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Domene FM, Silva JDLD, Toma TS, Silva AD, Gomes R. Reproduction in cisgender same-sex couples: a scoping review. CIENCIA & SAUDE COLETIVA 2024; 29:e18172023. [PMID: 38655957 DOI: 10.1590/1413-81232024294.18172023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 04/26/2024] Open
Abstract
The aim of this article is to present the state of the art, in the field of public health, on cis homoparental reproduction, from 28 studies addressing barriers to reproduction by homoparental couples for legal, ethical, technical or economic reasons, in addition to prejudice and discrimination. Six studies addressed facilitators, such as receptiveness in services, availability of conception and contraceptive methods and training of health professionals. The results show that the discussion has focused more on the barriers than on the facilitating factors. This may indicate a continuing need to problematise the hegemonic model of a heterosexual, nuclear family.
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Affiliation(s)
- Fernando Meirinho Domene
- Núcleo de Evidências (NEv-IS), Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo. R. Santo Antonio 590. 01314-000 São Paulo SP Brasil.
| | - Jessica De Lucca Da Silva
- Núcleo de Evidências (NEv-IS), Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo. R. Santo Antonio 590. 01314-000 São Paulo SP Brasil.
| | - Tereza Setsuko Toma
- Núcleo de Evidências (NEv-IS), Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo. R. Santo Antonio 590. 01314-000 São Paulo SP Brasil.
| | - Adriano da Silva
- Departamento de Estudos sobre Violência e Saúde Jorge Careli, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Romeu Gomes
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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2
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Gomes R, Toma TS, Silva JDLD, Domene FM, da Silva A. Homoparenting as a public health issue: a scoping review. Rev Saude Publica 2023; 57:80. [PMID: 37937654 PMCID: PMC10609659 DOI: 10.11606/s1518-8787.2023057005447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To map global scientific production on homoparenting in the field of collective health or public health. METHODS In terms of methodological procedures, a scoping review was carried out, guided by the following question: What are the aspects addressed in global scientific production regarding homoparental families in the field of collective or public health? The searches were carried out in seven sources of scientific literature, including 58 studies, involving scientific articles and dissertations. The analytical treatment given to the studies, most of which were qualitative, followed the content analysis technique in the thematic modality. RESULTS The results indicate that the perceptions of homosexuals and professionals about the care provided and health services in general was the topic addressed by the largest number of studies (n = 31), followed by heteronormative context of health services (n = 26); disclosure of sexual orientation (n = 20); fertilization (n = 14); educational information and actions (n = 5). CONCLUSION Although the issue of same-sex parenthood has been discussed in some health sectors, there is awareness that it is necessary to rely on a consolidated basis through numerous studies when discussing this issue. It is concluded that, among other aspects, the scope of this review is not sufficiently problematized within the scope of health professionals' training and performance.
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Affiliation(s)
- Romeu Gomes
- Fundação Oswaldo CruzInstituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes FigueiraDepartamento de EnsinoRio de JaneiroRJBrazil Fundação Oswaldo Cruz
.
Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira
.
Departamento de Ensino
.
Rio de Janeiro
,
RJ
,
Brazil
- Hospital Sírio-LibanêsDiretoria de Compromisso SocialSão PauloSPBrazil Hospital Sírio-Libanês
.
Diretoria de Compromisso Social
.
São Paulo
,
SP
,
Brazil
.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeNúcleo de EvidênciasSão PauloSPBrazil Secretaria de Estado da Saúde de São Paulo
.
Instituto de Saúde
(NEv-IS).
Núcleo de Evidências
.
São Paulo
,
SP
,
Brazil
| | - Jessica De Lucca Da Silva
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeNúcleo de EvidênciasSão PauloSPBrazil Secretaria de Estado da Saúde de São Paulo
.
Instituto de Saúde
(NEv-IS).
Núcleo de Evidências
.
São Paulo
,
SP
,
Brazil
| | - Fernando Meirinho Domene
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeNúcleo de EvidênciasSão PauloSPBrazil Secretaria de Estado da Saúde de São Paulo
.
Instituto de Saúde
(NEv-IS).
Núcleo de Evidências
.
São Paulo
,
SP
,
Brazil
| | - Adriano da Silva
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sergio AroucaDepartamento de Estudos sobre Violência e Saúde Jorge CareliRio de JaneiroRJBrazil Fundação Oswaldo Cruz
.
