Tabitha Freeman, Susanna Graham, Fatemeh Ebtehaj, Martin Richards-Relatedness in Assisted Reproduction_ Families, Origins and Identities-Cambridge University Press (2014)

Relatedness in Assisted Reproduction

Assisted reproduction challenges and reinforces traditional understand-ings of family and kinship. Sperm, egg and embryo donation and sur-rogacy raise questions about relatedness for parents, children and otherpeople who may be involved in the conception, gestation and care of achild. How socially, morally or psychologically significant is a geneticlink between a donor-conceived child and their donor? What differencedoes it make if this link is with an egg donor or a sperm donor? Whatdoes it mean for a parent to be genetically unrelated to their child? Whatshould offspring born through assisted reproduction be told about theirorigins and is such information important for their identity? How iskinship experienced by men and women using collaborative reproduc-tion in heterosexual couples, same-sex couples or single-parent families?How does the wider cultural, socio-legal and regulatory context impacton these experiences?

This multidisciplinary book presents fresh insights into the key issueof relatedness in assisted reproduction. An international team of aca-demics and clinicians brings together new empirical research and arange of social science, legal and bioethical perspectives to explore thecomplex meanings of origins, identities and kin connections in assistedreproduction families.

tabitha freeman is a Research Associate at the Centre for FamilyResearch, University of Cambridge.

susanna graham is a Research Associate at the Centre for FamilyResearch, University of Cambridge.

fatemeh ebtehaj is an Associate Member of the Centre for FamilyResearch, University of Cambridge.

mar tin richards is Emeritus Professor of Family Research atthe Centre for Family Research, University of Cambridge, which hefounded and directed until 2005.

Relatedness in AssistedReproductionFamilies, Origins and Identities

Edited by

Tabitha Freeman, Susanna Graham,Fatemeh Ebtehaj and Martin Richards

University Printing House, Cambridge CB2 8BS, United Kingdom

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Library of Congress Cataloguing in Publication dataRelatedness in assisted reproduction : families, origins and identities / edited byTabitha Freeman, Susanna Graham, Fatemeh Ebtehaj and Martin Richards.

pages cmIncludes bibliographical references and index.ISBN 978-1-107-03828-8 (hardback)1. Reproductive technology. 2. Reproduction – Moral and ethical aspects.3. Relatedness (Psychology) I. Freeman, Tabitha, 1971– editor of compilation.RG133.5.R384 2014618.1′7806 – dc23 2014007596

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Contents

List of contributors page viiAcknowledgements x

Introduction 1tabitha freeman

Part I Conceptualising relatedness

1 A British history of collaborative reproduction and therise of the genetic connection 21mar tin richards

2 Undoing kinship 44jeanette edwards

3 Genetically challenged: the determination of legalparenthood in assisted reproduction 61julie mccandless and sally sheldon

4 On the moral importance of genetic ties in families 79john b. appleby and anja j. kar nein

5 Who cares where you come from? Cultivating virtuesof indifference 97hallvard lillehammer

6 Legal kinship and connection in US donor families 113naomi cahn

7 Relatedness in clinical practice 129andrea mechanick braver man and

lucy fr ith

v

vi Contents

Part II Experiencing relatedness

8 Defining connections: gender and perceptions ofrelatedness in egg and sperm donation 147rene almeling

9 The significance of relatedness for surrogates andtheir families 162vasanti jadva and susan imr ie

10 Frozen symbols of relatedness: Belgian infertilitypatients and their decisions about unusedcryopreserved embryos 178veerle provoost and guido pennings

11 Family relationships in gay father families with youngchildren in Belgium, Spain and the United Kingdom 192marcin smietana , sarah jennings , cathy

herbrand and susan golombok

12 Stories of an absent ‘father’: single women negotiatingrelatedness through donor profiles 212susanna graham

13 Infertility, gamete donation and relatedness in BritishSouth Asian communities 232nicky hudson and lorraine culley

14 Families created by assisted reproduction: children’sperspectives 251lucy blake , sophie zadeh , helen statham

and tabitha freeman

15 Making connections: contact between sperm donorrelations 270tabitha freeman , kate bour ne , vasanti

jadva and venessa smith

16 Relational lives, relational selves: assisted reproductionand the impact on grandparents 296petra nordqvist and carol smar t

Index 312

Contributors

rene almeling Department of Sociology, Yale University

john b. appleby Centre of Medical Law and Ethics, King’s CollegeLondon

lucy blake Centre for Family Research, University of Cambridge

kate bour ne Victorian Assisted Reproductive Treatment Authority

andrea mechanick braver man Department of Obstetrics andGynecology, Thomas Jefferson University

naomi cahn Law School, George Washington University

lorraine culley School of Applied Social Sciences, De MontfortUniversity

fatemeh ebtehaj Centre for Family Research, University ofCambridge

jeannette edwards Department of Social Anthropology,University of Manchester

tabitha freeman Centre for Family Research, University ofCambridge

lucy fr ith Department of Health Services Research, University ofLiverpool

susan golombok Centre for Family Research, University ofCambridge

susanna graham Centre for Family Research, University ofCambridge

cathy herbrand Reproduction Research Group, De MontfortUniversity

vii

viii List of contributors

nicky hudson School of Applied Social Sciences, De MontfortUniversity

susan imr ie Centre for Family Research, University of Cambridge

vasanti jadva Centre for Family Research, University of Cambridge

sarah jennings Centre for Family Research, University ofCambridge

anja j. kar nein Institute for Political Science, Goethe-Universitat

hallvard lillehammer Department of Philosophy, Birkbeck,University of London

julie mccandless Department of Law, London School ofEconomics and Political Science

petra nordqvist The Morgan Centre, University of Manchester

guido pennings Bioethics Institute Ghent, Ghent University

veerle provoost Bioethics Institute Ghent, Ghent University

mar tin richards Centre for Family Research, University ofCambridge

sally sheldon Kent Law School, University of Kent

carol smar t The Morgan Centre, University of Manchester

marcin smietana Department of Sociological Theory, University ofBarcelona

venessa smith The London Women’s Clinic

helen statham Centre for Family Research, University ofCambridge

sophie zadeh Centre for Family Research, University of Cambridge

Discussants

irenee daly Centre for Family Research, University of Cambridge

yolanda garcia -ruiz Faculty of Law, University of Valencia

zeynep gur tin Department of Sociology, University of Cambridge

rober t klitzman College of Physicians and Surgeons, ColumbiaUniversity

List of contributors ix

soraya tremayne Institute of Social and Cultural Anthropology,University of Oxford

sher yl vanderpoel World Health Organization

effy vayena Department of Biomedical Ethics, University of Zurich

kathar ine wright Nuffield Council on Bioethics

Acknowledgements

This book was produced as part of a Wellcome Trust EnhancementAward in Biomedical Ethics held by Professor Susan Golombok andothers at the Centre for Family Research, University of Cambridge. Weare extremely grateful to the Wellcome Trust for supporting this projectand to the Brocher Foundation for hosting a workshop enabling us todevelop the ideas and chapters in this book.

Book contributors and discussants at the Brocher Foundation, LakeGeneva, November 2012

x

Acknowledgements xi

The editors would like to thank all those involved in this project. Notleast, our warmest thanks to the chapter authors for their fascinatingcontributions and their time, energy and patience during the editorialprocess. We are grateful to the grant holders and collaborators on theWellcome Enhancement Award: in particular, we would like to thankSusan Golombok and Helen Statham for all their encouragement, workand support in making this project possible, as well as Zeynep Gurtin andEffy Vayena for their help in securing the workshop funding. We wouldlike to extend our gratitude to everyone who contributed to making ourworkshop such a memorable occasion, including the discussants for theirvaluable input. Bringing together a multidisciplinary and internationalmix of academics, practitioners and policy-makers in such beautiful sur-roundings created a wonderful workshop on every level, and we are mostgrateful to the staff at the Brocher Foundation for all their assistance, par-ticularly Marie Grosclaude. Our sincere thanks also to Ayesha Gill forher editorial comments and to Abby Scott, Kathy Oswald and FrancesMurton for all their hard work behind the scenes.

Introduction

Tabitha Freeman

Planting a seed

This volume sets out to explore questions about relatedness raised byassisted reproduction. Our principal focus is on the connections and dis-connections created between people through the use of assisted repro-ductive technologies (ARTs) involving parties other than the intendedparent(s) in the conception and/or gestation of a child. These other par-ties include donors of eggs, sperm or embryos as well as surrogates whocarry pregnancies for others, people I will refer to here collectively as‘reproductive others’. Intended parents may be heterosexual or same-sex couples, single people or those involved in more complex parentingarrangements. Indeed, assisted reproduction generates various possibil-ities of family building, both challenging and emulating the traditionalnuclear family ideal of father, mother and biological children that retainsa strong cultural presence within Western societies. Furthermore, ‘repro-ductive others’ may be unknown or known to intended parents, embrac-ing a spectrum that includes those who will remain anonymous, thosewho may be identified in the future and those who are known fromthe outset, and ranging in degrees of familiarity from family membersto ‘strangers’ living in other countries. Children born through assistedreproduction are likewise not a homogeneous group, not least becausethey may or may not be aware of the nature of their conception or theidentity of those involved.

Simply put, assisted reproduction refers to the creation of a child bymeans other than sexual intercourse between their parents. One of theoldest forms of assisted reproduction involves ‘artificial insemination’,usually with sperm other than that of the intended father;1 a processthat enables women with a subfertile male partner, a female partner orno partner at all to achieve a pregnancy. Conversely, the sperm of the

1 Now known as ‘donor insemination’ (DI). For a full description of the historical develop-ment of assisted reproductive techniques and their associated terminology, see Richards(Chapter 1).

1

2 Tabitha Freeman

intended father can be used to conceive with a woman other than theintended mother, as is the case with surrogacy. In the 1980s, followingthe introduction of in vitro fertilisation (IVF), came the possibility of eggdonation and new forms of surrogacy arrangement.2 In this way, ARTshave visibly and practically unhooked the symbolic link between ‘biolog-ical’ and ‘social’ parenthood,3 opening up a multitude of reproductivepathways and kinship configurations. These reproductive possibilitiesmay be variously restricted, supported or encouraged by the particularcultural, socio-legal and regulatory contexts in which assisted reproduc-tion is practised. In turn, the meanings that people attach to relatednessin assisted reproduction are shaped by this wider cultural, legal and pol-icy landscape as well as their own personal experiences, ideals and socialcircumstances.

The involvement of ‘reproductive others’ in assisted reproduction thusraises a number of social, ethical and psychological issues, some of whichwere addressed in our earlier book (Richards, Pennings and Appleby,2012). Here we focus specifically on questions concerning the natureand meaning of relatedness between parents, children and others whomay be involved in the conception, gestation and care of a child as wellas their family members. With the increasing availability of ARTs in con-temporary societies, accompanied in some contexts by a growing open-ness around their use, these questions remain highly contested. Indeed,current transitions and ongoing developments in this field, of which theremoval of donor anonymity in the UK and elsewhere is just one pertinentexample, ensure that new issues concerning the meaning of relatednessare coming to the fore all the time. It is precisely such questions that haveinspired the present book.

Take, for example, a gay man’s five-year journey to fulfil his lifelongdesire to have a child, reported in a UK newspaper just at the time ofwriting.4 In what is pitched as a story about gay parents ‘coming out’,this man tells of his negotiation of various reproductive routes with hispartner, an emotional helter-skelter describing the many choices, changes

2 Until the advent of IVF, surrogacy arrangements by necessity required the use of thesurrogate’s own egg. IVF has meant that surrogates may now carry embryos created withsomeone else’s egg, whether the intended mother or an egg donor. There are various termsfor these types of surrogacy; in this book, we will refer to surrogacy using the surrogate’segg as ‘traditional’ surrogacy and surrogacy using another’s egg as ‘gestational’ surrogacy.For further discussion, see in particular Jadva and Imrie (Chapter 9).

3 While the distinction between ‘biological’ and ‘social’ parenthood underpins traditionalunderstandings of Western kinship, the meaning of these terms and the distinction itselfis problematic, as will become apparent in this Introduction and throughout the volume.For further discussion, see in particular Edwards (Chapter 2).

4 Ottolenghi (2013).

Introduction 3

and constraints along the way. Not least is his partner’s transition fromassuming without a sense of pity or loss that he would never become afather, to supporting the man in trying to have “your child”, to activelywanting and becoming a joyous parent to “our child”. Likewise, theman himself leaves behind “one of the many chips on my shoulder:that a baby without a mother wasn’t quite right” to embrace fully andopenly being a family with “two dads”. This journey took these menthrough several stages, first seeking a co-parenting arrangement with alesbian couple contacted via a website; many months of friendship andintense discussion over an increasingly complex informal contract aboutpotential parenting arrangements ended with both couples realising thatthey did not want to share their hypothetical child and thus going theirseparate ways. A close friend, a single heterosexual woman in her 40s,then approached them with the idea of creating “one large extendedfamily”; several failed attempts at self-insemination and IVF cycles usingher eggs and the man’s sperm led to feelings of devastation, a damagedfriendship and no child. Finally, the couple decided to embark on “amotherless route” of egg donation and gestational surrogacy at exorbitantcost through a US agency offering to “match” couples with surrogatesand egg donors; their stated reason for going overseas being that, unlike inthe UK, US surrogates can be paid. At last, a child was conceived. We donot hear whose sperm was used, it was simply “sperm we had donated”.While the egg donor was selected rather randomly via a computer screenreflecting their perception that “we just don’t know how genes work”,remaining nameless and uninvolved throughout, the men share close,intense emotional experiences with the surrogate, a woman who hadpreviously carried a surrogate pregnancy and already had four childrenof her own. The story ends with the couple holding the surrogate’s handsthroughout the labour before she instructs them immediately after thebirth to “go play with your son!”.

This story is not unique. Stories about different routes to parenthoodand family building are told and retold throughout the public domain andin people’s daily lives, and form the substance of the experiences we relayin this volume. Such stories illustrate just some of the variety and com-plexity of people’s involvement in assisted reproduction and the issuesaround relatedness that may be raised. What is the relative significance ofa child’s connection to an egg donor or surrogate? Would the connectionto a sperm donor be perceived any differently? Does it matter if a surro-gate uses her own egg or that of another woman? Why do some peoplewish to co-parent rather than pursue adoption, gamete donation or sur-rogacy? How many parents can a child have? Is it important for a childto have a mother and a father, and what does being a mother or a father

4 Tabitha Freeman

mean? Is the identity of a parent based on having a biological connectionto a child? If a parent, or a parent’s partner, does not have a biologicalconnection to a child, how do they define this relationship? Will this beany different for men and women in heterosexual couple, same-sex cou-ple or single parent families? How do prospective parents select a gametedonor or surrogate? What characteristics, if any, are important? Shouldparents create, maintain or break links with these people? What informa-tion, if any, should a child have about any ‘reproductive others’ involvedin their creation, and should they have any contact with them? How dosperm donors, egg donors and surrogates feel about children they helpto create? How might a child feel about other children conceived withgametes from their donor or carried to birth by their surrogate? How dothe parents of recipients and donors feel about the grandparental rela-tionships that may evolve? What role does ethnicity, sexuality, genderand age play in shaping people’s perceptions of relatedness? What doesit actually mean to have a biological connection to someone? What doesit mean to wish for a child of one’s ‘own’?

In engaging with such questions, the aim of this book is to bringtogether different disciplinary perspectives and new empirical insightsto examine how relatedness is being conceptualised and experiencedacross different reproductive contexts, including various reproductivetechniques, family formations and cultural settings. The chapters drawupon a range of social science, legal and bioethical perspectives to explorehow relatedness is being defined and negotiated, both by the family mem-bers and ‘reproductive others’ directly involved and within the variousprofessional, policy and academic discourses that surround this practice.By way of introduction, I will draw out some key themes that emergedover the course of this collaborative project and highlight some of thewider issues raised. A useful starting point that has framed much of ourdiscussion is the conundrum that assisted reproduction both emphasisesand downplays the significance of biological connections. In particular,one of the core issues that we have kept returning to throughout thisproject concerns the implications of the contemporary framing of kin-ship within a reductionist and gendered language of ‘genetic relatedness’.Indeed, the current cultural significance bestowed upon genetics as theessence of individual identity and relatedness forms part of the widerbackdrop of this book,5 and as such, the meaning and significance of‘genetic connection’ as a particular way of perceiving relatedness betweenparents, children and ‘reproductive others’ will be brought to the fore.

5 For further discussion, see for example Finkler (2000).

Introduction 5

The (in)significance of biological connections

Assisted reproduction opens up various permutations for bringingtogether what are often most simply described as the biological and socialcomponents of parenthood, with ‘biological’ in this context referring toboth the provision of gametes (the ‘genetic’ connection) and pregnancyand birth (the ‘gestational’ connection).6 A child may be created withno biological connection to their parent(s) if conceived with donatedgametes and carried to birth by a surrogate. Alternatively, those whoprovide the gametes and gestate a child may each seek some form ofparental involvement; for example, if a lesbian couple conceives via IVFwith one partner providing the egg and the other undergoing the preg-nancy using the sperm of a male friend who also wants to play a role in thechild’s life. Most commonly, a child may be born to a couple where onlyone parent has a biological connection, as is the case when a heterosexualor lesbian couple conceives by donor insemination (DI). The biologicalconnections between children and those who provide the gametes andcarry the pregnancy thus carry different meanings in different reproduc-tive contexts, in some instances, corresponding to a parental relationshipand in others, raising questions about their psychological, social, legaland moral significance.

There are no fixed answers to these questions, and throughout thisbook, it will be seen that the significance of these biological connectionsmay be variously elaborated upon, downplayed or negated. Furthermore,it is important at the outset to unpack what is viewed as constituting the‘biological’ itself. As Edwards (Chapter 2) argues so eloquently, ‘the bio-logical is deeply social’, meaning that ‘which “biological facts” becomesocially relevant and the value or significance placed on them cannot beassumed’. Assisted reproduction focuses the cultural gaze on the ‘repro-ductive moments’7 of conception and gestation (O’Brien, 1981), thuseclipsing the many ‘biological’ exchanges between parent and child thatmay hold greater saliency in different historical and cultural contexts:for example, with kin connections made through breast milk, blood and

6 While discussions of biological connections in this Introduction and elsewhere in thepresent volume may be framed in terms of ‘genetic’ and ‘gestational’ links, the significanceof birth – intrinsically linked to gestation – should not be overlooked. This reflectsthe more general point that the embodied role of women in the reproductive processmeans that separating out their biological contributions is conceptually problematic, incomparison to what is often presented as the simplistic equation of biological fatherhoodwith the provision of sperm. For further discussion, see Rothman (1989).

7 O’Brien identifies the different ‘moments of the reproductive process’ as ‘menstruation’,‘ovulation’, ‘copulation’, ‘alienation’, ‘conception’, ‘gestation’, ‘labour’, ‘birth’, ‘appro-priation’ and ‘nurture’ (1981: 47).

6 Tabitha Freeman

food (Edwards, Chapter 2; Jadva and Imrie, Chapter 9). As well asbeing culturally specific, perceptions of these reproductive moments arehighly gendered, with the cultural and socio-legal association of father-hood with conception and motherhood with pregnancy and birth beingdeeply embedded within Western culture. In the next section, I shalllook at how illuminating these gendered assumptions provides a fruitfulmeans for questioning why genetic connections have taken on such kin-ship significance in contemporary societies, drawing on the conceptualand empirical examples raised within the chapters that follow.

Gendering biological connections: parenthood and the meaningof genetic and gestational links

In Western societies, kinship systems have traditionally been conceptu-alised as the social interpretation of the biological ‘facts’ of reproduction.While this model has been challenged both conceptually and empirically(Edwards, Chapter 2),8 the ideology of the naturalised basis of kin rela-tions remains prevalent today, enshrined in the traditional nuclear fam-ily ideal comprising a heterosexual couple and their biological childrenbound by marital and ‘blood’ ties. Although this ideal may not reflect theempirical diversity of contemporary family structures (Cahn, Chapter 6),socio-legal and cultural definitions of parenthood remain wedded tonotions of biological connection. As our legal and historical chaptersdescribe, fatherhood is identified with conception and the provision ofsperm through sexual intercourse (i.e. ‘paternity’) and motherhood, withthe embodied processes of gestation and birth (i.e. ‘the birth mother’)(e.g. Richards, Chapter 1; McCandless and Sheldon, Chapter 3; Cahn,Chapter 6). This essentialist rhetoric is further illustrated by the verymeaning of the verbs ‘to father’, associated with begetting, founding ororiginating, and ‘to mother’, associated with nurturing, caring and givingbirth.

The identification of fatherhood with conception and motherhood withgestation and birth provides a prevalent theme throughout this volume,underpinning assumptions about the nature of parental relationships thatemerge in various guises across socio-legal, professional and personal nar-ratives about assisted reproduction. At the same time, exploring issuesraised by assisted reproduction allows us to question these taken-for-granted assumptions and expose their socially constructed nature: moth-ers who have children through surrogacy and men who become fathers

8 For further discussion, see for example Strathern (1992), Franklin and McKinnon (2002)and Carsten (2004).

Introduction 7

using donated sperm challenge these concepts of parenthood and raisequestions about the gendered significance placed upon genetic and gesta-tional connections. If genetic connections are associated with fatherhoodand gestational connections with motherhood, what significance, if any,is attributed to women’s role in conception through the provision of theegg? What are the wider implications of identifying fatherhood with con-ception in a genetically essentialist culture where biological connectionsare reduced to genetic links? How and why might there be differences inthe social, moral and psychological meanings attached to children’s con-nections with those who provide the sperm for their conception, thosewho provide the egg and those who carry the pregnancy and give birth?

In order to unpack such questions, it is useful to take a step back andconsider a fundamental tension within the symbolic link between socialand biological parenthood underpinning traditional kinship systems: thatis the invisible and uncertain connection between biological paternity andsocial fatherhood.9 Indeed, whilst socio-legal determinations of father-hood may allude to the significance of a man’s biological connection to achild, in practice, social factors such as a man’s relationship to a child’smother and intention to parent may be prioritised; a trumping of thesocial over the biological that is exemplified by the marital presumptionof paternity (McCandless and Sheldon, Chapter 3). This gives rise to thepossibility of misattributed paternity within the traditional family model,thus contesting the very principles upon which this socio-legal rhetoricis based.

The question therefore arises why, despite its tenuous nature, has theequation between fatherhood and conception taken on such great socialand cultural significance? Indeed, it would be hard to overestimate thesymbolic value placed on the association between fatherhood and concep-tion within Western cultural history, with the ‘discovery’ of the male con-tribution to the reproductive process through the recognition of the causallink between heterosexual intercourse and pregnancy being conceptua-lised as the essential foundation of (patriarchal) civilisation.10 The ideaof the father as originator is embedded in historical and contemporaryunderstandings of conception in lay and scientific discourse, wheresalient metaphors such as the male ‘seed’ and the female ‘soil’ ascribecausality to the male contribution as the active ingredient initiating new

9 At least until the advent of IVF and DNA paternity testing, the connection betweenbiological paternity and social fatherhood could be described as invisible and uncertain.For further discussion, see Freeman and Richards (2006).

10 There are numerous accounts of the foundational significance attributed to the discoveryof paternity in the origins of patriarchy and of civilisation itself: see for example Mead(1949) and Kraemer (1991).

8 Tabitha Freeman

life (Delaney, 1986; Martin, 1991). Furthermore, the ‘blood’ ties bet-ween generations are invariably conceptualised as following the maleline, forming the basis of patrilineal systems of inheritance upon whichWestern kinship systems are typically based.

Mary O’Brien’s 1981 book The Politics of Reproduction remains a use-ful critical framework for uncovering the underlying paradox by whichsuch great ideological significance is placed upon men’s relatively min-imal biological contribution to reproduction in face of women’s morevisibly extensive procreative roles of gestation and birth. For O’Brien, itis the very vulnerability of men’s biological role that leads to the ‘sanc-tification of the sperm’ (1981: 7); the ideological potency placed uponmen’s reproductive contribution within patriarchal societies both hid-ing and ultimately exacerbating the ‘soft core’ of paternal uncertainty(1981: 55) upon which this supremacy is ironically founded. Followingthis line of feminist argument, within contemporary societies, the cul-tural significance placed upon the biological connection between fathersand children can be perceived as taking on a new twist with the arrivalof the ‘genetic paradigm’ through which the mechanics of conceptionand procreation are now framed. As Barbara Katz Rothman describes,‘kinship through fathers is based on the act of impregnating and thereforeglorifies genetic connections’ (1989: 90).

Whether or not the glorification of genetic connections in contempo-rary Western societies should be interpreted as inherently patriarchal, it isclear that the discussion of reproduction and relatedness is fundamentallygendered and that this process of gendering is manifest in the differentcultural emphasis, value and meaning placed on various aspects of thereproductive process and forms of biological connection. As Richardsdiscusses in Chapter 1, by conceptualising reproduction in terms of theequal transmission of DNA at the moment of conception, the languageof genetics appears gender neutral; at the same time, the ‘equality’ ofDNA is undercut by the relative value and significance placed on sexual‘difference’ regarding male and female bodies, gametes and reproduc-tive functions. The cultural identification of fatherhood with conceptionhas enabled the reduction of the biological connection between fatherand child to a ‘genetic’ link initiated through the provision of sperm. Bycontrast, the association of motherhood with gestation and birth leadsto the relative insignificance bestowed upon the egg in the determinationof motherhood: in comparison to the potency of the sperm, the egg hasremained culturally invisible.

There are numerous examples of gendered differences in the relativevalue ascribed to genetic connections throughout this volume, from the‘privileging of genetic fatherhood’ in comparison to ‘the very explicit

Introduction 9

silencing of the female genetic link’ in UK family law (McCandless andSheldon, Chapter 3) to the very different connotations of egg and spermdonation in different cultural settings (Richards, Chapter 1; Hudson andCulley, Chapter 13). More broadly, these gendered differences appear tohave an impact on how egg and sperm recipient parents, offspring anddonors may think about each other in practice. For example, Almeling(Chapter 8) describes how the US commercial market encourages spermdonors to perceive themselves as fathers, and egg donors as ‘not moth-ers’, of any children conceived using their donated gametes. Conversely,there are indications that recipients and offspring may feel differentlyabout connections with sperm donors and egg donors. There are manymore reported cases of parents and children being interested in spermdonor connections; differences that may be further mediated by fam-ily structure. For example, findings discussed here suggest that singlewomen contemplating ‘double donation’ (i.e. procedures involving eggdonation and sperm donation) may place greater emphasis on a child’sconnection with a sperm donor than an egg donor (Graham, Chapter 12),while children conceived by sperm donation to a single mother mayexpress more interest in their donor than those sperm donor-conceivedchildren growing up in families with a social father (Blake et al.,Chapter 14; Freeman et al., Chapter 15).

A further example that highlights the potential immateriality of thefemale genetic link is Jadva and Imrie’s (Chapter 9) finding that surro-gates do not consider themselves to be the mother of the child they gestateregardless of whether that child was conceived with their own egg or thatof another woman. As this illustrates, surrogacy enables the dissociationof motherhood from pregnancy and birth, opening up the possibility fornew evaluations of the ‘gestational’ connection. Indeed, the empiricalmaterial in this book illustrates that, while deeply gendered and cultur-ally embedded, the meanings ascribed to genetic and gestational linksare often fluid in practice and may change in relative significance acrossdifferent family and reproductive contexts. Continuing with the case ofsurrogacy, for example, Smietana et al. (Chapter 11) report how gay cou-ples who use gestational surrogacy and egg donation to become parentsmay attribute social significance to the surrogate’s involvement with theirchild and value this connection over that with the egg donor, while fallingshort of perceiving it as a parental relationship. By contrast, in the contextof gestational surrogacy for a female recipient, both the surrogate and eggdonor may be written out of the picture or ‘de-kinned’ in order to main-tain the recipient’s identity as the child’s mother (Edwards, Chapter 2).

These examples illustrate how the ‘choreography’ (Thompson, 2005)of biological and social connections at play in assisted reproduction may

10 Tabitha Freeman

lead to the reinforcement or silencing of genetic and gestational bondsin the creation – or negation – of kin relationships. Within contemporaryWestern societies, the (in)significance placed upon biological connectionsis reflected by the wider cultural climate in which assisted reproductionoccurs. On the one hand, biological connection is reified through thesymbolic significance attributed to genetics as the essence of identity andrelatedness; on the other, changing demographic patterns and the fluidityof family structures have led to an increasingly visible fragmentation ofsocial and biological kinship as evidenced, for example, by the growingnumber of children being brought up in households with ‘non-biological’fathers. It is therefore perhaps not surprising that debates about assistedreproduction can get caught up in moral panics around the decline ofthe traditional nuclear family at the same time as ARTs are celebratedas enabling greater numbers of people to build their families of choice.This cultural climate fosters contradictory discourses around the valueand meaning of biological connection, and genetic connection in partic-ular, that shape perceptions of relatedness in assisted reproduction. Inthe following sections, I shall look at how such tensions are played outregarding two aspects of relatedness that emerged as salient themes in theconceptual and empirical chapters that follow: namely, the meaning ofhaving one’s ‘own child’ and the significance (or not) placed on a child’sknowledge of his or her ‘genetic origins’.

A child of one’s own

There are references scattered throughout this volume to people usingassisted reproduction to pursue their desire to have their ‘own child’.Indeed, this is often conceptualised as the raison d’etre of assisted repro-duction, enabling those who would otherwise be unable to, to ‘create’a child rather than follow alternative paths to family building such asadoption or step-parenting. While for a person to have his or her ‘ownchild’ could most straightforwardly be interpreted as having a biologi-cal relationship, as soon as ‘reproductive others’ are introduced into theequation, this takes on a different light. Indeed, one of the most strikingaspects of the chapters in this book is the sheer multiplicity of mean-ings that an ‘own child’ can take, which in itself gives insight into thecomplexity of perceptions of relatedness in assisted reproduction.

In clinical practice, there is a working assumption that people will pri-oritise having their ‘own child’ without the involvement of ‘reproductiveothers’ (Braverman and Frith, Chapter 7). This means that for men andwomen alike, procedures utilising their own gametes are most likely pre-ferred to donor conception, even though they may be more costly, invasive

Introduction 11

and, in some cases, carry greater risks and lower success rates. The rela-tively recent developments of intra-cytoplasmic sperm injection (ICSI),to enable the use of subfertile men’s sperm, and mitochondrial dona-tion, to avoid the transmission of mitochondrial disease while enablinga mother to have a genetic connection with her child, are good cases inpoint (see Richards, Chapter 1 and McCandless and Sheldon, Chapter 3,respectively).

For men, it might be assumed that perceptions of having their ‘ownchild’ will be synonymous with being the provider of sperm, reflectingthe strong cultural equation between fatherhood and conception dis-cussed above; indeed, we see this manifest in sperm donors’ perceptionsof offspring conceived using their gametes as their children (Almeling,Chapter 8). However, not all the male narratives reported in this bookinterpret having one’s ‘own child’ in this way. For example, some gayfathers expressed a preference for adoption as a route to having their‘own child’ over assisted reproduction involving their own sperm, withthe adoption process promising ‘complete parental exclusivity’ with-out the potential intervention of ‘reproductive others’ (Smietana et al.,Chapter 11). Furthermore, while sperm donation may raise manyambivalences and concerns for male recipients (Braverman and Frith,Chapter 7; Hudson and Culley, Chapter 13; Nordqvist and Smart,Chapter 16), the absence of a biological connection to their child doesnot seem to impact negatively on father–child relationships in practice(Golombok, 2013). For example, Blake et al. (Chapter 14) describe howan awareness of being conceived by sperm donation does not lead child-ren in heterosexual couple families to be confused over the identity oftheir father or to reject him as a ‘non-biological’ parent, highlighting thesaliency of social bonds in defining experiences of relatedness.

For women, the concept of ‘own child’ may be even more fluid andcontextual, in part reflecting the observation that the biological is notreadily reducible to genetics for women given the multiplicity of phys-ical interactions embedded in the procreative processes of pregnancy,birth and breastfeeding. Indeed, the concept of ‘ownership’, so closelylinked to genetics and paternity, may be less relevant or problematic forfemales than the embodied experience of creating a child. Women mayexpress a preference for assisted reproduction rather than other meansof family building such as adoption through the very desire to experi-ence pregnancy and birth and to have the ‘baby experience’ (Graham,Chapter 12). For example, in her analysis of the narratives of singlemothers, Graham identifies how the symbiotic link between mother andchild during gestation is perceived as affording the possibility of devel-oping the embryo into an ‘own child’, regardless of whether one’s own,

12 Tabitha Freeman

or a donor’s, egg was involved. Once again, the relative significance ofgestational and genetic links in defining an ‘own child’ will likely varyaccording to personal circumstance, with women who seek a child viaegg donation potentially prioritising the gestational link while those whopursue gestational surrogacy may place more emphasis on genetic ties(Braverman and Frith, Chapter 7).

The meaning of ‘own child’ is not only defined in terms of a relation-ship between an individual parent and a child, it may also be perceivedin relation to a couple or a wider family network or community. Forexample, in illuminating heterosexual couples’ perspectives on ‘unused’embryos created with their own gametes during the course of fertilitytreatment, Provoost and Pennings (Chapter 10) explore how the embryomay come to represent more than a sum of its parts, with couples express-ing a strong sense of ‘ownership’ of the embryo as a unique and personalsymbol of their relationship in comparison to the relative detachment felttowards an individual gamete. When placed within the broader familyand community context, having an ‘own child’ may reflect a wider senseof belonging necessitating different forms of kinship work. Such kinshipwork may include the emotional investment of grandparents in incor-porating a child within a particular family (Nordqvist and Smart, 2014;Chapter 16) or the concealment of gamete donation to enable a child tobe accepted by a particular ethnic community, as discussed in relationto different South Asian communities in the UK (Hudson and Culley,Chapter 13).

In the various examples of people seeking an ‘own child’ cited in thisvolume, implicit assumptions are made about the relative contribution ofthe social and biological in ensuring this bond. Such assumptions shapethe way people select and negotiate particular routes to parenthood, withideas about genetic inheritance, the interaction between mother and childin utero, and the role of ‘nature versus culture’ in a child’s developmentbeing interwoven with people’s desires to have an ‘own child’ within thepractical constraints and means available to them. A pertinent exampleof this is the selection criteria and decision-making processes recipientsmay employ when choosing a gamete donor (e.g. Edwards, Chapter 2;Braverman and Frith, Chapter 7; Almeling, Chapter 8; Graham,Chapter 12; Hudson and Culley, Chapter 13).11 Again, one of the strik-ing features of these discussions is the sheer range of considerations that

11 While it should not be assumed that all recipients have, or want, choice about the char-acteristics of the gamete donor that they use, the fact that the idea of recipient ‘choice’and ‘selection’ of sperm and egg donors has, in itself, become a focus of discussionsuggests how concepts of relatedness between donors and offspring are coming to thefore, particularly in contexts where there is no longer donor anonymity.

Introduction 13

recipients may draw upon. Donors may be chosen on the basis of theirmedical history, height, ethnicity, marital status or religion, their feelingsabout future contact with any offspring or whether they are a ‘nice’ per-son. As ever, these discussions indicate that the gender of the donor andindeed, of the recipient(s), may play a fundamental role.

Furthermore, while it might be assumed that, in an age of geneticessentialism, donors will be chosen primarily in the hope that desirablephysical and psychological characteristics will be passed onto a child, thediscussions in this book indicate that donor selection is far more complexin practice. Donors may be selected with the aim of ‘mimicking’ naturalconception: for example, by being ‘matched’ with the characteristics ofthe ‘non-biological’ parent in a heterosexual couple in order to concealthe use of gamete donation or by a single woman seeking a sperm donorto whom she might have been attracted. Similarly, donors may be chosenso that the use of donated gametes goes unnoticed by others (Hudsonand Culley, Chapter 13) or so that the gamete donation becomes partof a story that is shared, as for example if the donor’s characteristics areincorporated into a child’s narrative about his or her origins (Blake et al.,Chapter 14). One of the overriding features of these discussions is that,despite differences in selection preferences, what is commonly sought isa resonance between the recipient(s) and donor, whether physical, emo-tional or cultural, in order that parents can work towards incorporating –or negating – the existence of the donor into their quest to create their‘own child’.

Knowledge of one’s genetic origins

Ideas of what may be transferred, shared, disclosed or concealed regard-ing the biological connection between donors and children created withtheir gametes tie in closely with another aspect of relatedness that becamea focal point of this book: specifically, the moral, social and psychologi-cal significance (or not) placed on knowledge of one’s ‘genetic origins’.Is it important for a child to know the identity of their sperm or eggdonor? How does this impact on their own sense of personal identity?Such questions form the basis of key ethical and regulatory debatesin assisted reproduction concerning parental disclosure and whether achild has the right to be told of their donor conception or the identityof their donor (Richards, Chapter 1; Appleby and Karnein, Chapter 4;Lillehammer, Chapter 5; Cahn, Chapter 6). As Richards’ (Chapter 1)historical account of UK regulation of gamete donation illustrates, thisemotive debate is one that rolls and rolls, being propelled by differ-ent evaluations of the (in)significance of biological connections. While

14 Tabitha Freeman

for some, knowledge of one’s ‘genetic identity’ is a fundamental rightlinked to a child’s welfare, for others, the significance of knowledge ofone’s progenitors should not be overstated, as illustrated by Appleby andKarnein’s (Chapter 4) discussion of different bioethical approaches. AsRichards’ analysis also demonstrates, overriding this on-going debate isa discernible trend towards ‘openness’, at least within the UK context.Indeed, there is an emerging consensus in professional and policy dis-course in the UK, the USA, Australia and some other Western countriesthat parental disclosure in early childhood of the fact of donor concep-tion, if not the identity of the donor, is in the best interests of the child(Braverman and Frith, Chapter 7; Freeman et al., Chapter 15). Whilewe would not claim that the chapters in this book offer a means of resolv-ing this debate, the discussions here do provide fresh perspectives andstimulate new questions.

