United States, I have a sense as to the healthcare system as well as friends and colleagues in the field of reproductive endocrinology. However, I was not prepared for ‘The Surrogacy’ in terms of how incredibly sensational and inaccurate the portrayal of surrogacy is compared to what occurs today with well-regulated, commercial surrogacy in the United States.

Full disclosure, I have only watched the first two episodes of ‘The Surrogacy’ before writing this critique. This is because almost all of the surrogacy-related interactions transpired during these two episodes, and because the telenovela genre is not one of my favorite formats. To be honest, my daytime viewing growing up was more ‘The Price is Right’ rather than ‘The Young and the Restless,’ and I have never watched even a single episode of ‘Real Housewives.’ ‘Bad’ gay, I know, but true.

In terms of structuring this article, I wanted to focus on a few key questions:

• Who created this show, and do they have any ulterior motives with regard to surrogacy?

• How does this show compare to surrogacy today in Mexico?

• How does the portrayal of surrogacy in the show compare to surrogacy in the United States?

• What is the impact of the show on the current international impression of surrogacy?

‘The Surrogacy’ was written and created by Aida (or Araceli) Guajardo (https://es.wikipedia.org/wiki/A%C3%ADda_Guajardo). Aida is a seasoned telenovela writer, who has thirteen TV credits (https://www.imdb.com/name/nm1583648/). One of her previous shows, ‘Alma de Hierro’ or ‘Iron Soul’ in English, was nominated for a GLAAD award in 2009 for the novel on which it was based (https://es.wikipedia.org/wiki/Alma_de_hierro#Premios_GLAAD_2009). Although what I could find online for Aida is quite limited (most likely due to my lack of Spanish language skills), I do not believe she has any personal or professional vendetta against surrogacy or the LGBTQ+ community, and so surrogacy in Mexico was likely just another theme from which she was inspired to write a telenovela. Based on how extreme and insane the plot twist and character portrays are in the show (i.e. lawyers threatening and beating people up in back alleys), it does seem that ‘The Surrogacy’ is not in any way meant to attack and damage surrogacy, but rather just provide the backdrop for another wild, soap opera-like TV show.

In terms of surrogacy in Mexico, significant changes have occurred since the time frame in which ‘The Surrogacy’ is set. The show takes place in 2004 and 2005. [Fun fact, although the characters have iPhones, the first generation of the iPhone was not even released until 2007 (https://en.wikipedia.org/wiki/History_of_the_iPhone)]. Before 2021, surrogacy was illegal in Mexico. After 2021, there was a Mexican Supreme Court decision that legalized commercial surrogacy, but this has been slowly and irregularly adopted by the various Mexican states (https://www.sensiblesurrogacy.com/surrogacy-in-mexico/ and https://www.growingfamilies.org/surrogacy-in-mexico/#:~:text=In%202021%20the%20Mexican%20Supreme,family%20through%20an%20affordable%20arrangement). There are a number of surrogacy agencies that are active in the country, but there is still a warning on the United States Department of State website about the challenges of pursuing assisted reproductive technologies (ART) in Mexico (https://mx.usembassy.gov/surrogacy-art-and-dna-testing/). However, I believe it is an unjust and damaging aspect to have the show take place almost 20 years ago, when the climate and legality of surrogacy in Mexico has evolved considerably, and I even question whether the iPhone error is because they wanted the show to appear more current than it actually is. Because let’s be honest, in 2004/2005, we were all still rocking our Motorola Razrs.

Moving on to the extreme contrast of how surrogacy is portrayed in the show compared to the reality of what transpires between intended parents (IPs), surrogates (or gestational carriers, GCs), and agencies in the United States. However, before I dive into the extreme inaccuracies of the show, I would also like to point out another telenovela-like plot twist shared in the first episode. As an aside, my day job is a physician researcher designing clinical trials for a global pharmaceutical company. In previous roles, I have actually worked on clinical trials in Mexico. Therefore, I am uniquely qualified to state that the ‘shady’ consenting and ethical abuse that the main family’s pharmaceutical company is doing would be extremely unlikely. Global studies are intensely scrutinized by ethics committees, review boards, and regulatory bodies, and so the fact that they are conducting these heinous scientific experiments on vulnerable women just plays into the extreme soap opera-like drama of the show. Now, back to the surrogacy aspects. I would like to emphasize that the comparison I have below is between surrogacy in the United States and surrogacy in the show, which is not indicative of surrogacy in present day Mexico. Also, these are just a few of the main differences I noted, but in reality, the entire situation in the show is so fantastically inaccurate that it really should not even be a reasonable comparison for what actually transpires. Lastly, because Medium is not a fan of tables or charts, I have crafted these differences into six bulleted categories, with subsequent descriptions for the United States (U.S.), Neflix’s ‘The Surrogacy,’ and the importance of the category for the surrogacy process.

