Table 1.

Overview of coding, definitions, and reliability.

Themes	Definitions	Examples	K-Alpha	Agreement
Internalization (32)	The process by which an external experience of stigmatization becomes part of one’s internal representation of oneself	“I don’t know how my husband copes. What does he feel about my belly? I know I do it for our family, but I understand. I make him suffer.”	0.76	78%
Avoidance— Secrecy (123)	Concealing labeling information and keeping one’s reproductive status or choice a secret	“I do not say anything to friends; relatives do not know and will not find out. Even under torture, I will not tell any relatives about being an SM and how much I get paid. Only my husband and my doctor know. And you girls.”	0.82	91.7%
Avoidance— Withdrawal (234)	Dodging or avoiding interactions with people who might be prejudiced, or socializing primarily with others who are in similar situations	“After leaving my husband in the 2nd month of pregnancy, I moved to a biological mother spare apartment with my children. I talked with relatives on Skype—no one guessed anything: my belly was under the table, and my face “just got fatter.”	0.85	91.6%
Avoidance— Passing and/or covering (96)	The SM’s pregnancy cannot be hidden. Yet the SM presents it as a sign of another, less stigmatizing, attribute.	“I was pregnant in the winter. So yes, the neighbors noticed the growing belly. However, I told them that there was nothing to congratulate me on, that I was being treated with steroids. That’s why I was so swollen.”	0.80	80%
Challenging— Education (69)	Educating others to reduce stereotypes	“It was hard for me to persuade my husband. He was firmly against it. Like a woodpecker, I had the same conversation with him every day. I explained that this is a good thing, that this is helping people, that I will not sleep with anyone. I brought him brochures from the clinic, where everything is explained, and printed articles about surrogate motherhood for him. He was against it. He believed that we would be dishonored in the eyes of his relatives and would never get rid of the shame.”	0.88	93.3%
Challenging— resistance (87)	Challenging stigma by resistance and confronting the stigmatizing environment	“Everyone will be bothering me with the question— where is the child? Neighbors, mothers in the kindergarten, and relatives. I do not care. The main thing for me is to earn money for housing for my children and me, and I don’t care about others, even if I have to disclose it. Poker face and let the whole world wait.”	0.79	80%
Group identity (63)	Identifying more closely with other SMs and approaching the group for online support	“I use this support group every day. It is lovely to communicate with like-minded people, tell my thoughts, share the “secrets of surrogate motherhood” :-)). It is my shelter from my mad environment.”	0.89	91.3%