The "natural" in the artificial: Surrogates’ reproductive literacy in navigating the health care system

This study examines how demographic changes among Israeli surrogates have transformed their approaches to medical authority and bodily autonomy within the surrogacy process. We explore the changing medical experiences of second-generation Israeli surrogates, marking a significant new trend that differs from earlier approaches. To this end, we conducted narrative interviews with 47 retired surrogates in Israel between July 2022 and March 2023, employing qualitative methodology and inductive thematic analysis. While first-generation surrogates typically embraced medicalization to create distance between themselves and the pregnancy, our findings demonstrate that contemporary surrogates actively integrate their natural reproductive capabilities into surrogacy protocols. This research suggests that demographic changes—from single mothers with lower socioeconomic status to predominantly middle-class, educated married women—have reshaped surrogate agency. Consequently, we introduce two key concepts: "repro-tech literacy," the specialized knowledge that surrogates acquire to navigate ART along with their embodied knowledge, and "hybrid model of reproduction," where surrogates strategically combine medical advancements with natural capabilities. Contemporary surrogates actively negotiate various medical aspects, including hormonal treatments, embryo transfers, and delivery methods, often challenging standardized protocols that they perceive as unnecessary for IVF patients without reproductive constraints. This research presents new theoretical frameworks that advance our understanding of surrogate agency in reproductive medicine and challenge existing paradigms of medicalization in third-party reproduction. Our findings reflect a broader cultural shift toward selective medicalization and have practical implications for developing more ethical, patient-centered approaches to third-party reproduction.