Escola Nacional de Saúde Pública Sergio Arouca
.
Departamento de Estudos sobre Violência e Saúde Jorge Careli
.
Rio de Janeiro
,
RJ
,
Brazil
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3
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Rausch MA, Wikoff HD. Protective Relational Factors of Lesbian Couples Navigating the Fertility Process. JOURNAL OF HOMOSEXUALITY 2023; 70:1725-1742. [PMID: 35179456 DOI: 10.1080/00918369.2022.2042660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Little research about lesbian couples' experiences with fertility treatment exists in the counseling literature. While there is an increase in lesbian couples exploring fertility options to expand their families, it is important to understand their experiences during this stressful process. This research seeks to understand these experiences using Moustakas' Imaginative Variation method with seven lesbian couples. Results include feelings of isolation, psychological and physical stress. Despite myriad difficulties associated with assisted reproductive technology, participants' experiences show the presence of strong relationship factors, divided into three categories: connectedness, mutuality, and resilience. The use of Relational Cultural Theory may be helpful to lesbian couples looking to expand their families through reproductive methods.
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Affiliation(s)
- Meredith A Rausch
- Department of Advanced Studies and Innovation, Augusta University, Augusta, Georgia, USA
| | - Haley D Wikoff
- Department of Counselor Education and College Student Personnel, Western Illinois University, Macomb, Illinois, USA
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Brandão P, Ceschin N, Gómez VH. The Pathway of Female Couples in a Fertility Clinic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:660-666. [PMID: 35668678 PMCID: PMC9948101 DOI: 10.1055/s-0042-1744444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study aims to describe the main characteristics of female couples resorting to a fertility clinic, to understand whether these patients have clear previous plans concerning procreation and how they end up completing their family planning, and to briefly describe the main outcomes of the recepción de ovocitos de pareja (ROPA, in the Spanish acronym: in English, reception of partner's oocytes) method. METHODS This is a descriptive retrospective study of the pathway and outcomes of female couples in a fertility clinic during a 2-year period. RESULTS A total of 129 couples were treated. Only one third of the couples had no condition potentially affecting fertility or advanced age. Most couples were decided to undergo artificial insemination or in vitro fertilization and the majority kept their plans, as opposed to 38% of the couples who decided to the ROPA method (lesbian shared in vitro fertilization) who changed plans. Live birth rates per treatment (including frozen embryo transfers) for artificial insemination, 58% for in vitro fertilization, 80% for treatments with donated oocytes or embryos, and 79% for ROPA. Four in five couples achieved live births. CONCLUSION The present study highlights the importance of a thorough medical workup in same-sex couples resorting to assisted reproduction. Despite the higher-than-expected rates of fertility disorders, the outcomes were good. Most couples end up in a single parented method. Furthermore, the results of the ROPA method are reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, IVIRMA Global Valencia, Valencia, Spain.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nathan Ceschin
- Department of Reproductive Medicine, Feliccità Instituto de Fertilidade, Curitiba, PR, Brazil
| | - Victor Hugo Gómez
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, IVIRMA Global Valencia, Valencia, Spain
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Gregory KB, Mielke JG, Neiterman E. Building Families Through Healthcare: Experiences of Lesbians Using Reproductive Services. J Patient Exp 2022; 9:23743735221089459. [PMID: 35372679 PMCID: PMC8966110 DOI: 10.1177/23743735221089459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The use of assisted human reproduction (AHR) represents a meaningful and important life event for lesbians wishing to create biologically related families. Despite increasing numbers of lesbians utilizing AHR services, barriers to access persist. This qualitative study investigated the experiences of lesbians and their interactions with reproductive services in Ontario, Canada, where limited public funding is available for all AHR patients and where the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community makes up to 30% of clientele. Eleven semi-structured interviews were conducted, and findings revealed a wide range of experiences. Lesbian patients expressed a desire for more support from their care providers in navigating a complex and costly medical journey through a system largely designed for the needs of heterosexual patients. Additionally, private fertility clinics, as the environment for accessing publicly funded services, were felt to contribute pressure to pay out-of-pocket for add-on medical procedures. To improve the quality of care, participants recommended providing more high-level information on the medical journey and taking an individual approach with lesbian patients, in particular, assuming a patient has sufficient fertility until proven otherwise.