Conceptually, the current significance placed upon ‘genetic identity’is challenged in this book, both through asserting an ethical place for‘indifference’ to one’s genealogical origins (Lillehammer, Chapter 5),and through refuting the very meaning of ‘genetic identity’ as a vacuousconcept (Richards, Chapter 1). Conversely, it is argued that the contem-porary rhetoric does not go far enough and that strengthening and broad-ening a framework of rights and responsibilities based on the significanceof genetic identity should be considered. For example, Cahn (Chapter 6)presents an argument for extending the rights accorded to genetic con-nections within the traditional nuclear family to those between familieswho conceive using the same gamete donor. To this end, she advocatesthe facilitation of social connections between ‘donor-conceived familycommunities’ through recognition of some of the genetic connectionscreated by donor conception, particularly with regard to the half-siblingrelationship between children conceived by the same donor.

Empirically, the chapters also reflect diversity in evaluations of the sig-nificance of knowledge of one’s genetic origins. Bringing together the lim-ited empirical material available reporting children’s own perspectives,Blake et al. (Chapter 14) find that, for children who are aware of theirdonor conception, feelings about the donor may range from indifferenceto curiosity to a desire to seek contact with this person. Furthermore,donor-conceived people’s interest in their donor may rise and fall at dif-ferent points over the life course (see also Freeman et al., Chapter 15).Thus, despite concerns of policy-makers, parents and others, childrenseem able to integrate information about their donor origins into theiremerging sense of identity and family narratives, even when the donoris anonymous, particularly if told about their donor conception at anearly age. Examining the motivations of sperm donor-conceived offspring

Introduction 15

who go on to seek information about their donors reveals a sense ofcuriosity, particularly regarding potential resemblances in appearanceand personality, with issues relating to knowledge of one’s genetic ances-try and medical background also being key (Freeman et al., Chapter 15).While these motivations reflect offspring’s interest in, and awareness of,their genetic relatedness to the sperm donor, this does not necessarilyaccord with a perception of genetic connection as being the basis of a kinrelationship; rather, finding out about the donor is viewed as a means offinding out about parts of their own personal identity.

The spectrum of levels of interest in gamete donors and ‘genetic ori-gins’ thus reflects the (in)significance of biological connections: for manydonor-conceived offspring, the indifference contemplated by Lilleham-mer (Chapter 5) is realised in practice, while for some, especially spermdonor offspring, the cultural emphasis placed on genetic origins under-pins a desire to establish contact with the donor (Freeman et al., Chapter15). Furthermore, the translation of the genetic connections created byassisted reproduction into socially significant relationships discussed byCahn (Chapter 6) is also apparent in the growing phenomenon of donor-conceived families seeking and making contact with those who share thesame sperm donor. Freeman et al. (Chapter 15) look at how these con-nections between ‘donor relations’ are being initiated in different regula-tory and cultural settings. In doing so, questions are raised concerning theincreased saliency of the genetic connections between donor-conceivedoffspring, donors and half-siblings in the context of sperm donation com-pared to egg donation, and in families headed by solo mothers and lesbiancouples compared to heterosexual couple families.

Understanding assisted reproduction: concepts andexperiences of relatedness

This book opens up fascinating avenues of discussion on how the con-nections and disconnections created between people through assistedreproduction are perceived and defined by all involved, as well as withinthe wider socio-legal, professional and cultural discourses in which thesepractices are framed. While the book is structured in two parts con-cerning ‘conceptualising’ and ‘experiencing’ relatedness, the discussionsillustrate the complex interplay between concepts and experiences as peo-ple negotiate the ideals and realities of building families through assistedreproduction.

In attempting to understand these issues, we have confronted the limi-tations and inadequacies of the current language used to describe kinship,reproduction and relatedness. What should a donor-conceived child call

16 Tabitha Freeman

their donor or half-siblings by donation? What does it mean if a childdescribes their sperm donor as their ‘father’? Why is the term ‘donor’used if that person was paid for providing their gametes? What does ‘bio-logical parenthood’ mean for a man or a woman? While the genetic prismthrough which biological relatedness is perceived means that ‘biologicalfather’ is often equated, or used interchangeably, with ‘genetic father’,the category of ‘biological mother’ is potentially more problematic: twowomen may have a biological connection to a child if one provides theegg and the other gestates the child.12 What do we mean if we seek toidentify a person’s ‘real’ mother or father? Do we conjure up genderedmetaphors when we talk about eggs and sperm, or hide gender differenceswhen discussing gametes and genetic connections?

In dealing with questions around terminology, we have tried to remainsensitive to who is using what terminology and how, and to focus attentionon how meaning depends on context: for example, kinship terminologysuch as ‘auntie’ and ‘brother’ may be used as terms of affection not relat-edness, while terms such as ‘father’ may be used to signify relatednesswith no emotional attachment. The discussions also show how under-standing relatedness in assisted reproduction is leading to the creationof new kinship vocabularies, whether through applying familiar languagein different contexts or developing new terms; for example, using termslike ‘cousin’ or ‘sister’ to describe a half-sibling by donation, or ‘tummysister’ or ‘surro-sister’ to describe the relationship between a surrogate’sown child and a child she carried for another family. Indeed, in somecases, there appears to be an endless list of potential terminology: in thechapters that follow, a ‘sperm donor’ is described variously as ‘donor’,‘father’, ‘progenitor’, ‘biological father’, ‘genetic father’, ‘dad’, ‘daddy’,‘donor daddy’, ‘donut dad’ and so on. This often appears to be accom-panied by an underlying sense that no terms are ‘quite right’. In seekingto reflect different voices, different perspectives, different terminologiesand different meanings, we hope that our interdisciplinary discussionsalso encourage reflection on the role that academic, clinical and policydiscourses may play in reinforcing, challenging and defining ideas aboutrelatedness. While it has sometimes been necessary to seek consistencyand clarity in terminology, in other cases, such consistency may be unde-sirable or impossible to achieve. Of all terminology used in this book,the term ‘genetic’ appears to be the most elusive and pervasive of all,

12 Mitochondrial transfer, which enables a child to be conceived with the nucleus of onewoman’s egg and the mitochondria of another’s, adds further complications to this issue.See Richards (Chapter 1), Edwards (Chapter 2), McCandless and Sheldon (Chapter 3)and Appleby and Karnein (Chapter 4).

Introduction 17

carrying fluid, multiple and sometimes conflicting meanings despite theessentialist rhetoric underpinning it.

Perhaps above all else, the discussions in this book reveal what couldbe described as the embeddedness of concepts and experiences of relat-edness in assisted reproduction. The kin connections created by assistedreproduction are seen to extend beyond the triad of parents, ‘reproduc-tive others’ and children in a complex web of relations reaching acrossand within generations; for example, to include grandparents (Nordqvistand Smart, Chapter 16) and future children, as well as those connectedwhen an individual carries pregnancies or enables their gametes to beused to conceive children within several different families, including theirown (Jadva and Imrie, Chapter 9; Freeman et al., Chapter 15). As ourdiscussions highlight, this web of connections is further complicated bythe varying levels of information, contact and communication betweenthe parties involved. Reading people’s narratives of assisted reproductionin this book also illustrates how concepts and experiences of related-ness extend across time and space; the expectations, fantasies, hopes,ambivalences and unknowns involved in assisted reproduction formingtrajectories that span mourned-for pasts and anticipated futures as peoplemake sense of their families, origins and identities.

In unpacking what can be described as the ‘messy’ reality of familybuilding and kinship creation through assisted reproduction, we see howpeople often adopt a pragmatic approach, both compromising and refor-mulating their ideals, ethics and choices along the way. One of the moststriking features of these narratives is that almost all of the empirical chap-ters contain some reference to people’s feeling that assisted reproduc-tion is ‘strange’; whether choosing a sperm donor, meeting one’s ‘donorsibling’, contemplating ‘motherless’ family building or using previouslyfrozen embryos to create a child, descriptions such as ‘weird’, ‘bizarre’,‘surreal’, ‘odd’ and ‘unfamiliar’ abound. We all hold ideals in our headsabout the nature of reproduction, families and relatedness against whichwe define the realities of our experiences and the experiences of thosearound us. What this allusion to the strangeness of assisted reproduc-tion suggests is that, while this form of family building challenges thenuclear family norm, the ideology of biological relatedness remainsdeeply engrained. In deviating from internalised norms and cultural ide-als about what is ‘normal’ and ‘natural’, people seek to negotiate newreproductive pathways and kinship formations as best as they can. Whilemuch has been said about the ways that assisted reproduction confrontsthe cultural significance attributed to gender difference – to the fatherwho provides the sperm and the mother who gives birth – one lastingmessage from the experiences of those involved in assisted reproduction

18 Tabitha Freeman

is that of the interdependency between the sexes and between individualsin creating families.

References

Carsten, J. (2004). After Kinship. Cambridge University Press.Delaney, C. (1986). ‘The meaning of paternity and the Virgin birth debate’.

Man, 21, 494–513.Finkler, K. (2000). Experiencing the New Genetics: Family and Kinship on the

Medical Frontier. Philadelphia: University of Pennsylvania Press.Franklin, S. and McKinnon, S. (2002). Relative Values: Reconfiguring Kinship

Studies. London: Duke University Press.Freeman, T. and Richards, M. (2006). ‘DNA testing and kinship: paternity,

genealogy and the search for the “truth” of our genetic origins’, in F. Ebtehaj,B. Lindley and M. Richards (eds.), Kinship Matters. Oxford: Hart.

Golombok, S. (2013). ‘Families created by reproductive donation’. Child Devel-opment Perspectives. 7, 61–5.

Kraemer, S. (1991). ‘The origins of fatherhood: an ancient family process’.Family Process, 30, 377–92.

Martin, E. (1991). ‘The egg and the sperm: how science has constructed aromance based on stereotypical male-female roles’. Signs, 16, 485–501.

Mead, M. (1949). Male and Female: A Study of the Sexes in a Changing World.London: Victor Gollancz.

Nordqvist, P. and Smart, C. (2014). Relative Strangers: Family Life, Genes andDonor Conception. Basingstoke: Palgrave Macmillan.

O’Brien, M. (1981). The Politics of Reproduction. London: Routledge and KeganPaul.

Ottolenghi, Y. (2013). ‘Dads at last’. The Guardian Weekend, 3 August, 16–21.Richards, M., Pennings, G. and Appleby. J. (eds.) (2012). Reproductive Donation:

Practice, Policy and Bioethics. Cambridge University Press.Rothman, B.K. (1989). ‘Women as fathers: motherhood and child care under a

modified patriarchy’. Gender and Society, 3, 89–104.Strathern, M. (1992). Reproducing the Future: Essays on Anthropology, Kinship and

the New Reproductive Technologies. Manchester University Press.Thompson, C. (2005). Making Parents: The Ontological Choreography of Repro-

ductive Technologies. London: MIT Press.

Part I

Conceptualising relatedness

1 A British history of collaborativereproduction and the rise of thegenetic connection

Martin Richards

Introduction

Collaborative reproduction1 has a long history and has always raiseddifficult and controversial issues about the status of the children whomay result, their place in genealogies of their families, and indeed, thatof the other reproductive collaborators who may be involved. This iswell illustrated by the account in the Old Testament of the Bible of thefamily of the patriarch, Abraham. His wife, Sarah (who was also his half-sister) failed in their long marriage to produce the prophetic son whomGod had promised. She suggested to Abraham that he should lie withher handmaiden, Hagar. In due course Hagar bore a son, Ismail. LaterSarah became pregnant by her husband and gave birth to Isaac. Whowas then the first born inheritor of Abraham? Today with the develop-ment of assisted reproductive technologies (ARTs), the possibilities forcollaborative reproduction are more varied. As well as surrogates whomay carry a fetus conceived by artificial insemination (AI), or embryoscreated by in vitro fertilisation (IVF) with the sex cells of the intendingparents, there are those who have children using eggs, sperm or embryosprovided by donors or vendors.2 In this chapter I shall first considerthe oldest of these techniques, artificial insemination by donor (AID),3

1 Collaborative reproduction is a useful term which refers to assisted reproductive tech-nologies which involve reproductive donation and the use of sex cells or embryos providedby others who are not the intended parents, or the employment of a woman (i.e. a sur-rogate) other than the intended mother to carry the pregnancy. Sex cells is the collectiveterm for the female and male reproductive cells (i.e. the eggs and sperm), or in biology,the gametes (i.e. ova and spermatozoa).

2 The field of collaborative reproduction is beset with problems of terminology. Most sexcells used clinically are not donated. Rather, they are more often traded for money orproduced in return for monetary compensation or the receipt of reproductive treatments.However, in both commerce and discussions of clinical practice the process of providingsperm and eggs is usually termed ‘donation’ and in respect for this tradition, I shall usethe terms donor and donation.

3 Through most of its long history the process of mechanically transferring sperm hasbeen known as artificial insemination (AI) (or occasionally, artificial impregnation or

21

22 Martin Richards

and then broaden the discussion to include egg donation, which becamewidely used in clinical practice soon after the development of IVF in the1980s. In presenting this historical account, my focus is on the socio-legal regulation of the kin connections of children conceived with eggsand sperm from others, their parents and the providers of the necessarysex cells. I will argue that these relations have come to be seen through thelens of ‘genetic connection’ which shapes a view of familial relationshipsand the regulation of collaborative reproduction. Initially the notion ofgenetic connection was used simply to signify the link between the childand the provider of sex cells in collaborative reproduction. However, asI shall describe, the term has taken on a life of its own and now geneticsmay be seen by some as a creator of personal identity.

A historical perspective on British policy and practice

Artificial insemination by donor

AID became established as a clinical treatment for male factor infertil-ity in the 1930s in Britain, though rather earlier in the USA (Swanson,2012). However, the practice in fact dates back at least to the nine-teenth century4 and from time to time had been promoted not simplyas an infertility treatment, but for other ‘social’ reasons: for example,as a means for First World War widows and others who lost potentialpartners to have children without the sin of illicit sexual intercourseoutside marriage (Lois, 1916), or for single women (Swan, 1918) andlater for professional single women to avoid them becoming ‘embitteredspinsters’ (McCandless, 1943). Others saw AID as a tool for eugenicimprovement enabling married couples to use sperm from superior men(Brewer, 1935; Muller, 1936; Huxley, 1941), while Marie Stopes advised

fecundation). Where donor sperm is used it is artificial insemination by donor (AID),or otherwise artificial insemination by husband (AIH). Since the 1990s, perhaps as thepractice became more commonplace and acceptable, it has become usual to drop theword artificial and talk of donor insemination (DI). In their book, Lethal Secrets, Baranand Pannor (1989) argue that the language of AID seems archaic and does not describecontemporary practice and that ‘artificial’ should be eliminated because conception is‘achieved through the meeting of the fertile egg and sperm, an event also natural andnot artificial’ (1989: 4). Clearly the boundaries of the natural and the artificial are beingshifted. These authors enjoin us to follow their example and use the term donor insemi-nation. But in deference to history I shall use the terms AID and AIH.

4 The clinical history of AIH is longer. Sir Everard Home (1799) describes a case ofhis brother-in-law’s, John Hunter, concerning a London cloth merchant with severehypospadias. Hunter provided the husband with a syringe and instructed him to fill itafter coitus and inject it into his wife’s vagina ‘while the female organs are still under theinfluence of coitus and in the proper state for receiving the semen’. A child was born.

A British history of collaborative reproduction 23

its use as a home remedy for infertility which ‘avoided the use of expen-sive doctors’ (Richards, 2008a). However, the clinical use of AI waslargely confined to insemination using a husband’s sperm until the1930s.

Accounts of early practice of AID (Lane-Roberts et al., 1939; Barton,Walker and Wiesner, 1945; Jackson, 1957) describe the careful selec-tion of ‘decent and child worthy’ married couples for their psychologicaland eugenic suitability, and of donors, to rule out inherited disease andeugenic unsuitability, for a process which would be carried out in secretwith the donor unknown to the recipient and vice versa. Parents wereadvised to register the birth as the husband’s child and not to reveal theiroffspring’s donor origin to anyone, including their child. In that way theiroffspring would be protected from knowledge of their illegitimate status.Some practitioners matched the blood groups of donors and husbandsso that blood tests could not reveal out of wedlock paternity. The usualpractice was to advise couples to continue to have sexual intercoursethroughout the AID treatment, and some practitioners used a mixtureof the husband’s and donor’s sperm. These practices meant that couplesmight retain the hope that the child would be conceived with the hus-band’s sperm and the doubt over paternity would justify the registrationof the birth in the husband’s name.

Accounts of clinical artificial insemination in the 1940s provoked alengthy and often hostile correspondence in the British Medical Journaland increasingly negative reactions from the press and public including,for example, condemnation from the Catholic Cardinal of Liverpoolof ‘test tube babies’.5 In fact, as early as 1897, the Catholic Churchpronounced a non licere for AI and it regarded obtaining semen by ‘solitarypollution’ as gravely sinful (Glover, 1948).

In 1946 the Public Morality Council, a body pledged to fight immoral-ity and sexual impropriety, called a conference in London addressed bymedics, a sociologist, psychologists, lawyers and churchmen to ‘uncoverimplications of the practice’. Most of the speakers, apart from two clin-icians (Barton and Walker) involved in the practice, condemned AIDbecause it involved masturbation, adultery and the production of illegiti-mate children, and was thus considered a threat to family life and society.As sociologist, E.O. Jones commented:

5 This term evokes conception as the work of white-coated scientists rather than the resultof the coupling of loving (married) partners in the family. It was commonly used to referto AID babies, especially in the USA, and can be traced back to the early twentiethcentury. It was the title of a medical monograph on artificial impregnation (Rohleder,1934), and later came to be used for IVF children (see also Squier, 1994).

24 Martin Richards

The children would be deprived of a natural father whose paternal care, affec-tion and authority could hardly fail to be jeopardised by a wholly fictitious andunnatural state of affairs, harmful alike to all concerned . . . and the communityat large . . . the sexual act would lose its romantic significance and be reduced to amechanical process in which marriage need play no part at all, and if the practicewere extended to spinsters and widows . . . a state of promiscuity would result.(Public Morality Council, 1947: 24)

In 1945, a Commission was established by the Archbishop of Canterburyto receive evidence and consider the matter (Wand, 1948). The compo-sition of the Commission was very much what we might expect for a con-temporary bioethics review body, including a medical psychologist, anobstetrician, a paediatrician, a social worker, a judge, a lawyer/politicianand a trio of theologians, chaired by the Lord Bishop of London.

The Commission found both ‘assisted insemination’ as a sequel tonormal intercourse, and AIH, including where semen is produced bymasturbation, to be acceptable as this would be directed to the ‘pro-creative end of marriage’. However, it concluded that AID should becriminalised. As the Commission argued:

[AID] involves a breach of the marriage. It violates the exclusive union setup between husband and wife. It defrauds the child begotten, and deceivesboth his putative kinsmen and society at large. For both donor and recipientsthe sexual act loses its personal character and becomes a mere transaction.For the child there must always be the risk of disclosure, deliberate or unintended,of the circumstances of his conception. We therefore judge artificial insemina-tion with donated semen to be wrong in principle and contrary to Christianstandards. (Wand, 1948: 58)

Framing AID as a scientific development, the Archbishop in his prefacereminded readers that scientific progress might be a mixed blessing:6

The growth of natural science and of technical skill has vastly increased the extentto which man can control natural processes and direct them to his self-chosenends. But because man can now do certain things [it] no way settles the questionof whether he ought to do them. (Wand, 1948: 6)

6 Such comments were widely mirrored elsewhere. For instance in a Mass Observationdiary in 1946 B. Charles noted a report in the News of the World stating that thousandsof babies have been born in the USA through AID. ‘This artificial insemination seems tome quite unnecessary, and, therefore, like aviation, probably productive of a great dealof downright harm to the human race. In theory there should be no limit to experimentbut in practice there are certain things that should not be experimented with . . . and thisartificial insemination should be left alone’ (Garfield, 2004: 208).


So it was with test-tube babies. In quoting from an English Sunday paper,the report made a direct connection between atomic bombs and AID:7

A super-race of test-tube babies will become guardians of atom-bomb secrets ifa proposal presented today to President Truman is passed into law. Fathers willbe chosen by eugenic experts of all United Nations. Mothers will be hand-pickedon their health and beauty records, family backgrounds and their achievementsin school and university. The idea is to get the best possible brains in the worldcontrolling future atomic power . . . It is proposed to rear hundreds of these test-tube babies. They would be reared by welfare specialists of the world. (SundayDespatch, 21 October 1945: 33)

Carsten (2004) has pointed out that contemporary lay concerns aboutIVF and other ARTs are often phrased in terms of familiar anxieties aboutkin relationships such as those surrounding incest, adultery, divorce andadoption. The Archbishop’s Commission took a natural law view of fam-ily life with the sexual relationship of the (married) couple at its core,which would be violated by the introduction of sexless reproductioninvolving a third party. All the attendant anxieties of adultery (of both wifeand married sperm donor), masturbation, incest, illegitimacy, threats tomarriage and divorce are invoked in the report.

The report considered the use of AID in cases of male sterility, thepotential transmission of an inheritable disease or defect by the husbandand other eugenic uses. While such ends might be justified, the meanswere not. Sympathy was expressed for women with sterile husbands whowanted to bear, and not simply rear, children, although it was suggestedtheir desires could be ‘inordinate’. It was also recognised that not allinfertile couples would be willing to face the risky results of adopting achild with ‘unknown character and heritage’, and that, with a falling birthrate, there might soon be too few children available for adoption. How-ever, AID was rejected because it could not fulfil the ends of marriageand would only have undesirable effects on the institutions of marriageand the family. The children produced would be illegitimate and theirregistration as those of the fathers constituted perjury, and the practiceitself was probably illegal on the basis of conspiracy.

The Commission’s advice to criminalise AID was accepted by theArchbishop but never followed. However, the report received wide pub-licity including, for example, a play on the topic, Breach of Marriage

7 While the Commission would seem to have accepted this newspaper report as an accurateaccount of events, the story was rather differently presented in the press in the UnitedStates. There it was reported as a less than serious suggestion from a member of thepublic that had been sent to a Congressional Committee considering nuclear policies.

26 Martin Richards

(Sutherland, 1949), which had a successful West End run before trans-ferring to New York’s Broadway. In 1949, the matter was again raised inthe House of Lords where concerns were expressed about the injusticewhich would follow if an AID child succeeded to a hereditary title or ifthere was a ‘breaking of the blood line governing privileged status’, suchas an earldom.

Despite all the objections, the practice slowly grew, not least because itwas becoming increasingly difficult for infertile couples to find infants toadopt. By 1960, it was estimated that more than a thousand AID babieshad been born during the previous two decades in the UK. In 1958, atleast in law, the issue of adultery was laid to rest. In a Scottish divorcecase (Maclennan v. Maclennan, 1958), it was held that a wife seekingAID without her husband’s knowledge had not committed adultery. Asa result of the ensuing discussion, the Government set up a committee(Feversham, 1960) to consider AID and whether any change to the lawwas necessary or desirable. The long and detailed report went over muchof the same ground as Wand (1948). It was very critical of AID andconsidered whether it should be prohibited or regulated. While prohi-bition might reduce the practice, it was thought that it might be drivenunderground with even more undesirable results. It also held that anyattempt to regulate would be an infringement of the practice of doctors,while issuing any guidance to doctors would likely encourage the prac-tice. So the final conclusion was that ‘the practice of AID is to be stronglydiscouraged [but] it should not be declared criminal or be regulated bylaw’ (Feversham, 1960: 82).

The Committee accepted that donation would be anonymous and AIDwould be a secret, with the following comment:

While some couples could no doubt be relied on to keep the secret, there wouldalways be the possibility, however reliable the couple, of a child hearing of AIDthrough circumstances beyond their control. [There would be] serious conse-quences for the child if he discovered he was conceived through AID. He wouldlearn that his ‘parents’ had deceived him and that he was probably in law ille-gitimate through a deliberately planned act of his mother and husband . . . [Andthat] he was conceived . . . through a test-tube, a method of conception whichis repugnant to a considerable section of the community . . . It seems to us thatthose who argue that a child is entitled as of right to know that he is AID origin,even though the knowledge may do him great harm, are really arguing againstthe continuation of AID rather than in favour of telling the child. (Feversham,1960: 44–5)

As the lesser of evils, they considered that sometimes an offspring mightbe told of AID at an appropriate age, although they ended this partof their discussion with the comment, ‘we feel, however, that in the


interests of the child alone . . . the practice [of AID] should be discour-aged’ (1960: 46).

As a way of protecting the welfare of children, the report recommendedthat a husband should be required by law to maintain a child conceivedby AID, although there should be no amendment to the laws relating tolegitimacy or registration of births. It advised that the legitimisation ofchildren, not of their ‘natural parents’, would be a new concept whichwould alter the meaning of parentage and would suggest the removal ofall distinctions between legitimate and illegitimate children. Legal adop-tion by the couple was rejected because it would reveal the AID child’sillegitimacy. A proposal that AID children might have a more limitedstatus, which would be ascertainable by reference to a secret record, wasalso rejected. On the other hand, there was a recommendation that AIDwithout a husband’s consent should be made a new ground for divorce.Unsurprisingly, the report concluded that in no circumstance should asingle woman be artificially inseminated. It was argued that not onlydid children need fathers but, as the usual clinical reason for AID wasmarriage to an infertile man, this could not apply to unmarried women.Therefore, AID was ruled out for all unmarried women.

A decade or so on, the next report on AID signalled a significantchange in attitudes within the medical establishment. In 1971, the BritishMedical Association set up an inquiry into ‘the place of AID in ourmodern society’ and a panel, largely composed of clinicians, was formedunder the Chairmanship of Sir John Peel, a former President of theRoyal College of Obstetrics and Gynaecology (Peel, 1973). This noted agrowing demand for AID which was thought to be caused by changingpublic opinion on questions of sexual behaviour and attitudes to AIDand, more practically, a sharp decline in the number of children placedfor adoption (8,417 in 1971, down 38 per cent from the 1967 figure). ThePeel Panel reversed the conclusions of the Earl of Feversham’s Reportand recommended that the law be changed to legitimise AID children ofmarried couples and that for the purposes of birth registration, an AIDchild should be deemed to be the child of the husband. It proposed thataccredited centres for AID, along with frozen-semen banks, should beestablished in the National Health Service (NHS). AID would operateon a confidential basis, but NHS centres and private practitioners wouldbe required to record relevant details of the prospective mother and herhusband. Unlike earlier reports, there was also a plea for research, bothto exploit the opportunities for genetic research afforded by AID, and toinvestigate effects of AID on the development of personal relationshipsin families. However, as with the recommendations of all earlier reports,no action followed and the practice of AID continued in a legal limbo.

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The new ARTs

In July 1978, a new image of reproduction went round the world withthe news of the birth of the first IVF baby. The most intimate and hid-den moment of procreation was now disembodied and made visible asscientists mixing sperm with eggs in a glass dish. This new symbol ofbaby making as egg meeting sperm heralded the new breed of ‘test-tubebabies’. For the cover of Time Magazine, Roger Hysser famously echoedMichelangelo’s Creation of Adam, but added the hand of Edwards or Step-toe to that of God, pointing to a test tube containing the IVF embryo.

Initially IVF was as controversial as AID had been forty years earlier –a step too far for uncontrolled science – and it produced a similar publicrevulsion. For some, there were the same objections: a departure frommarital sexual intercourse which separated its procreative and unitiveaspects. In this case, there was a further deviation as procreation waseffected by scientists in a laboratory. Significantly, parents were not evenpresent at the conception of their child. Thus procreation was redefinedas the union of egg and sperm rather than the coupling of a man andwoman. Some feminists saw a male abuse of female bodies in ‘the greattechnological fuck’ (Klein, 2008), while some clinicians welcomed it as anew technique for alleviating infertility which might be the only methodfor some people to have their ‘own child’ (i.e. conceived with their ownsex cells).

The first IVF baby’s fourth birthday was marked by the Governmentby setting up an inquiry to consider ‘recent and potential developmentsin medicine and science related to human fertilisation and embryology’(Warnock, 1984: 4). The philosopher, Mary Warnock, was appointed tochair a group largely comprising of clinicians, scientists and lawyers, andjust one theologian. Their report focussed on infertility and its alleviationand research on human embryos. Following the development of IVF, eggand embryo donation were now possible and there was also a new formof gestational surrogacy to consider in which an embryo created by IVFusing a couple’s egg and sperm could be carried to birth by anotherwoman. Warnock’s approach could not have been further from that ofWand: central for Wand were the marital relationship and the violationof this which AID would entail. For Warnock (1984), these were dis-embodied technical procedures for conception which could be deployedfor clinical treatment. Considering collaborative reproduction was dif-ficult because the Committee were caught between seeing the ‘geneticconnection’ as socially determinative and shoehorning practices as far aspossible into a traditional model of the family. Thus, donation was to beanonymous and they wanted to write sex cell providers out of the story:‘It is a matter of good practice [that] any third party donating gametes


for infertility treatments should be unknown to the couple before, duringand after the treatment and equally the third party should not know theidentity of the couple being helped’ (Warnock, 1984: 15).

However, they also proposed that offspring had a right to know themanner of their conception, though not the identity of the donor. Alllegal rights and duties of parenthood were to be transferred from donorsto the receiving couple. While recommending that at birth, the receivingcouple should be registered as the parents, it was also suggested thatparents should be able to record the birth as ‘by donation’, so that birthregistration would remain a ‘true genetic record’. Their approach couldnot work in all situations. For instance, it was recognised that in intra-familial donation, anonymous donation was not feasible and the donorwould be known to the recipients. Or if sperm provision was arrangedprivately and insemination took place outside a clinic, the donor wouldbe regarded legally as the father with at least financial responsibilitiesfor the child as would be the case if an unmarried couple conceivedthrough sexual intercourse. The report took a liberal view that treat-ments should not be confined to married couples.8 However, under theproposed regulations, treatment for women without partners would leadto the implausible situation of an apparent virgin birth with a child whowould be fatherless in the eyes of the law.

At the time Warnock reported, egg donation had been attempted inthe United States and Australia but only a single live birth had beenrecorded. The Report argued that having accepted AID, it would be‘illogical’ not to accept egg donation. While there are necessary differ-ences in the practicalities of egg and sperm donation,9 following theconcept of the contribution of genetic material, similar regulatory prin-ciples would apply to sperm, egg and embryo donation. These includedonor anonymity, a couples’ access to limited information about donors,and that a donor offspring may, after the age of majority, request to seethis non-identifying information. As the report put it:

Egg donation produces for the first time circumstances in which the geneticmother (the woman who donates the egg), is a different person from the womanwho gives birth to the child, the carrying mother . . . In order to achieve some

8 When arrangements were being debated in Parliament under the 1990 HFE Bill, anamendment to exclude the unmarried from treatment was defeated by a very narrowmajority. However, a compromise amendment requiring clinicians to recognise a child’s‘need for a father’ was passed. Subsequently, some, but not all, clinics regarded this as areason to exclude single women and lesbian couples from treatment.

9 For example, at that time, unlike sperm, it was not possible to freeze eggs for future use.Also, egg donation carries some medical risks for the donors. While sperm is producedthrough the sexual act of masturbation, eggs are ‘harvested’ after hormonal stimulationthrough surgery. For further discussion, see Haimes (2002).

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certainty in the situation . . . the donation should be treated as absolute as that,like a male donor, she [female donor] should have no rights or duties with regardto any resulting child . . . The woman giving birth should, for all purposes, beregarded in law as the mother of that child. (Warnock, 1984: 37–8)

What was not said is that this uncertainty with two mothers only arisesif the genetic connection is seen as socially determinative or, indeed,if sperm and egg donors are regulated in the same way. Traditionallymotherhood, in law and in custom, is determined by gestation and theact of giving birth, not by any bloodline connection. Indeed, that positionis maintained in the UK regulation of surrogacy, where the woman givingbirth is regarded as the mother irrespective of whether or not the childshe is carrying was conceived with her own egg or that of another. Thecommissioning couple only become legal parents after the baby is handedover if they go through a process akin to a legal adoption (for furtherdiscussion, see McCandless and Sheldon, Chapter 3).

Unlike all its predecessors, the Warnock Report influenced and indeedeffectively determined public policies with regard to the donation of sexcells. Its recommendations were embodied in the Human Fertilisationand Embryology (HFE) Act (1990) and in the subsequent guidancegiven to licensed clinics by the regulatory body created by the legislation,the Human Fertilisation and Embryology Authority (HFEA). The onlysignificant change to their advice related to the genetic connection thatwas not followed in regulation was the recording of ‘by donation’ on birthcertificates (see Blyth et al., 2009). Nor, in effect, was a child’s right toknowledge of the fact of their donor conception fully supported. Underthe regulations, it was left to parents to decide whether or not to tellchildren of their donor conception. As we now know, most heterosexualcouples choose not to tell, so the possibility of accessing informationabout the donor in adulthood is irrelevant for most donor offspring (seeBlake et al., Chapter 14). While recently there are some indications thatmore parents are telling children of their origins, many heterosexual cou-ples still decide not to follow the growing rhetoric in the UK that early‘disclosure’ is in the best interests of the child (Appleby, Blake and Free-man, 2012; Nuffield Council on Bioethics, 2013). Since the HFE Actcame into force in 1990 there has been one significant change in regula-tion: donor anonymity ended in 2005. I will return to the significance ofthis decision later.

Genes R Us? The genetic connection

It has been argued that the techniques and practices of assisted repro-duction, including collaborative reproduction, support and promote


the social significance of the genetic link and the traditional nuclearfamily (e.g. Widdows, 2006). It is certainly the case that these techniquesoffer new means of reproduction for infertile heterosexual couples whichpreserve a genetic connection with children for both, or at least one, ofthe parents. The same is true for women without a partner or with asame-sex partner, who, without the aid of ARTs, could only reproducethrough sexual intercourse with a man who could claim legal parentagefor the resulting child. Likewise, as Smietana et al. discuss in Chapter 11,surrogacy and egg donation have enabled gay male couples to have chil-dren with a genetic connection to one partner, and now single men toohave that opportunity.10

For heterosexual couples, collaborative reproduction (except surro-gacy) allows the appearance of a traditional family from the outset: cou-ples experience a visible pregnancy and birth, and unless couples chooseto disclose their use of others’ sex cells (which most do not), family andfriends may be none the wiser. Of course, for same-sex couples or sin-gle people some explanation of the origin of the child may be requiredand, not surprisingly, most (although not all) in this situation do tell theirchildren and others of the conception through collaborative reproduction(see Graham, Chapter 12; Blake et al., Chapter 14).

One can also see a strong preference for parents to have their ‘ownchild’, using their own sex cells in the choices they make for using par-ticular technologies. Even when this may require much more complex,invasive and probably more expensive technology, heterosexual couplesmay go to considerable lengths seeking conception that involves their ownsex cells; an observation that is also apparent in the reproductive decision-making of some single women (Graham, Chapter 12) and gay couples(Smietana et al., Chapter 11).11 So for example, couples may choose

10 Whilst advances in ARTs open up the possibility for those without reproductive partnersto have children, the ability to do this in practice may depend on the particular regulatorycontext. For example, a single person in the UK cannot currently obtain a parentalorder, thus restricting the possibility for single men to have children via surrogacy andegg donation within the UK.

11 This same preference has launched a major research programme to develop a newform of IVF with nuclear transfer. Women with some rare mitochondrial diseases maytransmit these to their children. This can be avoided by using IVF and a donor egg.However, new technology is being developed which would permit an affected womanto use the nucleus (essentially the genome) from an egg of her own, together with anenucleated egg of a donor to conceive a child by IVF (or the equivalent exchange usingearly embryos). Such technology is likely to be inefficient so that many eggs may berequired to achieve a successful transfer, and there are potential risks of abnormalityfor children conceived in this way. And female offspring will transmit their modifiedgenetic make-up to their own children. The technology will also be far more costly thanthe tried-and-tested techniques for using a donor egg. These planned developments arediscussed by McCandless and Sheldon in Chapter 3.

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IVF and ICSI12 when a male partner is subfertile, rather than the muchsimpler (and cheaper) process of insemination with donor sperm. Thisemphasis on having their ‘own child’, or having children through meansthat can appear ‘natural’ and conventional, is perhaps surprising in asociety where family structures have become much more fluid. In theUK today, almost half of all children are conceived outside marriage andrelatively high rates of separation and divorce mean that many childrengrow up with unrelated father figures in their households. More womennot living with a partner are choosing to have children. However, to setagainst this tendency for more fluid family structures, including somethat do not reflect genetic connections, there have been other develop-ments which may be seen to stress the potency of a genetic link. Herethere is evidence from the wide use of DNA-based relationship test-ing and for the growing perception that DNA sequences may be seento be determinative of social relationships. The most widely used of allDNA tests are paternity tests (Rothstein et al., 2005), and it has beenwidely argued that these have reinforced the view that fatherhood is to bedefined biologically rather than socially, so that a genetic (DNA) link hasbecome a sufficient basis for legal fatherhood (Anderlik and Rothstein,2002). This essentialist approach is further exemplified by the strongassociation between paternity and economic responsibility enshrined inthe Child Support Act (1991) under which shared DNA sequences deter-mine a man’s obligations to pay child support (Freeman and Richards,2006).

