Procreative consciousness in a global market: gay men's paths to surrogacy in the USA

Having children in cross-border contexts: late-family formation among homoparental families in Spain

Considered until recently unfit to rear children, non-heterosexual people have been excluded from forming families in most countries. Many, worldwide, demand access to family formation, claiming the same aptitudes as heterosexual people for raising children. However, when non-heterosexual singles and couples want to become parents in Spain, they must consider transnational contexts, resorting to inter-country adoption or surrogacy abroad, processes that contribute to delay their family formation. They must consider not only Spanish sociocultural conditions, but other countries' legal restrictions regarding parents' gender, social status, and sexual identity. These families experience great difficulty in gaining access to reproductive health services. Based on multi-site ethnographic fieldwork, this text addresses how, despite legislative changes allowing homoparental family formation in Spain, these parents must overcome complex bureaucratic processes when they decide to have children, while facing homophobic attitudes and policies in their quests to become parents.

The Surrogacy Regulation Act of 2021: A Right Step Towards an Egalitarian and Inclusive Society?

With the advent of major scientific and technological advancements in obstetrics and gynecology, surrogacy is quickly becoming a viable alternative to enable people of all genders to become parents. However, its path toward reality is still fraught with legal and ethical dilemmas. With the Surrogacy Act of 2021 coming into effect earlier this year, the present article aims to dissect the various legal nuances involved while also considering the societal norms governing the actual scenario at ground zero. Our review discusses the aspects of eligibility criteria, the health implications, the rights of the surrogate mother and the child born, the financial burden, and compensation. We aimed to bring attention to this act and its implications on marginalized segments of society, with an attempt to bring beneficial changes for them. In this review, we provide viable alternatives adopted across the globe to solve the identified issues to make the present act non-discriminatory and more rewarding to all involved beneficiaries.

Birth includes us: Development of a community-led survey to capture experiences of pregnancy care among LGBTQ2S+ families

BACKGROUND

Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender-minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss.

METHODS

We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi-stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience.

RESULTS

The final survey instrument spans the perinatal care experience, from preconception to early parenthood, and includes items to capture experiences of care across different pregnancy roles (eg, pregnant person, partner/co-parent, intended parent using surrogacy) and pregnancy outcomes (eg, live birth, stillbirth, miscarriage, and abortion). Three validated measures of respectful perinatal care are included, as well as measures to assess experiences of racism, discrimination, and bias across intersections of identity.

DISCUSSION AND CONCLUSIONS

By centering diverse perspectives in the review process, the Birth Includes Us instrument is the first survey to assess the range of experiences within LGBTQ2S+ communities. This instrument is ready for implementation in studies that seek to examine geographic and identity-based perinatal health outcomes and care experiences among LGBTQ2S+ people.

Queer decisions: Racial matching among gay male intended parents

How does race and location shape the reproductive decisions of gay men who are intended parents? In this article, we propose the concept of strategic racialization to characterize the ways in which gay male parents employ racial matching in their selection of egg donors and surrogates in the United States and United Kingdom. We argue that racial matching is a strategy of stigma management. This study draws upon interview data from 40 gay male couples who formed families through surrogacy. We find that pre-conception fathers seek racialized resemblance to reinforce kinship between themselves and their children. In California and England, gay men seeking donor eggs engage in racial matching, which reveals that the racialized biogenetic model of kinship remains dominant. This study makes a significant contribution to the literature on race and queer family formation.

Correlates of Taiwanese Gay and Bisexual Men's Family-Building Preferences: A Mediation Analysis

This study investigated the role of filial piety, internalized homophobia, and desire for genetic relatedness with one's child in gay and bisexual men's family-building choice. A sample of 1,023 Taiwanese gay and bisexual men with a desire to have a child was recruited to complete an online survey that included the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and questions about desire for genetic relatedness with a child and acceptance of adoption and surrogacy. Mediation models, with desire for genetic relatedness as a mediator, were tested. The results show that those who chose surrogacy-only were older and had higher socio-economic status than those who selected adoption-only and both options. Filial piety and internalized homophobia were positively associated with the acceptance of surrogacy-only over adoption-only and both options. Desire for genetic relatedness mediated these relationships. This finding elucidates how sociocultural factors shape family-building preferences among gay and bisexual men.