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Affiliation(s)
- Kelly B Gregory
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John G Mielke
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Elena Neiterman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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6
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Tao H. A desirable future or unaffordable hope? Queer people becoming parents through assisted reproductive technology (ART) in Guangdong, China. CULTURE, HEALTH & SEXUALITY 2022; 25:413-427. [PMID: 35294853 DOI: 10.1080/13691058.2022.2049879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Based on one-year's ethnographic fieldwork, this article unpacks experiences of assisted reproductive technology (ART) among queer parents and queer wannabe parents in Guangdong, China. Although existing state regulation on the use of ART and birth planning tends to deny parenthood to single and queer people and further limits their ability to form legible family units, queer parents who have had children through ART are growing in number in urban China. This research delineates how state and cultural conventions, together with market and economic conditions, have shaped queer individuals' decision making regarding whether, when and how to have children. Findings make an original contribution to studies of the use of reproductive technology in Chinese queer lives. Narratives regarding how queer parents employ ART services unscramble links between sexual citizenship and reproductive agency, as individuals make consumer choices and reproductive decisions synchronously. The paper also explores alleged LGBT-friendly ART companies and the image of a desirable 'rainbow baby' they have created. Chinese queer parents' participation in assisted reproduction has destabilised the dominant hetero-reproductive family matrix while simultaneously contributing to stratified reproduction.
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Affiliation(s)
- Han Tao
- Department of Anthropology, University of Sussex, Brighton, UK
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7
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Meier S, Ramos-Ortiz J, Basille K, D'Eramo AC, Diaconu AM, Flores LJ, Hottle S, Mason-Yeary K, Ruiz Y, DeMaria AL. Cross-border reproductive healthcare attitudes and behaviours among women living in Florence, Italy. BMC Health Serv Res 2022; 22:238. [PMID: 35189893 PMCID: PMC8862247 DOI: 10.1186/s12913-022-07621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of women living in Italy and seeking cross-border reproductive care (CBRC), especially for medically assisted reproduction (MAR), has increased. The purpose of this study was to explore CBRC attitudes and behaviours among a cohort of reproductive-aged women who have never engaged in CBRC to gauge social and cultural perceptions and gain a deeper understanding of family planning discourse. METHODS In-depth interviews were conducted during May - June 2018 with 30 women aged 18-50 living in or around Florence, Italy and enrolled in the Italian healthcare system. Interviews offered in-depth insight into CBRC attitudes, behaviours, and experiences among a cohort of women living in Italy who had never engaged in CBRC. Researchers used an expanded grounded theory through open and axial coding. Emergent themes were identified via a constant comparison approach. RESULTS Three themes and two subthemes emerged from the data. Participants discussed how limitations in Italy's access to MAR can lead women to seek reproductive healthcare in other countries. Women had mixed feelings about the effect of religion on legislation and reproductive healthcare access, with many views tied to religious and spiritual norms impacting MAR treatment-seeking in-country and across borders. Participants perceived infertility and CBRC-seeking as socially isolating, as the motherhood identity was highly revered. The financial cost of traveling for CBRC limited access and exacerbated emotional impacts. CONCLUSIONS Findings offered insight into CBRC perceptions and intentions, presenting a deeper understanding of the existing family planning discourse among reproductive-aged women. This may allow policymakers and practitioners to address social and cultural perceptions, increase access to safe and effective local care, and empower women in their family planning decisions.
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Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Jaziel Ramos-Ortiz
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA
| | - Kelsie Basille
- School of Nursing, Purdue University, West Lafayette, IN, USA
| | | | - Adria M Diaconu
- Department of Health & Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Lesley J Flores
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Savannah Hottle
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | | | - Yumary Ruiz
- Department of Public Health, Purdue University, 812 West State Street, West Lafayette, IN, 47907, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, 812 West State Street, West Lafayette, IN, 47907, USA.
