Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities

Child adoption in the face of reproduction gone awry continues to remain an under researched aspect of contemporary Indian reality. This paper seeks to unpack some of the critical cultural issues underscoring the deep-seated reluctance towards adoption. Drawing on a larger multi-sited research project examining the experience of infertility and assisted conception in India, the paper sheds light on the state of current adoption practices in India. Thus, when faced with infertility, couples in this research emerged as favouring secret gamete donation as a means of bypassing infertility rather than the option of adoption. Invoking the concept of systematic misrecognition, the paper situates the modalities of salvaging infertility, either through medically assisted conception or adoption, as structuring infertile people's quest for children. The paper relates the perceived stigma associated with infertility treatment and adoption with the inclusion of a "third party" that fractures the culturally conceptualized boundaries of family as inextricably tied to the conjugal bond. It is therefore argued that secrecy is born out of a need to obfuscate a "public and visible" violation of a culturally priced ideal that views an intimate connection between the "married body" and the progeny. Adoption continues to remain an undesirable option because the links between an adopted child and the social parent become a public, vocal, and visible admission of infertility that cannot be subsumed, like donated gamete conception, under a conspiracy of silence.

A group-work approach in family building by donor insemination: empowering the marginalized

Family building with donor insemination (DI) is often perceived as stigmatizing and the secrecy surrounding the practice contributes to this perception. In recent years, patient organizations in several countries have started to challenge this stigma and marginalization. This paper reports on a professional group-work approach for couples in Germany using DI. Participants of four seminars with a total of 74 participants and a return rate of 89% were asked to report on their expectations of and experiences during the seminars. Participants were asked to comment on their views and perspectives regarding DI practice. The results indicate a need for more information on DI and for the opportunity to meet other couples in the same situation. Participants also argued for normalization and social acceptance for families built by DI. The group-work approach described in this paper contributes significantly towards fulfilling the needs of couples involved in DI.

Counselling lesbian couples: requests for donor insemination on social grounds

Fertility centres are increasingly involved in dealing with requests from lesbian couples for donor insemination (DI). Data were collected on 95 Belgian lesbian couples who applied for DI. The majority of couples were well integrated in a social environment (family, friends and work) that consisted mainly of heterosexuals. They tended to be open about their homosexuality and most couples considered the social environment to be tolerant towards their homosexual orientation. Couples who considered alternatives to DI would have liked to have had more information on the donor and were more inclined to introduce a 'godfather' who would take special interest in the child. Couples who considered DI to be the best solution considered the absence of a father to be less of a problem for the child and wished to have no information at all as regards the donor. Approximately half the couples considered their family a two-mother unit. For the other couples, the family unit consisted of a mother and her partner who shared parental responsibility for the child equally. The issues that are considered important to cope with and on which lesbian couples should be counselled are presented in the discussion.

What does it mean for youngsters to grow up in a lesbian family created by means of donor insemination?

In many countries fertility services still refuse to inseminate lesbian couples because they believe the child's welfare would be at stake. One of their concerns is that these children will be stigmatized because of their non-traditional family structure. In this follow-up study, we interviewed children from lesbian donor insemination (DI) families about how they present their 'non-traditional' family to people in their immediate social environment. We also explored whether or not children were teased or harassed about their lesbian family and whether or not coping with a non-traditional family constellation was reflected in their psychological well-being. According to this study, almost all children from lesbian DI families share the fact that they live in a two-mother unit spontaneously with close friends who react positively. Others are only informed about the non-traditional family structure when they ask questions about it. From the children's answers, we can conclude that for some peers it is hard to understand that someone can have two mothers without having a father somewhere. Compared with children from heterosexual families, these DI children are not more likely to be teased but they are more prone to family-related teasing incidents. However, introducing their non-traditional family into their peer group does not seem to interfere with their psychological well-being. Nonetheless, teachers indicate that children from lesbian families experience more attention problems compared with children from heterosexual households.

[The importance of the physician after successful artificial insemination by donor]

A treatment by artificial insemination by donor because of male infertility represents a drastic experience for the affected couples. Imaginations concerning the importance of the anonymous donor or the physician were already picked out as a central theme in the past. In some studies, for example, these imaginations were thought to have an adverse effect on the satisfaction in the partnership as well as for the development of the child. Aim of the examination on hand was the current meaning of the treating physician six years after treatment and his position in the self-system of the couples concerned. 15 successful couples could be examined by Repertory Grid method. The results of this study showed, that the physician had no prominent meaningfulness for the couples six years after the therapy. In the analysis of the self-system of the couples, gender specific differences could be seen. In the self-system of the treated women, the physician had a position close to their self and their ideal-self. This position was influenced by the self-esteem of the women. A higher self-esteem was associated with a greater closeness to the physician as well as to their partner. The analysis of the self-esteem of the affected men showed a completely different pattern. The greater the self-esteem of the male patients, the greater the devaluation of the physician, which showed in a greater distance to their ideal-self. The gender specific perceptions of the inseminating physician can be interpreted as specific adaptations to different coping requirements.

