The practice of surrogacy has found itself at the centre of a fierce public debate in recent weeks, ignited by high-profile revelations and a deeply controversial legal case. With Lena Dunham announcing she used a surrogate to start a family, and the extraordinary saga of McKenna West — a gestational carrier who fled to Texas to avoid a legally requested termination — capturing national attention, the Guardian has spoken with women across the United States who have personally experienced the process. Their accounts paint a complex picture of choice, compensation, and the emotional realities behind one of the most polarised reproductive issues of our time.
A Conversation Reignited
The recent surge in public discourse around commercial surrogacy has been driven by two watershed moments. Dunham, the writer and actress, has spoken openly about her fertility struggles for years, detailing an Ehlers-Danlos syndrome diagnosis, nearly two decades of advanced endometriosis, and a total hysterectomy at the age of 31. Her 2026 book, Famesick, chronicles these battles at length, and her Vogue essay announcing her surrogate journey has drawn both support and fierce criticism.
Meanwhile, the case of McKenna West has raised profound questions about the legal and moral boundaries of gestational agreements. West, a surrogate carrying a child for intended parents, discovered the foetus had a congenital heart defect. When the biological parents requested an abortion, West refused, violating the terms of her contract. She subsequently fled to Texas, where abortion is banned, and gave birth to the child. She has since sought conservatorship, which would grant her a say in the child’s medical treatment. The US Supreme Court has declined to intervene, leaving the matter to play out in the courts.
Four Women, Four Perspectives
Liggia Spicer, a 34-year-old from upstate New York, first considered becoming a surrogate after learning about a close friend who had undergone a hysterectomy following cancer treatment and longed to have a child. After roughly two years of deliberation, she approached her husband with the idea. She eventually partnered with ConceiveAbilities, an agency that subjected her to what she described as a rigorous screening process — encompassing background checks, financial reviews, psychological evaluations, and a thorough examination of her labour and delivery history. Most programmes require that a woman has previously given birth before qualifying.
The agency provided her with legal representation to draft a surrogacy contract, a comprehensive agreement established before embryo transfer that outlines the rights of both parties. It covers insurance, medical expenses, liability for complications, and the intended parents’ involvement during medical appointments and delivery.
Spicer was compensated $67,000, paid in instalments across the duration of her pregnancy. She now works as a surrogate engagement coordinator at ConceiveAbilities.
Kristy Miller, a 38-year-old from Indianapolis who has served as a surrogate twice, also worked through ConceiveAbilities. She recalled the importance of autonomy during the matching process. “I remember feeling very strongly that I wanted there to be a trusting relationship,” she said. “I didn’t want to feel micromanaged. I didn’t want someone to be kind of dictating what I ate every day, or how I took care of myself.”
Christine S, a 38-year-old who declined to share her surname for privacy, carried and gave birth to a child for a same-sex male couple in 2025 through the New York Surrogacy Center. She received $45,000 for her time, in addition to having her medical and legal fees covered. Christine acknowledged that critics of commercial surrogacy raise legitimate concerns about reproductive exploitation, but argued that opponents are often poorly informed about how the process actually works in the United States.
“I think it’s just [that] they don’t understand enough about it,” she said. “Because there are situations where there are women that are held against their will to breed, right? Like that is a legit concern. But I volunteered. I didn’t do this against my will.” She described the arrangement as demanding yet rewarding — “a high-risk job, but it was also a high reward.”
Kimber Alston, a 36-year-old based in Texas, is currently pregnant with her fifth surrogate child and has been pregnant nine times overall. Her first experience was in 2018, carrying for a same-sex male couple in Italy. Since then, she has undertaken journeys both independently and through agencies, welcoming children who now live in Paris, Mexico, and cities across the globe. She works for a surrogacy agency she previously used as a client.
“What keeps me going is being able to help people have something that they couldn’t have otherwise,” Alston said. She described the emotional weight of watching intended parents arrive at match calls, often in tears. “I’m in these match calls and watching them cry and not be able to have a child of their own. I’m like: ‘If I could do it just one more time, I might as well just do it.'”
The Question of Bodily Autonomy
The McKenna West case has thrown a harsh light on a question that lies at the heart of surrogacy law: how much control does a gestational carrier truly have over her own body? West’s decision to refuse a termination and flee to a state with restrictive abortion laws placed her in direct conflict with the legal contract she had signed. Her subsequent bid for conservatorship adds another layer of complexity, potentially granting her medical decision-making authority over a child she carried but did not raise.
Spicer addressed this tension directly. “As surrogates, we do things that we may not do in our own pregnancies, but at the end of the day, it’s not our child,” she said. “As long as what we’re being asked is safe to do.”
Shattering the Stereotype
Perhaps the most persistent myth the interviewed surrogates encountered was the assumption that carriers form a maternal bond with the child they carry and might refuse to hand it over after birth. None of the four women interviewed had experienced anything remotely resembling this.
“I have never known a surrogate who felt like ‘mom’ to the baby [they were] carrying,” Miller said. “I think it’s hard for people to wrap their head around that unless they are truly considering [surrogacy].”
Spicer echoed this sentiment with characteristic bluntness. “Honestly, I tell a lot of girls who want to be surrogates: ‘You have to have a sense of humour. You have to just take things on the chin and laugh it off.’ You could tell them until you’re blue in the face: ‘I’m not attached to this baby,’ and they still just don’t understand.”
Critics of the practice have also argued that it commodifies women’s bodies, with social media users reacting to Dunham’s announcement by writing sentiments such as “Let’s not normalise buying humans” and “The concept of rich people renting poor people’s wombs will never not be strange.” Christine S acknowledged that such concerns are not entirely unfounded, but maintained that informed, voluntary participation fundamentally distinguishes the American surrogacy model from exploitative arrangements.
Why it Matters
The surrogacy debate is not a fringe issue confined to legal circles or reproductive rights forums — it touches on fundamental questions about bodily autonomy, economic inequality, and what it means to build a family in the modern era. As more public figures like Lena Dunham speak openly about their surrogate journeys, and as cases like McKenna West expose the fault lines in existing legal frameworks, the need for clear, compassionate, and comprehensive regulation becomes ever more urgent. The women interviewed here are not abstract symbols in a political argument; they are individuals who have made deliberate, informed choices to help others experience parenthood. Their voices deserve to be heard with nuance and respect, rather than reduced to slogans. Until the law catches up with the complexity of lived experience, stories like these will continue to remind us that behind every contract and every headline, there is a human being making an extraordinary decision.