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Fertility health information seeking among sexual minority women. Fertil Steril 2021; 117:399-407. [PMID: 34674826 DOI: 10.1016/j.fertnstert.2021.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To qualitatively explore and describe fertility information-seeking experiences of sexual minority women (SMW) couples using assisted reproduction. DESIGN Qualitative thematic analysis of 30 semistructured, in-depth individual and dyadic interviews with SMW couples. SETTING Video conferencing. PATIENT(S) Twenty self-identified lesbian, bisexual, and queer women comprising 10 same-sex cisfemale couples (10 gestational and 10 nongestational partners) using assisted reproduction technology in the United States. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) We describe how SMW came to learn about ways to achieve pregnancy through information seeking, acquisition, appraisal, and use. RESULT(S) Analysis revealed three primary themes. First, uncertainty and information scarcity: SMW have basic knowledge about how to conceive but uncertainty persists due to information scarcity regarding how same-sex couples navigate assisted reproduction. Second, women attempt to collect fragmented information from disparate sources. The participants discussed a mixture of formal and informal, online, textual (books), and in-person seeking, finding, and synthesizing information that ranged from reliable to unreliable and from accurate to inaccurate. Finally, persistent heteronormative communication focused on the needs and conditions of male-female couples who experienced subfertility or infertility, rather than barriers related to social constraints and the absence of gametes that SMW sought to overcome. CONCLUSION(S) These findings support and extend existing evidence that has focused primarily on online fertility information seeking. Our findings suggest that shifts in fundamental assumptions about who seeks assisted reproductive support and why, together with improvements in fertility-related health communication, may result in more inclusive care for this population.
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Fantus S. Experiences of gestational surrogacy for gay men in Canada. CULTURE, HEALTH & SEXUALITY 2021; 23:1361-1374. [PMID: 32876535 DOI: 10.1080/13691058.2020.1784464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
This paper reports on findings from a qualitative study that examined how Canada's socio-political context influenced gestational surrogacy for same-sex male couples. Semi-structured interviews were conducted with gay fathers and gestational surrogates to investigate supports and barriers of pursuing surrogacy. Questions explored publicly available information, policies and practices of fertility clinics and hospitals, post-birth resources and cultural attitudes regarding same-sex parenthood. Findings suggest that in Canada, a global leader in LGBT rights and inclusive same-sex parenting legislation, participants encountered inadequate same-sex inclusive resources and insufficient provider competencies. The aim of this study was to inform individual and institutional recommendations to counteract biases in fertility care and post-birth services. Following interview analysis, five key strategies were identified: (1) more accessible information on paths to same-sex parenthood; (2) more inclusive fertility clinic and hospital practices; (3) recognition of same-sex fatherhood in formal documentation; (4) post-birth resources such as formula feeding, play groups and first aid courses intended for same-sex parent families; and (5) shifts in cultural attitudes of same-sex parenthood and, specifically, gay fatherhood. Approaches that subvert heteronormative discourses embedded in fertility and reproduction are required to legitimise and support same-sex parent families.
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Affiliation(s)
- Sophia Fantus
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Social Work Complex, University of Texas at Arlington, Arlington, TX, USA
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Cultural competence in fertility care for lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider perspectives. Fertil Steril 2021; 115:1294-1301. [PMID: 33610322 DOI: 10.1016/j.fertnstert.2020.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To characterize the patient and provider perspectives on cultural competence in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) fertility care. DESIGN Systematic review. SETTING Not applicable. PATIENT(S) LGBTQ+ patients and their partners treated for fertility-related care; fertility providers who treat LGBTQ+ patients. INTERVENTION(S) We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of six databases: Medline-OVID, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.Gov, and PsycInfo. Citations of full-text articles were hand-searched using the Scopus database. Eligible studies were assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices, as well as the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. All screening, extraction, and appraisal were completed in duplicate with two independent reviewers. MAIN OUTCOME MEASURE(S) Patient-reported or provider-reported views on LGBTQ+ cultural competence in fertility care, including barriers and facilitators to inclusive care. RESULT(S) Of the 1,747 original database citations, we included 25 studies that met the inclusion criteria. Of the 21 studies that evaluated patient perspectives, 13 studies targeted same-sex cisgender couples while the remainder targeted transgender and gender-nonconforming participants (n = 6) or any individual who identified as a sexual or gender minority (n = 2). Key barriers for LGBTQ+ participants included gender dysphoria, heteronormativity, stigmatization, and psychological distress. The lack of tailored information for LGBTQ+ populations was repeatedly highlighted as a concern. Promising solutions included tailored information, psychosocial interventions, gender-neutral language, and inclusive intake processes. CONCLUSION(S) LGBTQ+ individuals face unique barriers in fertility care, as described by both patients and providers. This review describes a number of implementable solutions for equitable care, which should be given priority for both research and hospital interventions.
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