[May Medically Assisted Procreation (MAP) be relevant for homosexual women? Study among 147 gynaeco-logists involved in MAP techniques]

The second part of the twentieth century has seen societal modifications as well as evolution of medical techniques allowing now thinking human procreation in terms of choices or even rights. Certain voices require sometimes Medically Assisted Procreation (MAP) for lesbians. Even though society did not allow such a possibility in France, it seemed interesting to question about it professionals actively involved in the use of MAP techniques. Through systematic internet queries, we obtained a list of one hundred private or public french medical institutions with a unit for the treatment of sterility. A telephone call to their secretary allowed us to individualize those doctors who did practice MAP. A sample of 147 medical doctors practicing MAP was then drawn. They were questioned with a clinical instrument including 20 ended-questions in order to assess their opinions on: homosexual women with a desire of a child; possibility for these clinicians to intervene with a donor insemination in such situations; developmental risk for such children. One hundred twenty five (85%) accepted to answer. Nine percent of these gynaecologists still consider homosexuality as pathological, and 10% as deviant - contrary to international classifications of mental disorders - and 5% deny good maternal abilities to homosexual women. Before the so-called french laws of bioethics in 1994, none of them had practiced a donor insemination for a lesbian couple, though 4% had realized some for single homosexual women. Two third of them do not agree opening donor insemination to homosexual women though for half of them, the anonymity of a donor is not perceived as prejudicial to the child. Eighty-seven percent of these gynaecologists think that a child brought up by homosexual parents is at risk for developmental disorder, the configuration supposed the most pathogenic being when the birth results from a donor insemination. The supposedly most important risk factors are thought to be the marginality of an homosexual family and the lack of a paternal figure at home. However, for 68% of the clinicians, this role can be taken by another male figure. These reasons make the gynaecologists reluctant to participate actively in the constitution of such a kind of family by the practice of a donor insemination. Even though demands of lesbian couples were not listed as an indication of donor insemination in the laws of bioethics, this does not seem to lessen the number of these demands in this population, and moreover if the law would allow this indication, half of these doctors would agree to practice it. The expression of the desire of a child by homosexual women and their request for its realization through medical techniques places the clinicians at the center of an ethical reflexion fed more by personal affects rather than scientific studies - however available - on the development of children brought up by an homosexual couple. Indeed, these studies indicate that these children suffer more from a societal view than parental sexual orientation, and it seems therefore appropriate to shed light on it in order to alleviate the weight of a stigmatization without any clinical argument founding it until now.

When transgressions become transparent: limiting family forms in assisted conception

This article explores the social processes through which ideas about the family become translated into regulation and practice in assisted conception. Drawing on social problems literature, it is suggested that claims are made (by regulators, practitioners and others) about the desirability of certain family types and that forms of regulation occur when families transgress, in particularly obvious ways, the boundaries of those definitions. The apparently disparate examples of lesbian access to donor insemination and donor anonymity are brought together to illustrate the argument. It is also suggested that much formal regulation and clinical practice is directed towards making such transgressions less transparent, thus protecting the practice of assisted conception from unwelcome scrutiny.

Physiognomy, familism and consumerism: preferences among Jewish-Israeli recipients of donor insemination

This paper examines the physiological preferences of Jewish-Israeli donor insemination (DI) recipients regarding the desirable donor. (1) By comparing recipients' own physiognomy with that of a hypothetical donor, we explore some of the social potentials of DI in its emerging democratized form. We examine prevailing notions regarding the 'natural family' and 'family resemblance' and query the relative weight of the natural vs. the consumer model as applied to one's own family through considerations regarding physical appearance. While examining the 'natural family' concept as a limit in the making of actual Israeli families, we consider the meanings of choice in the context of procreative technologies. The study may also provide practitioners with relevant information for donor matching. The paper is based on questionnaires delivered in four sperm banks during the years 1995-1998. It is important to note that the preferences we study are hypothetical, as in Israel no choice is offered and donor matching is performed exclusively by doctors. (2) Three comparisons serve as vehicles for characterizing the gaps between the natural and the consumer model: women's preferences regarding the donor's appearance vs. their male partners' appearance; men's preferences vs. their own features; single women's preferences vs. those of married ones. The paper ends with a discussion of the social implications of democratized DI on family, gender power relations and social hegemony.