DNA testing may also be used for ancestry tracing, as in the case ofthe US President Thomas Jefferson, where testing confirmed that it ishighly probable that he fathered a child with one of his slaves, Sally Hem-mings. In collaborative reproduction such tests have also made anony-mous donation somewhat less anonymous. Surnames follow male blood-lines, barring such situations as adoption, extramarital conception andcollaborative reproduction. Companies in the business of familial DNAtesting have DNA databases of men who share a surname, which can besearched with DNA data from someone to look for a surname match.Using this approach, a young man in the USA found his ‘anonymous’sperm provider. With a sample of his own DNA, he obtained a rela-tively rare surname from an ancestry testing company and then searcheddirectories from his town of birth, leading him to his donor’s doorstep(Motluk, 2005).

12 Intra-cytoplasmic sperm injection (ICSI) was introduced in the 1990s and involves thein vitro injection of a single sperm into an egg. It carries a small increased risk of fetalabnormality and, of course, must necessarily be used in conjunction with IVF.


Consider a case where a clinical blunder led to couples ending upin court to get a determination of the paternity of their children andthere discovering the perceived social power of the genetic connection. Awoman undergoing IVF was, in error, inseminated with the sperm froma man in another couple also seeking treatment at the same clinic. Whilesuch hazards of collaborative reproduction may usually go unnoticed, orare explained away by the vagaries of family resemblance, in this case theerror became all too clear when a white couple gave birth to black twins.DNA tests confirmed that another man’s sperm had been mistakenlyused. The matter went to court for a determination of the parentageof the twins (Leeds Teaching Hospital NHS Trust v. Mr A, Mrs A andothers 2003a, b; Sheldon, 2005; Richards, 2008b). The white couple (theAs) who gave birth to twins were contesting parenthood with the blackcouple (the Bs) whose sperm had been used. Following the usual practiceof collaborative reproduction, one might expect Mr B to be written out ofthe picture as an unwitting sperm provider, and for the As to be given allthe rights and duties of parents; indeed, the Bs had accepted that the Asshould keep the twins and bring them up. However, this is not what thePresident of the Family Division, Dame Elizabeth Butler-Sloss, decided.Rather, she said that:

Although Mr A was not their legal father, [the twins] will remain with a loving,stable and secure home. They also retain the great advantage of preserving thereality of their paternal identity . . . to refuse to recognise Mr B as their biologicalfather is to distort the truth about which some day the twins will have to learnthrough knowledge of their paternal identity. (paras 56 and 57 of the judgment)

Recognising Mr B as the legal father was determined by the geneticconnection with the sperm provider. This judge here was following thepattern of more recent (post DNA testing) cases where married womenhave had affairs and there are questions about paternity of children bornsubsequently. Before DNA testing, it was usual in such cases for courtsnot to allow attempts to establish paternity through blood tests and arguethat it was better for children to remain as ‘children of the marriage’.Now the view is that paternity should be established by ‘science’ (i.e.DNA testing) and not by legal presumption, inference or indeed, theintentions of would-be parents, and that it is in a child’s interest to know‘the genetic truth’ (Bainham, 2008). As in the Leeds case, too bad forintending parents if the clinic messes up: although the As will bring upthe children as their parents, Mr B will be the father of the twins. As MrsA was the gestational mother of the twins, it would be unthinkable todisplace her as the twins’ mother and so her partner remains a coparent.Or in effect, as Sheldon (2005) points out, the twins will have two fathers

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but the ‘true father’ is Mr B who, as determined by genetic testing, willgive the twins their ‘paternal identity’, according to the judgment.13

Gender, eggs and sperm

Focusing on the genetic connection suggests an equivalence of sperm andegg donation: simply the two genetic components which come togetherat conception. Indeed, in some regulation sex cells are simply referredto as ‘genetic material’, which is largely the way the Warnock regulatorystructure framed it. However, there are marked gender differences in thepractice and representation of sex cell provision and the motivations ofwomen and men to donate, with women tending to express more altruis-tic impulses (Price, 1995; see also Almeling, Chapter 8). Haimes (2002)describes how, while egg donation is seen as familial, clinical and asex-ual, sperm donation is more individualistic with an overtone of a dubioussexual connection. And, of course, while egg donation involves medicaltreatment and surgery, sperm is produced through a sexual act. I havedescribed the historical perception of an adulterous relationship for bothrecipient and sperm donor. Hirsh (1993), in interviews with English mar-ried couples, found perceptions of sperm donation as ‘unfaithfulness’ formarried men and AID as ‘test tube adultery’; associations also identifiedby Hudson and Culley (Chapter 13) in the context of various South Asiancommunities in the contemporary UK. We might note in this context thatwhile egg donation by sisters and sisters-in-law are the commonest formsof intrafamilial donation, sperm donation between relatives is very rareand is seen by many as inappropriate (Lessor et al., 1990; see Freemanet al., Chapter 15 for further discussion of intrafamilial sperm donation).

In the commercial world of egg and sperm ‘donation’ in the USA,Almeling (2011; Chapter 8) describes how donor profiles are pack-aged representations shaped by the donor’s interest in being selectedby would-be recipients and the agency’s interest in selling sex cells. Cru-cially, ‘these interests are structured in part by gendered social norms’(Almeling, 2006: 155). Most telling were the differences between hermale and female respondents’ ways of talking about the children whomight have been conceived with their sex cell: while most men used thelanguage of kinship less than half the women did (for further discussion,see Chapter 8). To cite another example, Jadva and Imrie’s research with

13 I am unaware of similar cases regarding a mix-up of eggs. However, if Mrs A hadunwittingly received an egg from Mrs B she would, in law, be the mother because shecarried the pregnancy and it is perhaps possible that Mrs B would have been written outof the story.


surrogates’ families (Chapter 9) suggests that the genetic connection withthe egg provider is disregarded and the gestational link is determinative.Offspring and families see the kin connection with others born of their‘tummy mummy’ as the same whether or not the mother’s egg had beenused in the surrogacy.

But what of the children of donation? Do they regard their donors indifferent ways depending on whether they were conceived using donatedeggs or sperm? As discussed by Freeman and colleagues in Chapter 15,the overwhelming majority of offspring searching for ‘donor relations’,whether donors or ‘half-siblings’ by donation, are looking for those con-nected by sperm, rather than egg donation (Freeman et al., 2009; Jadvaet al., 2010, 2011). Not only may there be different perceptions of theconnection with the two sexes of gamete providers but unlike spermdonor children, egg donor offspring have biologically grounded relation-ships with both their father, via conception, and their mother, via preg-nancy and birth. It is significant that heterosexual parents are likely to bemore open with their children about the use of donor eggs than donorsperm. Perhaps this is because in the case of egg donation, both parentshave biological connections with their children.14 All this might suggestthat the social power of the genetic tie through sperm is more powerfulthan that through eggs. It is important to note, however, that there isonly very limited information available about donor offsprings’ attitudestowards their donors, especially for egg donor offspring. The little that isknown typically reflects the viewpoint of sperm donor offspring who areactively interested in, if not searching for, their donors (Blyth et al., 2012).

There is no gender equality in reproduction, nor as I have suggested,is the social power of female and male sex cells equal. The greater socialdeterminative power of sperm, the masculine genetic connector, reflectsmetaphors of reproduction, for example the ‘gardening’ metaphor ofman the sower of seeds and women the fertile ground that nurturesthem. While it has been long understood that pregnancy is initiatedby the semen transferred through sexual congress, eggs and ovulationare historically recent additions to the ‘facts of life’ of our culture. Onemight see more equal generative power in those disembodied IVF imagesof eggs and sperm in a petri dish. But even here sperm are seen as theactive penetrators of the passive egg – sometime literally as in picturesof ICSI with sperm being injected into an egg. So sperm, and the DNA

14 As a matter of biological correctness, I should note that a genetic connection is createdduring pregnancy as DNA is transferred between fetus and mother. Indeed, todaymaternal blood is used as a source for the fetal genome (DNA) for genetic testing. Onthis basis one could argue for a genetic connection between a child and both the womanwho provided the egg and another who had carried a pregnancy.

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that makes up most of its body, remains the active player of reproduction,travelling with its determinative social power.

Donor anonymity and the genetic connection

The Warnock Committee, like others before them, regarded donoranonymity as fundamental to collaborative reproduction. They claimedthat this would ‘protect all parties from legal complications but also fromemotional difficulties’ and was seen as a way of excluding the third partysex cell providers from an acknowledged role in reproduction (Warnock,1984: 15). Surrogacy apart, parents would experience pregnancy andbirth and bring up the child as their own with a place in their family,kinship and genealogy. All this was supported by changes in the lawregarding birth registration and parental rights and duties which oper-ated as if the child had been conceived with their own sex cells. However,there is a tension between donor anonymity and the perceived need ofthe child for information about their life story (Maclean and Maclean,1996). Warnock regarded it as wrong to deceive offspring about theirconception and to have secrets about their donor origins. Her reporttherefore recommended arrangements to enable donor-conceived indi-viduals to be given access to non-identifying information about the donorin adulthood. However, in 2004 it was decided that donor anonymityshould be ended and new regulations were promulgated (HFEA, 2004)to allow donor offspring conceived after April 2005 to seek identifyinginformation about their donor at age 18.

In the policy debates, a central argument in favour of the removalof donor anonymity invokes the recently promoted concept of ‘geneticidentity’. This seems to have been derived from the term used to describethe link between sex cell provider and offspring, the ‘genetic connection’.Rather confusingly, while it may signify the connection involving theprovision of ‘genetic material’ – the progenitor who provides sex cellsinvolved in the conception of offspring – it is also sometimes used forthe link between those, such as siblings, who are simply closely relatedin terms of shared DNA sequences but where there has been no transferof biological material.

However, in the debates about donor anonymity,15 the ‘genetic’has been invoked to do much more work than simply signify certain

15 Discussions and arguments about donor anonymity have almost exclusively focussedon sperm donation and paternity. However, the conclusion to end anonymity has beenapplied in relation to sperm, egg and embryo donation.


relationships. The claim is that knowledge of the identity of a donor isessential to an offspring’s complete genetic identity, that personal iden-tity is in some way defective or incomplete without knowing who yourprogenitor is. This we might regard as a ‘fixed’ notion of identity (Wilson,1997) rooted in genetics, emphasising genetic paternity and tied to thetracking of blood (or DNA) lines. However, this notion of a geneticallydetermined identity is very problematic. While it might sound like some-thing fundamental and significant, it is, I would argue, a meaninglessconcept. At best one might say the term ‘genetic identity’ is misleadingand does not describe what is missing if a donor’s name is not known.If we took the idea of genetic identity literally, we could provide donoroffspring with a genome sequence for their donor, or, indeed, they couldhave their own genome sequenced, or use genetic testing to characteriseaspects of their genome. However I do not think that DNA alphabetsoup is what donor offspring are perceived to lack. If DNA samples wereavailable from a number of possible donors, comparisons of the DNAcan link the offspring with a particular donor.16 ‘Half-siblings’ can alsobe linked. Blyth’s (2012) study of ‘Clan X’ adults conceived by spermdonation provides an example where DNA testing has been used to iden-tify a sperm donor and a group of ‘donor siblings’. But genetics, or DNA,does not in itself carry identity information. Names are not written incodes of base pairs. Members of the biosocial Clan X did not discover thename of the donor directly from the DNA analysis. Their knowledge ofthe clinic where they all had been conceived suggested the name of a pos-sible donor, the husband of the clinic director. His son was approachedfor a DNA sample and analysis indicated a link with most of the clanmembers’ DNA.

Genetic information itself does not individuate people. It is not a kindof molecular essence of personhood. This is most obvious in the case ofmonozygotic (‘identical’) twins with their very similar genome sequences.We have no doubts that they are separate people. However, complicationsmay arise if twins turn to crime as DNA left at the crime scene mightnot reveal who had been there, it would link to both people. Indeed, ifa monozygotic twin were to donate sex cells, genetic identity for the off-spring conceived would be doubly confused. Would the genetic identityquestion be answered by knowledge of the twin brother of the donor?

Another example which shows the disjunction between persons andgenomes are tetragametic chimeras – people whose body was made up

16 Though this process may not always be straightforward (e.g. Crawshaw et al., 2013).

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of two populations of cells each with different genomes.17 Consider thecase of a young American mother of three, Lydia Fairchild (ABC News,2006). She became unemployed and applied for public assistance. Thisrequired genetic testing to prove that everyone in her family was related.The tests indicated that she had no genetic connection with her children.She was accused of welfare fraud and she ended up in court continuingto assert that the children were her own and that she had given birth tothem. At this point she became aware of another person who had provedto be a chimera (Yu et al., 2002). New tests were used to examine cellsfrom different parts of her body and it was then established that she toowas a chimera. Her body had been formed by the fusion of twin embryosin her mother. These would have been created by the fertilisation of twoeggs by two sperm – fraternal twins. So she was two separate twins – twotwins then making one body and mind. Of course she is one person, butwith two genomes. Her children have a genetic connection with only onepart of her body – wherefore their genetic identity?

The fundamental point here in relation to donor anonymity is thatwhat donor offspring lack, and may want to know, is not informationabout themselves at all but about the person who provided the sex cellfrom which they were conceived: in fact, as I have suggested, it is nothingto do with genetics at all. The issue is information about the means ofconception and the other people involved and their actions and motives(see Lillehammer, Chapter 5). Accepting such arguments and difficul-ties, Wilson (1997) has put forward a plausible ‘narrative’ notion ofpersonal identity to replace the fixed identity invoked in genetic identityarguments.

A helpful way of approaching the idea of identity is an agglomeration in tapestry ofdifferent threads of narratives which people use to represent and to reflect on theirlives. Identity is tied up with the process of self-discovery and self-developmentthrough reflecting on, interpreting and reinterpreting these narratives of theirdifferent experiences . . . A person’s identity is greatly influenced by his or herinteraction and relationship with others . . . [The] influence of those around uson feelings of identity may also help to explain the significance of the past tomany people’s feeling of identity. (Wilson, 1997: 281–2)

Wilson used the notion of narrative identity to argue for a two-step systemof informing donor offspring about their origins. Step one would be torelease to them detailed biographical information about their donor. Thismight satisfy the curiosity of most offspring and fill in a gap in their life

17 In fact all our bodies include very many genomes if we take into account our micro-biome – all the bacteria, fungi etc. which make up most of the cells in our bodies. HereI am only referring to the genomes of our human cells.


story. But there may be some who might want to contact their donordirectly: they would be able to turn again to the registry and, in additionto the information they already have, obtain the name of their donorand use this for tracing. The Donor Registries in Victoria, Australia,work on a similar tiered system, enabling offspring to obtain informationabout their donor before choosing whether or not to try to contact them,thus leaving it to the offspring to decide what level of information orcommunication to seek with their donor (Freeman et al., Chapter 15).Thus far, we have very little idea what proportion of sex cell donationoffspring may be interested in tracing their donor. Current indicationsfrom sperm donation offspring are that numbers may be very small. It isunclear what interest there may be in tracing egg donors, although theusage of the registries in Australia, the UK and the USA indicates thatthere may be considerably less interest in tracing egg donors than spermdonors (Freeman et al., Chapter 15).

Conclusions

A generation ago artificial insemination with donor sperm was seen as adisruption of marital relations and a threat to the social order. Recastingcollaborative reproduction as a medical treatment for infertility and morelatterly, as a way of baby making for those without reproductive partners,has allowed a further disconnection of kinship from blood and DNA lines.In collaborative reproduction, as elsewhere, kinning (Thompson, 2001,2005; Howell, 2003; Bestard, 2004; Mamo, 2005; Grace and Daniels,2007; Edwards, Chapter 2) requires active social and sometimes legalconstruction. The notion of genetic connection, originally simply a wayof denoting some actors in collaborative reproduction, has gained socialpotency in a world where shared DNA sequences can create obligationsto pay child support. It is a terminology that encourages a biologicallydetermined view of parents and parenting and suggests that the socialsignificance of egg and sperm donation is the same. As I have described,there is a small but increasing body of evidence to suggest that attitudesof donors, recipients and their families toward sperm and egg donationmay be rather different; for example, in terms of differences betweenegg and sperm donors’ feelings about any offspring conceived from theirsex cells, parents’ greater reticence to disclose sperm donation than eggdonation and the greater numbers of sperm donor-conceived offspringactively seeking their ‘donor relations’ compared to those conceived usingdonated eggs.

Some of those who have used collaborative reproduction for babymaking are constructing new family forms and are open about the roles

40 Martin Richards

others have played in conceiving and/or gestating their children. However,particularly among heterosexual couples who use AID, we also see adifferent pattern where the facts of conception remain a secret of thecouple and kinship is normalised as if conception had followed theirown sexual intercourse. Despite the arguments others may make aboutthe merits of providing information for children (and others), and the‘rights’ of the child to information, at least within heterosexual couplefamilies, many children are not being told of their origins. However, asDNA testing has become freely available and is used in an ever-increasingnumber of situations for clinical, forensic and social reasons, such familysecrets become more vulnerable to discovery. The option for normalisingkinship as if conception had followed their own sexual intercourse maybe becoming less tenable. And a final thought: I wonder, if we were to userather different terminology and spoke, not of the genetic connection, butof the donor, or sex cell connection, whether we would come to perceivethe relationship rather differently?

Acknowledgements

I am grateful to Jill Brown for secretarial assistance. Thanks also to AlisonKrauss, the Be Good Tanyas, Blueflint, the Carter and Cox Families, theLow Anthem, the Flatlanders, Hazel Dickens, Bob Dylan, Joan Baez,Kitty Wells, Lynn Morris, Ray Charles and Roy Acuff for sustaining mewhile I was writing.

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Brewer, H. (1935). ‘Eutelegenesis’. Eugenics Review, 37, 121–6.Carsten, J. (2004). After Kinship. Cambridge University Press.Crawshaw, M., Gunter, C., Tidy, C. and Atherton, F. (2013). ‘Working with pre-

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Freeman, T. and Richards, M. (2006). ‘DNA testing and kinship: pater-nity, genealogy and the search for the “truth” of our genetic origins’, inF. Ebtehaj, B. Lindley and M. Richards (eds.), Kinship Matters. Oxford: HartPublishing.

Freeman, T., Jadva, V., Kramer, W. and Golombok, S. (2009).‘Gamete donation:parents’ experiences of searching for their child’s donor siblings and donor’.Human Reproduction, 24, 505–16.

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Hirsh, E. (1993). ‘Negotiated limits: interviews in South East England’, inEdwards, J., Franklin, S., Hirsh, E., Price, F. and Strathern, M. (eds.), Tech-nologies of Procreation: Kinship in the Age of Assisted Conception. ManchesterUniversity Press.

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Howell, S. (2003). ‘Kinning: the creation of life trajectories in transnationaladoptive families’. Journal of the Royal Anthropological Institute, 9, 465–84.

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Huxley, J. (1941). The Uniqueness of Man. London: Chatto and Windus.Jackson, M. (1957). ‘Artificial insemination (donor)’. Eugenics Review, 48, 203–5.Jadva, V., Freeman, T., Kramer, W. and Golombok, S. (2010). ‘Experiences

of offspring searching for and contacting their donor siblings and donor’.Reproductive BioMedicine Online, 20, 523–32.

(2011). ‘Sperm and oocyte donors’ experiences of anonymous donation andsubsequent contact with their donor offspring’. Human Reproduction, 26,638–45.

Klein, R. (2008). ‘From test-tube women to bodies without women’. Women’sStudies International Forum, 31, 157–75.

Lane-Roberts, C., Sharman, A., Walker, K. and Wiesner, B.P. (1939). Sterilityand Impaired Fertility. London: Hamish Hamilton Medical Books.

Lessor, R., Reitz, K., Balmaceda, J. and Asch, R. (1990). ‘A survey of publicattitudes toward oocyte donation between sisters’. Human Reproduction, 5,889–92.

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McCandless, A.E. (1943). ‘Correspondence: artificial insemination’. BritishMedical Journal, 4 October, 434.

Maclean, S. and Maclean, M. (1996). ‘Keeping secrets in assisted reproduc-tion – the tension between donor anonymity and the need of the child forinformation’. Child and Family Law, 8, 243–51.

Mamo, L. (2005). ‘Biomedicalizing kinship: sperm-banks and the creation ofaffinity-ties’. Science as Culture, 14, 237–62.

Motluk, A. (2005). ‘Tracing dad online’. New Scientist, 6, 5.Muller, H.J. (1936). Out of the Night. London: Gollancz.Nuffield Council on Bioethics (2013). Donor Conception: Ethical Aspects of Infor-

mation Sharing. London: Nuffield Council on Bioethics.Peel, J. (1973). ‘Annual Report of Council: Appendix V. Report of Panel on

Human Artificial Insemination’. British Medical Journal Supplement, April,3–5.

Price, F. (1995). ‘The donor, the recipient and the child – human egg donationin UK licensed centres’. Child and Family Law Quarterly, 7, 145–51.

Public Morality Council (1947). Artificial Human Insemination. London: Heine-mann Medical Books.

Richards, M.P.M. (2008a). ‘Artificial insemination and eugenics: celibate moth-erhood, eutelegenesis and germinal choice’. Studies in the History, Philosophyof Biology and Biomedical Sciences, 39, 211–21.

(2008b). ‘Genes, genealogies and paternity: making babies in the twenty-firstcentury’, in J.R. Spencer and A. Du Bois-Pedain (eds.), Freedom and Respon-sibility in Reproductive Choice. Oxford: Hart Publications.

Rohleder, H. (1934). Test Tube Babies: A History of the Artificial Impregnation ofHuman Beings. New York: Panurge Press.


Rothstein, M.A., Murray, T.H., Koebnick, G.E. and Majumder, M.A. (2005).Genetic Ties and the Family. Baltimore: Johns Hopkins Press.

Sheldon, S. (2005). ‘Fragmenting fatherhood: the regulation of reproductivetechnologies’. Modern Law Review, 68, 523–53.

Squier, S.M. (1994). Babies in Bottles: Twentieth Century Visions of ReproductiveTechnology. New Brunswick, NJ: Rutgers University Press.

Sutherland, D. (1949). Breach of Marriage: The Artificial Insemination Play. Lon-don: Duckworth.

Swan, H.W. (1918). Facultative Motherhood without Offence to Moral Law. Mel-bourne: Australian Authors’ Agency.

Swanson, K.W. (2012). ‘Adultery by doctor: artificial insemination, 1890–1945’.Chicago–Kent Law Review, 87, 591–633.

Thompson, C. (2001). ‘Strategic naturalization: kinship in an infertility clinic’, inS. Franklin and S. MacKinnon (eds.), Relative Values: Reconfiguring KinshipStudies. Durham, NC: Duke University Press.

(2005). Making Parents: The Ontological Choreography of Reproductive Technolo-gies. Cambridge, MA: MIT Press.

Wand, J.W.C. (1948). Artificial Human Insemination. London: SPCK.Warnock, Dame M. (1984). Report of the Committee of Inquiry into Human Fertil-

isation and Embryology. Cmnd.9314. London: HMSO.Widdows, H. (2006). ‘The impact of new reproductive technologies on concepts

of genetic relatedness and non-relatedness’, in H. Widdows, I.A. Idiakez andA.E. Cirion (eds.), Women’s Reproductive Rights. London: Palgrave Macmil-lan.

Wilson, S. (1997). ‘Identity, genealogy and the social family: the case of donorinsemination’. International Journal of Law, Policy and the Family, 11, 270–97.

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CasesLeeds Teaching Hospital NHS Trust v. Mr A, Mrs A and others (2003a). EWHC

259.(2003b). 1 FLR 1091.

Maclennan v. Maclennan (1958). S.L.T. 7.

LegislationChild Support Act (1991).Human Fertilisation and Embryology Act (1990).

2 Undoing kinship

Jeanette Edwards

In 1990 I returned to a small town in the north-west of England totalk to residents about what we then called new reproductive technolo-gies (NRTs). This was one strand of a collaborative study which alsoconsulted married couples in the south of England, embryologists andIVF clinicians, and the parliamentary debate prior to the enactment ofthe Human Fertilisation and Embryology Act in 1990 (Edwards et al.,1999). While we started, as anthropologists, with the premise that assist-ing conception also assists kinship (Strathern, 1992b), that is, thatassisted reproductive technologies (ARTs) create kin as well as offspring,we were unprepared for the level of kinship detail that people with novested interest in the technologies, either as patient or professional, wentinto. The people in Alltown who discussed ARTs with me, and with eachother, drew on what they knew of the intricacies of family relationships.1

They talked about the ways in which kinship is forged, maintained andbroken in their exploration of how conception might be assisted andinfertility overcome. They were acutely aware of both the potentialand the limits of ARTs despite, in many cases, never having discussedthese things before. While some of their interests were couched in theemotive language of the time, which included ‘test-tube’ and ‘designer’babies, with scientists ‘playing God’ in a ‘brave new world’, they neverthe-less focused in on what constitutes relatedness: on how, for example, bothsurrogate mothers and gamete donors would be related to commissioningparents (and their parents) as well as to the children conceived throughsuch interventions. They talked about wider kin and imagined how theparents and siblings of a gamete donor would be related, or not, to achild conceived with their relative’s gametes. They considered whetherchildren conceived with gametes from the same donor would be relatedand, if so, how (and this before the term ‘donor sibling’ was commoncurrency). Alltown people brought up the risks of inadvertent incest, the

1 I had previously carried out residential fieldwork in Alltown, and have been working thereas an anthropologist on and off now for twenty-five years.

44

Undoing kinship 45

stigma and ‘desperation’ of infertility, the need for confidentiality andprivacy, and the advantages and disadvantages of ‘keeping it in the fam-ily’ (i.e. of using gametes donated by kin). This is not to suggest that allthe people I interviewed, both formally and informally, touched on allthese subjects, but they all drew on their expertise of kinship to explorethe implications for families (not only individuals) of ARTs. And whilekinship was put together in newly reconfigured ways, which includednew kin figures, the parts remained the same. We argued then, and sub-sequently, that there were biological and social elements and emphasiscould be placed on one or the other or indeed both (Edwards et al., 1999;see also Edwards, 2000 and Edwards and Salazar, 2009).

ARTs proved to be one spark in the rekindling of anthropologicalinterest in kinship; an interest that was fuelled, on the one hand, bystudies of the ways in which ARTs travelled and were deployed in dif-ferent national contexts and, on the other, by changing values in whatconstituted ‘the family’ in European and settler societies. Changes inrates of marriage and divorce, and attitudes towards illegitimacy andhomosexuality, were already puncturing the sanctity of the conjugal andnuclear family.2 New and complex family forms, recombinant familiesfrom remarriage or new partnerships, shared collaborative reproduction(drawing in gamete donors and surrogates), shared collaborative parent-ing (drawing in donors as well as step-parents), and changing practicesin adoption, all revealed the component parts of kinship.

Two decades later the currency of ‘playing God’ and ‘test-tube babies’is less pronounced in the UK as infertility and its treatment have touchedmany families in some way. Its familiarity has been facilitated by the rapidand massive expansion of the media in which information is exchanged,opinions formed and potentialities, as well as limits, are aired. Interest-ingly, however, many of the kinship questions that residents of Alltownposed twenty years ago remain salient. They are applied to novel possi-bilities and new ways of assisting conception. They are also now, twentyyears later, centre stage in policy debate. Kinship, not overly relevantfor clinicians and parliamentarians in 1990 (Edwards et al., 1999), iscentral in current debates about confidentiality and disclosure as wellas to contemporary concerns about the governance of cross-border fer-tility treatment. Kinship is also immanent in deliberations on new andemerging technologies such as mitochondrial DNA transfer, which adds,for some people, the possibility of yet another kinship link, with some

2 The prior lack of interest in kinship in the West was shaped by the assumption that withindustrialization, the family, and particularly the conjugal family, had replaced the kingroup as the relevant kinship unit (Segalen, 2001).

46 Jeanette Edwards

commentators pointing out that this has the potential to create yetanother ‘mother’ (see McCandless and Sheldon, Chapter 3).3

From an anthropological perspective, the traffic between ARTs andkinship is two-way. If people seem to understand ARTs in the context ofkinship, so too their understanding of kinship is revealed in the contextof ARTs. ARTs provide an anthropological handle on indigenous mod-els of kinship, including the indigenous models of plural, late-modernEuropean societies.4 As ARTs travel, they carry with them some of theconcerns and debates that have emerged in their places of origin, but theyalso engage with already formed understandings of what is culturally andpolitically appropriate in the reproduction of proper persons. Specificcultural understandings of kinship inform what is and is not possible inassisted reproduction and it is through understandings of kinship thatcertain procedures are welcomed and others rejected. Kinship informsboth the reasons for intervening in conception and the ethical debatessuch intervention provokes.

Much has been written on the ways in which ARTs assist and createkinship, but kinship does not proliferate ad infinitum. I turn in this chap-ter to how kin are unmade, cut out and cut off: to how kinship is undone,and to how it may never have been there in the first place.

Kinning and de-kinning

Kinship was once understood as the cultural elaboration of biologicalfacts, with the assumption that the biological facts were given and uni-versally the same the world over (Schneider, 1984; Strathern, 1992a;Carsten, 2004). From one perspective, this is surely the case. But which‘biological facts’ become socially relevant and the value or significanceplaced on them cannot be assumed. The way in which biological con-nectedness is rendered visible and the metaphors or symbols throughwhich the story of procreation is told vary. ‘Biological facts’ need to besocially activated, which suggests that the biological is deeply social andthat the common and convenient divide between the social and the bio-logical obscures more than it reveals. Moreover, not only do they need to

3 See also the Nuffield Council on Bioethics report (2012), for a discussion of attendantconcerns about ‘identity’.

4 Furthermore, studying ‘English’ kinship provided further insight into the kinship modelsthat had informed early British anthropology and through which anthropologists hadattempted to make sense of radically different kinship systems. Kinship had been central inthe development of the discipline, but had been sidelined in the widespread dissatisfactionwith formal models culminating in ‘the reflexive turn’ in anthropology in the 1970s withits powerful critique of ethnocentricism.

Undoing kinship 47

be socially activated but also if by biology we mean corporeal substancesand bodily processes, then they, in turn, are made meaningful.

It has been argued that in Euro-American kinship systems the interplayof social and biological elements of relatedness allows one or the other tobe brought to the fore, albeit temporarily, thus screening out the signifi-cance of the other: so that a ‘real’ mother, for example, can be the personwho gestates the fetus, or who nurtures the infant, or who provides theegg; similarly a father may be the person who provides the sperm, or whodesires the child, or who cares and provides for it. This choreographybetween the ‘biological’ and the ‘social’ has emerged in many studiesthat have been conducted in key sites where ARTs are deployed and/ordebated, including fertility clinics and legislative and policy fora (e.g.Finkler, 2000; Thompson, 2005; Inhorn, 2007). This kind of analysis,however, while productively revealing the fluidity of kinship, runs thedanger of assuming, a priori, that we know what is included in the cate-gories of biological and social, thus under-problematising how elementsget categorised as such (Edwards, 2009; see also Hudson and Culley,Chapter 13; Klotz, 2012). What biological kinship is, for example, is notself-evident.

Signe Howell has written about the efforts that Norwegian parents putinto making their transnationally adopted children not only kin, but alsoNorwegian (Howell, 2006).5 She coined the term ‘kinning’ as a universalprocess whereby a ‘foetus or newborn child (or previously unconnectedperson) is brought into a significant and permanent relationship with agroup of people that is expressed in a kin idiom’ (Howell, 2006: 63). Herekinning is the process whereby the adopted child is ‘incorporated intoits adoptive parents’ kin network’ (Howell, 2001: 208). Howell draws onthe notion of ‘transubstantiation’ to explore the process that transformswhat she calls the ‘social essence’ of the child (its ‘being [or] self ’),while leaving its ‘substance’ (‘biological body’) intact (Howell, 2006:69). ‘Kinning’ suggests an active process of making kin rather than anidentity that is given or achieved. This is not the place to address theawkward Christian connotations of ‘transubstantiation’, but it does raisethe question of what exactly is transformed in the process of kinning andwhat bits of the biological body remain unchanged. Howell describeshow the processes of kinning transform the child’s non-physiologicalbeing and starts even before the child is identified, as the parents prepare

5 Norway has one of the highest rates, per capita, of transnational adoption in Europewhich is connected, among other things, to a relatively high birth rate (with few childlessfamilies), generous parental leave provisions and relatively restrictive legislation on ARTs,with egg donation prohibited and state-subsidised ART confined to married couples.

48 Jeanette Edwards

themselves to be parents of a ‘foreign’ child. It continues through the longdrawn-out process of allocation and paperwork, when all the parents haveis a photograph of the infant they know was ‘meant for them’, throughto bringing their child ‘home’ – to where he or she was ‘meant to be’. Onarrival in Norway infants are emplotted, with intensity, into their parents’kin universe.

Howell finds inspiration from indigenous people of the highlands ofEcuador in thinking through the ways in which babies born in Korea,Peru or India, for example, are transformed (in Howell’s term ‘tran-substantiated’) into kin. Mary Weismantel, writing of the Zumbaguanpeople in Ecuador, notes that every Zumbaguan adult had ‘several kindsof parents and several kinds of children. They remembered a man whofathered them, but another who “husbanded” their growth; they remem-bered a woman who gave birth to them, but others who fed them andtaught them to speak and to know’ (Weismantel, 1995: 689). They knowthat a child can be made ‘one’s own’ by eating the same food over time,and there is ‘no privileging of the relationship a child has with the genitoror genetrix over others who are called parents’ (Weismantel, 1995: 691).The point to make is that feeding a child over time is not a symbolicor ritual act that transforms the non-related child into one’s own, buta material bond created through shared food making up the same flesh(Weismantel, 1995: 694). For Zumbaguan people, conception is onlyone, relatively unimportant, stage in the lengthy process of growing per-sons and forging kinship. Thinking about making kinship as an active,reflexive and intentional process, which occurs over time, alerts us to thefact that kin do not come unbidden. Zumbaguan birth mothers, as wellas genitors, are free to ‘give up their children if they do not wish to raisethem [and] it is also possible to establish a more limited relationship witha child one wishes neither to abandon nor to parent’ (Weismantel, 1995:691).

There are many examples in the ethnographic record of how substantialconnections between parents and offspring, formed pre- and postnatally,are generated through particular kinds of food which may also stem fromancestral lands and labour.6 Marshall Sahlins reminds us in his recentessay, What Kinship Is – and Is Not, ‘[k]inship fashioned sociologicallymay be the same in substance as kinship figured genealogically’ (Sahlins,2013: 5). In other words, ‘the same stuff transmitted in procreation’ can

6 There are also many examples of how mothers’ milk is a significant kinship substanceand examples, especially from the Muslim Middle East, where sibling ties, with attendantmarriage prohibitions, are tightly formed between those who are fed from the same breastwhether genetically related or not (Altorki, 1980; Clarke, 2009).

Undoing kinship 49

be transmitted postnatally. He gives an example from the Nebilyer Valleyin Papua New Guinea where kinship is known to be produced by thetransmission of kopong (grease or fat) originating from the family land inwhich food is grown. It is transmitted in mother’s milk and father’s semen.It is also found in significant and ceremonial foods such as sweet potatoand pork, which means that sharing such food, over time, creates thesame kind of consubstantiality as breast-feeding and sexual procreation(Merlan and Rumsey, 1991, cited in Sahlins, 2013: 5). Thus childrenof immigrants can be fully incorporated as kin, at the same time as thechildren of two brothers are as much related through shared food asthrough their shared grandparents.

Weismantel is at pains to underline the materiality of the Zumbaguankinship forged over time through feeding: it is not a one-off symbolic act.

In Zumbaguan eyes, engendering a child is only one component in the lengthyprocess of physical and social reproduction, and not necessarily the most impor-tant. Andean beliefs and practices about illness, death and healing reveal anunderlying conception of the human body as a material object built up over timethrough various substances and acts: ingesting food and drink, sharing emotionalstates with individuals or spirits, being in close proximity to people or objects.(Weismantel, 1995: 694)

It is also clear that the bodies of the Norwegian transnationally adoptedchildren are shaped by Norwegian everyday practices, including eat-ing, walking on snow and skiing. Transnationally adopted children arenot only incorporated into kin networks but incorporated into the bodypolitic. Their bodies are literally moulded by the Norwegianness of thefood they eat and the terrain over which they move.7 ‘As the childrenlearn to speak Norwegian, they also learn to be Norwegian. They eatNorwegian food, play Norwegian games, and learn Norwegian songsand fairytales. From the point of view of adoptive parents, their newchild has “come home”’ (Howell, 2006: 76).

But for Howell, and the Norwegian parents with whom she works, thereis something immutable about the biological ‘essences’ of their children.

7 Tim Ingold has argued long and tenaciously about the co-constitution of bodies and beingin the world. His call to focus on the human-being-in-its-environment is not merelyan emphasis on nurture above nature, but a radical rethink of the common idea thatculture (diverse) is superimposed upon a human biology (universal). For Ingold, humancapacities, such as language and walking and the shape and anatomy of human bodies,are ‘neither given in advance as genetic endowment, nor transmitted as components ofa separate body of cultural information, but are rather generated in and through thedynamic functioning of developmental systems constituted by virtue of the involvementof human beings in their diverse environments’ (Ingold, 2000: 390).

