Father–child bonding and mental health in gay fathers using cross-border surrogacy during the COVID-19 pandemic

research question: what are the psychological implications of the COVID-19 pandemic for father–child bonding and mental health among Italian gay fathers pursuing surrogacy in the USA or canada? design: between 20 march and 29 July 2020, this cross-sectional case–control study collected data on father–child bonding quality, depression, anxiety and somatization in 30 Italian gay fathers (n=15 families) who were having or successfully had a child through cross-border surrogacy during the COVID-19 pandemic. these fathers were compared with a sociodemographically similar group of 50 Italian gay fathers (n=25 families) who had children through cross-border surrogacy prior to the pandemic. results: although father–child bonding quality and the mental health symptoms of fathers scored below the clinical cut-off points in both groups, fathers who had or were having a child during the COVID-19 pandemic reported poorer father–child bonding (estimate 3.04, SE 1.47, P=0.044) and more depressive (estimate –1.47, SE 0.49, P=0.005), anxious (estimate –1.96, SE 0.55, P<0.001) and somatic symptoms (estimate –2.48, SE 0.52, P<0.001). conclusions: the findings call for the development of international guidelines for cross-border surrogacy and underline the need for tailored and ongoing psychological and legal support for intended gay fathers to ease their strain and anxiety related to having a child through cross-border surrogacy during the COVID-19 pandemic.