[Invisible fathers: child development and family dynamics after heterologous insemination]

This study presents the long term outcome of the psychotherapy of a girl over seven years, which was born after donor insemination (DI) and aged eight became ill with a compulsive disorder. Aspects of child development, communication within the family and family dynamics related to this specific constellation are pointed out. This case-study presents one of the very few supplements to statistic data elaborated about assitsed-reproduction-families. Implications for individual therapy and therapeutic management of the family are discussed according to development of bonding and identity of the DI-child, father's role, dynamics of the couple and the incognito of the "invisible father".

Toward a family-building approach to donor insemination

Donor insemination (DI) is the oldest and simplest method of "treating" male infertility. The medical profession, prospective parents, legislators, and society in general are increasingly recognizing that providing DI services involves far more than facilitation of conception. This paper explores a multidisciplinary family-building approach to DI as an alternative to a treatment-of-infertility approach, and describes the need to provide patients with a broader and deeper preparation for this special type of parenthood. The short-term medical ease of the procedure is contrasted with the complexity and seriousness of the long-term social and psychological issues generated for the gamete provider, the recipient couple, and the offspring by the secrecy surrounding the procedure.

Donor insemination: eugenic and feminist implications

One concern regarding developments in genetics is that, when techniques such as genetic engineering become safe and affordable, people will use them for positive eugenics: to "improve" their offspring by enpowering them with exceptional qualities. Another is whether new reproductive technologies are being used to improve the condition of women or as the tools of a patriarchal system that appropriates female functions to itself and exploits women to further its own ends. Donor insemination is relevant to both of these issues. The degree to which people have used donor insemination in the past for positive eugenic purposes may give some insight into the likelihood of developing technologies being so used in the future. Donor insemination provides women with the opportunity to reproduce with only the most remote involvement of a man. To what degree do women take advantage of this to liberate themselves from male dominance? Through questionnaires and interviews, women who have used donor insemination disclosed their criteria for selecting sperm donors. The results are analyzed for the prevalence of positive eugenic criteria in the selection process and women's attitudes toward minimizing the male role in reproduction.

Donor insemination in Israel. Recipients' choice of donor

OBJECTIVE

To study the physiognomic preferences of Israeli Jewish recipients of donor insemination.

STUDY DESIGN

Donors were "scaled" by both their general popularity and their popularity among single women and married recipients. Following this procedure, the donors' physiognomic features were analyzed and interpreted in terms of Israel's sociopolitical system and the influences of the media.

RESULTS

The preferred donor was an educated Ashkenazi Jew who was about 180 cm tall and weighed 72 kg, with straight, light-brown hair and light-colored eyes. This profile deviates from the average features of Israeli men, who are significantly shorter and heavier. The recipients' preferences were noticeably homogeneous, with relatively minor differences between Oriental and Ashkenazi recipients.

CONCLUSION

The recipients' preferences reproduce Israel's class system, in which the Ashkenazi section is dominant. They also are influenced by the media and adopt prevailing body images.

Donor insemination in Israel: sociodemographic aspects

The paper describes the sociodemography of donor insemination recipients in Israel. Arab recipients are very few. Among the Jews, married recipients are generally younger than their single counterparts, and they are somewhat less educated and more religious. Ethnically, the percentage of Orientals among the married recipients is relatively higher; among the single women, Orientals are under-represented. On the whole, however, donor insemination seems to have reached Jewish Israelis of all segments of society.

[The secrecy aspect of donor insemination]

A literature review among couples treated with donor insemination (DI) showed that almost all participants had planned not to inform the child that this treatment had taken place. Many of the couples had told other people about the treatment, and thus opened up the possibility of a traumatic disclosure. Though secrecy about DI treatment could be taxing for the couple, this strain did not negatively influence the assessment of the relationship, parenthood, or the parent-child relation. Psychosocial development of DI-children was not different from other children's development. It was not possible to show a deleterious effect of keeping the treatment a secret. There is a lack of qualitative studies about the consequences of secrecy for the relationship between DI-parents, for parenthood and for the child. Only one study included adult DI-children.