50 Jeanette Edwards

These children are kinned through the transubstantiation of their non-physiological bodies – their ‘social essences’ – because their biologicalkinship is given and legible in their appearance as ‘non-Norwegian’: intheir skin and hair colour, and stature, for example. Biological substancehere is transmitted in genes, read in the phenotype, and unchangeable.These infants are available to be kinned, according to Howell, becausethey have been de-kinned. She describes how de-kinning occurs whena previously kinned person is expelled from its kin community or whena newborn child is never kinned in the first place: abandonment de-kins a child who is ‘denuded of meaningful relations’ (Howell, 2006:70). Of interest here is who does the de-kinning. For Howell it is thebirth parents who do the de-kinning in the act of abandonment, butunless we know how the Indian, Korean or Ecuadorian, for example,fetus or newborn was (or was not) incorporated into a kin universe,and then whether, and if so how, they were cut off from that universe,we cannot know if, and if so how successfully, they were de-kinned.From Howell’s ethnography, however, we do know of the effort thatNorwegian parents put into incorporating their children into a new, denseand thickly textured kin network to which they now belong, both pre andpostnatally. Their success is partly built on their children arriving tabularasa.

We know that in the UK, gametes can be conceptualised as ‘merelybodily matter’ (detachable and alienable) or a proxy for the person sup-plying them (inalienable). In the former they can be detached, while inthe latter they form enduring, albeit diffuse, links into the future (seealso Konrad, 2005). In this context, let me draw on another ethno-graphic example. Susan Martha Kahn’s study of ARTs in Israel (Kahn,2000; 2004), points to both the political, what she calls the ‘nexus ofpower’, and the kinship context in which ARTs were made available inthe mid 1990s. Israel had the highest number of fertility clinics per capitain the world, and ARTs, including IVF, gamete donation and surrogacy,were state-subsidised up to the birth of two live children. This, at thesame time as restricted availability of state-subsidised contraceptive orabortion services. Kahn (2000) locates the apparent pronatalism and‘imperative to reproduce’ in wider political trajectories with deep histori-cal roots. As well as a duty to reproduce and the attendant stigma ofchildlessness (barrenness) for religiously observant Israeli Jews, the anti-Semitism in the diaspora which had included attempts to restrict Jewishbirths, as well as the eugenic impetus of the Holocaust, informed an acutesensitivity to restrictions on reproduction. Such deep historical sensibili-ties were potently accompanied by a perceived demographic and military

Undoing kinship 51

threat from Palestinian and Arab birthrates both within Israel and acrossneighbouring states and territories. Kahn located state support and therelative lack of restriction on ARTs as one among other state interven-tions that had been made since the 1950s to encourage Jewish women toreproduce and Israeli Jewish families to grow.

Kahn describes a nuanced deliberation of what is and is not pos-sible in the substitution of gametes in a context where Jewishness isconferred from mother to child. She tracks a fine-tuned choreographybetween rabbinic deliberations, clinical practices and the desire of unmar-ried, Israeli women to achieve a pregnancy through donor insemination.While I cannot do justice here to the range of complex arguments madeby the key actors and evocatively presented by Kahn, I sketch brieflytwo outcomes of the rabbinic deliberations over the use of donatedgametes.

The Halakhic prohibition of masturbation and the implications of adul-tery in a Jewish man placing his ‘seed’ into the body of a married Jewishwoman led some rabbis to argue for the use of ‘Gentile sperm’. The useof non-Jewish sperm ‘circumvents the Halakhic problem of sperm pro-curement from Jewish sperm donors’ (Kahn, 2000: 104) and also avoidsthe connotations of adultery which is defined as sexual relations betweena married Jewish woman and a Jewish man who is not her husband (seealso Richards, Chapter 1, and Hudson and Culley, Chapter 13, for adiscussion of the association between sperm donation and adultery indifferent historical and cultural contexts). Importantly, however, for thepurposes of this chapter, the point to make is that the use of ‘non-Jewishsperm’ does not compromise the ethnic identity of the ensuing child whois Jewish by virtue of his or her mother. Kahn points out that in Halakhickinship thinking, non-Jewish paternity does not exist for Jewish children.She translates and cites Avraham Steinberg (1975) as follows: ‘there is nodiscussion whatsoever about the issue of maintenance (between a non-Jewish sperm donor and his child) because the obligation falls only on thefather and the child is considered to have no father’ (Steinberg, 1975:136, cited in Kahn, 2000: 207). Furthermore, Kahn argues, childrenborn from sperm from the same non-Jewish donor to different Jewishwomen are not related; which means that, theoretically, they can marrybecause ‘they share no substance’ (Kahn, 2000: 105). Kahn notes thatthis is according to ‘traditional rabbinic sources’, and it is not clear howfar this view would be carried into the pragmatics of daily life. Nonethe-less, it provides us with a lateral viewpoint from which to look again atthe significance placed currently in the USA and the UK on ‘donor sib-lings’: a significance which has emerged alongside a preoccupation with

52 Jeanette Edwards

disclosure and transparency in donor conception (Freeman et al.,Chapter 15). It also turns our attention to which bodily/biological sub-stances are shared.

Given that Jewishness is conferred matrilineally in a ‘country that con-fers citizenship based on religious identity’ (Kahn, 2000: 137), we mightexpect less contestation over the donation of eggs. However in the mid1990s, there was no clear agreement over whether the mother was theegg donor or the woman who gestated the baby, or both. With no rab-binic consensus, there was a leaning towards the view that the womanwho carries and gives birth to the child is the Halakhic mother. Thus,the egg donor need not be Jewish. It could be argued that the impera-tive to reproduce sways the argument, pushing it in a more pragmaticdirection. But if this were the only argument made, it would occlude thefact that the genetic material conveyed in the gametes is less significantthan either the religious identity or the married status of the donor andrecipient. Interestingly, the adulterous connotations of married Jewishwomen using donated sperm from a Jewish man who is not her husbanddo not arise when fertilisation occurs in vitro and the resulting embryo istransferred into the woman’s womb.

While it is clear that both secular and religious Israelis can and donegotiate the whole gamut of ARTs, the rabbinic discussions, which arenot conducted, in this case, outside the remit of the State, should not bedismissed as merely esoteric beliefs that people adhere to, ignore, bypassor accommodate. They give us insight not only into the ‘permissibility’ ofARTs, including surrogacy arrangements, in present-day Israel but alsoreveal a kinship system which places less store on the genetic links forgedby gametes and more on the identity and marital status of donor andrecipient (Kahn, 2004: 362).8 They also illuminate some of the concernsexpressed about novel possibilities such as mitochondrial DNA transfer:there may be more at stake when maternal reproductive substance carriesand conveys significant aspects of social identity.

Charis Thompson, in her study in Californian infertility clinics,describes processes of what she calls ‘strategic naturalizing’ (Thompson,2001) whereby various links between persons are negotiated, affirmed or

8 Similar significance on the marital status of donors and recipients emerges in ethnographyfrom other Middle Eastern countries and Iran (see for example, Inhorn, 2006a, 2006b,2007; Tremayne, 2009). For example, in Lebanon the imperative of privacy, the stigma ofinfertility and the legitimacy of the child through the proper and appropriate marriage ofparents means that there is little perceived need for disclosure and it is the legitimacyof the parents’ marriage that confers legitimacy to the child. There is not the samepreoccupation, as there is currently in the UK, and elsewhere, with the rights of the childto know the means of its conception and the identity of its donor.

Undoing kinship 53

denied in the process of legitimating the chosen procedures and hoped-for outcome. Thompson relates the experience of Vanessa who acted asa gestational surrogate for Ute and her husband. The embryo that wasimplanted was created from an egg donated by Ute’s daughter from a pre-vious marriage and sperm from Ute’s present husband. In order to ‘pro-tect’ Ute’s daughter from being considered the biological mother, the factof the donation was kept secret and all involved agreed not to disclose theprocedure to anybody outside the clinic. Ute also ‘unlinked’ her daughterfrom the baby by emphasising the genetic link between her daughter andherself. Ute made it clear that her daughter’s egg was the next best thingto her own because of the genetic similarity between them. Thompsondescribes it thus: ‘Ute was providing the essential genetic component,even though that genetic material had travelled a circuitous route fromher down a generation to her daughter and back up again’ (Thompson,2001: 188). Meanwhile Vanessa, who felt closely connected to Ute andher family and who described herself as having been ‘a relative for a yearand a half ’, was cut out of the kin network after the baby was born.Vanessa was hurt by the abruptness with which the ties between themwere severed after she had fulfilled her side of the ‘deal’.

Is it useful to think of Vanessa as having been de-kinned? The relat-edness between the gestational mother and the fetus is, from many per-spectives, acknowledged as biological although not necessarily genetic.It is a biological kinship, however, that can clearly be undone: that canbe trumped by genetic links, albeit by a circuitous route. Perhaps, fromthe perspective of Ute and her husband, Vanessa was never kinned in thefirst place, nor could she be if their aim was to ‘protect’ the maternalidentity of Ute. Vanessa, however, felt herself to be related and did notexpect to be ‘cut off ’ and certainly not so rapidly. I think it salutary tothink about the unsociable aspects of ARTs: to think more about pro-cesses of undoing and indifference and the ways in which kinship doesnot proliferate.

I noted earlier that the gamete donor can be perceived as irrevocablyconnected to the offspring conceived with their gametes. They can alsobe excised: irrelevant to the offspring nurtured in the mother’s womband shaped and moulded through the practices of its parents. MonicaKonrad describes the nameless relatives that egg donors project into thefuture. However, she also describes the work performed by recipients ofdonated eggs in de-conceiving the egg and thus the egg donor as relatedto their children (Konrad, 2005): as much work goes into disconnectingas connecting. But the disconnecting is only needed if relatedness isthought to be there in the first place and we cannot predict that foreveryone, everywhere there is an axiomatic connection between an egg

54 Jeanette Edwards

donor, say, and an ensuing child gestated in another body and fed byother parents. It is of ethnographic interest when there is.9

Indifference

As fertility tourism grows and as waiting lists, prohibitive costs, shortageof gametes or restrictive legislation propel people to Turkey, the CzechRepublic, Hungary or India for fertility treatment, the shadow figuresin the cheaper and hence more accessible egg donation programmesare the poorly remunerated egg donors (Whittaker and Speier, 2010).Perhaps less in the shadows are the Indian women acting as surrogatemothers for their wealthier compatriots and foreigners. Maya Unnithanhas written of the discrepancy between the way in which Gujarati womenand Western scholars perceive surrogacy in India. The latter are joinedby commissioning parents and members of the Indian government andlegislature in arguing for the ‘rights’ and freedom of women to choose tobecome surrogates and hence earn an income otherwise unavailable tothem. The Indian women acting as surrogates do not, however, mobiliseidioms of choice or freedom in explaining their decision, or reflecting ontheir work. Instead they speak of ‘sacrifice’: they point out that they arewilling to sacrifice their dignity and social standing for the well-being oftheir family (Unnithan, 2010).

Knowing this may make it more chilling than it already is to read ofthe advice given to would-be parents intending to travel to India to availthemselves of a surrogate mother.10 Peter, on his blog post Selecting aSurrogate, writes that after having finally gone through a successful roundof surrogacy, he and his wife want a sibling for their new baby and haverethought the criteria for selecting a surrogate. He advises IPs – which Iread as intending parents – that it is generally best to choose a surrogatewho has a track record of previous successful pregnancies and transfers.Of eleven criteria to consider when selecting a surrogate, bullet point3 advises on diet and 7 on age:

3) Vegetarian/diet. India has a high percentage of vegetarians. Our understandingis that this can lead to low iodine levels which may have caused the low T4 levels in

9 Marshall Sahlins has provided another way of looking at this:

‘One could even consider the notion of an original “analogic flow”, an ontogenic impetusto extend mutuality of being (i.e. kinship) to all communicable others. In this view, thework of culture is to delimit and differentiate the human potential for transpersonalbeing into determinate kinship relations’ (Sahlins, 2011: 230).

In this model, culture carves out kin from an undifferentiated mass.10 http://peterssurrogacyblog.blogspot.co.uk/2009/10/selecting-surrogate.html.

http://peterssurrogacyblog.blogspot.co.uk/2009/10/selecting-surrogate.html

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our [first] surrogate. While this can be overcome with vitamins, we may considera non-vegetarian surrogate for our next round.

7) Age. Age is most important for the eggs (if there is an egg donor), but not asimportant for the womb. For many, age is secondary to successful pregnanciesand limited unsuccessful transfers. However, age in the mid to late 20s is probablyin the sweet spot.

Bullet point 9 advises on size:

9) Height/weight/etc. Some Indian women are more petite and some IPs mayhave genes that could result in bigger babies. Some couples may want to pursue a‘bigger’ surrogate. It would seem that a big baby in a little woman could increaserisks during delivery, much as the larger babies caused by gestational diabetescan increase risks during delivery.

But ultimately:

10) Choice of surrogates. Even with the above, if the clinic has very limitedchoice, you’re going to get what is available.

Peter is clearly being helpful and civic-minded in sharing what he knowswith other unknown IPs, and he may well be creating and sustaininga community of IPs connected by his blog. The kinship that could, inanother context, be perceived to exist between the gestational motherand the fetus she carries is pre-empted in his objectification of surrogatesin terms of their ideal characteristics (for the job) and in an idiom ofconsumer choice.

Kinship does not proliferate despite the possibility that it can. Insteadnetworks are cut and cut across. We have argued elsewhere that Englishkinship can be imagined as endless – as infinite (Edwards and Strathern,2000).11 But it is only endless if the links are mediated by homogenouselements: genetic connection, for example, can go on forever. However,it is cut across by elements of a different sort: care, attention, class, place,desire and so on. The interdigitation of diverse kinds of linkages, whichhave been crudely separated as biological and social, give this kind of kin-ship ‘a self limiting character’ (Edwards and Strathern, 2000: 158). Here,we can see points at which Peter and Ute locate limits to their kinshipuniverse and for them the substance shared by their offspring and theiroffspring’s gestational mother is irrelevant to the future embeddednessof their children in a complete and complex kinship network.

11 Local family historians in the north of England say that the beauty of the genealogicalresearch they do is that it is infinite, never-ending. One may get stuck but there arealways other lines to investigate and other avenues to pursue.

56 Jeanette Edwards

As ARTs have become more familiar and more routine, albeit moretechnological, concerns about their reach have changed. Currently ques-tions arise around knowledge: who should know what and when? Thelaw in the UK has followed changing sensibilities on ARTs – endingdonor anonymity in 2005, and dropping the clause on children needinga father in 2009. The current call for disclosure is of a piece with othermoves towards transparency and openness. Under New Labour, regimesof audit proliferated, carried out in the name of transparency and inthe pursuit of accountability; add to this, burgeoning information andcommunication technologies, and the increasing centrality of the Inter-net in people’s lives. The move towards transparency and openness inARTs is taking place at a time when personal privacy and disclosure arebeing renegotiated in many spheres of daily life (Klotz, 2012). The Inter-net has also fed and facilitated a burgeoning interest in family historyand genealogical research. As the popular British television programmeuncovering celebrities’ family histories Who Do You Think You Are? entersits ninth series, it amplifies a conflation of heritage and identity, and res-onates with the argument that the identity of donor-conceived peopleis compromised without knowledge of the identity of the donor. Thisalso feeds a social-scientific anxiety about the increasing geneticisationof social life: the way in which genes and genetic explanation are comingto dominate understandings of complex social phenomena: kinship, ill-ness, crime and so on (Hedgecoe, 2009). Such a concern has to a certainextent been refuted by the intricate ways in which various publics haveappropriated genetic explanation amid an array of others. In kinship itturned out that the biological was not necessarily synonymous with thegenetic and as genetic bonds were made explicit so too were other kindsof connections equally as profound. Genetic kinship is deeply social. Itis activated, made prominent, ignored or displaced, and treated withreverence or indifference.

However in the conflation of genetics and identity, kinship becomesknowledge and identity gets disaggregated and unknotted. From a bundleof states and statuses just one strand of identity is singled out: knowing theidentity of the person who donated the gamete which led to your birthmeans knowing where you came from, means knowing who you are.But for most people the world over, including donor-conceived people,identity is a complex matrix of social positions: it is neither acquiredin one moment nor in one event. Identity is not usually a steady state,nor fixed, singular or given. The concept bears further scrutiny whenit is mobilised in the realm of ARTs. It is put to work in a number ofmore or less dense ways: from the identity (identifying information) ofthe donor, to the identity of the donor-conceived person which is said to

Undoing kinship 57

be enhanced or diminished by having or not having information aboutthe identity of the donor.

Making strange(rs)

The second wave of anthropological kinship, partly inspired by devel-opments in assisted reproduction, has been dubbed the ‘new kinship’studies (Franklin and McKinnon, 2001; Carsten, 2004). However, as isoften the case with newness, there is neither a radical break with the oldnor is the new completely unfamiliar (Edwards, 2009). As Sarah Franklinand Susan McKinnon put it, with a nod to Emily Martin’s seminal workon the romance of the egg and the sperm (Martin, 1991): ‘Kinship studyhas not reawakened, like some disciplinary Sleeping Beauty waiting to berescued: rather, it has been steadily reinventing itself, and in the process,has undergone a substantial makeover’ (Franklin and McKinnon, 2001:6). Franklin makes a similar point for biology, this time drawing inspira-tion from Donna Haraway (1997): rather than a ‘rigid and constraininggridwork’, biology is constantly changing and ‘can make itself strange asquickly as any of its critiques’ (Franklin, 2001: 320). For psychologistand philosopher of science, Susan Oyama: ‘Nature is thus not properlycontrasted with nurture in the first place; nature is a continual processof nurture’ (2000, cited in Schramm, Skinner and Rottenburg, 2012).

Early anthropological studies of ARTs entered the debate on whatconstitutes kinship in the West. They fed and developed the, by now,deafening critique of classical kinship studies which were accused ofexporting a European folk model of kinship that had privileged sexualprocreation and genetic relatedness (Schneider 1972, 1984; Delaney,1986; Strathern, 1988; Carsten, 2004). ARTs revealed a more flex-ible kinship thinking: kinship could be forged just as much throughcare, desire and attention as it could through biology/genetics. MarilynStrathern extended this further, identifying it as Euro-American and as a‘scientific kinship system’ where kinship is an artefact of the organisationof knowledges from different sources, with ‘different ways of verifyingconnections between persons’ (Strathern, 2005: 46). An ethnographicfocus on ART unpacked the component parts of kinship thinking familiarto Europeans, and not only were the social and the biological seen to bein tandem, but also science and politics. Questions still remain, however,about what gets to belong to the domains of the social and the biological.There has been a tendency to iterate all the ways in which kinship issocial, not merely biological, but this often leaves the biological intactand unexamined. The consubstantiality between Zumbaguan parentsand their children whom they feed and help to grow over time is not only

58 Jeanette Edwards

symbolic, although it is that, but also material/physical/biological; as tooare the efforts that Norwegian parents put into making their childrentheir own. What can be activated can be de-activated and some thingsnever activated at all. If biology is indeed ‘making itself strange’, then ofwhat the biological consists is strangely an ethnographic question.

References

Altorki, S. (1980). ‘Milk-kinship in Arab society: an unexplored problem in theethnography of marriage’. Ethnology, 19, 233–44.

Carsten, J. (2004). After Kinship. Cambridge University Press.Clarke, M. (2009). Islam and New Kinship: Reproductive Technology and the Shariah

in Lebanon. Oxford: Berghahn.Delaney, C. (1986). ‘The meaning of paternity and the virgin birth debate’.

MAN, 21, 494–513.Edwards, J. (2000). Born and Bred: Idioms of Kinship and New Reproductive Tech-

nologies in England. Oxford University Press.(2009). ‘What is the matter in kinship?’ in J. Edwards and C. Salazar (eds.),

European Kinship in the Age of Biotechnology. Oxford: Berghahn.Edwards. J. and Salazar, C. (2009). European Kinship in the Age of Biotechnology.

Oxford: Berghahn.Edwards, J. and Strathern, M. (2000). ‘Including our own’, in J. Carsten (ed.),

Cultures of Relatedness: New Directions in Kinship Studies. Cambridge Univer-sity Press.

Edwards, J., Franklin, S., Hirsch, E., Price, F. and Strathern, M. (eds.) (1999).Technologies of Procreation: Kinship in the Age of Assisted Conception, seconded., London: Routledge.

Finkler, K. (2000). Experiencing the New Genetics: Family and Kinship on theMedical Frontier. Philadelphia: University of Pennsylvania Press.

Franklin, S. (2001). ‘Biologization revisited’, in S. Franklin (ed.), Relative Values:Reconfiguring Kinship Studies. London: Duke University Press.

Franklin, S. and McKinnon, S. (2001). Relative Values: Reconfiguring KinshipStudies. London: Duke University Press.

Haraway, D.J. (1997). Modest Witness@Second Millennium. FemaleMan MeetsOncoMouse: Feminism and Technoscience. London: Routledge.

Hedgecoe, A. (2009). ‘Geneticization: debates and controversies’, in Encyclopediaof Life Sciences (ELS). Chichester: John Wiley & Sons, Ltd.

Howell, S. (2001). ‘Self-conscious kinship: some contested values in Norwegiantransnational adoption’, in S. Franklin and S. McKinnon (eds.), RelativeValues: Reconfiguring Kinship Studies. London: Duke University Press.

(2006). The Kinning of Foreigners: Transnational Adoption in a Global Perspective.Oxford: Berghahn Books.

Ingold, T. (2000). The Perception of the Environment: Essays in Livelihood, Dwellingand Skill. London: Routledge.

Inhorn, M. (2006a). ‘“He won’t be my son”: Middle Eastern Muslim men’s dis-courses of adoption and gamete donation’. Medical Anthropology Quarterly,20, 94–120.

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(2006b). ‘Making Muslim babies: IVF and gamete donation in Sunni versusShi’a Islam’. Culture, Medicine and Psychiatry, 30, 427–50.

(ed.) (2007). Reproductive Disruptions: Gender, Technology, and Biopolitics in theNew Millennium. Oxford: Berghahn Books.

Kahn, S.M. (2000). Reproducing Jews: A Cultural Account of Assisted Conception inIsrael. Durham, NC: Duke University Press.

(2004). ‘Eggs and wombs: the origins of Jewishness’, in D. Parkin and L. Stone(eds.), Kinship and Family: An Anthropological Reader. Oxford: BlackwellPublishing.

Klotz, M. (2012). ‘[K]information: gamete donation and the constitution of kin-ship through knowledge-management in Britain and Germany – an ethno-graphic exploration’. Unpublished PhD thesis, Humboldt Universitat zuBerlin.

Konrad, M. (2005). Nameless Relations: Anonymity, Melanesia, and Reproduc-tive Gift Exchange between British Ova Donors and Recipients. Oxford:Berghahn.

Martin, E. (1991). ‘The egg and the sperm: how science has constructeda romance based on stereotypical male–female roles’. Signs, 16, 485–501.

Nuffield Council on Bioethics (2012). Mitochondrial DNA Disorders: Novel Tech-niques for the Prevention of Mitochondrial Disorders. London: Nuffield Councilon Bioethics.

Sahlins, M. (2011). ‘What kinship is (part one)’. Journal of the Royal Anthropo-logical Institute, 17, 2–19.

(2013). What Kinship Is – and Is Not. University of Chicago Press.Schneider, D.M. (1972). ‘What is kinship all about?’ in P. Reining (ed.), Kinship

Studies in the Morgan Centennial Year. Washington, DC: AnthropologicalAssociation of Washington.

(1984). A Critique of the Study of Kinship. Ann Arbor: University of MichiganPress.

Schramm, K., Skinner, D. and Rottenburg, R. (eds.) (2012). Identity Politics andthe New Genetics: Re/Creating Categories of Difference and Belonging. Oxford:Berghahn.

Segalen, M. (2001). ‘Shift in kinship studies’, in S. Franklin and S. McKinnon(eds.), Relative Values: Reconfiguring Kinship Studies. London: Duke Univer-sity Press.

Strathern, M. (1988). The Gender of the Gift: Problems with Women and Problemswith Society in Melanesia. Berkeley: California University Press.

(1992a). After Nature: English Kinship in the Late Twentieth Century. CambridgeUniversity Press.

(1992b). Reproducing the Future: Essays on Anthropology, Kinship, and the NewReproductive Technologies. New York: Routledge.

(2005). Kinship, Law and the Unexpected: Relatives are always a Surprise. Cam-bridge University Press.

Thompson, C. (2001). ‘Strategic naturalizing: kinship in an infertility clinic’, inS. Franklin and S. McKinnon (eds.), Relative Values: Reconfiguring KinshipStudies. London: Duke University Press.

(2005). Making Parents: The Ontological Choreography of Reproductive Technolo-gies. London: MIT Press.

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Tremayne, S. (2009). ‘Law, ethics and donor technologies in Shia Iran’,in D. Birenbaum-Carmeli and M. Inhorn (eds.), Assisting Reproduction,Testing Genes: Global Encounters with New Biotechnologies. Oxford: Berghahn.

Unnithan, M. (2010). ‘Infertility and assisted reproductive technologies (ARTs)in a globalising India: ethics, medicalisation and agency’. Asian BioethicsReview, 2, 3–18.

Weismantel, M. (1995). ‘Making kin: kinship theory, and Zumbagua adoptions’.American Ethnologist, 22, 685–709.

Whittaker, A. and Speier, A. (2010). ‘“Cycling overseas”: care, commodification,and stratification in cross-border reproductive travel’. Medical Anthropology,29, 363–83.

3 Genetically challengedThe determination of legal parenthood inassisted reproduction

Julie McCandless and Sally Sheldon

Introduction

While the determination of legal parenthood has never been entirelystraightforward (Cretney, 2005: 533–6; Collier and Sheldon, 2008:Chapter 6; Cahn, Chapter 6) it has been further complicated by thecollaborative reproductive opportunities offered by reproductive tech-nologies (RTs)1 and the role played by genetic links in this processremains complex. There have always been cases where genetic or gesta-tional contributions towards parenthood have been divorced from socialparenthood, including where a birth mother gives up a child to the careof others or a child is conceived as a result of an extra-marital affair.However, RTs offer a new, evolving range of cultural practices where thiscan happen: gamete donation, for example, exists precisely to producea child who will have no genetic link with at least one of its social par-ents. Yet, as we aim to demonstrate in this chapter, widespread popularacceptance of the use of such practices is far from signalling a straightfor-ward decline in the significance of genetic links in the determination ofparenthood.

The task of the present study is to trace a far more complex pictureregarding the significance of genetic links in one specific context: the legaldetermination of parenthood following collaborative reproduction in theUK. In this exploration, we first set out the relevant law, before discussingthe importance attached to genetics within it and how such significanceis influenced by gender. Finally, we offer some thoughts on how sci-ence will continue to push moral, cultural, legal and, indeed, biologicalboundaries, in the construction of parenthood, taking the example ofone new therapeutic intervention that may become available in the nextdecade: the donation of mitochondrial DNA (mtDNA).

1 The term ‘ARTs’ seems to create, or indicate, a dichotomy between ‘natural’ reproduc-tion through sexual intercourse (which may well be assisted) and ‘assisted’ reproductivetechnologies, so we prefer the term ‘RTs’.

61

62 Julie McCandless and Sally Sheldon

Determination of legal parenthood under the HumanFertilisation and Embryology Act (2008)

Well-established common law principles determine legal parenthoodrelating to the vast majority of births in the UK. These provide that thebirth mother will be the legal mother (The Ampthill Peerage, 1977); whereshe is married, her husband will be presumed to be the legal father as perthe common law maxim, pater est quem nuptiae demonstrant (Blackstone,1753), which is now on a statutory footing in Scotland (Law Reform(Parent and Child) (Scotland) Act 1986, s. 5); and where she is unmar-ried, or where the presumption of her husband’s paternity is rebutted bygenetic evidence, this legal status will be accorded to the child’s geneticfather (A v. H, 2009). A separate set of complex statutory principlesapplies to a far smaller number of births achieved using donated sperm,eggs or embryos or where an embryo is created ex utero. In these cases,legal parenthood is determined with reference to the ‘status provisions’of the Human Fertilisation and Embryology Act 2008 (‘the 2008 Act’).These are briefly explained below.

Motherhood

The attribution of the status of mother is equally straightforward underthe 2008 Act: excluding the case of adoption, the birth mother andno other is to be treated as the legal mother of the child (s. 33). Thisremains true whether or not the egg used to conceive the pregnancy wasthe woman’s own and regardless of whether a surrogacy agreement wasin existence. Indeed, in the UK, a surrogate mother’s right to be recog-nised as a child’s legal mother has never been successfully challenged.In the recent case of Re P (Surrogacy: Residence) (2008) the surrogatemother retained the legal status of mother despite losing residence of thechild (see further below). The gestational grounding of legal motherhoodwas given further emphasis in the 2008 Act, which introduced explicitprovision that a woman is not to be treated as the parent of a child thatshe has not carried, except where she is so treated on the basis of herrelationship with the mother, their intention to create a child together orthrough adoption (s. 47). The section mirrors a similar provision which,in certain circumstances, exempts a man from being considered the legalfather of a child resulting from his donated sperm (s. 41). Yet with regardto men, such a provision is clearly legally necessary: unlike motherhood,fatherhood can be – and frequently is – acquired on the basis of a geneticconnection. With regard to women, the section is legally redundant,given the very clear provisions setting out that legal motherhood is to be

The determination of legal parenthood 63

established only through gestation (and ‘female parenthood’ only throughthe provisions detailed below).

As indicated in our interviews with the framers of the legislation, twoconcerns appear to have driven the inclusion of section 47 (McCandlessand Sheldon, 2010). First, and almost certainly most significantly, wasthe desire to pre-empt any possibility that two women might each claimto be recognised as the mother of a child citing, respectively, gestationaland genetic connections. Such claims would be most likely to arise in thecontext of a lesbian couple who wish both to enjoy a biological connec-tion with a future child and therefore choose to create an embryo fromone partner’s ova, which will be implanted in the other woman. Recog-nising two women as parents in this way would leave open the possibility(deemed undesirable) that a third party might also attempt to assert legalparenthood on either the statutory grounds in the legislation, or throughcommon law presumption. Second, it was suggested that the provisionmight reflect concerns about mitochondrial DNA donation, seeking topre-empt the possibility that a donor might assert some parental claimson this basis. We return to mtDNA donation below.

Fatherhood

While motherhood is determined exclusively with regard to gestation,for legal fatherhood, the 2008 Act strikes a complex balance between abroader range of factors: the genetic link, the relationship of the manto the mother and his intention to create a child. First, where a womanseeks treatment with her husband using donated sperm, he will be thelegal father unless it can be shown that he did not consent to the treatmentor ‘artificial insemination’ (s. 35). Second, for unmarried fathers, legalfatherhood is grounded in the parents’ joint intention: if there is neithera father by virtue of marriage nor a female parent by virtue of civilpartnership, then an unmarried man can be treated as a child’s father,provided that ‘agreed fatherhood conditions’ are met (ss. 36–7). Theserequire that both intended parents must have given written and signedconsent to the man being treated as the father of any child resulting fromthe licensed treatment; that at the time of implantation or inseminationneither party has given notice of withdrawal of this consent; and that thewoman has not given further notice that someone else should be treatedas the father (or female parent) of the child. Significantly, while theseprovisions do not restrict the acquisition of parenthood to a woman’spartner,2 they do contain one important limitation: the intended parents

2 Nonetheless, the Human Fertilisation and Embryology Authority’s Code of Practice(2009), has retained the language of ‘partner’, e.g. paras 8.3, 8.13.


must not fall within the prohibited degrees of relationship foreseen inincest legislation (ss. 37(e) and 58(2)). Finally, the 2008 Act allows for aman to be registered posthumously as the father of a child. This provision,which provides recognition for symbolic purposes only, applies whetheror not the man’s own sperm is used (ss. 39–40) and again turns on theparties’ consent (Sheldon, 2005).

Female parenthood

While same-sex couples have been able to achieve joint parenthoodthrough adoption since the Adoption and Children Act 2002 came intoforce in 2005, the 2008 Act allows, for the first time in UK law, fortwo women each to be recognised as the legal parent of a child fromthe moment of birth. The birth mother is the legal mother by virtue ofhaving gestated the pregnancy (s. 33). Her partner, or any other womanto whom she is not prohibitively related, can henceforth also be recog-nised as a ‘female parent’ on lines directly analogous to those by whichmen are recognised as fathers. Thus, where a woman is in a registeredcivil partnership, her partner will be recognised as the child’s ‘femaleparent’ unless it can be shown that she did not consent to the treatmentor ‘artificial insemination’ (s. 42). Significantly, as for heterosexual mar-ried couples, this provision does not apply merely to treatment receivedin a licensed clinic: where a civil partnered lesbian couple has a childthrough self-arranged donor insemination, both partners are now legallyentitled to be registered as parents on a child’s birth certificate and thegenetic father will not be recognised. Further, where a woman is notin a civil partnership, her partner, or another woman, can nonethelessbe recognised as a ‘female parent’ if treatment is received at a licensedclinic and the ‘agreed female parenthood conditions’, which exactly mir-ror the agreed fatherhood conditions set out above, are met (ss. 43–4).Provisions regarding posthumous registration are likewise extended tofemale parenthood. While the legislation contains two separate provi-sions for fathers (one regulating cases where the man’s own sperm wasused, another where it was not), for female parenthood only one provi-sion is deemed necessary (s. 46), with use of the woman’s own gametesdeemed irrelevant.

The enduring relevance of genetic links inthe determination of legal parenthood

The 2008 Act thus represents a deliberate intervention to prevent theacquisition of legal parenthood by some who would otherwise acquire it


by virtue of the common law and, as such, might be assumed to herald adecline in the legal significance of genetic parenthood. We would disputesuch a conclusion. On the contrary, genetic links remain highly relevantto establishing parental status both in their own right (as can be seenabove) and in terms of the role played in structuring the legal image ofthe ideal family, as we aim to demonstrate below. It is also worth not-ing one very significant preliminary point here: while genetic links arenot always determinative in the principles governing the allocation oflegal parenthood set out above, they are evidently deeply significant tomany of those undergoing infertility treatment services (and, indeed, tomany of those born as a result of them). It is noteworthy that in thevast majority of treatment services provided in clinics, the future parents’own gametes will be used, even in those cases where this requires a farmore complex and invasive procedure than recourse to donor gametes(e.g. ICSI). Further, significant research resources continue to be chan-nelled into exploration of new ways of maintaining genetic links betweenintending social parents and their offspring (e.g. donation of mtDNA,as discussed below). In permitting and facilitating such practices, theregulatory framework can be seen to be fundamentally underpinned byrecognition of the significance of genetic links to potential parents.

We would further suggest that genetic links remain relevant in lessobvious ways, through the role that they have played in structuring theideas of family that are entrenched in law. We have examined in detailelsewhere the extent to which the idea of the ‘sexual family’ (an ideal ofa heterosexual couple, joined through a formally celebrated union, liv-ing with genetically related offspring) has been important in this regard(McCandless and Sheldon, 2010; see further Fineman, 1995). Under-standings of this ‘ideal’ family form have been shaped by the limits ofbiological possibility, underpinning claims that certain family forms just‘aren’t natural’, and being visible in law’s continued adherence to a two-parent, ‘parentally dimorphic’ approach (allowing only for one motherplus one father or female parent) (McCandless and Sheldon, 2010: 193–7). It is the memory of the biological basis for the sexual family thatmight begin to make some sense of the legal possibility of recognisinga ‘female parent’ who is not simultaneously a ‘mother’, with the lattertitle reserved for those with a specific kind of biological link (throughgestation) with a child.

The refusal to recognise as parents two people who are in a prohibiteddegree of family relationships is also significant here. While most wouldsee nothing wrong with a mother and daughter (or two siblings) togetherraising a child, there is something far more challenging about the ideathat they should deliberately together choose to create and be recognised


as the parents of that child. Under the provisions described above, hus-bands and civil partners have ‘first shot’ at obtaining legal parenthoodalong with the child’s birth mother. Such couples will normally be in asexually intimate relationship and must, at least, be lawfully permitted tobe so: marriage and civil partnership are not open to those in the prohib-ited degrees of relationship foreseen in incest legislation (Marriage Act1949, as amended; Marriage (Prohibited degrees of Relationship) Act1986; Civil Partnership Act 2004). Those who do not achieve father-hood/female parenthood through a formally recognised union, can do sothrough the agreed conditions described above. While access to parent-hood under these conditions is not explicitly limited to those in a sexuallyintimate relationship, it is likewise not available to those within the pro-hibited degrees of relationship with the child’s mother. While there isnothing in the published deliberations regarding the 2008 Act to explainthis exclusion, one of the senior civil servants who oversaw the draftingexplained to us that there was ‘generally an idea of something not quitebeing right about a mother and sister raising a child together, in a legallyrecognised partnership’ (Webb, 2009).