Road of No Return: Uncertainty, Ambivalence, and Change in IVF Journeys in China

In this article, I present how in vitro fertilization (IVF) journeys become "bu gui lu" (a "road of no return") in China. I document the reproductive dilemmas intended parents encounter as they navigate and renegotiate the reproductive futures they desire throughout the process, and characterize the ambivalence caused by the space between individual struggles for conception and the wider demographic anxiety about national falling fertility rates. I argue that the ambivalence experienced by participants throughout their IVF journeys not only reveals the uncertainty they have about their reproductive futures and the ways to achieve them, but it also reflects the broader uncertainty of the demographic future of contemporary China.

First clinical report of 179 surrogacy cases in the UK: implications for policy and practice

RESEARCH QUESTION

What implications for policy and practice can be derived from outcomes and trends observed across 8 years of a surrogacy programme in two UK-regulated IVF centres (London, Cardiff)?

DESIGN

Retrospective cohort study analysing surrogacy treatments undertaken between 2014 and September 2021.

RESULTS

Surrogacy continues to rise in popularity in the UK despite the inability of those supporting safe and professional practice to advertise to recruit surrogates. In two IVF centres regulated by the Human Fertilisation and Embryology Authority (HFEA), both the number of surrogacy treatments and the proportion of those undertaken on behalf of same-sex male intended parents increased year on year in the period studied. From a cohort of 108 surrogates, 71 babies were born to 61 surrogates (with five pregnancies ongoing) by February 2022. No statistically significant difference in live birth rates (LBR) was observed between the heterosexual couples and same-sex male couples. Sample sizes of single and transgender intended parents were too small (n < 5) to compare. The use of vitrified oocytes in surrogacy treatments has increased year on year, while fresh oocyte use has declined since peaking in 2019. There was no significant difference in LBR between fresh and vitrified oocyte usage across the cohort.

CONCLUSIONS

The number of surrogacy treatments steadily increased, with clear evidence that the proportion of same-sex male couples accessing surrogacy is a major contributor to this growth. Vitrified/warmed oocyte use now outstrips the use of fresh oocytes in the surrogacy treatment cycles studied here. The results represent a strong basis for supporting the liberalization of regulatory reform expected to be introduced in the UK later in 2022.

The other side of the story: Intended parents' surrogacy journeys, stigma and relational reproductive justice

Current surrogacy research primarily focuses on commercial surrogacy with a particular emphasis on experiences of surrogate mothers, whereas intended parents' voices are dominated by western perspectives. Indigenous voices are only a whisper. This study presents another side of the surrogacy story by including the voices of intended parents residing in India, elicited through eight in-depth interviews. We assert there is need to understand Indian intended parents' socio-spatial experiences in the presence of a changing surrogacy law in India and the socio-cultural importance of childbearing and parenthood to move towards relational reproductive justice. By recognising the relational nature of surrogacy reproduction and drawing on the concepts of ethics of care in light of power and stigma discussions, this paper demonstrates how stigma is experienced by intended parents, its effect on their reproductive journey and wellbeing, as well as how stigma hinders achieving the vision of relational reproductive justice. We suggest that, in order to make surrogacy a positive experience for the people involved in surrogacy, there is a need to address stigma and view surrogacy as a relationship.

Discussing parenthood with gay men diagnosed with HIV: a qualitative study of patient and healthcare practitioner perspectives

BACKGROUND

Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate.

METHODS

Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care.

RESULTS

Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV.

CONCLUSIONS

Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.

O governo da gestação por substituição na era da biotecnologia: as biolegalidades cambiantes do parentesco

Resumo Este artigo examina como o direito interage com as mudanças biotecnológicas, olhando para a maneira em que, em processos de reprodução assistida, justificativas legais se relacionam com o conhecimento biológico e social que está redefinindo “pai” e “mãe”. Usando o conceito de “biolegalidade”, foco no surgimento de novas formas de parentalidade legal, analisando como a reivindicação por direitos pode ser baseada em verdades tanto genéticas quanto jurídicas. Ao contrário dos entendimentos convencionais em que “a lei se arrasta atrás da tecnologia”, o artigo visa demonstrar como o conhecimento jurídico interage com as tecnologias e as ciências da vida para rearranjar os próprios entendimentos sobre os direitos. A partir das práticas dos tribunais australianos em relação à legalização da paternidade de crianças nascidas de uma gestação por substituição no exterior, analiso argumentos e decisões de casos federais e locais, demonstrando como uma “abordagem de direitos humanos” promovida por juízes que agem no “melhor interesse de a criança” desestabiliza a aplicação de leis australianas locais que proíbem a gestação por substituição comercial.