Review: parent-child relationships and child development in donor insemination families

The present article reviews the empirical research regarding the parent-child relationships and the development of children in donor insemination (DI) families. Over the years, follow-up studies have appeared sporadically and, despite the varying quality of the research methods, preliminary findings have emerged. Heterosexual DI parents were psychologically well adjusted and had stable marital relationships. DI parents showed a similar or higher quality of parent-child interaction and a greater emotional involvement with their children compared with naturally conceived families. The majority of studies which investigated several aspects of child development found that, overall, DI children were doing well. Findings with regard to emotional/behavioural development, however, were divergent in that some studies identified an increase of such problems while others did not. A steadily growing group within the DI population is lesbian mother families. More recently, follow-up studies have been carried out among DI children who were raised from birth by two mothers. Despite many concerns about the well-being of these children, no adverse effects of this alternative family structure on child development could be identified. As the DI children in all investigations were still young, our knowledge about the long-term effects of DI remains incomplete.

What does it mean to be a donor offspring? The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy

In the absence of research with adult donor offspring, this study begins to bridge that gap by asking individuals about their experiences as donor offspring and considering the implications for psychotherapeutic and counselling practice. Sixteen participants (13 male, three female, age range 26-55 years) recruited through donor insemination support networks in the UK, USA, Canada and Australia, were sent semi-structured questionnaires by E-mail and post. Using identity process theory as a framework for understanding participants' accounts, the data were qualitatively analysed using interpretative phenomenological analysis. Participants consistently reported mistrust within the family, negative distinctiveness, lack of genetic continuity, frustration in being thwarted in the search for their biological fathers and a need to talk to a significant other (i.e. someone who would understand). These experiences could be postulated as being indicative of a struggle to assimilate, accommodate and evaluate information about their new identities as donor offspring. Psychotherapists and counsellors need to be aware of these identity issues if they are to meet the needs of donor offspring within therapeutic practice.

Disclosure of donor insemination to the child: the impact of Swedish legislation on couples' attitudes

The question whether or not parents of children conceived after donor insemination (DI) tell their offspring about its biological background was addressed. Swedish legislation from 1985 gives the child born after DI the right, when grown up, to receive identifying information about the sperm donor. Until now no information about compliance with the law has been available. All parents who gave birth to a child by DI after the new legislation in two major Swedish fertility centres (Stockholm and Umeâ) received a questionnaire containing questions about the issue of informing the child. The response rate was 80%. The majority of parents (89%) had not informed their children, whereas 59% had told someone else. As a response to an open question, 105/132 parents chose to comment on their answer about not having informed their child. Of these families, 61 intended to tell their child later, 16 were not sure and 28 were not going to inform the child. Compliance with the law must be regarded as low since only 52% of the parents had told or intended to tell their child. In addition, concern is raised about the children who run the risk of being informed by someone other than their parents.

Motivation, attitudes and experience of donation: a follow-up of women donating eggs in assisted conception treatment

This paper reports a follow-up of 39 women who had donated eggs to an assisted conception unit. Their experience of donation and their motivation and attitudes were assessed. Comparisons were made with a group of semen donors who were attending a second unit. Female and male donors donated for altruistic reasons and neither group wished to have contact with recipients or donor offspring or have their identity revealed. Female donors were more involved in the donation process and more interested in the outcome of donation. They also appeared to be more motivated by 'helping' than male donors. The sample of female donors contained a small group of women who were donating to sisters and friends. In comparison with anonymous donors, these women reported more effects upon the family and issues of secrecy and openness were more apparent. The results are discussed in the light of previous studies and the legal framework for donation in the UK. Attention is drawn to the lack of social psychological analyses in this controversial medical area.

Psychosocial adjustment among children conceived via donor insemination by lesbian and heterosexual mothers

This study examined the relations among family structure (e.g., number of parents, parental sexual orientation), family process (e.g., parents' relationship satisfaction, interparental conflict), and the psychological adjustment of children who had been conceived via donor insemination. The 80 participating families, all of whom had conceived children using the resources of a single sperm bank, included 55 families headed by lesbian and 25 families headed by heterosexual parents. Fifty families were headed by couples and 30 by single parents. Participating children averaged 7 years of age. Results showed that children were developing in normal fashion, and that their adjustment was unrelated to structural variables such as parental sexual orientation or the number of parents in the household. These results held true for teacher reports as well as for parent reports. Variables associated with family interactions and processes were, however, significantly related to indices of children's adjustment. Parents who were experiencing higher levels of parenting stress, higher levels of interparental conflict, and lower levels of love for each other had children who exhibited more behavior problems.