The concerns which underpin the incest taboo do not map in anystraightforward way to the context of collaborative reproduction, giventhe use of donated gametes and the dissociation between (heterosex-ual) sex and reproduction that RTs make possible (McCandless, 2009:Chapter 3; Nordqvist, 2008). It is further interesting to note that whilethe 2008 Act prevents close family members from being recognisedjointly as a child’s legal parents, there is no corresponding statutoryprohibition of the mixing of the genetic material of close family mem-bers in intrafamilial gamete donation. However, this issue has since beenconsidered by the Human Fertilisation and Embryology Authority (‘theHFEA’) as part of their general overview of donation policies (HFEA,2011a). While finding no evidence in the UK of close genetic relatives(e.g. a brother and sister) wanting to mix their sperm and eggs and sug-gesting that clinics would be able to refuse such requests in light of theirstatutory obligation to consider the welfare of the child before providing awoman with treatment (Human Fertilisation and Embryology Act 1990,as amended, s. 13(5)), the HFEA nonetheless chose to direct clinics notto perform such treatment (HFEA, 2009: s. 11.15). However, other typesof donation between family members (such as donation from a sister orsister-in-law, or intergenerational donation between, for example, a fatherand son or daughter and mother) are not similarly prohibited (HFEA,2009: s.11.16). Indeed, this kind of donation is sometimes seen as desir-able, with some finding an important sense of relatedness in gametesfrom another family member (Thompson, 2005). While many of these


relationships clearly fall within the prohibited degrees of relationshipforeseen in incest legislation, they have not been deemed to raise insur-mountable ethical issues. The law thus requires that the two contributorsof gametes are not close genetic relatives, while being less concerned withother forms of familial donation. While the 2008 Act does not requirethat an agreed second parent be in a sexual relationship with the legalmother, it is clear that the preferred family form at the heart of the legisla-tion remains at least potentially a sexual one and it is this which groundsthe inclusion of the incest prohibition.

Paradoxically, then, statutory provisions which in some instances oper-ate to extinguish the significance of genetic ties in the legal recognitionof parenthood are simultaneously underpinned, albeit in complex ways,by highly geneticised understandings of parenthood.

The gendered significance of genetic links

While genetic links are important, the above analysis also reveals the legalsignificance attributed to them to be uneven and highly gendered. Mostobviously, it has been seen that motherhood is firmly grounded in ges-tation and, while some may speculate that historically this merely stoodas a proxy for a genetic link, today it clearly holds significance per se.Law’s interest in genetic links has thus tended to be more firmly focussedon fathers (Collier and Sheldon, 2008). What is perhaps less obvious isthe impact of this gendering of genetic links on the position of ‘femaleparents’. It is noteworthy that while there was some, albeit limited, dis-cussion regarding whether ‘female parents’ ought to be recognised atall, once that decision was made, how one might seek to frame suchrecognition appears to have received very little critical scrutiny (McCan-dless and Sheldon, 2010). The Department of Health reported that ‘westarted with married couples and then read across to civil partners, andthen having done something for civil partners, we considered the posi-tion of unmarried heterosexual couples . . . And, having done that forunmarried heterosexual couples, we considered the position of non-civilpartners and introduced the parental agreement there. That was the pro-cess’ (Webb, 2009).

Yet in some instances, simply reading across provisions designed withheterosexual couples in mind to same-sex couples will deliver unequalresults: here, the impossibility of acquiring either motherhood or ‘femaleparenthood’ through a genetic link can result in asymmetrical applica-tion of these provisions. This can be illustrated by the case of a non-civilpartnered lesbian couple who decide to create a child with a biologicalconnection to each of them, with one party donating an egg and the other


intending to gestate the resulting embryo. If the couple stay together andgo on to have a successful pregnancy, both women may acquire parentallegal status; the birth mother through her gestational connection to thechild and the other woman by satisfying the agreed parenthood con-ditions. However, fertility treatment can be a difficult and protractedprocess and it is easy to imagine a scenario whereby the couple sepa-rate before a successful pregnancy occurs, leaving embryos stored withthe clinic.3 While the first woman has a legal right to request that suchembryos be destroyed, she may fail to do so, move away and lose touchwith the clinic. At that point, there is nothing to stop the second womanmaking use of these embryos without her former partner’s permission if‘reasonable steps’ have failed to establish contact (1990 Act, as amended,s. 14(6E)). And where the agreed parenthood conditions are no longermet for the first woman (for example where the birth mother has formeda legally binding agreement with a new partner or otherwise altered herconsent), she might find herself with no legal rights at all with regard tothe genetic child who she had initially jointly planned. A man who hascontributed sperm to create an embryo to be implanted in his partnerwould not find himself in this position because he would achieve father-hood not on the basis of the agreed fatherhood conditions but on thebasis of his genetic connection with the resulting child.

The legal regulation of surrogacy provides a second interesting illus-tration of the potential differential impact of provisions that, on the faceof the statute, treat men and women equally. While the 2008 Act makesno special provision for the initial attribution of legal parenthood follow-ing surrogacy arrangements, some arrangements will be captured by thelegislation by virtue of involving IVF, gamete donation, or self-arranged‘artificial insemination’ when the surrogate mother is married or in acivil partnership. As others have argued in detail elsewhere, these rulescan offer a poor fit for surrogacy arrangements, even risking in somecases of cross-border provision to leave a child with no legal parentsat all (Re X & Y (Foreign Surrogacy), 2008; Horsey, 2010; Re IJ (AChild), 2011). Without having space to rehearse those arguments here,we would like to highlight one further aspect of the legislation that againdemonstrates the relevance of gender to genetic links.

When certain conditions are met, the 2008 Act provides for a typeof fast-track adoption, known as a ‘parental order’ following surrogacyarrangements (s. 54). As with adoption, this transfer of parenthood sev-ers all legal connections with the child’s birth parent(s) and can only

3 Following amendments made in 2008, the default maximum storage period for gametesand embryos is now ten years: s. 15 2008 Act.


take place with the consent of the birth mother and father or femaleparent (if there is one), unless there are exceptional circumstances suchas the surrogate mother disappearing or being unable to give consent(D (Minors) (Surrogacy), 2012). Only those who are married, in a civilpartnership or ‘an enduring family relationship’ can apply for a parentalorder and, crucially, they can only do so if they have at least a partialgenetic connection to the child (s. 54(1)–(2)). At first glance this appearsto reinforce the genetic underpinnings of parenthood, yet the formulationof its inclusion sends rather uneven messages about the legal recognitionof genetic ties. On the one hand, it is the couple’s genetic connection tothe child that entitles them to a less stringent adoption procedure and,indeed, which makes this a ‘surrogacy’ arrangement rather than a privateadoption agreement arranged before birth. Yet, while recognising thesignificance of the genetic connection in this way, the 2008 Act operatessimultaneously to dismiss it, effectively understanding the intending par-ents as gamete donors to the surrogate mother. Even if one intended par-ent complies with the relevant formalities and gains legal parenthood byvirtue of the agreed parenthood provisions, his or her entitlement toparental status would not be based on his or her genetic connection tothe child, as the agreed fatherhood conditions only apply when ‘donatedsperm’ has been used and, as we have seen, the conferral of femaleparenthood on the basis of a genetic link is prohibited (s. 47). Paradox-ically, then, the 2008 Act prevents someone from acquiring any rightsto parental status on the basis of genetic links (1990 Act, as amended,Schedule 3), before requiring just such a genetic link as the basis for(re)acquiring parental status following the birth of the child.

During the Parliamentary debates that preceded the 2008 Act, reformswere mooted that would have allowed intended genetic fathers easieraccess to legal fatherhood, with no corresponding provisions being pro-posed for genetic intended mothers (Hansard, 2008). While ultimatelythese amendments were not passed – on the justification that the avail-ability of parental orders would provide a sufficient and more coherentresponse – it is noteworthy that they were discussed only in relation tomen, notwithstanding the more onerous procedure and time investmentrequired of women wishing to provide eggs to the surrogate mother.

In addition, the combination of the very explicit silencing of the femalegenetic link in the legislation with the emphatic legal grounding of moth-erhood in gestation, signals a far more precarious position for geneticintended mothers, as compared to fathers, given both the broader priv-ileging of genetic fatherhood in family law (Collier and Sheldon, 2008:Chapter 5) and the gendered social power of male sperm as comparedto female eggs (McCandless, 2009: Chapter 3; Almeling, Chapter 8). A


recent surrogacy case is illustrative here. A married woman agreed to actas a surrogate for a married couple. Having become pregnant followinginsemination with the intended father’s sperm, she severed all contact,claiming to have miscarried. When the intended father found out aboutthe deception, he applied to the courts for a residence order. Wheresomeone without legal standing as a parent has not lived with a childfor a certain period of time, he or she needs special permission from thecourt to apply for this (Children Act 1989, s. 10; McCandless, 2005).However, in the various hearings of the case (Re P (Surrogacy: Residence),2008; Re N (A Child), 2007), the trial judge and leading Court of Appealjudge appear to conflate genetic fatherhood with legal fatherhood andthe two rulings proceed on the basis that the intended father needs nospecial permission for the application. Only Lloyd LJ pauses to questionthis interpretation of the 2008 Act (Re N (A Child), 2007, paras 19–20),under which the mother’s husband was clearly the legal father, unless thechild was conceived through sexual intercourse between the mother andthe intended father (s. 35). He reasoned, however, that this was unimpor-tant for the substantive question in the residence order determination,given that the court was obliged to treat the child’s welfare as paramount(Children Act 1989, s. 1(1)). Ultimately this justified a residence order inthe genetic father’s favour and, if deemed necessary, further consequen-tial orders could be granted to smooth over the lack of legal status (Re N(A Child), 2007, para 19). Rather than consider parental entitlementson the basis of the statutory regime, the courts cast the decision in thefollowing terms: ‘The fact that both families constitute one of the child’snatural parents means that both sides start from the same position, nei-ther side being able to claim that the blood tie should favour their claim’(Per Coleridge J, Re P (Surrogacy: Residence), 2008, para 21).

The Court’s removal of a young child from the care of its legal motherand her husband (with no allegation made that they were inadequateparents) has already been subject to criticism, as has the attempt tocast the female and male contribution to reproduction as ‘the same’(Ashenden, 2010; Jackson, 2010). However, for our purposes, anotherissue is of interest: the situation of the intended mother in the case, whowas jointly awarded the residence order alongside her husband. While aresidence order does confer parental responsibility, she is not considereda legal parent and cannot become one without adopting. However, whenjoint residence orders are awarded, there remains doubt as to whether ornot the non-parent will continue to have parental responsibility shouldthe joint residence order cease and/or the couple separate (McCandless,2005). Further, while the intended mother in this case was not the geneticmother of the child, what of an analogous case where it was she, rather


than her husband, who had a genetic connection with the child? Mightshe similarly expect to obtain a residence order? This is, after all, theone instance in the legislative framework for determining parenthoodwhen the female genetic connection clearly ‘counts’. Any response tothis question is inevitably speculative. The more general willingness ofthe courts to award men parental entitlements on the basis of not onlygenetic links under the auspices of child welfare, but also rather morenebulous bases – such as their ability to explain to a child ‘the delicateissue of the circumstances of her conception and birth’ (Re D (A Child)(IVF Treatment), 2001; Sheldon, 2005) – might possibly also extend togenetic mothers in this situation. Further, the courts are demonstrablykeen to be seen to offer formal equality in their treatment of mothersand fathers. Notwithstanding these factors, however, it seems unlikelyto us that a future court could so easily conflate genetic motherhoodwith legal motherhood (however erroneously) and proceed with theirdetermination on that basis.

Future genetic complications: MtDNA donation

While the collaborative reproductive scenarios facilitated by RTshave already tested (and almost certainly influenced) broader culturalconceptions regarding parenthood, evolving scientific developments willcontinue to stretch them further. Indeed, as the gap between the possibil-ities offered by scientific intervention and ‘natural’ reproduction widens,it is not just legal parenthood that becomes ever harder to define butalso ‘genetic parenthood’ itself (Mertes and Pennings, 2008). Whileresearch into a number of new techniques might illustrate this point(e.g. ooplasmic transfer, reproduction through fetal oocytes, reproduc-tive cloning, and artificial gametes created through somatic cell hap-loidization) we focus here on just one such development, currentlyunder active discussion in the UK: the donation of mitochondrial DNA(mtDNA).

Mitochondria (tiny structures within our cells that provide the energyfor them to function) are responsible for the transmission of a small num-ber of devastating, incurable disorders each year, resulting in stillbirth,miscarriage, infant mortality and various severe symptoms in around160 births per year in the UK (HFEA, 2011b: Annexe A). Scientistsare currently exploring the possibility of avoiding such transmission byreplacing the mitochondria of the intending mother with healthy mito-chondria from a donor egg. An embryo created using donated mtDNAwould derive 37, or around 0.1 per cent, of its genes from the donatedmitochondria, with the rest of its genetic material deriving from nuclear


DNA (nDNA) provided either by the intending parents or the intendingmother and a sperm donor. While a future child would thus have receivedgenetic material from three people, the function of these 37 genes is gen-erally believed to be restricted to governing the actions of the mitochon-dria, rather than affecting the characteristics of a future child; althoughthis is a matter of scientific debate (NCB, 2012: para. 1.6).

Under the 2008 Act, at the time of writing, it is lawful to create embryosusing donated mtDNA but not to use them reproductively, as only ‘per-mitted embryos’ may lawfully be implanted into a woman (s. 3ZA(4)),and the definition of ‘permitted’ currently excludes embryos where thenuclear or mtDNA of any cell of the embryo (or the egg used to create it)has been altered. However, foreseeing future developments in this area,the framers of the 2008 Act included a special power to make regula-tions (subject to Parliamentary approval) that would render lawful theuse of eggs or embryos which have ‘undergone a prescribed process toprevent the transmission of serious mitochondrial disease’ (s. 3ZA (5);1990 Act, as amended, s. 45(4)). The Government has now statedits intention to make use of this power (DH, 2014, 2.4), publishingdraft regulations that would permit mtDNA donation on a case-by-casebasis, subject to specific approval from the HFEA (DH, 2014, AnnexB, Regulation 9). At the time of writing, the regulations are subject topublic consultation before they go before Parliament. The ethical issuesraised by mtDNA donation have similarly received attention both fromthe HFEA (which equally held a public consultation) (HFEA, 2012), andthe Nuffield Council on Bioethics (NCB), which has recently publisheddetailed deliberations (NCB, 2012).

While mtDNA donation raises a range of interesting issues, we confineourselves here to a brief assessment of some questions which it raises withregard to parenthood. First, we note again that interest in this new areaof research is fundamentally underpinned by a desire to maintain geneticlinks between a mother and child. MtDNA disorders affect only a smallnumber of women each year (albeit often with devastating effect) andcould be completely avoided through use of donated eggs. The promiseof this technology is to block transmission of such disorders while stillallowing a woman to have a child created using her own (nuclear) geneticmaterial. The resources devoted to researching this new intervention,and the understanding that women will desire to make use of it, thusclearly signal the importance devoted to the preservation of genetic linksbetween parent and child.

Second, an important head of controversy concerning mtDNA dona-tion has been the fact that it would result in a child who had inherited


genetic material from three individuals, sometimes described as creatingchildren with ‘three parents’ (Collins, 2012; Sample, 2012). Of course,the mtDNA donor would not be a legal parent: as noted above, this pos-sibility is specifically and deliberately excluded by the 2008 Act. But thisleaves unanswered a range of other important questions. Does it makesense to describe her as a mother in any broader sense? Is she a geneticmother, a genetic parent or a progenitor? Does answering these ques-tions provide a definitive response to the question of whether the legalregulations which apply to (other) gamete donors should also apply toher? In particular, should she be identifiable to those born as a result ofthe donation?

The NCB Working Group’s detailed consideration of these questionsled it to conclude that while perception of the personal and social relation-ships created by mtDNA donation was a matter for the individuals con-cerned, the attribution of ‘motherhood’ was not indicated ‘either biolog-ically or legally’ (NCB, 2012: para 5.7). This is the position also adoptedin the Government’s draft regulations (DH, 2014, Annex B, Regulation11). The NCB was less clear, however, on the mtDNA donor’s statusas a gamete donor and recommended that this question needed further,careful consideration from Parliament. Its own tentative view was thatmtDNA donors should not be given the same status as other gametedonors in all aspects and, notably, that they should not be mandatorilyrequired to be identifiable to the adults born from their donation (NCB,2012: para 5.14).4 Again, this is the position adopted in the draft reg-ulations, which provide that, on reaching the age of 16, a person whothinks he or she may have been born as the result of mtDNA donation,can apply to the HFEA to see if it holds any information about this onits register and, if so, to access non-identifying information about thedonor (DH, 2014, Annex B, Regulation 10). However, unlike in the caseof gamete donation, identifying information will not be available and itwill not be possible for a person born of donated mtDNA to apply tothe HFEA to find out if he or she is related to an intended spouse, civilpartner or intimate partner (DH, 2014, Annex B, Regulation 11), as he

4 5.14. It recommended that mtDNA donors should, however, be subject to the samerestrictions and safeguards as other egg donors including the number of times that theymay be subject to ovarian stimulation. In some circumstances, a sperm donor may benecessary to fertilise the egg of the mtDNA donor in order to create an embryo, with thatembryo then being enucleated and the man’s nuclear material discarded. The NCB wasclear that this category of donor should not have the same status as those who contributenuclear material and, notably, that he should not be identifiable to a future child (NCB,2012: 5.18).


or she will not be treated as related to anyone who shares the same mito-chondrial donor or to the donor herself. This, the Government notes, isbecause there is such a small (0.01 per cent) genetic relationship betweenthe mitochondrial donor and any child born through mitochondrial dona-tion (DH, 2014, 2.29).

While it is undoubtedly correct to conclude that the mtDNA donor isnot a legal mother, the claim that she is not a genetic mother is more con-troversial, with this case serving to illustrate the lack of any agreed under-standing of what we mean by genetic motherhood (or, indeed, geneticparenthood more generally). What arguments might support the Gov-ernment’s position? First, as it notes, mitochondria contribute only a verysmall proportion of the genes that will make up the embryo. However,the NCB dismissed any suggestion that the number of genes contributedis a good measure of their importance: for example, the Y chromosomesimilarly contains a small number of genes (NCB, 2012: para. 4.56).This suggests that the absolute number or relative proportions of genesaffected by a therapy is not determinative of their significance. Is it thenthe impact of the mtDNA which matters? Again, presumably not, asin this case the impact of the mtDNA is great, indeed often devastat-ing: it is precisely this which makes the promise of mtDNA donation socompelling (NCB, 2012: para 4.57).

If there is an important distinction to be made between donation ofnuclear and mtDNA then, it must lie in two considerations. First, thereis a broad (if not complete, see Chinnery et al., 1999; Lease et al.,2005) scientific consensus that mtDNA does not influence the physicalcharacteristics or personality traits of the resulting child. Second, mtDNAdoes not offer a unique identifying connection with a child’s parents inthe same way as nDNA. Rather, it provides a connection to a whole groupof relatives, including the mtDNA donor and her mother, brothers andsisters, maternal aunts and uncles and maternal grandmother. This hasthe consequence that where the mtDNA is donated by an appropriatefemale relative, it would be identical to any healthy mitochondria thatthe intended mother might have. Indeed, it is the way in which it relatesto this broader network of maternal relations that gives mtDNA anysignificance that it currently enjoys in the popular imagination: it is knownfor its perceived role in linking us to our ancestry. What is unknown(and, we would suggest, unknowable given the impossibility hitherto ofseparating nuclear and mtDNA), is whether this leads people to treatmtDNA as significant in its own right, or whether it is significant merelyas a mechanism for finding out more about the origins of one’s nDNAancestors. If it is the latter, then separating mt and nDNA deprives afuture child of being able to discover this information. And given that


this is a ‘germline therapy’,5 with women born from the procedurespassing the donated mtDNA onto their children, with any daughters,in turn, passing it on to their own genetic offspring, this will also affectgenerations extending into the future.

Where does this leave us? Mertes and Pennings offer a helpful defi-nition of genetic parenthood, listing three criteria that must be met forsomeone to be considered a genetic parent: first, genetic informationhas to be passed on from parent to child; second, the parent needs tobe a physical cause of the child; and, third, genes have to be reshuffledonce in the process of transmission from parent to child (2008: 13). Onthis definition, the mtDNA donor is not a genetic parent, as her geneticmaterial is not ‘reshuffled’ (2008: 11). Mertes and Pennings’s definitiondoes capture some important intuitions about parenthood: specifically,here, the idea of ‘reshuffling’ or mixing one’s genes with those of another,thereby creating a new unique combination in the child or children pro-duced, does appear to reflect an important idea about what many mayconsider to be special about parenthood (see further Provoost and Pen-nings, Chapter 10). What remains unknown, however, is how compellingthis concept of genetic parenthood is likely to prove to the public andwhat popular responses to the idea of mitochondrial donation will looklike. Beyond any significance it has gained in terms of popular under-standings of genealogy, society has not yet had the opportunity to weaveits own cultural stories around mtDNA. Thus, while scientists may talkof the transfer of mtDNA as analogous to ‘replacing the battery in acamera’, with the brand of battery not affecting the camera’s functioning(NCB, 2012: para. 4.5), it remains to be seen whether the broader pub-lic will attach greater significance to it. More specifically, it is impossibleto know the extent to which the curiosity of children born of gametedonation (and the claims that some make to know the ‘genetic truth’of their birth) will also extend to donors of mitochondria (NCB, 2012:para. 4.93). What we can say with more confidence is that law will forma significant part of the cultural story told about mitochondria’s impor-tance. As such, if – as currently appears likely – regulations will requireregistration of mtDNA donors with a view to providing non-identifyinginformation for resulting children, this will not merely reflect currentunderstandings of the significance of mitochondria but will also serve toshape them (NCB, 2012: para. 3.21).

5 It is disputed whether this term should be reserved merely for interventions which alternuclear DNA. See NCB (2012) at 4.31, noting disagreement on this point and, at 4.33,citing Lord Walton and Evan Harris as proponents of the alternative view.


Conclusions

The significance of genetic connections in the attribution of legal par-enthood is complex, shifting, highly gendered and will undoubtedly con-tinue to develop in the future, not least in the face of further challengesposed by new and evolving technologies. It is seen in the discussionabove that the significance attributed to genetic links can be emphasisedor minimised, depending on shifting legal standards, and the circum-stances and preferences of the adults involved. However, while we canseek to expand traditional kinship models to accommodate new tech-nologies (NCB, 2012: para. 4.14), these will only stretch so far beforecracks become evident (McCandless and Sheldon, 2010). The exampleof mtDNA donation is just the last in a long line of challenges to suchtraditional models.

The example of mitochondrial donation also provided a clear illus-tration of the fact that there is no objective, scientific base on whichwe can hope to construct a perfect regulatory edifice. Rather the def-inition of ‘genetic parenthood’ itself is complex and underpinned byvalue judgments: for example, whether we consider ‘reshuffling’ to bea prerequisite may reflect, in part, broader moral and emotional com-mitments to particular social ideas regarding parenthood. We do notassume that this lack of coherence is inherently problematic. It may beinevitable and it may simply reflect the complicated ways in which peopleunderstand legal and genetic relationships more generally. But what isclear is that the normative question of how genetic connections should beafforded legal recognition in the context of parenthood will brook no easyresponse.

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Jackson, E. (2010). ‘Commentary on Re N (A Child)’, in R. Hunter, C. McGlynnand E. Rackley (eds.), Feminist Judgments: From Theory to Practice. Oxford:Hart Publishing.

Lease, L.R., Winnier, D.A., Williams, J.T., Dyer, T.D. et al. (2005). ‘Mitochon-drial genetic effects on latent class variables associated with susceptibility toalcoholism’. BMC Genetics, 30, S158.

McCandless, J. (2005). ‘Recognising family diversity: the “boundaries” of ReG.’. Feminist Legal Studies, 13, 323–36.

(2009). ‘Reproducing the sexual family: law, parenthood and gender in assistedreproduction’. Unpublished PhD thesis, Keele University.

McCandless, J. and Sheldon, S. (2010). ‘The Human Fertilisation and Embry-ology Act (2008) and the tenacity of the sexual family form’. Modern LawReview, 73, 175–207.

Mertes, H. and Pennings, G. (2008). ‘Embryonic stem cell-derived gametesand genetic parenthood: a problematic relationship’. Cambridge Quarterly ofHealthcare Ethics, 17, 7–14.

Nordqvist, P. (2008). ‘Feminist heterosexual imaginaries of reproduction: lesbianconception in feminist studies of reproductive technologies’. Feminist Theory,9, 273–292.

Nuffield Council on Bioethics (NCB) (2012). Novel Techniques for the Preventionof Mitochondrial Disorders: An Ethical Review. London: Nuffield Council onBioethics.

Sample, I. (2012). ‘“Three parent babies” cure for illness raises ethical fear’. TheGuardian, 5 June.

Sheldon, S. (2005). ‘Fragmenting fatherhood: the regulation of reproductivetechnologies’. Modern Law Review, 68, 523–53.

Thompson, C. (2005). Making Parents: The Ontological Choreography of Repro-ductive Technologies. Cambridge, MA: MIT Press.

Webb, E. (2009). Interview on file with authors.

http://www.gov.uk/government/consultations/serious-mitochondrial-disease-new-techniques-to-prevent-transmission

http://www.gov.uk/government/consultations/serious-mitochondrial-disease-new-techniques-to-prevent-transmission

http://www.hfea.gov.uk/5605.html







CasesA v. H (2009). 3 FCR 95.The Ampthill Peerage (1977). AC 547.D (Minors) (Surrogacy) (2012). EWHC 263.Re D (A Child) (IVF Treatment) (2001).1 FLR 972.Re IJ (A Child) (2011). EWHC 921 (Fam).Re N (A Child) (2007). EWCA Civ 1053.Re P (Surrogacy: Residence) (2008). 1 FLR 177.Re X & Y (Foreign Surrogacy) (2008). EWHC 3030 (Fam).

UK legislationChildren Act (1989).Civil Partnership Act (2004).Human Fertilisation and Embryology Act (1990), as amended.Human Fertilisation and Embryology Act (2008).Law Reform (Parent and Child) (Scotland) Act (1986).Marriage Act (1949), as amended.Marriage (Prohibited degrees of Relationship) Act (1986).

4 On the moral importance of geneticties in families

John B. Appleby and Anja J. Karnein

How now, you wanton calf,Art though my calf?Thou want’st a rough pash and the shoots that I have,To be full like me: yet they say we areAlmost as like as eggs; women say so,That will say anything but were they falseAs o’er-dyed blacks, as wind, as waters, falseAs dice are to be wish’d by one that fixesNo bourn ‘twixt his and mine, yet were it trueTo say this boy were like me.

Leontes in Shakespeare’s The Winter’s Tale, 1623, I.2.126–34

Many people seem to attribute great significance to genetic ties1 withinthe family, and are willing to go to great lengths, as well as to accepthigh medical risks, and often considerable financial expenses, to ensuregenetic relatedness to children they produce using assisted reproductivetechnologies (ARTs).2 Interestingly however, these same technologiesoften make it necessary for those seeking genetic relatedness to deny itssignificance by facilitating the creation of families in which genetic tiesare partly severed and relocated to people outside the family (for instancewhen third-party gamete donation is used) (Readings et al., 2011). Whatare we to make of these reproductive possibilities? Should we welcome

1 In this chapter we use the terms ‘genetically related’ and ‘genetic tie’, interchangeably, torefer to the way parents may be associated with the offspring conceived with their eggsand sperm. Children are therefore conceived with their parents’ ‘genetic material’ andwill share around 50 per cent of their genes with them (as would also be the case withsiblings). This same logic is often applied in DNA tests used to establish paternity (seefootnotes 5 and 9, and Richards, Chapter 1). In this chapter we distinguish the terms‘genetically related’ and ‘genetic tie’ from ‘biologically related’, because the latter termdoes not necessarily imply any degree of genetic relatedness between individuals. Forexample, a gestational surrogate can be biologically related to the child she is carrying;however, the gestational surrogate will not be genetically related to that child.

2 When we talk about ‘ARTs’ we are predominantly referring to in vitro fertilisation or IVF(including intra-cytoplasmic sperm injection or ICSI) and the technologies involved inthe procurement and storage of donated gametes.

79

80 John B. Appleby and Anja J. Karnein

them (because they create genetic ties which otherwise would not existand are thus ‘superior’ to adoption) or try to limit their use as they mayundermine the traditional ideal of the nuclear family? In this chapter, weargue that the new possibilities ARTs offer should be welcomed, althoughthere do not appear to be particularly compelling arguments from eitherthe perspective of children or that of the adults involved for the essentialimportance of genetic ties. Thus, we maintain that ARTs should besupported because (1) they help to fulfil the desire of many adults tohave children they are genetically related to, but, even more importantly,(2) at the same time ARTs help to undermine the importance that thesedesires are often credited with. We consider this latter development to bepositive since it holds the promise of rendering society increasingly opento non-traditional family forms.

Our argument proceeds in three steps. First, we review philosophi-cal accounts of procreative responsibility and show that although suchaccounts are frequently used to garner support for the significance ofgenetic relatedness in families, the arguments inherent in these accountscan be used equally well to defend the creation of family forms in whichchildren are not genetically related to their parents. Second, we take aclose look at philosophical theories that emphasize the importance ofgenetic ties to child welfare and we argue that harmful consequences forchildren who do not have genetic ties to their parents are likely to bedue to social conventions that are not yet ready to accommodate emerg-ing family forms. Third, we turn to examining the desire of adults tohave genetically related offspring and illustrate how this desire is bothexpressed in and undermined by different pursuits of ARTs.

Genetic relatedness and reproductive responsibility

Throughout history and across a wide range of different cultures whatare often referred to as ‘blood ties’3 have been of singular significance.Take Shakespeare’s The Winter’s Tale. Here Leontes, King of Sicily, ispathologically obsessed with the question of whether his children arerelated to him by ‘blood’. He is, unfortunately, so convinced that his wife,Hermione, has cheated on him with his childhood friend Polinexes, Kingof Bohemia, that he dismisses all clues (connected to resemblance) thatwould prove him wrong. With respect to his daughter Perdita, he simplyconcludes that ‘This brat is none of mine, It is the issue of Polinexes.

3 Today we know that ‘blood’ does not mediate relationships between parents and children.However, in discussions of lineage and kinship, the language of ‘blood’ or ‘blood ties’ isoften used as a metaphor to depict a shared genetic tie between individuals. See foot-note 1.

On the moral importance of genetic ties in families 81

Hence with it, and together with the dam. Commit them to the fire!’(II.3.93–6). But the possibility of having been cuckolded (and not beingthe man who conceived Perdita) is not Leontes’ only concern. In thebelief that breastfeeding transmits certain traits of the mother to herchild and that the mother’s menstrual blood leads to any resemblanceto the father being overridden by resemblance to the mother (Davidson,2009),4 Leontes, in a conversation with Hermione, expresses both hisrelief about it being a wet nurse who breastfeeds his son and anger at hisson having been too affected by his mother’s blood: ‘Give me the boy. Iam glad you did not nurse him./ Though he does bear some signs of me,yet you/ Have too much blood in him’ (II.1.56–8).

Many readers encountering these ideas today are likely to be inclinedto dismiss Leontes’ convictions about breastfeeding and the effects ofa woman’s menstrual blood on her child. Some readers, however, willpresumably be quite sympathetic to Leontes’ concern about the impor-tance of being the progenitor of his children (although hopefully few willbe drawn to Leontes’ drastic reaction to suspecting that his children arenot of his ‘blood’).5 For those invested in arguing for the significance ofgenetic ties within families, there are a number of different claims wereview in this chapter, starting in this section with ones emphasizing theimportance of procreative responsibility. We argue that bringing childreninto this world certainly comes with a number of serious responsibilities,but that it is still quite a leap to conclude that it is necessarily the geneticparents who have to take on primary responsibility for child rearing.

Daniel Callahan is among those who believe that procreative respon-sibility ought to be taken very seriously: whoever genetically fathers chil-dren should bear primary responsibility for raising them.6 Callahan is

4 For a discussion on ‘milk kinship’ see Edwards, Chapter 2.5 These days the language of ‘blood ties’ is less common in everyday discussions about

relatedness and it has been largely replaced with the language of ‘genetic ties’ or ‘geneticrelatedness’. The ‘geneticization’ of society’s popular understanding of relatedness wasfuelled by the emergence of genetic testing for paternity in the 1970s and has persistedto the present day, due in large part to the ongoing influence of ‘the new genetics’ (seeRichards, Chapter 1; Lippman, 1991, 1992; Hedgecoe, 1998; Pembrey, 2000; Grossberg,2005; Adams, 2008). A helpful publication on this significance of genes and genetictesting is Robert Klitzman’s book Am I My Genes? (2012).

6 Some may dispute our interpretation of Callahan’s use of ‘biological’ parenthood to implya genetic tie. For example, one might argue that Callahan is only interested in attributingparental responsibility to sperm donors because they make a biological contribution,generally speaking, and that Callahan is not specifically interested in the father’s genetictie to the child. However, we read Callahan as referring to the moral importance of thegenetic tie (see footnote 1 for a definition of this) between fathers and their children.In our view, Callahan’s references to legal fatherhood (in the USA) directly infer thathe is talking about the significance of genetic relatedness (rather than simply biologicalrelatedness – see footnote 1). We hold that this is sufficient evidence to support our


especially concerned about the responsibility of fathers because he seestheir role as parents being under attack by feminists and by societal acqui-escence in the face of male irresponsibility (exemplified by the broadacceptance of practices such as anonymous sperm donation). He claimsthat ‘biological fatherhood carries with it permanent and nondispens-able duties’ (Callahan, 1992: 736) and that the transferral of parentalobligations to adoptive parents, for example, is only legitimate underexceptional circumstances (1992: 743). But what is so important aboutmen raising the children they beget, and only them?

To some extent, this unequal treatment (of mother and father)can be explained if we take Callahan’s principal worry seriously,namely that fathers ‘just don’t really count in that brave new worldof reproduction’ (1992: 736) and that allowing men to abdicate theirprocreative responsibilities very easily (in the case of anonymous spermdonation, for instance) contributes ‘to the further infantilisation ofmales, a phenomenon already well advanced in our society, and itselfa long-standing source of harm for women’ (1992: 743). If that isCallahan’s primary concern, however, then the obvious solution neednot be to hold every sperm donor responsible for his genetic offspring.Donating sperm, unlike other, more ‘traditional’ forms of irresponsiblemale reproductive behaviour, is not inevitably a negligent or immaturechoice. Rather, it may just as well be the choice of a highly responsibleindividual who wishes to help infertile persons fulfil their desire to havea child. The kind of irresponsibility that Callahan is worried about thusprimarily expresses itself in men having careless (i.e. unprotected) sexualintercourse with women and then disappearing without taking anyresponsibility for the resulting child. So arguably, condemning spermdonation because of concerns about male irresponsibility misses themark.

This becomes especially obvious once one realizes that Callahan pri-marily wants society to maintain balanced families (i.e. consisting of amother and a father). ‘A mother can better be a mother if she has theactive help of a father who takes his duties seriously. Likewise, the fatherwill be a better father with the help of an equally serious mother. Thechild will, in turn, gain something from both of them, both individuallyand as a pair’ (1992: 746).

But the idea that a child needs to grow up with both a mother and afather – an idea now disputed by empirical evidence (Biblarz and Stacey,2010; Appleby et al., 2012b; Graham and Braverman, 2012) – does notimply that both the mother and father have to be the genetic parents.

interpretation of his argument and other scholars agree (Roberts, 1995; Cahn, 1997;Glennon, 1999; Steinbock, 2004; Fuscaldo, 2006; Draper, 2007).


Moreover, if one compares Callahan’s position with those of otherphilosophers similarly concerned with procreative responsibility, itbecomes obvious that his suggestions about the importance of geneticties are not an inevitable response. Like Callahan, David Benatar, forinstance, holds the view that bringing people into existence is frequentlytaken far too lightly. He argues that the majority of people who chooseto procreate do not take their decision seriously enough and do notadequately consider the commitment of time and resources that rearingchildren requires, let alone the potential harm persons could suffer if theyare not properly looked after while they are growing up. Unlike Calla-han, Benatar’s intention is to provide an ‘account that is not essentiallygenetic and which does not regard a causal role to be a sufficient conditionfor responsibility’ (Benatar, 1999: 174). Instead, Benatar’s argument isbased on a notion of reproductive autonomy. He maintains that individ-uals have the autonomous choice to decide if they want to bring childreninto existence or not. While an autonomous agent is afforded the procre-ative liberty to cause children to come into existence, an agent must alsotake into account his or her procreative responsibilities which includemaking sure that these children are cared for and raised properly so thatthey can flourish in society. The problem according to Benatar is that veryfew genetic parents who go on to transfer their parenting responsibilitiesto others, such as recipients of donated gametes, actually ensure that thesocial parents are capable of properly fulfilling the responsibilities thathave been transferred to them.