Sexual identities and reproductive orientations: Coming out as wanting (or not wanting) to have children

In the context of growing visibility, recognition and acceptance of lesbian motherhood and gay fatherhood in countries such as Britain, it is important to ask how younger generations of sexual minorities approach the possibility of becoming a parent. Drawing on interviews with lesbians and gay men who do not have children but may have them in the future, I explore how people become aware that having children is an option. By attending to how this consciousness manifests in conversations and how conversations shape the consciousness, I illuminate specific dynamics that raising the topic of parenthood creates in intimate interactions. My data show that it is often unclear to men and women who form same-sex relationships whether they are socially expected to have children. I argue that this ambiguity requires a kind of 'coming out' through which feelings about parenthood are made explicit. Using the concept of coming out, I ask: What if we were to think of people in terms of their 'reproductive orientations' rather than sexual identities? I suggest that, similar to expressing sexual identities, articulating reproductive orientations involves aligning with particular life trajectories based on binary logic. However, with ambiguous expectations about parenthood, neither having children nor remaining childfree is explicitly normative. As such, unlike coming out as lesbian or gay, which transgresses norms surrounding sexuality, coming out as wanting or not wanting to have children challenges normativity itself. I reflect on how this 'normative challenge' makes it possible to imagine parenthood and 'childfreedom' as intimacies of equal value.

Cross-border reproductive care in the USA: Who comes, why do they come, what do they purchase?

This article explores the participation of non-US-resident patients/clients in the US reproductive market, garnering a picture of cross-border reproductive care (CBRC) into the USA by drawing on the existing literature, identifying the frequency of and motivations for such arrangements, the primary sending countries, and the reproductive services sought. I find that although the expense of US CBRC necessarily limits the patient/client pool, it is largely non-economic factors that drive CBRC into the USA. The US CBRC patient/client base, which is diverse in terms of national origin, race and sexual orientation, is recruited by the US fertility industry and drawn to the full range of assisted reproductive technology (ART) services, such as in-vitro fertilization, surrogacy, oocyte donation and preimplantation genetic screening/preimplantation genetic diagnosis, available in the US market which are often restricted or limited in their countries of origin. CBRC patients/clients enjoy the legal clarity for establishing parentage and citizenship for their children available in the USA, as well as what some view as a medically and ethically superior ART market.

Understanding Parenting Intentions Among Childfree Gay Men: A Comparison With Lesbian Women and Heterosexual Men and Women

Introduction

There is a growing interest in the parenting intentions of gay men. Prior research has found that gay men are less likely to become parents compared to their heterosexual and lesbian peers, but we know very little about why this discrepancy exists. Our first aim was to investigate whether the strength of parenting intentions is similar or different among childfree gay men compared to lesbian women, and heterosexual men and women. Our second aim was to explore the extent to which the theory of planned behavior (TPB) model (attitude, subjective norms, and self-efficacy) is universal in predicting the strength of parenting intentions across gender and/or sexual orientation.

Methods

The study was based on a United States cross-sectional, internet-based survey of childfree people who want to become parents in the future. The sample consisted of 58 gay men, 66 lesbian women, 164 heterosexual people (128 women and 36 men).

Results

A Bayesian ANCOVA showed no support for a gender difference in the strength of parenting intentions. Moderate evidence was provided for gay men and lesbian women reporting a similar strength of parenting intentions compared to their heterosexual peers. Bayesian linear regression analyses showed that perceived positive and negative life changes were stronger predictors of the strength of parenting intentions for men than for women. Perceived positive life changes predicted the strength of parenting intentions similarily across sexual orientations. For gay men and lesbian women, perceived parental acceptance of future parenthood was a weaker predictor of the strength of parenting intentions compared to heterosexual people.

Conclusion

Those who perceived parenthood as bringing positive life changes, especially for men, expressed stronger parenting intentions.