Finances

• U.S. — The GC and immediate family cannot have any financial liabilities, debts, or actually ‘need’ the income from surrogacy.

• ‘The Surrogacy’ — The character who becomes the GC is the epitome of coerced with her father’s arrest and her poor financial prospects.

• Importance — GCs should feel no pressure to engage in surrogacy for any financial need or desperation. The money should not be the primary driver for the GC.

Legal representation

• U.S. — The GC and IPs each get separate legal representation so there is no conflict of interest for any of the contracting or during the negotiations.

• ‘The Surrogacy’ — The IPs had a very questionable lawyer who completely manipulated the police and GC into the arrangement, and then was murdered for her work.

• Importance — The contracting and arrangements between the GC and IPs need to be negotiated, reasonable, and agreed upon. This can only be done with adequate legal counsel.

Psychological screening

• U.S. — GCs are required to undergo psychological evaluation to ensure that they understand the emotional journey and arrangement. Part of this is that GCs should already have had at least one healthy pregnancy in order to understand how they will be as a pregnant woman.

• ‘The Surrogacy’ — The GC character underwent no psychological evaluation and was in no mental place to engage with surrogacy. She has also never had a pregnancy before and so has no concept of herself or her feelings during a pregnancy.

• Importance — Surrogacy and pregnancy in general require strong, stable mental health. This is essential for the GC and IPs to have a healthy relationship.

Social support

• U.S. — GCs have to display strong social support from their own partner, family, friends, children, and professional relationships. They should not rely on the IPs for all their social support.

• ‘The Surrogacy’ — The GC character is literally isolated from all her family and friends and confined to a rural cabin with her only interactions being with the male IP, who then also forms a romantic relationship with her.

• Importance — Social support is a critical component to physical and mental health, and it is necessary for any pregnancy. Much of this can come from the IPs, who are encouraged in the U.S. to have a meaningful relationship with their GC, but it should not only be from them in order for the GC not to feel emotionally dependent.

Background checks

• U.S. — The GC, their immediate family, and anyone they live with undergoes a background check for any criminal or financial disclosures.

• ‘The Surrogacy’ — This was obviously not done given the coercion and overall illegal framework for the show.

• Importance — This is to ensure that both the GC and IPs are engaging in the arrangement where both parties are honest and informed.

Medical consent

• U.S. — The GC and IPs would have to discuss twins, and there are many agencies and clinics who do not implant multiple embryos because of the higher risk during such a pregnancy.

• ‘The Surrogacy’ — Not only was the GC character not informed of the twins at all, but all medical information was withheld from her, which as a physician, I have to say is all kinds of illegal and wrong.

• Importance — GCs should know and accept any risks in the pregnancy, and situations such as twins, selective reduction, and genetic testing (both before and after implantation) are all discussed openly so that all parties are informed.

In addition to the comparison above, I wanted to comment on the absurdity of the pressure on the GC in the show. The family keeps talking about how this is their ‘last chance’ given they only have these embryos left. However, if they are so affluent, why not just make more embryos? This makes no sense except to overly dramatize the story for the telenovela purposes.

While I do believe that the gross discrepancies between the United States and Netflix versions of surrogacy are not directly intended to vilify and attack surrogacy, it is unfortunate that this show has come at a time when surrogacy and family planning through these means is coming under threat, especially in Europe and for LGBTQ+ families. Italy has been the most targeted, actually trying to invalidate parental rights and remove LGBTQ+ parents from their children’s birth certificates earlier this year (https://theconversation.com/lgbtq-parents-are-being-removed-from-their-childrens-birth-certificates-in-italy-heres-whats-behind-this-disturbing-trend-208241 and https://www.ansa.it/english/news/general_news/2023/06/23/milan-court-annuls-birth-certificate-of-gay-couples-child_9370ec6d-5b35-4142-bc95-cad4d666955c.html). In March 2023, issues have also been raised in Spain over a celebrity who engaged with commercial surrogacy in the United States (https://www.reuters.com/world/europe/spanish-government-criticises-tv-celebrity-alleged-surrogacy-miami-2023-03-29/). I plan to write more about this trend in another article, but my perspective on these legal policies and news stories is that they are further fueled by the misinformation from Neflix’s ‘The Surrogacy.’ I believe that surrogacy — both altruistic and commercial — should be legal and well-regulated. These practices are going to happen, and by regulating them, they are made safe and effective for all parties involved. Vague regulations or all-out bans are not going to do anything except force people to go to other places. Even if they do go to other places — and people will do what they have to in order to have a family — then what happens when they come home and their rights and abilities to function as parents are hampered by legal challenges in their own country?

There is much more to discuss with the evolving surrogacy regulations throughout the world. However, I strongly urge Netflix and the creators of ‘The Surrogacy’ to move away from sensational topics that are actually extremely sensitive and complicated, as shows like this do nothing but damage the hope that people all over the world have of starting and having a family of their own.