What remains unclear about this argument is why Benatar considers itthe responsibility of the genetic parent not only to rely on others wantingchildren to be good parents but also to really ensure – that is, make surewith some certainty – that they will be good parents. While this soundslike an ideal that would be worthwhile striving towards, this is not theway we usually go about non-medically assisted reproduction. We do notusually expect persons engaging in sexual intercourse to have checkedtheir partner up and down to make sure they make a good parent. More-over, it is also strange to assume that somebody could, with any degreeof certainty, tell beforehand who would make a good parent. It wouldbe more reasonable, therefore, to argue that what gamete donors shoulddo is to make themselves known and remain available in case the socialparents fail in their attempts to be reasonably good parents. Alterna-tively, there could be a licensing programme prior to receiving donorgametes along the lines suggested by Hugh LaFollette (1980).7 This

7 In some cases the law has attempted to enforce criteria for good parenting. For example,in the UK, according to the HFE Act 2008, fertility clinics have a legal responsibilityto ensure that all gamete recipients are able to meet the welfare needs of a future child.


would shift the responsibility of guaranteeing good parenting towardssociety as the main beneficiary of reproduction (Karnein, 2012b). Inthat case, everyone who successfully acquired a licence should be viewedas a reasonably good parent and adults donating their gametes to suchpersons should be acknowledged as having acted responsibly (and evenmore so than those having unprotected sexual intercourse with someonenot thus licensed).8

The larger question such considerations raise is: what is it that is sup-posed to morally bind genetic parents? Is it first, that they contributed,through their voluntary actions, to the existence of a child, or is it second,that they are more genetically similar than anyone else to the new beingthey have created? If it is purely for reasons of having contributed throughvoluntary actions, Giuliana Fuscaldo asks:

How do we determine what or who among the countless contributing factors isthe cause of a child’s existence? In the case of an IVF pregnancy, for example, isit the action of the man and woman who provide the gametes, the embryologistwho inseminates the egg, the clinician who performs the embryo transfer, and soon? (Fuscaldo, 2006: 67, emphasis in original)

If, by contrast, the only reason we think genetic ties are decisive in deter-mining who should raise a child is that the child typically shares moregenes in common with their progenitors than anyone else,9 then volun-tary action seems to play no role, or only a subordinate one at best. Inother words, if someone stole a person’s gametes and created a child,then this would automatically implicate the person who never consentedto or did anything to bring about the existence of a new individual. Takethe urban legend Fuscaldo mentions surrounding the expression ‘son

However, considerable debate remains over the question of what children’s welfare needsare and how to determine the likelihood that these needs will be met by intending parents( Pennings, 1999; Jackson, 2002; Pennings et al., 2007).

8 LaFollette recognises that it would be difficult to agree on a set of criteria for what makesa good parent. As a result he suggests that we could, at the very least, identify what badparents are (e.g. those who abuse their children) in the hope that this would help toprotect many children from some of the most dangerous parents.

9 Some cases of identical twins may cause problems for any argument that ties parentalresponsibility to persons to whom the child is most genetically similar. Problems arisein at least two scenarios. First, if a child has an identical twin then he or she would bemore closely genetically related to the twin than to his or her progenitors; yet, we wouldnot consider the twin a parent on this basis. Second, if a child’s father or mother has anidentical twin then it will be the case that the child is just as closely genetically related totheir progenitor’s twin as they are to their progenitor; yet, it would seem odd to treat anaunt or uncle as a parent on the basis of genetic similarity alone. As we will discuss later,these possible situations with identical twins (or clones) cause problems for the way wesometimes think about the relevance of genetic ties for parenthood. We are grateful toMartin Richards for bringing these examples to our attention.


of a gun’. According to this legend, during the American Civil War therewas an incident in which a bullet carried away the left testicle of a soldierand propelled it into the lower abdomen of a nurse who happened tobe tending to injured soldiers somewhere close. She, in turn, is said tohave given birth to a healthy baby boy nine months later from whom abullet had to be removed (Fuscaldo, 2006: 67). Fuscaldo, to our mindaccurately, comments on this by remarking that it ‘seems implausible tosuggest that the genetic link between the gamete provider and the childin “son of a gun” entails that the soldier is responsible for his care’ (2006:68). This is presumably because claims about the distribution of respon-sibility for raising a child must have something to do with what personsdid or did not do to contribute to the existence of a child, rather than withthe issue of whether their genes are involved in creating a new person.10

We will return to this thought later on in the course of evaluating themixed message of ARTs.

Fuscaldo herself defends a theory she calls ‘candidate parenthood’(2006: 71), which holds that causing someone to come into existencecan be narrowly translated into parental obligations so long as bringingthe child into existence was the result of a free and foreseeable act.She thinks that ‘even if the genetic relationship between begetters andchildren generates parental obligations, if these obligations are fulfilledequally well by individuals other than the genetic parents, then failing toraise one’s genetic child does not . . . amount to failing in one’s duties’(2006: 73). She suggests that when it comes to the transferral of parentalduties the ‘question is not, will someone else do a better job, but will theydo a good enough job?’ (2006: 73).

That seems to be a perfectly reasonable response to questions of repro-ductive responsibility – unless, of course, it turned out that no geneticallyunrelated parent can do a good enough job. This brings us to our next

10 It is worth noting that our intuition about the soldier not being responsible for the care ofthe child is contrary to the law in places such as the UK (see McCandless and Sheldon,Chapter 3), USA or Australia (Cahn, 1997; Draper, 2007; Human Fertilisation andEmbryology Act 2008). As mentioned in footnote 4, the law typically attributes paternityto the genetic father, regardless of the circumstances (with the exception, for example,of sperm donation at a UK fertility clinic) leading up to the birth of the child. However,recent cases of pregnancies using ‘stolen’ sperm have raised similar intuitions to the oneswe have in the ‘son of a gun’ case (Ware, 2011; Goldman, 2013). For example, a Texasman named Jason Pressil claimed that in 2007 his girlfriend collected his sperm froma used condom and had it frozen at a Houston fertility clinic without his knowledgeor consent (Ware, 2011). After the relationship ended three months later, she had thefertility clinic use his gametes for IVF which eventually led to her giving birth to twins(Ware, 2011). However, Pressil did not find out about the ‘theft’, IVF treatment, andresulting children until 2011 at which point the children’s mother asked that he, thegenetic father, pay her child support (Ware, 2011).


set of considerations. We now turn to scholars who focus on child wel-fare and believe that children need to be raised by their genetic parents,not primarily because these parents (through procreation) acted in cer-tain ways to incur this responsibility but because they consider childflourishing to be dependent on being raised by genetic parents. To thiswe respond by pointing out that any harm a child may incur due tobeing raised by non-genetically related parents (i.e. social parents) ispresumably caused in large part by societal attitudes toward unconven-tional family forms (Nachtigall et al., 1997) and, as such, has a remedyother than condemning the practice of producing such families, namelyto change societal attitudes (see also Lillehammer, Chapter 5).11

Genetic relatedness and children’s welfare

There are a number of scholars who ardently believe that it is vitallyimportant to the welfare of children that they be raised by their geneticparents. Among these scholars is James Nelson who maintains that thereis ‘a great deal of evidence that suggests that genetic ties are of immenseimportance to family life’ (Nelson, 1992: 78). The evidence he speaks ofrefers to the fact that adopted children often end up wanting to searchfor their genetically related parents and are ‘more vulnerable than non-adoptees’ (1992: 78) to having problems developing their identity inadolescence and adulthood. Nelson argues that one way to describe theharm to the welfare of adopted children is that of ‘loss and alienation’(1992: 82).

According to what he calls the ‘genetic narrative view’, genetic rela-tionships help to explain how we ‘establish structures of meaning throughwhich we try to make sense of our lives’ (1992: 82). Years later DavidVelleman picked up on the notion of genetic narratives. Like Nelson,Velleman argues that children need not only know who their geneti-cally related parents are but also need to maintain close relationshipswith these parents in order to flourish.12,13 Similarly, by understandingtheir family history he believes children can benefit from learning howtheir genetic predecessors coped with life (Velleman, 2005, 2008).

11 An additional concern is that persons could be harmed if they were to find out late orby accident that they were donor conceived; however, evidence also suggests that somepersons who find out late or by accident do not report being harmed by the news (Turnerand Coyle, 2000; Readings et al., 2011; Nuffield Council on Bioethics, 2013).

12 It is not clear what Velleman would say in the case of a parent who has an identical twin.It is quite possible that he would place considerable importance on the child knowinghis or her uncle (the identical twin), but would still treat the child’s progenitor as theparent.

13 For a related discussion on ‘genetic identity’ see Richards, Chapter 1.


For Velleman, it is important that we each adequately relate our selfto our body and he thinks that ‘coming to terms with our bodily selvesis thus part of the human predicament’ (2008: 259–60). In light of thisfundamental task, Velleman argues that our genetic family consists of theonly other people who had to cope with inheriting a similar ‘supply ofraw materials’ to the ones we have been given; therefore, they are in thebest position to help us understand who we are. If persons fail to form anidentity that ultimately integrates their imagined self with their physicalbody, they risk feeling alienated from their own body (Velleman, 2008:260). For these reasons, Velleman believes that too many progenitors,such as sperm donors, do not take their contribution towards bringinga child into the world seriously enough (2008: 260) and consequentlymorally wrong the children they create. Like Callahan and Nelson, Velle-man believes that parental responsibilities are typically not transferable.

Philosophically, one might doubt whether persons’ identity develop-ment depends so heavily on comparing oneself with the physical featuresof one’s loved ones (see Karnein, 2012a), the resemblance to whichmight not even be that obvious. But even if Nelson and Velleman wereright about it being important, maybe even very important, to children’sflourishing for them to be raised by their genetic parents, it would behard to maintain that it is a necessary ingredient to childhood flourishingthat cannot, in any way, be made up by a number of other factors suchas love and care (by non-genetically related parents). Empirically, claimssuggesting that children do less well growing up with non-geneticallyrelated parents appear to be unsupported by the evidence that is cur-rently available (Hahn, 2001; Golombok, 2002; Golombok et al., 2006;Shelton et al., 2009).14 Similarly, instances of harm to donor-conceivedindividuals’ identities usually only occur when parents, either intention-ally or by accident, inform them at a later stage in life (i.e., adolescenceonwards) about the lack of a genetic tie between one or both parents(Turner and Coyle, 2000; Golombok, 2002).

But empirical evidence aside for the moment, consider the fictionalcharacter of Leontes, whose obsession over blood ties – which, througha modern lens, we interpret as an obsession over genetic ties – is notentirely unrealistic: he certainly proved to be a spectacularly poor father,although he was indeed that which he doubted, namely the genetic parentof his two children. Presumably, given his paranoia, it would have beenbetter for Maximus and Perdita to have been brought up by a loving

14 For a detailed comparative analysis of the developmental welfare of children whowere donor conceived and those who were not, see Hahn (2001) and Appleby et al.(2012a).


and caring non-genetically related father. But Leontes provides just oneexample of the many ways in which being raised by a particular set of(genetic) parents may be suboptimal for children.

So what, if anything, may be wrong with creating children who willbe genetically unrelated to their social parents? What, for instance, arethe kinds of difficulties such children are likely to encounter?15 To ourmind, whatever difficulties there may be, these are likely to be largelydue to societal attitudes that render it important for children to havecertain conventionally accepted stories to tell about their genetic lineageand their parents.

Consider being born out of wedlock in a contemporary Western soci-ety, for instance, which we cannot imagine causes a child too many diffi-culties growing up. By comparison, consider being born out of wedlockat a time when primogeniture was the social norm, as it was histori-cally in England, for example. Here, ‘If the society privileges geneticconnections in inheritance, support, emotional well-being, or identity,then it will necessarily be in children’s interest to maintain and nurturetheir relationship with genetic parents’ (Cahn and Carbone, 2003: 1025).Today, growing up in a new family form (e.g. with same-sex or geneticallyunrelated heterosexual parents) may do what being born out of wedlockdid then: ‘The natural nuclear family schema plays an important role informing identities – including healthy identities – in our current culturalcontext, and many people are stigmatized by not being able to “fit” theschema; . . . Being stigmatized is harmful and it is difficult to live a goodlife when stigmatized in this way’ (Haslanger, 2009: 28).

This having been said, neither Naomi Cahn and June Carbone norSally Haslanger take this to mean that there is something wrong aboutbreaking with such patterns. Instead, Cahn and Carbone go on to say that‘the fact that this may be true, however, is not much of an argument forwhy the practices should continue, especially for a society at a crossroadswith a real ability to choose among a variety of possible paths’ (Cahn andCarbone, 2003: 1025). Haslanger similarly argues that, ‘the problem, asI see it, lies in the reification of the schema as universal, necessary, andgood, and not the families that fail to match it’ (Haslanger, 2009: 29).

15 Some evolutionary psychologists point to studies that suggest parents are more likelyto abuse their children if they are not genetically related to them (e.g. the relationshipbetween stepfathers and stepchildren). This phenomenon is referred to as the ‘Cinderellaeffect’ (Daly and Wilson, 1999). However, the evidence for the Cinderella effect has beenwidely disputed on the basis that the researchers defending this view do not adequatelyconsider the myriad of other social conditions in play (e.g. family instability), aside fromgenetic relatedness, which may be responsible (Buller, 2005).


This is an interesting but perhaps not entirely obvious conclusion. Itstill remains true that children may experience some hardship due totheir parents’ choice of letting them grow up in such non-conventionalcircumstances. Thus, we do not want to say that such parental choicesare necessarily entirely without negative consequences.16 What we dowant to say is that none of these possible negative consequences renderthe choice itself morally problematic. For a better illustration, contrastthis case with that described in Shel Silverstein’s song ‘Boy named Sue’(1969, made famous by Johnny Cash). It tells the story of a father whochooses to name his son ‘Sue’, thereby intentionally causing his boysome hardship in a world that expects girls but not boys to be calledby that name.17 This choice may, indeed, be thought to be morallyproblematic.

There are certainly scenarios in which making such a choice wouldnot appear to be entirely unreasonable. If, as a prospective parent, forinstance, one thought that giving one’s son an all-male name wouldperpetuate a system of gender injustice, one might try to break thatpattern by not adhering to the particular social norm of name-giving thatone considers to be worth criticising. While this will not make growingup with this name any easier for the boy, we might think that the parentswere doing this for a good cause. Most people, however, are likely to alsobelieve that individuals should not use their children in this way and, ifthey want to fight gender injustice, should do it by way of making theirown lives harder (and not that of their offspring). But this case is unlikethat of adults choosing to bring children into this world who will beraised in the kind of unconventional circumstances18 we are concernedwith here. They are usually not instrumentalising their children in thename of a grander purpose (such as to change social mores about thenuclear family), but are having the children for their own sake.

The same is true of the father depicted in the song. He does notchoose the name ‘Sue’ for any greater end but for the more local purposeof ‘toughening up’ his son, who he knows will grow up without a fatherand will thus face extra challenges. This makes his choice better and

16 However, research is increasingly showing that children who grow up in emerging familyforms, such as same-sex parent families, on the whole enjoy a level of well-being that iscomparable to that of any other child. For a more detailed discussion and review of theevidence in support of this claim, please see: Biblarz and Stacey, 2010; Appleby et al.,2012a; Appleby et al., 2012b.

17 For those unfamiliar with the song, these lines illustrate the problem well: ‘It seems Ihad to fight/ my whole life through./ Some gal would giggle and I’d get red/ And someguy’d laugh and I’d bust his head,/ I tell ya, life ain’t easy for a boy named “Sue”’ (ShelSilverstein, ‘Boy named Sue’).

18 For a discussion about different family types, see Blake et al., Chapter 14.


worse (at the same time) than that of the parents seeking to fight genderinjustice. It is better in that the father is not instrumentalising his sonfor a greater purpose. But it is also worse in that the father chooses thisname in order to make his child have a hard time which, again, may not beentirely ill-intentioned since he thereby hopes to mitigate the real crueltyof abandoning his child.

Unlike Sue’s father, however, adults seeking reproductive assistanceare usually well-intentioned in a more straightforward sense: they wantto have children in order to care for them. The unfortunate possibilitythat a lack of genetic ties may make their children’s lives harder is aforeseeable but in no way inevitable consequence. It could largely beavoided, or so we are claiming, if social attitudes and narratives were tochange. So just as it would not be wrong for a person to have a girl in aworld in which growing up as a woman is harder than growing up as aman, it cannot be wrong for individuals to raise non-genetically relatedchildren just because it may be easier (right now) to grow up as part of atraditional nuclear family.19

This having been said, it is, of course, one thing to argue that if societalnorms were to change, the problem of being raised in non-geneticallyrelated families would cease to exist for the child. It is quite another todeny that raising genetically related offspring may continue to be whatadults want for themselves. Thus, in light of our argument that the chiefcauses of what may make being raised by non-genetically related parentsundesirable for children are unaccommodating societal attitudes, howshould we deal with the popular appeal that ARTs have for adults whohope to create genetically related offspring?

The conflicting message of ARTs

Widespread endorsement of a variety of means of assisted reproductionat the cost of other means of having a child (such as through adoption)may appear to provide compelling evidence that it is important for (atleast some) adults to have their ‘own’,20 that is, genetically related, child(Sparrow, 2006). At the same time one has to realize that individualsand couples seeking genetic ties through assisted reproduction frequentlyfind themselves in situations in which it becomes necessary for them

19 For an historical discussion about the ethics and law surrounding the creation of familiesvia gamete donation, see Richards, Chapter 1.

20 For further discussions on the language of ‘own’ children, see: Almeling, Chapter 8;Smietana et al., Chapter 11; and Graham, Chapter 12.


to deny the importance of both parents having genetic ties with theirchild(ren).21

Robert Sparrow has illustrated this nicely in the case of reproductivecloning, which is one of the more controversial possible (future) ways forinfertile singles or couples to have genetically related offspring. Sparrowreasons persuasively that ‘given that couples can always become parentsby adopting a child or, more controversially, by arranging for a childto be conceived for them to adopt, arguments for cloning must rely onthe importance we place on parents being able to have children that aregenetically related to them’ (2006: 310). From this perspective, Sparrowgoes on, cloning may appear to be a superior way of becoming a parent,since here genetic likeness is assured (2006: 313). Sparrow asks his read-ers to think carefully about a person who clones herself in order to havea genetically related child. Who should we assume is the parent of thecloned child? Sparrow answers that it is the parents of the person whocloned herself (2006: 315). According to the standard view of (genetic)parenthood, to the person who cloned herself, her clone is much morelike a twin than her child. Sparrow suggests that ‘our ordinary intu-itions about genetic relatedness are unreliable here because the normalconnection between genes and the history whereby they are transmittedhas been severed’ (2006: 314). What this case shows is that underly-ing our conventional beliefs is a picture of parenthood that involves thefusion of two independent genomes. This picture is upset in the case ofcloning. Sparrow concludes that ‘paradoxically then, in order to resistthe claims of the parents of the donor to the cloned child, this argu-ment for human reproductive cloning must place more weight on theintention to parent a child, than we do in cases of ordinary reproduction’(2006: 315). This special emphasis on intention, Sparrow goes on, ‘there-fore works to undermine the justification for cloning in the first place’(2006: 315).

The same could be said about many forms of assisted reproduction. Ifthe reason a couple cannot conceive, for instance, is because of male infer-tility, then this couple may seek out a sperm donor who may not wish to be(or be welcome as) part of the resulting family. Likewise, a gay couple maychoose to have a genetically related child (at least to one party) without,at the same time, desiring close company with either the egg donor (agenetic parent) or the gestational surrogate (the biological parent).

21 For example, intending parents may seek out a fertility clinic in the hope of having agenetically related child via IVF. If the gametes of either of the intending parents cannotbe used for medical reasons, they may instead choose to have a donor conceived childwho is genetically related to only one (or neither) of them (Readings et al., 2011).


Individuals pursuing ARTs thus send a highly mixed message aboutthe importance of genetic relatedness to them, as do ARTs themselves.On the one hand, it seems to be important to some that at least one of theparents is genetically related but, on the other hand, the non-geneticallyrelated parent is supposed to count as the genuine second parent (asopposed to any third party who might be genetically involved). Advancesin reproductive science and medicine are likely to aggravate this tension.While some such advances seem to reinforce the importance of geneticties (the creation of artificial gametes, for instance, which may renderthe introduction of ‘foreign’ DNA through gamete donation obsolete),others may work to undermine the traditional ideal of the nuclear family(treatment for mitochondrial DNA disorders,22 for instance, which maylead to the creation of children with genetic contributions from threeparents).

So just as we may take seriously the idea that genetic ties are importantto those pursuing ARTs, we should also take into consideration that it isregularly the case that couples seeking genetic ties through assisted repro-duction accept that these ties may be (partly) severed and, at the sametime, expanded to third (sometimes even more)23 parties who may ormay not be welcome in the family. This indicates that even in the subjec-tive experience of individuals, genetic ties may be desirable all else beingequal, but not so important all else not being equal. So what do we makeof this? We believe that ARTs and the mixed message they involve oughtto be welcomed. There is no reason to think that individuals are betterparents just because they happen to be fertile or have a partner of theopposite sex. Therefore, the wish of those who are single or are, for what-ever reason, infertile should be honoured, even if fulfilling that wish maysometimes challenge traditional understandings of the family. The moremixed the message of ARTs therefore, the better, since the more societyis confronted with novel family forms the more conventional these varia-tions will become and the less difficult it will be for children growing upin such families.

22 The only way to ‘treat’ mitochondrial DNA disorders (as opposed to: (1) just deselectingaffected embryos through pre-implantation genetic diagnosis (PGD) or aborting them;or (2) using donated eggs) is by using donated mitochondrial DNA (Nuffield Councilon Bioethics, 2012). This means that the resulting child will have been created withthree separate DNA contributions: one from the nucleus of the intending mother’s egg,one from the sperm, and one from the donated mitochondrial DNA. For more on thelegal aspects of this technology see McCandless and Sheldon, Chapter 3.

23 We could imagine a case in which an infertile couple requires both an egg and a spermdonor as well as a surrogate mother to carry the child. Also, single mothers will at leastrequire donor sperm and single fathers will at least require donor eggs and a surrogate(see Graham, Chapter 12; Graham and Braverman, 2012).


Perhaps it may eventually even turn out that something else entirelylies behind what is today often expressed as the wish to have a geneticallyrelated child. As straightforward as this wish may appear to be, there areat least two (connected) desires that may drive it. To begin with, adultsmay want their genetically ‘own’ child in order to preclude other adultsbesides themselves and their partner to make any (emotional) claims onthe child they want to rear as their ‘own’. Similarly, having a geneticallyrelated child inevitably implicates a person in the creation of a child. Andperhaps it is important to be implicated or involved in some way to feelfully responsible. If this were accurate, it would explain our intuitionswith regard to the ‘son of a gun’ case, which (like Fuscaldo) we took toindicate that what matters to parents is their voluntary involvement inthe creation of their child. Since such voluntary involvement was, untilrecently, inevitably bound up with having ‘genetic’ ties, only time will tellwhether the latter will continue to be important to prospective parentsonce the former can be achieved on its own.

Conclusion

The question we have tried to answer is what to make of some of thepossibilities ARTs offer to establish non-traditional families, and in par-ticular families in which genetic ties have been partially severed anddislocated. We began by examining claims that based the importanceof genetic ties on notions of reproductive responsibility and found thatstressing its significance does not necessarily imply that it is the geneticparents who should be responsible for raising ‘their’ children. From theperspective of the child’s welfare, we then argued that not being genet-ically related is not one of the ways for parents to wrong their children.This is not to say that no harm may occur, only that, whatever harmdoes materialise, it is often not the parents who are to blame since thesource of this harm is likely to be prevailing societal norms that expressnegative attitudes toward unconventional family forms. As for prospec-tive parents, we also pointed out the mixed message sent by many ofthose pursuing assisted reproduction to fulfil their wish for genetic ties.These prospective parents frequently accept that genetic ties will onlyexist to a partial extent within their family and are presumably able toalter their narrative about the importance of genetic ties if it turns outthat they require donor gametes, for instance, to have children. Theseconsiderations led us to welcome the mixed message of ARTs in thename of changing social values towards more open attitudes to differ-ent family forms, including those with partially severed and dislocatedgenetic ties.


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5 Who cares where you come from?Cultivating virtues of indifference

Hallvard Lillehammer

Introduction

My mother once told me that we choose our parents. At first I had noidea what she was talking about. It briefly occurred to me that she wasgiving expression to some kind of hippy existentialism. Later on I beganto think she had a point. In this chapter I attempt to articulate whatthat point might have been. In doing so my aim is to give an interpreta-tion of my mother’s remark according to which it articulates an ethicallysignificant insight. I will try to make sense of the idea that, in suitableconditions, making the kind of choices my mother was talking about canbe both conducive to well-being and a genuinely virtuous achievement.I will describe how this achievement relates to some controversial ques-tions about the responsibilities that parents are sometimes said to have toinform their children about their genealogical origins. By ‘genealogicalorigins’ I mean to include facts about the nature of our conception, gesta-tion or birth, as well as features of our familial history, such as facts aboutstep-parenting, adoption, extramarital relationships and the like. Morenarrowly, I hope to throw light on some of the ethical challenges involvedin creating or bringing up children who are in some way estranged, orotherwise detached, from one or more of their biological parents. By ‘bio-logical parents’ I mean (apart from parents reproducing in ‘conventional’ways) persons providing gametes, persons providing embryos, and per-sons carrying a pregnancy on behalf of someone else during the courseof assisted reproduction. The class of such children includes some chil-dren born as the result of assisted reproduction. It also includes adoptedchildren, children with one or more missing parents (including orphans),conventionally conceived children one of whose social parents is not theirbiological parent, and others. The exact process by which the children inquestion are brought into existence, such as whether gamete or embryodonation was involved, is not crucial to my main concern here. What iscrucial is the potential for estrangement or detachment that the processin question creates, and the ethical significance of that potential.

97

98 Hallvard Lillehammer

Like millions of children of her generation, born either during or inthe immediate aftermath of the Second World War, my mother grewup with an absent father. In her case, the identity of the father wasknown, and some forms of communication between father and child werepossible (exchanges of letters, gifts, etc.). Yet there was no prospect of anydirect personal contact between father and child, and the amount andkind of information passed on to my mother about her father’s identityand personal circumstances were severely affected by the complexity ofpost-war European political demographics and historical memory. At onepoint in my mother’s early adulthood, written communication betweenfather and daughter flared up, and then came to an end. From that pointonwards, questions about her father’s identity or circumstances seemto have played at most a peripheral role in my mother’s life, except forisolated episodes, mainly in response to the curiosity of her own children.Until the death of my grandmother in the late 1990s, questions about mymother’s genealogical origins on her father’s side seem to have been oflittle importance to her conception of who she was, or to how she wouldpresent herself to others as a daughter, wife, mother, friend or member ofher community. So exactly what, given these constraining facts about herown familial circumstances, did she mean when she said that we chooseour parents? In the next section I sketch one possible answer to thatquestion. In the following sections, I then consider two lines of argumentfor the claim that my mother was talking about a kind of choice which isalways wrong for someone to impose wilfully on another in the presenceof ethically acceptable alternatives (which in her case, I assume, did notexist).

Choice and identity

On one standard interpretation, what my mother said about choosingour parents is obviously false. Normally, we do not choose our parents.Never in the biological sense, and in a social sense in particular circum-stances only, such as in certain divorce proceedings, or in other situationsinvolving the possibility of shared or alternative parenting. In any case,the kind of dependency experienced by children with respect to theirparents, at least in the early years of life, is such that there is very limitedscope for their exercise of any meaningful choice for or against specificparental relationships. So what could my mother possibly have meant?

Making a choice implies the existence of more than one option. Mak-ing a choice voluntarily is often said to require at least one alternativeoption that is in some sense (e.g. morally or prudentially) acceptable (cf.Olsaretti, 2004). Yet saying this leaves much unspecified about the nature

Who cares where you come from? 99

and ethics of making choices. There are many different circumstancesin which someone might be said to choose something, either voluntar-ily or non-voluntarily. In one kind of case, someone could be said tochoose something if they have the option to decide between that thingand another thing of the same kind. Suppose I am travelling by planeto a philosophy conference on assisted reproduction. During the flight, Imight be presented with an in-flight meal with a choice between chickenor beef. Alternatively, I might be presented with a choice between takingor not taking the meal. Obviously, these two scenarios do not exhaust thepossibilities. On some airlines you can decline both the chicken and thebeef and request a vegetarian option instead. Other passengers prefer tobring their own food on board, as often seen on low-cost carriers. Somevery keen passengers may even take their chances and ask for chickenand beef. Then there are different kinds of choice exercised with respectto the same option. Suppose only beef is on offer. Still, the beef couldcome with a salad, a piece of bread and some cheese, and a glass ofjuice or water. Or perhaps you are able to combine parts of the hot mealserved at one point in the flight with parts of the cold meal offered atanother point. In each case, and for a wider or narrower range of options,you would have the opportunity to make a voluntary choice, and therebyexercise your agency in more or less successful or admirable ways.

According to one way of interpreting my mother’s remark, what shewas bringing to my attention was that working out one’s relationshipto one’s parents is a long-term creative process that involves a complexexercise of agency, and in the course of which a wide range of ethicallysignificant choices will be made about the nature of that relationship,even in circumstances (such as those she experienced) where the rangeof options on offer is severely constrained. Thus, a relationship with one’sparents is one that could develop in such a way as to become more orless detached, either physically or psychologically. And these days it ispossible to have a close personal relationship with one’s parents eventhough you live permanently on the other side of the world. As a child,many of the aspects of that relationship are in the parents’ gift. Yet atsome point, many of us find ourselves in a position of having to choosewhere to live in relation to our parents, how and how often to see orcommunicate with them, whom to see more often, and whether, and ifso how, to involve them in our own domestic affairs. Children exercisesuch choices in meaningful ways in so far as they might have some sayabout whether they mostly play inside the home with their parents presentor absent, outside the home with other children, in a club, in the homeof other children or with other relatives; and so on. In my mother’s case,these choices were severely constrained in at least one important respect.


Yet it is a notable feature of her relationship with her father that she doesnot appear to have found these limitations either deeply problematic orconstraining. Nor does her eventual decision to terminate contact seemto have been experienced as a grave loss, at least by her. I have no reasonto believe that my mother’s experience is either special or unique in thisrespect.

I say that a person’s conception of him- or herself as a certain kind ofindividual is a sense of having a certain kind of ‘practical identity’; anidentity people may or may not think of themselves as sharing with othersto whom they consider themselves to be closely related in some way (aswhen someone identifies him- or herself as a certain kind of person, oras a member of a team (cf. Korsgaard, 1995)). To form a conceptionof oneself in relation to one’s parents involves a complex exercise ofagency in the course of which a person develops a practical identity thatis informed both by his or her beliefs about what that relationship isand what it ought to be. To that extent, it inevitably involves a range ofethically sensitive choices, even if the options for relating to one or moreof one’s parents are severely restricted by facts beyond one’s control.One may become one kind of person who self-identifies as a person froma two-parent family, where both social parents are also assumed to beone’s biological parents. One may become another kind of person whoself-identifies as a person from a single parent family, a family with anabsent father, or a family where there is no social relationship with oneor more of one’s biological parents, for example in cases of anonymoussperm or egg donation. Making the kinds of choices that are necessary toform and sustain such a practical identity can obviously be done more orless successfully or admirably. In particular, choosing (or choosing notto have) a certain kind of relationship with one or more of one’s parentscan have significant effects on the level of someone’s wellbeing, and canin some cases amount to a virtuous achievement, and one that need notbe purchased at the cost of either ignorance or self-deception. It is in thissense that I think my mother was right to say that we choose our parents,and that in saying so she was giving expression to an ethically significantinsight.

Identity, knowledge and virtue

No reasonable person would seriously deny that it is possible to respondin the most admirable ways to having a severely restricted range ofoptions. Even so, there are situations in which so responding is at best avirtue of necessity, and in which we might consider it better if the per-son in question would never have had to exercise the relevant choices in


the first place. The fact that children can grow up to live well and formethically admirable, good or otherwise satisfactory relationships with oneor more of their parents in a range of difficult circumstances (regardlessof whether or not these circumstances involve non-conventional meth-ods of conception or gestation) does not imply that it is therefore eitheradmirable, good or even permissible to place them deliberately in thosedifficult circumstances. There is more than one line of argument thatmight be thought to put the enforced detachment of children from coreaspects of their genealogical origins into ethical doubt. Here I shall con-sider two. The first relates to the place of self-understanding in our for-mation of a virtuous practical identity. The second relates to the fact thatcertain forms of adaptive preference formation can be a symptom of oneperson having been wronged by others. Before I address these lines ofargument, however, I shall briefly explain the notions of a ‘virtue’ and a‘virtuous achievement’ on which my discussion depends (cf. Hursthouse,2012).

For the purposes of this chapter, I say that a ‘virtue’ is an admirablecharacter trait, and a ‘virtuous achievement’ its successful manifestationor exercise, where by ‘successful’ I mean ‘actually successful’, not just‘successful as things appear to its subject’ (more of which below). Thus,you might admire someone for their honesty (a virtue), especially in asituation where telling the truth was a difficult thing to do (a virtuousachievement). Some people think that possession of virtue to a very highdegree is necessary to live a good life. I do not make that claim. What I doclaim, though, is that virtue can enhance a good life, such that living welland being virtuous constitutes one of the greatest excellences of whichhuman lives are capable. Furthermore, even if trade-offs are sometimespossible or even necessary, the aim to live well while also being virtuousis itself a distinctively admirable one. If I tell you that I dream of a goodand virtuous life, I do not expect to have to give you any explanation orexcuse.

What personal features does a good and virtuous life require? Forpresent purposes, the main feature that matters is self-knowledge. If youhave poor knowledge of yourself, you may be less likely to live well, orto develop what you yourself would consider an admirable character.Indeed, it is reasonable to think that a highly virtuous person is a personwho knows him- or herself unusually well: people for whom disclosureof further facts about themselves would not subvert their general senseof who they are and what they ought to be. Some of these facts will beintrinsic to that person, such as how he or she looks and feels. Other factswill be relational facts, such as how that person is related to the peoplearound him or her, or to past events affecting the choices he or she has


to make about the course of his or her life. There are several ways inwhich such facts are said to affect the way someone’s life is going andthe extent to which it makes sense to admire them. One way is for thosefacts to be significant in themselves (e.g. the fact that you are a humanperson). Another way is for those facts to be significant in virtue of theperson investing them with significance, as when you decide to pursue acertain project. A third way is for those facts to be accorded significanceby others, for instance the fact that you are a suitable candidate for beinginvited to participate in another person’s project. In each case, there isboth a first-person and a third-person perspective one might take onthe evaluative significance of those facts – perspectives that will oftencome apart (cf. Griffin, 1986; Feldman, 2004). Thus, I might think Ihave gained acceptance as a member of a circle of friends with whom Ipersonally identify, but actually have failed to do so because the othermembers of the circle do not in fact identify with me. It is a controversialquestion to what extent I can be said to be doing very well in this kindof case. Alternatively, I might proudly represent myself in public as anexemplary embodiment of admirable personal features, the possessionof which is known to be a necessary condition for admittance to a clubof which I am a member, whereas in fact an exception was made in mycase and the people who admitted me are sworn to secrecy about thecompromising terms of my admission. The extent to which my prouddisplays can be said to be an admirable expression of the features inquestion in this kind of case is controversial (even if I have actuallyacquired those features in the interim). The issue is partly a matter ofhow the attitudes and behaviour of others, including their possession andapplication of knowledge about me, affects our third-person evaluationof the significance of my behaviour. The suggestion is not that in everyinstance where someone is kept in the dark, or where other people misleadus about some aspect of our lives, it is impossible for us to live either wellor admirably. Who ever lived a life without being subject to some form ofdeception with regard to certain facts about their life or character? Thesuggestion is that sometimes, when facts about someone that are unknownto him are handled by other people in ways that create a serious mismatchbetween what the person take himself to be and what he actually is, thiscan be a genuine obstacle to his efforts to live either well, or admirably,or both.

Knowing who you are

At some point in our life, at least some of us ask ourselves who we are,and who we want to be. Both questions involve a factual as well as an


ethical component. Who I am is in part a function of my past and presentcircumstances, and is partly determined by others. It is also a functionof what I do in response to those circumstances, both with respect to myactions and with respect to my conception of who I am. In particular,some of my actions, including those by means of which I come to definemyself as a certain kind of person, will partly be based on developing aself-conception, and therefore based on who I take myself to be.

What do I need to know about myself in order to truly understandwho I am in such a way as to live well or virtuously? In one view, knownas ‘origin essentialism’, my numerical identity, as the unique individualthat I am, is determined by my causal and, most importantly, my geneticorigins (cf. Parfit, 1984; Nagel, 1991). According to this view, if someonehad been conceived just before or just after me, or had been differentlyconstituted genetically through conception and gestation, that personwould not have been me. It follows that unless I know the basic facts aboutmy genealogical origins (including the basic facts about my conceptionand gestation), I literally don’t know who I am, in the sense of being oneparticular distinguishable individual.

Even if we are convinced by origin essentialism as a correct accountof numerical identity, as in being one identifiable individual rather thananother, it does not follow that the facts determining my numerical iden-tity are sufficient to determine my practical identity, as in being (andself-identifying as being) a human individual with some distinguishingfeatures rather than others. There are many things that could make moreof a difference to how I think of myself than the facts that determine how Iwas constituted as a biological entity. These include features of the socialenvironment into which I am born. They also include ways in which Ican mould myself to form certain characteristics in light of what I con-sider to be good or admirable. Yet even if we do not consider facts aboutnumerical identity to determine facts about practical identity, it couldstill be reasonable to take an interest in facts about our genealogical ori-gins in our construction of a practical identity. First, some of our physicaland other medically relevant characteristics are inherited via our biolog-ical parents. Second, some physical and psychological characteristics areinherited via our biological parents and may find expression even if we donot grow up among those parents. In each case, these inherited featuresmay affect the way other people behave towards us regardless of how werelate to those characteristics ourselves. Third, many people identify withtheir genealogical origins beyond merely taking an interest in physical andpsychological similarities and medical statistics, and to the point of givingfacts about those origins a pivotal role in the construction of their prac-tical identity. Indeed, many of us live in cultural circumstances where


facts about our genealogy form a central part of widely shared practicesof mutual recognition, solidarity and respect. Of course, our interest inthe facts of genealogy may vary according to circumstances. Thus, it isprobably more pleasing to learn that one’s ancestors performed impres-sive or heroic acts of achievement and sacrifice than to learn that theywere engaged in acts of indiscriminate brutality. Yet regardless of whatwe may or may not feel about these facts ourselves, the way other peoplefeel about them can sometimes have a decisive influence both on ourability to live well, and on our capacity to achieve certain forms of virtue.

Clearly, some facts about a person’s genealogical origins (such asthe identity of their social parents) can be more central to someone’sconception of herself than others (such as the identity of distant bio-logical relatives). Even so, there is some plausibility to the idea that themore about those origins one knows, the more about one’s place in theworld one is able to understand. This thought naturally gives rise tothe following argument. Virtuous agency requires the construction of avirtuous practical identity. The construction of a virtuous practical iden-tity requires accurate self-knowledge. Accurate self-knowledge requiresknowledge about one’s genealogical origins. All else being equal, the moreextensive knowledge about one’s genealogical origins one has, the betterplaced one will be to construct a virtuous practical identity. Therefore,to deliberately prevent someone from acquiring accurate knowledge ofher genealogical origins will harm her chances of constructing a virtuouspractical identity. To that extent, it is wrong for parents to curtail theirchildren’s access to facts about their genealogical origins. The wrong inquestion might in principle be outweighed by facts of the particular casethat make the communication of such facts either difficult, impossible orotherwise to the detriment of the child in question. And the inability toform a genuinely virtuous practical identity need not detract from some-one’s ability to live well. Yet the fact that this possibility could be realisedin any particular case does not detract from the fact of its wrongness, atleast other things being equal (cf. Velleman, 2008).

This argument rests on a number of questionable assumptions (someof them descriptive, some of them ethical). Even so, I think it would be amistake to dismiss it without qualification. It would be both dogmatic andunreasonable to flatly deny that knowledge of one’s genealogical originscan be valuable, so to prevent someone from acquiring such knowledgeis to potentially burden them with a significant loss. Why, for example,should children growing up in families where one or more of their biolog-ical parents is absent or unknown be uniquely excluded from developinga conception of themselves that is based on a truthful account of theirgenealogical origins, as in cases of anonymous egg or sperm donation?


Even so, the argument is faced with a number of difficulties whichtogether cast doubt on the idea that detachment from knowledge aboutone’s genealogical origins (whether by acquaintance or by description) isnecessarily harmful to the development of a virtuous practical identity.

First, just as it is not necessarily better in general for me to knowmore about something than to know less about it, so it is not necessarilybetter for me to know more rather than less about some aspect of mygenealogical origins. Facts about those origins can be depressing, con-fusing, disruptive, distracting or simply boring. Perhaps I have exactlyseven ancestors named ‘Paul’. So what? With respect to children like mymother, who grow up in the absence of one or more of their biologi-cal parents, the extent to which accurate genealogical knowledge wouldeither enhance or detract from their chances of successfully developing avirtuous practical identity is a context-sensitive matter. Furthermore, thepotential for harm does not come only from one direction. The ethicalflipside of a potentially harmful ignorance of one’s genealogical origins isa potentially harmful insistence in a genealogically obsessive culture thateveryone should take an active interest in those origins. To enforce suchan interest on everyone regardless of their contingent inclinations andcircumstances could be both oppressive and, in cases where it is likely tobe a cause of exclusion or stigmatisation, potentially cruel.

Second, we do not care about our origins in every possible way. I mightidentify more with one of my parents than with the other; with my friendsmore than with my cousins; with a cause more than with my country; withmy job more than with my gender. If so, I will partly detach myself fromcertain aspects of ‘who I am’ in order to cultivate the practical identity ofsomeone with a multiplicity of overlapping social identities, at least someof which could be of greater significance to me than even basic facts aboutmy genealogical origins. One possibility (and the one apparently realisedby my mother) is to develop a practical identity in full consciousness thatthere are gaps in certain core facts about one’s genealogical origins, assomeone who does not care (or does not care very much) about certainfacts about the exact nature of his biological lineage. To put it differently:one type of person that you can become is someone who does not care(or care that much) where you come from; who your biological parentsare; the home town of your paternal grandparents; that you are oneof your biological father’s five hundred donor children, or that you werebiologically constituted by a mixture of leftovers on a dish. That someonecould decide to become such a person, and could do so admirably, isindicated by the case of the millions of people (like my mother) whosedetachment from some aspect of their biological inheritance has beenforced upon them by circumstances beyond their control (such as death,


adoption, gamete or embryo donation or having one or more absentparents). To this extent, cultivating an attitude of indifference towardseven core aspects of one’s genealogical origins can constitute an exerciseof virtue. Thus, even if we were to think of the value of self-understandingas some kind of ethical ‘master-value’ (or even as a ‘constitutive aim ofaction’), it would not follow that the kind of self-understanding thatprioritises knowledge of one’s genealogical origins must be thought of aseither the only genuine, or the most valuable, form of self-understandingthat someone could virtuously cultivate. Another option, and one thatcould in principle be equally admirable, is one in which other attachmentsprovide the primary resources for the construction of a virtuous practicalidentity. The cultivation of a practical identity in conditions of substantialdetachment from core facts about one’s genealogical origins is thereforein principle consistent both with genuine virtue and with the kind ofself-understanding on which virtue depends. One kind of person I cantruly know myself as being, is the kind of person who does not care (ordoes not care very much) about those things.

Not knowing who you are

In order for someone to decline something, that thing had better be onoffer. It is one thing to develop a virtuous practical identity in conditionswhere facts about one’s genealogical origins play little or no role whilebeing aware that there are significant gaps in one’s knowledge of thosefacts. It is quite another to develop such an identity in the false belief thatone’s knowledge of those origins is accurate or complete. The response tothe line of argument considered in the previous section presupposes thatthe person whose practical identity is in question is aware of the epistemiclimitations of their situation in a way that is not the case for many childrenwho grow up in a state of detachment from their genealogical origins,and for whom the decision scenario described in the previous section istherefore not relevant. It therefore does not follow from the arguments ofthe previous section that there are no residual obstacles to the decisionon the part of someone’s parents to either protect or exclude their chil-dren from knowledge of basic facts about their genealogical origins. Allthat follows from those arguments is that there are no such obstacles inprinciple (at least with respect to self-understanding) in cases where theepistemic limitations in question are known to the persons themselves.So what, if anything, can be said about cases where this condition failsto be met?

One response that is clearly inadequate is to appeal to the obviousfact that all children face the task of constructing a practical identity in


conditions where some facts about their genealogical origins are unknownto them. This response fails to address the main issue for two reasons.First, and as already noted, some facts about our genealogical originsare likely to make a much bigger difference to our self-understandingthan others (even if these facts will vary from person to person). Second,there is an ethically relevant difference between someone else decidingwhat it is crucial for you to know about yourself and making that deci-sion yourself. Children who grow up in the absence of one or more oftheir biological parents, including most children born as a result of donorconception, are often put in that situation by someone else. How shouldwe ethically describe the scenario in which someone places another per-son in conditions where they are either kept in the dark about core factsabout their genealogical origins, or are actively prevented by others fromlearning such facts? Answering that question gives rise to a further lineof argument against the claim that living in ignorance of core facts aboutone’s genealogical origins is compatible with the successful developmentof a virtuous practical identity.

There is a distinctive kind of wrong that is associated with the detach-ment of its victims from their real interests in the service of the inter-ests of others. In the domain of politics this kind of wrong is some-times described in terms of ‘false consciousness’ to describe someonewho may think they are successfully pursuing their genuine interests,whereas in fact their condition is primarily serving the interests of others,interests whose satisfaction depends on other people being substantiallydetached from their own (Geuss, 1989). Thus, a member of the con-temporary working class could take pride in their pursuit of affordabledesigner sportswear and the latest generation of smart phones, neverseriously considering the possibility that it is exactly by having theirattention focused on the accumulation of trivial consumer goods thattheir labour and acquiescence can be effectively mobilised in the inter-ests of the power and privilege of the economically and politically dom-inant super-rich. In a similar way, women who express contentmentat radically asymmetric power relations between the sexes are some-times described as suffering from false consciousness in virtue of havingbeen forcibly detached from developing an adequate grasp of what isessentially an oppressive and exploitative relationship between men andwomen.

There are at least two sorts of case of this kind of direct relevance tothe present topic. On the one hand, there is the case of someone whois detached from her real interests through having cultivated a concep-tion of her interests to accord with the options actually available to her,where this does not involve her being ignorant of any relevant fact, but


is compatible with her being aware of the way in which her choices areeffectively constrained. Consider a prisoner who adjusts his routine toprison life in order to survive a long term of incarceration, or a victimof dictatorship who adjusts his ambitions to take account of the fact thathe is living in a police state. On the other hand, there is the case ofsomeone who is detached from her real interests through having beenkept ignorant of some facts, their ignorance of which is the cause of herfailure to pursue those interests. Consider someone who is fully devotedto constructing a pleasant living environment within a prison compound,without ever paying any serious thought to the fact that his actions wouldbe forcibly prevented should he try to leave. Instances of either kindcould be described as cases of ‘adaptive preference formation’. Adaptivepreference formation in cases where the pursuit of one’s ‘real’ interestshave been put out of bounds by others in a way that is either easily avoid-able or unnecessary is a widely recognised form of unjust servitude. Ofcourse, not all forms of adaptive preference formation are ethically prob-lematic in this way. Thus, even though changing my route through themountains because of the weather or altering my vast weekly intake ofalcohol to reduce my health insurance premium could both be extremelyunwelcome and seriously inconvenient for me, I would not thereby con-sider myself to be a victim of any kind of wrongdoing on that account.Indeed, one of the basic marks of knowing right from wrong is the abilityto distinguish the obstacles to possible action that do, from those thatdo not, constitute unjustified interference with our pursuit of our realinterests.

It might be argued that even though the development of a practicalidentity in full awareness of the restricted potential for knowledge ofone’s genealogical origins could be a non-malignant form of adaptivepreference formation, the cultivation of a practical identity by some-one who is deliberately kept ignorant of core facts about his or hergenealogical origins would be a case of false, if contented, conscious-ness. One case of this kind of relevance to the ethics of assisted repro-duction would be that of a donor-conceived child whose personal senseof self-worth is for some reason conditional on a false belief about hisinheritance of certain physical traits from one or more of his socialparents.

There are at least four ethically significant analogies between the for-mation of a practical identity in a state of imposed ignorance about one’sgenealogical origins and a state of false consciousness as I have defined ithere. When taken together, these analogies might be thought to providean argument in favour of the claim that parents ought to make available


to their children (in some way, and at some point) such facts about theirgenealogical origins as they may have at their disposal.

First, in both cases the unavailability to a child of some possible prac-tical identities is conditional on a form of detachment (involving eitherignorance or lack of acquaintance) that is not of their own making, but hasbeen imposed on them (in some cases deliberately) by others. Second, thedetachment in question either is, or could be, imposed on the child at leastpartly in the interest of others (such as social parents, absent biologicalparents, or anonymous and identity-release gamete donors), whose inter-ests will normally play a significant part in any decision about which, ifany, facts to disclose, and how. Third, for at least some people, ignoranceabout their genealogical origins may result in a genuine loss of oppor-tunities for valuable self-understanding and social relationships, suchas a potentially meaningful relationship with a person involved in theirconception or gestation. Fourth, although some children would clearlydecide not to take up these opportunities if presented with them, otherssurely would, in which case the fact of their ignorance will make a substan-tial difference, both to their potential for constructing at least one kind ofvirtuous practical identity and to other facts about the course of their life.For this latter class of people, the actual conditions in which they aremade to develop a practical identity arguably do stand as a genuineobstacle to the cultivation of a practical identity that is informed by whatfor them either is, or would be, an important aspect of their self under-standing.

Against these considerations, the following disanalogies provide a casefor the claim that keeping certain facts about their genealogical originshidden from children is not necessarily wrong in itself, and can in somecircumstances actually be the best, or even the right, thing to do forparents or other carers (cf. Appleby, Blake and Freeman, 2012).

First, even if the interests of parents are in some way served by theignorance of their children, it does not follow that those interests arethereby served conditionally on that ignorance. The two could coexist, orbe statistically related, without either one being a condition of the other,or anyone ever producing one in order to serve the other. By analogy,the fact that my father never taught me how to hunt may have beenconvenient for him given that he wanted to teach me how to fish, evenif it is false (which it is) that he never taught me how to hunt in orderto be able to teach me how to fish. Second, even if parental interestsplay a role in their decision of what to tell their children about theirgenealogical origins, only a pathological form of parenting would ignorethe interests of the child completely. In such a case, ignorance of her


genealogical origins is likely to be the least of the child’s problems. Ingeneral, decisions about what to tell one’s children, how to do so andwhen, are subject to a wide range of ethically significant considerations,including the capacity of the child to understand and process the relevantinformation, to make meaningful use of the information in thought andaction, and the potential for harm associated with either giving, facilitat-ing, making available, withholding, evading, manipulating, refusing orobstructing the child’s pursuit of the relevant information at any giventime. These are all considerations that can be substantially informed bywhat would be in the child’s best interest. It follows that one of the neces-sary conditions for false consciousness, or any other form of maladaptivepreference formation, will fail to be met in many cases where childrenare kept ignorant of some core aspect of their genealogical origins. Third,and as already noted, it cannot be assumed in connection with the firstline of argument considered in the previous section, that acquiring moreknowledge of genealogical origins is necessarily going to benefit people,either with respect to their ability to live well, or with respect to theircultivation of a virtuous practical identity. And even if it is, it cannot beassumed that gaining access to this knowledge will necessarily be morebeneficial with respect to the cultivation of a virtuous practical identitythan either a comparative state of ignorance, or a state of deliberatelycultivated detachment from that knowledge.

Of course, if a person’s path through life is conditioned by a stateof ignorance imposed on them by someone else, then those who haveimposed that state of ignorance are taking an ethically significant risk,in part because the information in question could become available andthereby affect (either positively or negatively) the way the child relatesto himself and to those who kept the information from him. Thus, theproject of bringing up a child to a state of adulthood while preventingthe disclosure of central facts about his genealogical origins (such as theidentity of one or more of his biological parents) is one that may requirethe cultivation of sophisticated habits of information management, atleast some aspects of which could be mishandled, either by those whobring the child up or by other members of the relevant community,and/or subsequently picked up on by an aggrieved child as a cause ofanger or resentment. Incidentally, this is a kind of risk that would notbe removed by the guaranteed provision of a facility for disclosure, suchas the legal right granted by some states to donor-conceived children toknow the identity of their biological parents once they become adults(Draper, 2005). Being detached from some core aspect of one’s genea-logical origins during a formative period of one’s life could reasonablybe experienced as a significant loss; even if it is a loss that needs to be


evaluated in light of the fact that any path marked out for us by others isthereby a path marked out for us at the exclusion of other paths.

Conclusion

The extent to which not knowing one’s genealogical origins may affectsomeone’s ability to live either well or virtuously inevitably depends onfeatures of his or her circumstances above and beyond the question ofwhat those facts are and the intrinsic features of that person’s nature orpersonality. It also depends on how this absence of knowledge is embod-ied in the social world in which that person lives, how that knowledgerelates to what he or she thinks of him- or herself as being, and what (ifanything) other people do with that knowledge. In some cases, the rel-evant facts may present no obstacle to that person’s well-being or his orher ability to cultivate a virtuous practical identity. In other cases, such asthose where the knowledge in question would undermine that practicalidentity, or where others have acted so as to make that person’s commit-ment to some of his or her life projects depend on what is essentially afalse view of his or her place in the world, the relevant facts can presentobstacles both to that person’s well-being and to their capacity to cultivatea virtuous practical identity. This conclusion highlights what is a basictruth about the contextual dependence of many of the most interestingquestions about the ethical significance of our knowledge of the past.Although some of that significance clearly derives from what the relevantfacts about the past are, some also depends on what people either havechosen, or will choose, to do with their knowledge of those facts, andhow they come to treat each other as a result. In the light of this truth,it is only reasonable to be sceptical about highly general and inflexibleclaims concerning the rights and wrongs of different forms of assistedreproduction, and the informational challenges to which they give rise.

References

Appleby, J., Blake, L., and Freeman, T. (2012). ‘Is disclosure in the best inter-ests of children conceived by donation?’, in M. Richards, G. Pennings andJ. Appleby (eds.), Reproductive Donation: Practice, Policy and Bioethics. Cam-bridge University Press.

Draper, H. (2005). ‘Why there is no right to know one’s genetic origins’, inN. Athannasoulis (ed.), Philosophical Reflections on Medical Ethics. Bas-ingstoke: Palgrave Macmillan.

Feldman, F. (2004). Pleasure and the Good Life. Oxford University Press.Geuss, R. (1989). The Idea of a Critical Theory: Habermas and the Frankfurt School.

Cambridge University Press.


Griffin, J. (1986). Well-Being: Its Measurement, Meaning and Importance. OxfordUniversity Press.

Hursthouse, R. (2012). ‘Virtue ethics’, in E. N. Zalta (ed.), The Stanford Ency-clopedia of Philosophy (online). Available at: http://plato.stanford.edu/entries/ethics-virtue/.

Korsgaard, C. (1995). The Sources of Normativity. Cambridge University Press.Nagel, T. (1991). Mortal Questions. Cambridge University Press.Olsaretti, S. (2004). Liberty, Desert and the Market: A Philosophical Study. Cam-

bridge University Press.Parfit, D. (1984). Reasons and Persons. Oxford University Press.Velleman, J. D. (2008). ‘The gift of life’. Philosophy and Public Affairs, 36, 245–

266.

http://plato.stanford.edu/entries/ethics-virtue/

http://plato.stanford.edu/entries/ethics-virtue/

6 Legal kinship and connection inUS donor families

Naomi Cahn

When people choose to use third-party sperm or eggs, they are challeng-ing the traditional legal construction of the family. This model, histori-cally based on the unity of biology, parenthood and marriage, is alreadybecoming increasingly irrelevant because of the decline of marriage in theUSA and Europe (Cherlin, 2009; Carbone and Cahn, 2014). Third-partygametes undermine the very unity of biology, parenthood and marriage,even as they, both paradoxically and ambiguously, affirm the importanceof biology (McCandless and Sheldon, Chapter 3). First, the use of third-party gametes creates a new family member and also creates affinityties between partners (‘donor-conceived families’). Second, beyond thisnew family, it also creates genetically based relationships between (1) thedonor and resulting offspring and (2) all of the offspring resulting fromthat donor’s gametes (‘donor half-siblings’ and ‘donor-conceived familycommunities’).

This chapter explores the meaning and interpretation of genetic con-nection and kinship in US jurisprudence and regulation, with a particularfocus on donor-conceived family communities. US law is slowly adjust-ing to the realities of donor-conceived families, but it has not yet entirelyadapted to these new communities, which are outside the parametersof conventional family law doctrine. Although donor conception is gen-erally viewed within a health law framework, donor-conceived familycommunities actually contest traditional assumptions about the state’srole in family law and the very definition of family. Accordingly, they alsooffer insight into other intrafamilial relationships, such as stepfamiliesand parents who have children with multiple partners.

The language in this area is complex, reflecting different meanings andthe complexity of the social, legal, and political issues involved (Richards,Pennings and Appleby, 2012; Kramer and Cahn, 2013). Egg and spermdonors may view their contributions differently (Almeling, Chapter 8),and the attitudes of egg and sperm donor offspring may not be compa-rable (Richards, Chapter 1; Freeman et al., Chapter 15). Because most

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of the research to date has focused on sperm donor family communi-ties, it is somewhat speculative to include egg donor family communities.Nonetheless, this chapter concludes with suggestions for a new paradigmto govern all donor-conceived family communities, regardless of whetherthey are formed through egg or sperm donation.

US family law and donor-conceived families

The parent–child relationship

Common law has generally used the marital presumption as a startingpoint to identify parents (Hertz, 2009; Allan, 2010). That is, married par-ents are assumed to be the parents of any child born into the marriage.However, in some jurisdictions, notwithstanding the strength of the mar-ital presumption, early cases involving sperm donation led to a marriedmother being accused of giving birth to a non-marital child (Bernstein,2002; Cahn, 2009b). Clearly, this reflects concern about who should berecognised as a ‘parent’ of a child born as a result of sperm donation,and the prioritisation of biological contribution. Non-marital parent-hood has historically been based on biology, the male progenitor andthe birth mother, without any relationship presumption (McCandlessand Sheldon, Chapter 3).

As the number of children born from donor gametes has increased, andsome of the secrecy surrounding donor conception has dissolved, manyjurisdictions have enacted laws focused on legitimating donor-conceivedchildren born into marriages and clarifying that donors are not legalparents of children born from assisted reproduction. Nonetheless, nosingle comprehensive system has arisen to supplement, or even replace,the marital presumption. States’ approaches to parenthood reflect theirapproaches to whether biology, intent, marriage or contract constitutethe appropriate source of family identity (Carbone and Cahn, 2011).1

Nonetheless, and perhaps surprisingly, there is no universal answer tothe question of what exactly is the legal relationship between donor anddonor-conceived offspring. In some states, the designation of parenthoodturns on whether a doctor was involved in the insemination processand the absence of physician involvement may convert a donor into afather (Polikoff, 2009). In other states, the law is clear that an unknowndonor has no parental rights, regardless of physician involvement. Gaps inexisting state regulations are vast; though virtually all states have statutoryor case law on some aspects of sperm donation, not all states address

1 See, e.g., Watermeier v. Moss (2009); Fisher v. Tucker (2010).

Legal kinship and connection in US donor families 115

circumstances involving unmarried parents ( Jaeger, 2010). States areincreasingly likely to address donor eggs, although fewer address embryos(Cahn, 2013).

Notwithstanding the lack of uniformity among states concerningthe legal relationships established through collaborative reproduction( Andrews and Elster, 2000; Joslin, 2010), model (non-binding) acts havebeen proposed that would ensure donors have neither legal rights norobligations. The Uniform Law Commission (ULC) has twice attemptedto develop comprehensive parenthood legislation: through the 1973 andthe 2002 Uniform Parentage Acts (UPAs). While these models have beeninfluential, and more than half the states have adopted some version ofthem, the remaining states either have no statute or have statutes diver-ging significantly from both UPAs.

The 1973 UPA applied only to married couples, providing that thehusband would be the legal father if: (1) the husband’s consent was givenin writing, and (2) the insemination was done under the supervision of alicensed physician. The UPA did not address non-marital children con-ceived through artificial insemination, and it also left the parental statusof the sperm provider unclear even when a married woman was insem-inated without the involvement of a physician (Polikoff, 2009; Joslin,2010).

In an effort to respond to the enormous changes in the reproductivetechnology field and the construction of families, a replacement UniformParentage Act was proposed in 2000 (Degtyareva, 2011; ULC, 2011).Though the 1973 Act dealt only with artificial insemination, the newAct (amended in 2002) addressed a variety of legal problems that mightresult from egg or sperm donation, as well as the freezing of embryos.2

While early drafts continued to require physician involvement to termi-nate the donor’s parental rights, the final Act abandoned that require-ment. According to the final Act, an egg or sperm donor is not a par-ent when a child is conceived through ‘assisted reproduction’, meaningreproduction not involving sexual intercourse.3 Indeed, the 2002 UPAcomments clarify that ‘[i]n sum, donors are eliminated from the parentalequation’.4

The model law has not, however, resulted in uniformity. Only a handfulof states have even enacted statutes that explicitly define parentage of chil-dren born through egg donation. Though the ‘laboratory of states’ allowsfor a multiplicity of approaches to parenthood and experimentation with

2 Uniform Parentage Act (2000) (amended 2002), prefatory note to art. 7.3 Uniform Parentage Act (2000), §§ 102(4), 702.4 Uniform Parentage Act (2000), § 702 cmt.

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different processes and presumptions, the resulting patchwork does notprovide certainty for parents, children and donors (Hills, 1998; Gerken,2010). Instead, it fosters an incoherent approach to fundamental issuesof intimacy and identity. Consequently, in a few states, the fears of donorsand intending parents about unexpected legal obligations and rights actu-ally have a somewhat credible basis, though no unknown donor has everasserted any legal claims concerning their offspring – and such a sce-nario is highly unlikely. Lesbian, gay, bisexual and transgender (LGBT)parents who use donor gametes face an array of differing state laws thatmay, or may not, provide any legal certainty to their parenting relation-ships, even if they are married (Movement Advancement Project, FamilyEquality Council and Center for American Progress, 2012; Carbone andCahn, 2013).

When a known donor is used, the situation changes. For example,a child in the District of Columbia could have three legal parents, arecognition that parenting can result from function or biology. A lesbiancouple might agree that one of them will use donor sperm, and thatboth will be the parents of any child. In addition, if they use a knowndonor, they might also sign an agreement acknowledging him as a parent.The resulting child will have three parents because the law ‘conclusivelyestablishes the partner as a parent. The agreement with the donor meansthat he, too, is a parent’ (Polikoff, 2009). California has consideredlegislation allowing recognition of three parents, which would certainlycover the rights of a gamete provider (Jones, 2012).

The known donor and recipient may make various types of agree-ments, ranging from one that precludes entirely the donor’s involvementto one that allows for quasi-parental status. Or there may be no formalagreement. Consider the relationship between George Russell and CarolEinhorn. He was a year ahead of her in college; many years later, hecontributed sperm ‘as a favour’, and she became pregnant. Their son,Griffin, calls Russell ‘Uncle George’, while his partner is ‘David’. Thoughhe spends four nights a week in the same apartment as Griffin, Russellexplains: ‘“I don’t feel paternal toward him. Yet it’s odd when I look athim and I see me”’ (Kleinfeld, 2011).

The legal parameters of this relationship are fuzzy. Einhorn could sueRussell for child support, and he could sue her to establish custodialrights. Both would probably win. Even if they had a formal agreement,its enforceability depends on state laws concerning how artificial insemi-nation must be performed and whether there is legal recognition of thesecontracts. A few states explicitly permit the recipient and the donor toenter into an agreement concerning the donor’s rights. New Hampshireallows the sperm donor to agree to paternal responsibilities, including


child support liability (Ball, 2012).5 In Texas, a sperm donor cansign up to serve as the father if he provides the sperm through aphysician.6 Known donors may come back and assert parental rights tothe child despite a previous agreement not to do so.7 Indeed, if knownsperm donors claim paternity, they are often successful, regardless ofthe existence of a written agreement providing otherwise. Unknowndonors generally do not even know whether their gametes have becomechildren. Apart from safety regulations, there are no laws (apart froma 2011 statute enacted in Washington State) allowing for the release ofthe donor’s identity or requiring clinics or banks to maintain records,nor are there any legal terms regarding confidentiality and disclosure.

Donor-conceived family communities

While the law is generally silent on contact between donor-conceivedfamilies, law and practice are diverging substantially. As parents explainthe facts of conception to their children, who understand they may berelated – biologically – to numerous potential half-siblings, some donoroffspring and parents have begun to search for those with shared spermdonors and to advocate for disclosure of donor identities (see Freemanet al., Chapter 15). Thousands of people throughout the world havebegun using the Internet to expand their ‘kinship circle’ and create whatthey often think of as a ‘unique extended family’ in which they are ‘raisingchildren who are far-flung and yet intimately related’ (Mundy, 2007). Inthe USA, Wendy Kramer and Ryan Kramer, her sperm donor-conceivedson, started the Donor Sibling Registry (DSR) in 2000, which has facili-tated contact among more than 10,000 genetically related people, includ-ing donors and half-siblings (Donor Sibling Registry, 2013). US spermbanks themselves have begun offering sibling registries, and increasinglyprovide the option of open-identity donation, allowing donor identifica-tion once offspring reach a certain age (Braverman, 2010). So far, mostof the research and advocacy has involved sperm donor half-siblings, butas egg donor half-siblings come of age, they too may begin to search.Of course, as Martin Richards suggests (Chapter 1; see also Freemanet al., Chapter 15), egg donor offspring may have less interest in findinghalf-siblings for a variety of reasons. Nonetheless, as existing researchon both sperm donor offspring and adopted individuals indicates, some

5 N.H. Rev. Stat. Ann. §§168-B:3 I(e), 168-B:11 (2011).6 Tex. Fam. Code Sec. §160.7031 (2011). There appear to be no similar provisions with

respect to an egg donor.7 In re Mullen (2009).

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number will be interested in learning more about their donor relatives –and so too may those born through surrogacy arrangements.

Beyond private initiatives, no US federal laws provide any acknowl-edgement of donor-conceived family communities and there are nogovernment-supported registries allowing donors and offspring to findeach other voluntarily, nor facilitating offspring of the same donor find-ing one another. Questions exist as to whether there might be some legalbasis for recognising donor-conceived family communities.

US Supreme Court jurisprudence on the recognition of other formsof familial relationships provides a starting point for analysing this legalpotential. The Court has considered horizontal relationships betweenadults and vertical ones between parents and children (although it haspaid little attention to sibling/sibling relationships). Throughout, thoughthe Court has reaffirmed parents’ rights, there remains a tension betweenrecognising the interests of individuals who choose to form families andthe rights that flow from family status.

Indeed, the challenges raised by donor-conceived families and theircommunities take their place within this fundamental tension – the fam-ily as an entity versus the family composed of individuals.8 Constitutionalprotection for the family began as a relational and status-based concept,applicable between parent and child and between wife and husband(notably not between sibling and sibling), recognising a parent’s rightto direct a child’s upbringing and the privacy of the marital relationship,9

although it has expanded to include the rights of individuals within fam-ilies to some personal autonomy. In the absence of sexual intimacy ormarriage, legal rights for any connection between members of differentdonor-conceived families will be difficult to establish.

US family law and donor siblings’ rights

Clearly, children’s rights within this canon are more attenuated thanthose of adults.

Siblings’ interests

The US Supreme Court has largely reinforced the notion that the tra-ditional family unit provides adequate constitutional protection for chil-dren. The Court tends to equate children’s interests with those of their

8 Griswold v. Connecticut (1965), 483–6; Eisenstadt v. Baird (1972), 453.9 Loving v. Virginia (1967), 11–12; Griswold v. Connecticut (1965), 485–6; Pierce v. Soc’y

of Sisters (1925), 535; Meyer v. Nebraska (1923), 399, 403; see also Wisconsin v. Yoder(1972), 219 (allowing Amish parents to withdraw children from school after eighthgrade); Lawrence v. Texas (2003), 578.


parents and to protect children derivatively, through doctrines such asparental autonomy and familial privacy (Rosenbury, 2007).10 Parents areentitled, based on several Supreme Court decisions, to substantial defer-ence on their choice of how to raise their children.11 Even when it comesto children’s rights to receive adequate services to prevent abuse andneglect by family members, the Court has generally reinforced the state’sdecision-making process rather than children’s rights.12 The failure torecognise sibling associational rights (those between ‘tummy mummysibs’) more generally provides yet another example of the paucity of chil-dren’s rights.13

Family law decision-making for younger children generally involves atriad of parties: either mother–father–child, or parent–child–state. Theassertion of a right by one almost inevitably involves restricting the rightsof the others. If, for example, the parents have a thick constitutional rightto decide what is in their children’s best interests, then the child lacksa corresponding right to compel parents to act in accordance with thatbest interest standard. Of course, the absence of a right does not dictate aparticular outcome. Instead, it may leave the issue open to public policybalancing. If, for example, a parent does not have a constitutional right toveto an abortion favoured by the child, the state may still choose to permitthe parent some involvement, short of a veto, in a daughter’s decision. Insuch a setting, the lack of formal recognition of children’s rights may beless critical than questions of the appropriate public policies.

The Supreme Court’s privacy and family cases suggest different, possi-bly conflicting, ways to analyse donor family connections. We might thinkof each member of the donor triad as holding separate, potentially com-peting rights: offspring versus donor versus parents (Chestney, 2001).When they are young, offspring’s rights have less strength than those ofthe donor or parents. Even when offspring are adults, however, framedin terms of privacy interests, the donor and the parents may have rightsthat could trump the interest of the offspring (Sauer, 2009). Moreover,the donor may seek to protect the rights of children he has parented andwho may not know about the existence of donor siblings.

10 In Michael H. v. Gerald D. (1989), 130, the Court refused to decide whether a childhad ‘a liberty interest, symmetrical with that of her parent, in maintaining her filialrelationship’ (plurality opinion). It has never recognised such an interest.

11 Troxel v. Granville (2000), 65–6, 75; see also Pierce v. Soc’y of Sisters (1925), 534–5.12 See, e.g., Suter v. Artist M. (1992), 360; DeShaney v. Winnebago Cnty. Dep’t. of Soc.

Services (1989), 195–7 (holding that social workers had no obligation to prevent childabuse by removing child from father’s custody, despite receiving several complaints).

13 The Supreme Court has never directly decided whether siblings enjoy constitutionallyprotected associational rights under the First or Fourteenth Amendments to the UnitedStates Constitution.

120 Naomi Cahn

If we make children’s ‘best interests’ central, however, then perhapstheir rights – however defined – might trump those of adults. (The con-cept of the ‘child’s best interests’ is central to US family law, thoughmultiple definitions of children’s best interests exist.) The complexitiesresult from acknowledging that donor-conceived people can be eitherchildren or adults and, accordingly, their interests may vary dependingon their age.

On the other hand, this entire framework is predicated on potentialconflicts among the different individuals involved (Huntington, 2008),and may itself threaten the connections that characterise these relation-ships. It assumes that interests are unitary and unchanging, contrary tothe reality of donor-conceived families.

Instead, consider that there may be no actual conflict; offspring mayhave no desire for any information about donors, or donors, offspringand parents may all prefer contact. An alternative framework might pre-suppose harmony among the interests of all involved, or not privilegethe interests of parents to make choices that will bind their children inperpetuity. Parents can change their minds about wanting contact withother donor-related families; donors who agreed to be anonymous maylater want contact with the families they have created (Almeling, 2011).Assuming common interests and facilitating contact, then, might be moreappropriate than presuming potential conflict.

Donor sibling rights

Donor family communities are based on the shared genetic materialbetween ‘half-siblings’. Yet donor siblings are, of course, different fromsiblings who have grown up together. They have no shared family history,residence, or common legal or social parent (Dolgin, 2008), even thoughthey share genes. Their relationships are based only on shared biologicalmaterial, rather than any other basis for claiming kinship (Hertz, 2009).Nonetheless, just as in the adoption context, where siblings who havebeen adopted into different families and have never lived together stillsearch for one another, hoping to establish a relationship, the same istrue for donor half-siblings (Hasday, 2012). What matters here is thegenetic link, not the manner of conception or legal family construction.Consequently, although many observations concerning siblings do notapply to donor-conceived children, some analogies can provide usefullessons.

Recognising siblings’ rights? Though existing law is not entirelysupportive, policy reasons provide a basis for according siblings’ rights;


so long as states give ‘special weight’ to parental preferences, then thereis constitutional space for recognising siblings’ rights.

Preserving the bond between siblings who have grown up togetherprovides many psychological and social benefits (Marrus, 1999) andthe sibling relationship provides support and opportunities for learningnumerous skills. Courts have relied in part on these benefits in protectingsibling association rights in some contexts.14

In recognising that these benefits also accrue in half-sibling relation-ships, the law could protect these connections in a variety of ways, asdiscussed in the next section. For donor-conceived families, this meanslegal regulation to provide opportunities for half-siblings to developrelationships. In turn, this suggests that the appropriate state role issupporting the development of new relationships with members of adonor-conceived family community who share the same donor, ratherthan adhering to a strict model of the nuclear family that foreclosesthe possibility of ‘half-siblings’. Indeed, the need for such an approachis a core theme of this chapter. If donor-conceived families are, liketraditional families, relational entities, then the law can protect andfoster their relationships. Accordingly, this means acknowledging (andperhaps contesting) that genetics do provide one culturally significantbasis for kinship, while also recognising the socially constructed natureof family in which both genetic and social ties play a role (Appleby andKarnein, Chapter 4). Moreover, as the donor conceived begin advocacyefforts through the legal system, and as other countries face advocacyefforts and implement radically different frameworks,15 the existingAmerican system faces increasing pressure.

The way forward

First, the law could provide parameters to foster and nurture donor-conceived family communities while also protecting against unwantedcontact. Regulation need not mandate conformity, such as requiring

14 In re Tamara R. (2000), 854.15 See, e.g., Donor Sibling Registry (2013). Though no donor-conceived individual has

yet brought suit in the USA to discover information about a donor or potential half-siblings, Olivia Pratten brought a lawsuit in British Columbia, claiming that she wasentitled to disclosure of her donor’s identity based on the Canadian Charter of Rightsand Freedoms guarantee of personal equality and security. Pratten v. British Columbia(Att’y Gen.) (2011). Joanna Rose, in the UK, argued that she was legally entitled to thename of her sperm-donor ‘father’. Rose v. Sec’y of State for Health (2002), ¶¶ 38, 47; seealso Rose (2009). In the United States, donor gamete recipients, but not their children,have brought suit based on medical issues. Johnson v. Superior Court (2000); Doe v. XYZCo. (2009).

122 Naomi Cahn

contact between siblings, but could instead provide opportunities thatdo not currently exist. Second, US law could provide standardisationand predictability, unlike the current system which tolerates, but doesnot explicitly support, creating connections. Among other problems withthe existing, ad hoc system, donor-conceived people may not know aboutthe private Internet or sperm-bank registries, may have inadequate infor-mation about their donor because no records were maintained, or maylook for banks that no longer exist.

Finally, explicit regulation could help donor-conceived family com-munities – and family law itself – realise constructively their goals ofpromoting intimacy and protection for emotional connections. The law’ssilence about these larger communities provides limited space, perhapsreflecting a normative view that these are medicalised interactions ratherthan relationships, with health law and contracts providing the relevantlegal framework, and with sperm banks, egg agencies and individualsinterested in contact establishing the emotional parameters of these com-munities. Indeed, as the former president of one of the leading fertilityclinic trade associations explained, ‘when these decisions are made bydonor and a parent, the child doesn’t have a say’ (Crary, 2010).

If this is a societal choice to foreclose connection by making decisionswithout considering the child’s interest, then it is useful to acknowl-edge such a perspective so that members of the donor world understandthat the law will not encourage them to develop connections. Nonethe-less, the very different presumptions in adoption (Cahn, 2009a; Appell,2010), the nascent development of pressure from members of the donor-conceived community, the different regulatory framework established inother countries, and the early stirrings of lawsuits putting pressure on theexisting system, together challenge the normative framework pursuant towhich these communities are structured by health law and contracts.Existing regulation of reproductive technology, focused on gamete safetyor truth in advertising, caters only to the parents as patients, not to thefamilies they are creating.

Solutions

Given a state goal to foster institutions that sustain family, variousguiding principles help structure the framework for these new policies(Eichner, 2010). Future regulation should focus on relationships andpotentially differing interests, not just on the reproductive products ofsperm and eggs; this points towards more human, and humane, legalapproaches. Legal treatment of the donor-conceived family and commu-nity relationships could draw on legal treatment of adoptive relationships


(Appell, 2008, 2010). Adoption law, for example, has moved towardsincreasing recognition of the child’s right to learn about his or her bio-logical parents, and enforcement of agreements for contact between thebiological parents and the child.

To ensure both support and clarity, US law should respond at two criti-cal points: first, it should explicitly define the legal relationships betweendonors, recipients and offspring; and second, it should facilitate con-nections between donor-conceived families who share the same geneticheritage along with the donors themselves. As an initial matter, donorsmust be assured that they will have no parental rights or obligationsunless they have arranged otherwise (Polikoff, 2009). This certainty,that donors will not become responsible for child support or be able toassert custody and visitation with respect to any of their donor-conceivedoffspring, encourages contact among all involved.

Based on this legal clarity, the second step becomes feasible: the statemust give explicit recognition to donor-conceived family communities,acknowledging the emotional and biological connections that can existbetween members of these communities. Accordingly, the state mightadopt a position that affirmatively facilitates these communities, notonly by further regulating the fertility industry but also by ensuringthe integrity of the family networks. Specific regulation recommenda-tions include: requiring the fertility industry to engage in better record-keeping, making it possible to engage in organised tracing (donors aretypically given numbers by sperm banks, but they may not know theirown numbers and records may have been destroyed); allowing donor-conceived offspring to learn their origins, perhaps through double birthcertificates; ensuring that offspring have information about the identity ofthe donor and the existence of any half-siblings, whether donor-conceivedor not; and setting limits on the number of children born from any gameteprovider, not just for health reasons but also to prevent communities ofhundreds of offspring.

Different forms of legal intervention show the possibilities for recog-nising and protecting donor-conceived family communities. First, underthe existing system, donor-conceived families can already designate othercommunity members as agents for healthcare and financial decision-making. Regardless of the legal status of the relationship, they can choosea member of their donor-conceived family communities to act as a fidu-ciary in case of incapacity, and they can devise property to anyone.

As a second reform, new laws could expand the rights available beyondthese specific, individually focused designations to allow more formalrecognition of familial status. For example, the state grants multiplebenefits to couples based on marriage, ranging from tax treatment to

124 Naomi Cahn

surrogate decision-making authority in the case of illness to intestacypreferences. The state might accord similar benefits to donor-conceivedfamily communities who choose to assume various family-related obli-gations.

Adoption allows legal strangers to opt into the state-recognised sta-tus of parenthood. Donor-conceived people might be allowed to optinto legally sanctioned relationships, such as the status comparable todesignated beneficiaries under some state laws. For example, Coloradoprovides for a ‘designated beneficiary’ agreement.16 Once registered, thecouples are eligible for such benefits as health insurance, inheritancerights and retirement benefits. The system is notable for the ease withwhich couples can enter and exit the legal status, and the freedom partieshave to define the scope of the relationship with their partners; partnerscan each choose which rights and protections they want to extend to oneanother, and there is no requirement of reciprocity. The Colorado legis-lation is limited, however, to same-sex couples and other couples legallyprohibited from marrying one another. The law could be expanded toallow members of donor-conceived family communities to opt into theserights and duties through voluntary designation of a specified legal status.This would facilitate recognition of the genetic ties between donor half-siblings as well as the social affinity between parents of donor-conceivedoffspring. Opting in requires an affirmative action (Thaler and Sunstein,2008); the default option remains no legally recognised relationships.

Third, existing benefits could be expanded to include donor-conceivedfamily communities. For example, the US Family and Medical LeaveAct (FMLA) is limited in scope and application; its grudging supportfor conventional families reflects a compromise in which employers hada significant voice. Employees are entitled to take up to twelve weeks ofunpaid leave for medical reasons related to a spouse, child, or parent.17

Siblings are not included (so the law would certainly not apply to half-siblings). The FMLA could be expanded to include any type of sibling(Leib, 2007; Rosenbury, 2007).

Fourth, in addition to creating a national registry for donors and off-spring (Cahn, 2009b), special sibling registries would facilitate intergen-erational meetings; indeed, many states already have such registries foradopted individuals (Hasday, 2012). These registries would include anychild linked through a donor’s gametes, regardless of whether the donoris the legal parent, as well as families formed through both gestational

16 Colo. Rev. Stat. § 15–22–105 (2009).17 See 29 U.S.C. § 2612 (a)(1) (2006); 29 C.F.R. § 825.122(c)(3) (2010).


and traditional surrogacy (Jadva and Imrie, Chapter 9); the focus is onthe genetic connection.

The most fundamental change requires a paradigm shift towardsdonor-conceived family communities: they must take their place in thejurisprudence of family law and constitutional law, not solely in theadministrative jurisprudence of technology, health and safety regulation,where the emphasis on is protecting patients, not – as in family law – onrelationships.

Conclusion

Although the relationships between donor-conceived half-siblings beginby acknowledging the genetic link, moving forward by developing newlegal support to foster those connections offers lessons for other genet-ically and affinity-based ties. In a post-divorce society, with multiple-partner fertility, bonds potentially transcend the confines of the tradi-tional nuclear family.

Ultimately, as we think about donor-conceived families and their com-munities, there is a profound irony that must be acknowledged. Familylaw is moving toward a more expansive view of how families are formed,turning away from biology and marriage as constitutive of family andinstead becoming more accepting of relationships based on function,affection, and contract (Singer, 1992; Kessler, 2007; Rosenbury, 2007;Polikoff, 2009). At the same time, it is biology, and biology alone, thatprovides the basis for a connection between donor-conceived family com-munities: their only link is a donor’s gametes (Dolgin, 2008). Yet it isthat genetic link that allows for affinity-based networks that reach farbeyond the nuclear family and that suggests the recognition of otheraffinity-based connections in other families.

References

Allan, S. (2010). ‘Recognition of same-sex parenting in Australia: South Aus-tralia, the final frontier?’. Alternative Law Journal, 35, 227–231.

Almeling, R. (2011). Sex Cells: The Medical Market for Eggs and Sperm. Berkeley:University of California Press.

Andrews, L.B. and Elster, N. (2000). ‘Regulating reproductive technologies’.Journal of Legal Medicine, 21, 35–65.

Appell, A.R. (2008). ‘The endurance of biological connection: heteronormativity,same-sex parenting and the lessons of adoption’. Brigham Young UniversityJournal of Public Law, 22, 289–325.

(2010). ‘Reflections on the movement toward a more child-centered adoption’.Western New England Law Review, 32, 1–32.

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Ball, C.A. (2012). The Right to be Parents: LGBT Families and the Transformationof Parenthood. New York University Press.

Bernstein, G. (2002). ‘The socio-legal acceptance of new technologies: a closelook at artificial insemination’. Washington Law Review, 77, 1035–1120.

Braverman, A.M. (2010). ‘How the internet is reshaping assisted reproduction:from donor offspring registries to direct-to-consumer genetic testing’. Min-nesota Journal of Law, Science and Technology, 11, 477–96.

Cahn, N. (2009a). Old Lessons for a New World: Applying Adoption Research andExperience to Assisted Reproductive Technology. New York: Evan B. DonaldsonAdoption Institute.

(2009b). Test Tube Families: Why the Fertility Market Needs Legal Regulation.New York University Press.

(2013). The New Kinship: Constructing Donor-Conceived Families. New YorkUniversity Press.

Carbone, J. and Cahn, N. (2011). ‘Marriage, parentage, and child support’.Family Law Quarterly, 45, 219–40.

(2013). ‘The past, present, and future of the marital presumption’, in BillAtkin and Fareda Banda (eds.), International Survey of Family Law. Bristol:Jordan Publishing Limited.

Carbone, J. and Cahn, N. (2014). Marriage Markets: What Is Really Happeningto the American Family. New York: Oxford University Press.

Cherlin, A. (2009). The Marriage-Go-Round: The State of Marriage and the Familyin America Today. New York: Vintage Books.

Chestney, E.S. (2001). ‘The right to know one’s genetic origin: can, should, ormust a state that extends this right to adoptees extend an analogous right tochildren conceived with donor gametes?’. Texas Law Review, 80, 365–91.

Crary, D. (2010). ‘Sperm-donors’ kids seek more rights and respect’. BostonGlobe, August 15.

Degtyareva, V. (2011). ‘Defining family in immigration law: accounting for non-traditional families in citizenship by descent’. Yale Law Journal, 120, 862–908.

Dolgin, J.L. (2008). ‘Biological evaluations: blood, genes, and family’. AkronLaw Review, 41, 347–98.

Donor Sibling Registry (2013). www.donorsiblingregistry.com.Eichner, M. (2010). The Supportive State: Families, Government, and America’s

Political Ideals. New York: Oxford University Press.Gerken, H. (2010). ‘Foreword: federalism all the way down’. Harvard Law

Review, 124, 4–74.Hasday, J. (2012). ‘Siblings in law’. Vanderbilt Law Review, 65, 897–931.Hertz, R. (2009). ‘Turning strangers into kin: half-siblings and anonymous

donors’, in M.K. Nelson and A.I. Garey (eds.), Who’s Watching?: DailyPractices of Surveillance among Contemporary Families. Nashville: VanderbiltUniversity Press.

Hills, Jr., R.M. (1998). ‘The political economy of cooperative federalism: whystate autonomy makes sense and “dual sovereignty” doesn’t’. Michigan LawReview, 96, 813–944.

Huntington, C. (2008). ‘Repairing family law’. Duke Law Journal, 57, 1245–1319.

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Jaeger, A.S. (2010). ‘Assisted reproductive technologies, collaborative reproduc-tion, and adoption’, in J.H. Hollinger (ed.), Adoption Law and Practice, sec-ond ed., New York: Matthew Bender.

Jones, A. (2012). ‘California bill tests traditional notions of parenthood’. WallStreet Journal, July 13.

Joslin, C.G. (2010). ‘Protecting children(?): marriage, gender, and assisted repro-ductive technology’. Southern California Law Review, 83, 1177–1229.

Kessler, L.T. (2007). ‘Community parenting’. Washington University Journal ofLaw and Policy, 24, 47–77.

Kleinfeld, N.R. (2011). ‘And baby makes four’. New York Times, June 19.Kramer, W. and Cahn, N. (2013). Finding Our Families. New York: Penguin.Leib, E.J. (2007). ‘Friendship and the law’. UCLA Law Review, 54, 631–707.Marrus, E. (1999). ‘“Where have you been, Fran?”: the right of siblings to seek

court access to override parental denial of visitation’. Tennessee Law Review,66, 977–1018.

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Mundy, L. (2007). Everything Conceivable: How Assisted Reproduction Is ChangingMen, Women, and the World. New York: Alfred A. Knopf.

Polikoff, N.D. (2009). ‘A mother should not have to adopt her own child: parent-age laws for children of lesbian couples in the twenty-first century’. StanfordJournal of Civil Rights and Civil Liberties, 5, 201–267.

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Rose, J. (2009). ‘A critical analysis of sperm donation practices: the personaland social effects of disrupting the unity of biological and social relatednessfor the offspring’. Unpublished manuscript. Available at: www.nla.gov.au/openpublish/index.php/aja/article/viewFile/1687/2048.

Rosenbury, L.A. (2007). ‘Between home and school’. University of PennsylvaniaLaw Review, 155, 833–98.

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Cases

United StatesDeShaney v. Winnebago Cnty. Dep’t. of Soc. Services (1989), 489 U.S. 189.Doe v. XYZ Co. (2009). 914 N.E.2d 117 (Mass. App. Ct.).Eisenstadt v. Baird (1972). 405 U.S. 438.

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http://uniformlaws.org/ActSummary.aspx?title=Parentage%20Act

http://uniformlaws.org/ActSummary.aspx?title=Parentage%20Act

128 Naomi Cahn

Fisher v. Tucker (2010). 697 S.E.2d 548 (S.C.).Griswold v. Connecticut (1965). 381 U.S. 479.In re Mullen (2009). 924 N.E.2d 448 (Ohio App. 1 Dist.).In re Tamara R. (2000). 764 A.2d 844 (Md. Ct. Spec. App.).Johnson v. Superior Court (2000). 95 Cal. Rptr. 2d 864 (Cal. Ct. App.).Lawrence v. Texas (2003). 539 U.S. 558.Loving v. Virginia (1967). 388 U.S. 1.Meyer v. Nebraska (1923). 262 U.S. 390.Michael H. v. Gerald D. (1989). 491 U.S. 110.Pierce v. Soc’y of Sisters (1925). 268 U.S. 510.Suter v. Artist M. (1992). 503 U.S. 347.Troxel v. Granville (2000). 530 U.S. 57.Watermeier v. Moss (2009). 2009 WL 3486426 (Tenn. Ct. App. Oct. 29).Wisconsin v. Yoder (1972). 406 U.S. 205.

UKRose v. Sec’y of State for Health (2002). 2 F.L.R. 962 (U.K).

CanadaPratten v. British Columbia (Att’y Gen.) (2011). BCSC 656 (Can. B.C. Sup. Ct.).

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USA legislationUniform Parentage Act (2000), (2002).

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7 Relatedness in clinical practice

Andrea Mechanick Braverman and Lucy Frith

Introduction

The ever-evolving perceptions of families and family-building lead tochallenges in the clinical consultation for those wishing to have a fam-ily through assisted conception. The myriad of options available meanthat great skill is needed to introduce these choices to the intended par-ents and to facilitate the exploration of their meaning. This chapter willdiscuss how the concept of family is approached in clinical practice inthe United States and the challenges this presents to professionals andintended parents. First, it will examine the changing conceptions of whatconstitutes a family. Parents through donor conception often say thatthird-party assisted reproduction allows them to have ‘a child of theirown’, and this chapter will explore the corresponding emotional andpsychological meanings for parents. The chapter will go on to considerdisclosure of donor origins to the future child. In particular, the chapterwill explore how professionals from a multitude of training backgrounds(mental-health professionals, nurses and doctors) present informationabout disclosure in consultations and the influence these approacheshave on intended parents. It will also discuss how the influence of supportmaterials such as children’s books, websites, movies, television and sup-port groups can affect how the concept of family is portrayed to intendedparents. The Internet has implications for the accessibility of informationfor donor-conceived persons, donors and intended parents, potentiallycircumventing the control of the assisted reproductive technology (ART)clinic, and these developments will also be discussed. The first author(AMB) is a psychologist who has worked in third-party assisted repro-duction in the USA for over twenty-five years, and this chapter draws onher professional experience.

Changing conceptions of the family

Representations in popular culture are a useful way of charting changingperceptions of the family. Until the end of the millennium, there were

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130 Andrea Mechanick Braverman and Lucy Frith

few representations of the family beyond the traditional nuclear familycreated by a heterosexual couple through sexual reproduction. However,the contemporary American family no longer looks like the one portrayedin the long-running comedy, Father Knows Best, which entertained thenation from the 1940s with the daily lives of a ‘typical’ white middle-classnuclear family. Now TV families are much more diverse: for example, theprogramme Modern Families (2009) has traditional heterosexual marriedparents with three children, alongside a ‘blended’ post-divorce remarriedfamily and a gay couple with an adopted child. More recent popular filmshave addressed new family forms created by assisted reproduction, suchas The Kids are All Right (2010) and The Switch (2010), and illustratehow contemporary families do not necessarily have opposite-sex parentsor even two parents of whatever gender. Today, with the rise of theInternet, there are many websites and chat rooms about using assistedreproduction and donor gametes, so prospective parents have access tomany different portraits of making families. The Zeitgeist of the familyand what constitutes relatedness is evolving, and prospective parents areaffected by this.

There are two interconnected concepts of relatedness in operation inthe ART clinic: relatedness as defined by genetic ties and relatedness asa choice, where individuals do not depend on genetic connections butrather make an affirmative choice of kinship. Relatedness as a choicehas deep roots. For example, in many cultures children grow up with afamily friend who is not biologically related being referred to as an auntor uncle. Another example is step-siblings in blended families who maychoose to call each other ‘brother’ or ‘sister’ due to feelings of love oreven a shared lived experience rather than a genetic connection. Thesedifferent forms of relatedness, commonly referred to as the ‘biological’and the ‘social’ (Strathern, 1992), assume differing importance for dif-ferent people. As Carsten argues, ‘different elements of and qualities oftechnology are selected, highlighted, erased, or interwoven with aspectsof kinship [which] suggest quite complex, unpredictable, and creativeprocesses at work’ (2004:164). Gestational surrogates (who carry a childconceived from another woman’s egg), for example, who have a biologicalclaim through gestation, often feel they are not related to the child theycarry (Jadva and Imrie, Chapter 9). In clinical interviews, egg donorsclearly express this concept, as illustrated by the following reflection: “Iknow I have a genetic tie to the child, but I don’t think that matters. Theperson who raises you and loves you and worries about you is the mom.I’m just giving a cell” (personal communication from an egg donor toAMB). This anonymous egg donor’s sentiment captures a consistentlyexpressed view (see Almeling, Chapter 8). A known egg donor, who haschildren and donated to a friend, made a similar point: “My kids are the

Relatedness in clinical practice 131

ones I’m raising. I look at my friend’s child with great curiosity and somepride. But I just don’t feel that maternal ‘zing’” (personal communica-tion from an egg donor to AMB). By contrast, many other women saythey cannot donate eggs because it feels like they would be giving awaytheir children and here genetic relatedness does assume importance.

With groups like the Donor Sibling Registry (DSR), families are form-ing kinship ties through the Internet with people who, although geneti-cally related to them, have no pre-existing social or legal relationship withthem (see Freeman et al., Chapter 15). Historically, medical providersand sperm banks took the view that the genetic connection did not cre-ate networks of families. This argument was designed to eliminate anykinship role for the donor or among genetic half-siblings from the samedonor. Now some of these ‘families’ are affirmatively stating the opposite:genetic ties and the desire to make them meaningful can be defined as afamily (see Cahn, Chapter 6). Advocacy and social groups on the Inter-net also paint various pictures. For example, in its very name, the DSRadvocates the importance of the genetic relatedness of siblings. How-ever, other parents or donor-conceived persons express discomfort usingthe term ‘sibling’ and opt for alternative terms, such as ‘half-sibling’,to denote a different level of relatedness. The meanings of concepts ofrelatedness are always evolving.

There are other viewpoints that should not be ignored. In particular, itis important to remember the unheard voices of those donor-conceivedpersons, parents and donors who are not seeking out contact registriesand websites and have no desire or interest in making this type of contact.This group may have a different definition of relatedness that excludes,or downplays, the significance of genetic ties. Furthermore, the viewsand attitudes of donor-conceived persons, parents and donors may dif-fer according to whether egg donation or sperm donation is involved(Almeling, Chapter 8; Freeman et al., Chapter 15).

Having ‘a child of our own’

It is within the context of these wider social, cultural and technologicalrevolutions that people now seek fertility treatment. Intended parents or‘patients’ present themselves in many different ways at the ART clinic:some present as a couple (heterosexual or same-sex), part of a couple orwithout a partner. Some seek a donor or surrogate from the clinic; othersmay come with a known donor or surrogate or with reproductive collab-orator(s) with whom they wish to enter into a co-parenting arrangement(Smietana et al., Chapter 11; Freeman et al., Chapter 15). In addi-tion to the initial relationship status, intended parents also present invarious degrees of urgency or despair about having a family. For some,


the challenge to become a parent may be that they do not have a part-ner and need a donor. For others, there may be known or undiagnosedmedical issues that create challenges to achieving a pregnancy. These arecoupled with how the presenting patient feels about what constitutes afamily.

The simple request, ‘I want to be a parent’, is often more complicatedthan it seems. Take the woman who presents at age 49 who says, ‘Iwant to be a parent’. Does she mean that she wants to try to conceivewith her own eggs or that she wants to be an egg recipient and have thegestational experience of pregnancy? Or the woman who has a congenitalabsence of the uterus and makes that same request. In this case, she isalready cognisant that being a parent will be through a genetic ratherthan gestational connection to her child.

The medical team at the ART clinic also bring their own personalbeliefs and prejudices to patient consultations about what constitutesa family as well as their own assumptions about what the preferredpath to parenthood may be. Assumptions may be made that a patientmay wish to pursue treatment further in order to have a genetic off-spring, when in actuality they may be emotionally, physically and/orfinancially exhausted and prefer to be a non-genetically related par-ent through adoption or gamete donation. These conversations needto be facilitated between the clinical staff and the intended parents,as disconnects between doctor and patient can occur easily with poorcommunication.

Genetic information and connection are not emotionally neutral norstraightforwardly constructed. Nor does an individual’s genetic make-upcompletely determine his or her life course. However, dismissing genet-ics as unimportant appears to be as equally misleading to intended par-ents as viewing genetics as deterministic of their child’s being. In CharisThompson’s work the flexibility of the meanings of these connections isbrought to the fore: biology does not provide a monolithic or straight-forward conception of kinship (Thompson, 2005). The idea of having ‘achild of our own’ involves complicated and complex thoughts and feel-ings about the role of genetic connectedness and how these relationshipsare constructed in practice (Carsten, 2004).

One of the emotional hallmarks of infertility is the feeling of being ‘outof control’. In early treatment, this may refer to the feeling of being tossedabout by the unpredictable schedule of monitoring or even anticipatingthe onset of menses so that the cycle can start. Control can also be aconsideration when intended parents think about how their child mightturn out: for example, will they be intelligent? Will they have a goodtemperament? What sort of personality will they have? Will there be anyhealth issues? Sharing genetic origins gives the illusion that the outcome


of the desired child is somehow ‘controlled’ because of the known familyhistory.

Some intended parents express particular fears about who a child con-ceived via a donor might turn out to be. These parents talk about howhaving an unknown genetic history can feel foreign or threatening becausethe child may be felt to be different from the parents. Intended parentsoften express acceptance of ‘a child of our own’ who turns out to havedifficulties or issues but do not feel a similar acceptance should a donor-conceived child have such difficulties. The concept of ‘a child of ourown’ appears to relate to an extension of oneself or ownership of one’sgenetics as well as a willingness to embrace both the good and bad thatare potentiated through one’s own genetics. Intended parents who pur-sue gestational surrogacy with their own gametes also frequently expresstheir desire to have ‘a child of our own’ and do not regard having a med-ical issue which prevents the ability to carry a pregnancy as an obstacleto meeting this desire. Such intended parents often perceive themselvesas no different from other individuals or couples in pursuing this dreamand see the child no differently from how they would if they had carriedthe pregnancy; thus it is the genetics once again that seems to act as thetrump card in what makes ‘a child of our own’ in these cases.

In contrast, parents who pursue gamete (egg and/or sperm) or embryodonation express a variation on this theme. Parents often have two typesof beliefs. First, if one of the partners is providing gametes, then thefeeling often expressed is ‘at least we will have one set of our genesinvolved’. There is a sense of comfort or ‘know-ability’ in having a geneticconnection. This may be seen as offsetting the unpredictability of usingsomeone else’s genetics. As one intended mother stated: “At least we’llhave my husband’s genes. It gives me comfort that I picked him and it putssome of my choice into my child. I am hoping that he has really stronggenes and we will see more of him than donor”(personal communicationfrom a female egg recipient to author AMB).

Second, parents may express identification with donor gametes byselecting a donor that is ‘similar to me or my family’. Finding a donorwho shares a physical resemblance or strikes an emotional resonance tothe non-genetic parent can make the intending parent feel more like theyare having ‘a child of my own’. Most recipients struggle with the ques-tion of what they believe regarding the ‘nature versus nurture’ debate.There is the belief and/or hope that parents can determine how the childwill look as physical characteristics are often seen as more heritable thanother characteristics such as interests, values or even intelligence or tem-perament. Again, the beliefs of intended parents may tend towards twodifferent viewpoints. First, one in which most or all traits are perceivedto be heritable such that careful selection of their donor is deemed to


control the outcome of how their child will look or act. Second, there isthe belief that nurturing the child will override any genetically influencedtraits. Clinicians also have a range of beliefs regarding how much natureor nurture influences the child, and these beliefs can be communicatedto, and strongly influence, the intended parents as they make their selec-tions. Personal experiences can also steer expectations. For example, aperson who grows up in a family where family members are very similarto each other in terms of physical characteristics and/or personality mayfeel that genetics plays a stronger role than a person who grows up ina family with very heterogeneous physical characteristics and dissimi-lar personalities. Both intended parents and clinicians alike make donorselections buffeted by multiple and conflicting societal influences thatlead to their own expectations about how any resulting child might lookor act.

When a couple is making these decisions, there can often be a desireto select a donor similar to the non-genetic parent (whether this be anopposite sex or same-sex couple). For most couples, this means selectingon physical characteristics and the idea that the child will ‘pass’ as agenetic child for either partner. The fantasy is that the child will havephysical similarities to both social parents; the possibility that the childcould look dissimilar to either or both despite careful selection is oftennot considered. Many couples also select donors with similar personalitycharacteristics, such as being extroverted or enjoying specific activitieslike the outdoors or the arts. This is based on a similar fantasy that thechild will be like the recipient parents, rather than feeling different orforeign to them thus keeping the spectre of the donor present. Thereis an underlying contradiction often heard by donor-conceived childrenwhen their parents deny the importance of the lack of a genetic link withthe non-genetic parent but do not address the fact that they deliberatelychose to have a genetic link to one parent and carefully selected thedonor on characteristics they assumed likely to be inherited. Some singlemothers by choice state that they intend to select a donor that matchestheir family’s physical characteristics or ethnic origins. This choice maybe made to protect the child from having striking dissimilarities from themother and inviting queries about whether the characteristics are fromthe father’s side of the family (see Graham, Chapter 12).

In a US study of male and female partners of sperm donor recipients,Frith, Sawyer and Kramer (2012) found that much thought was givento donor selection. In heterosexual couples, recipients selected charac-teristics similar to the non-biological father so that they could ‘pass’ ashis genetic child. This consideration also pertained to the non-biologicalmothers in same-sex couples (see also Nordqvist, 2012). This may also


serve the purpose of creating an illusion of genetic relatedness and anemotional bridge with the non-genetic parent.

The practice of donor matching has been attributed to the framingof gamete donation within a biomedical model, as well as the desireto conceal the use of donated gametes and allow the mimicking of thetraditional family (Hudson et al., 2009). Frances Price (1997) examineddonor matching in the UK and argued that doctors classify donors andtry to match them to recipients to enable secrecy and concealment ofgamete donation. This practice incorporates a popular knowledge ofgenetics and enables the child to ‘pass’ as a naturally conceived child.This is an attempt to avoid overt ‘difference’ between child and couple,and when a ‘good match’ is achieved the donor disappears from view.Wilson (1997) has noted that when adoption practice was anonymousagencies tried to ‘match’ children to recipients in a similar way to tryto appear as a traditional family. This practice is not without ethicalproblems: why should the practice be kept secret and concealed, andhow do trends towards non-anonymous donation and more opennessaffect this idea of donor-matching? Further, as Hudson et al. (2009: 70)point out, ‘attempting to match people by phenotype raises interestingexistential questions about the nature of concepts of “race” and ethnicity,which have been hitherto concealed’ (for further discussion, see Hudsonand Culley, Chapter 13).

However, despite these potential ethical concerns, donor-matching isoften important to couples. There are generally three models for donor-matching in the USA if the recipient is not using a donor known to him orher: using the ART clinic’s recruited donors; using a donor recruiter (i.e.a for-profit company that finds potential donors and is usually accessiblethrough the Internet); self-recruitment through advertising but mediatedby a company or attorney. Within these models there are different screen-ing policies. Some donor candidates are screened medically and/or psy-chologically first and some are available to be selected and then screenedfor suitability.

American clinics have many different models of matching based in parton donor availability. If there are more donors than recipients, recipi-ents are usually given the donor profiles and make their own selection.Standard information on a donor profile would include: physical char-acteristics (e.g. height, weight, ethnicity, hair colour, eye colour); healthhistory for the donor and extended family; interests (e.g. artistic, ath-letic); a personal essay with a self-description and/or reasons for choosingto be a donor; and other more psychosocial information. Some profileswill include a current and/or childhood photograph. Some clinics offerdonors who are willing to be ‘open’ and will meet or talk by phone


with the recipients, or donors who affirmatively agree to have contactwith any donor-conceived child in the future. Very few clinics make theactual choice for the recipient and, with the advent of Internet databases,many have profiles that recipients can view and make their selection aftercomparing profiles.

In clinics that have fewer donors than recipients, the nurse or donorcoordinator selects a donor profile to present to the recipient who haswaited the longest based on their expressed preferences regarding donors’characteristics. Most clinics allow recipients to refuse the profile and con-tinue to receive new ones without losing their place in the waiting list.When another person besides the recipient is selecting profiles, selectionbias can easily occur by editing which profiles are presented based onassumptions about the importance of attributes such as physical char-acteristics, ethnic background, interests and attractiveness. The donorrecruiter or donor administrator may make a selection so that certainprofiles are never viewed; alternatively, profiles may be presented withthe qualifier of being ‘an excellent match’. All these factors may bias therecipient’s appraisal of the donor. In one study (Braverman et al., 2010b),recipients’ attitudes about donor selection were monitored from prior toentering an egg donor programme to after delivery. The physician, nurs-ing and mental-health professional consultation were demonstrated tohave an influence on the recipients’ preferences about donor character-istics and their importance.

It might be expected that the selection criteria used by recipients, oron behalf of recipients, may include the donor’s physical characteris-tics, ethnic or racial background, education, religion and interests. How-ever, we know little about what recipients actually request. In a recentAmerican study (Braverman et al., 2010a), egg recipients’ rank-orderedexpressed preferences for donor characteristics tended to remain sta-ble over time, even though nurse and mental-health professionals hadsome influence on the perceived importance of individual characteris-tics. Recipients tended to feel less strongly about individual characteris-tics after their child(ren) were born. Although individual characteristicswere moderately important to most recipients, health concerns aboutthe donor remained the most important preference, from the time priorto selecting a donor through to the delivery of the offspring. The leastimportant characteristics were: religion, willingness to meet offspring inthe future, willingness to be in a registry, if the donor already had achild, graduate education, and financial motivations for donation. Mostimportant characteristics were health of donor and family health: goodpersonal health, mental health and family health history were deemed themost important characteristics in an egg donor, both before entering the


programme and after delivery (Braverman et al., 2010a). This overridingconcern regarding the donor’s health (and the health of the donor’s fam-ily) has also been found in other studies (Rodino, Burton and Sanders,2011; Frith, Sawyer and Kramer, 2012).

Disclosure and clinical practice

An important part of clinical practice, alongside choosing a donor, ishow to approach the issue of disclosing to the child that she was con-ceived with donor gametes. There has been a substantial debate overthis topic in the literature (see Appleby, Blake and Freeman, 2012). Onearea of debate concerns the dominant influences on parental disclosuredecisions. Such influences are hard to determine. For instance, whatinfluence do clinicians have on parents’ disclosure patterns? What is theimpact of the advice given during treatment on future choices?

The legal context in which gamete donation operates is also animportant element in parents’ disclosure patterns. For example, Swedenbecame the first country to remove donor anonymity in 1985. Studiesthat observed parents’ disclosure decisions in Sweden reported that only1 per cent of parents intended to disclose before the change in law(Milsom and Bergman, 1982), while by 2000, 50 per cent of parentsstated they planned to disclose sperm donation to their child (Gottlieb,Lalos and Lindblad, 2000). In the most recent Swedish study (Isakssonet al., 2011), only 3–6 per cent of parents thought it was in the child’sbest interest not to be told about their donor origins. Legislation alonedoes not change attitudes, but in this context there does seem to be anincreasing acknowledgement of the donor’s role in the child’s conceptionand a perceived importance of knowledge about genetic parents. If leg-islation does not command immediate changes in attitudes and feelings,the question remains as to what extent doctors and clinicians influencetheir patients’ decisions.

Another potential influence upon intended parents comes frommental-health professionals and the associated discourse around how dis-closing to children, family and others should be approached. There areguidelines for counsellors from both the American Society for Reproduc-tive Medicine (ASRM) and the European Society for Human Reproduc-tion and Endocrinology (ESHRE). The consensus that children shouldbe told from a young age and allowed to ‘grow into’ their understandinghas emerged over the past decade. This can create ethical tensions forcounsellors. Counselling is traditionally an area where the professionalaims to be non-directive, to listen to the client and to allow her or him towork through their own beliefs and life choices. However, in the field of


donor conception, with the growing professional consensus that goodpractice is to counsel intended parents to tell their child about how theywere conceived, a form of directiveness is introduced into the consulta-tion. How does a counsellor respond to intended parents who say thatthey will never tell their child and that they want to keep the whole thingsecret from everyone? Is the counsellor’s role in this consultation to per-suade intended parents to tell their child? Or is it simply to suggest thevarious options and mechanisms for telling if they ever come round towishing to do this? A role for counsellors could be to set out the pos-sible implications of the various options for intended parents, pointingout the potential dangers with keeping secrets and the difficult issues,both practical and moral, with not telling their child the circumstancesof their conception. The broad content of the counselling approach hasnow been established but the art form of providing a supportive andthought-provoking consultation is still challenging.

A question might be asked here concerning the evidence for telling: istelling children about their origins beneficial or harmful? Evidence in thisarea is hard to establish. As a recent literature review in this field noted,there are few published studies and some suffer from methodological lim-itations (Blyth et al., 2012). An important limitation is that the majorityof studies concern sperm donation and it may be that those conceivedfrom egg donation have a different view on the issue of being told thatthey were donor conceived. As discussed by Blake et al. in Chapter 14,one key finding from the research is that early disclosure may be advan-tageous, supporting the advice given by counsellors. Furthermore, theliterature review concluded that ‘the studies consistently report that most[sperm] donor-conceived people have an interest in securing informa-tion about their genetic and biographical heritage . . . the evidence is suf-ficiently robust to promote the implementation of policy and practicein collaborative reproduction that reflects the importance of maximis-ing future choices and opportunities for donor-conceived people’ (Blythet al., 2012: 769). Although research evidence cannot dictate what isright for a particular family, it can suggest ways of approaching the issuefor intended parents.

One approach to encouraging disclosure has been to reframe the choiceto disclose as part of the story-telling that accompanies each child’s per-sonal history. Parents are encouraged to lay out the basic facts and fun-damentals of the story (e.g. the medical problem that resulted in the factthat one or both of the parents’ gametes could not be used), as well asthe basic emotions of the story (e.g. sadness that the parents’ gametescould not be used but happiness that there was a way to have a child).


Parents are encouraged to think about story-telling over a child’s lifetimeand how the foundation of the story is built upon as the child grows up.Providing resources such as children’s books and peer support groups aswell as normalising thoughts and feelings are important tools in disclo-sure. There are many books available for children to discuss their donororigins or the participation of a gestational surrogate in their birth (seethe children’s book list at the end of the chapter). In all these books, thedonor or surrogate is not depicted as a relation but is recognised for hisor her role in the creation of the child’s life; for example: ‘He isn’t goingto be part of our lives, but it is good to know how kind and generoushe was. Without him, we wouldn’t be lucky enough to have you now’(Infertility Research Trust, 2002: 22). By depicting the donor as kind,nice or generous, they overtly define the role the donor plays to bothintended parents, donor-conceived children and other family or friends.

Explaining to parents that their children’s thoughts and feelings willchange over time may aid in supporting their ability to have this discussionwith their children. Likewise, framing the parents’ grieving and mourningfor a ‘genetic child’ as evolving over time, just as the emotional attachmentto their donor-conceived child will grow as it does between any parent andchild, normalises the experience. If parents view their donor story as partof the child’s story, and if they acknowledge that there is no one story inan increasingly complex society, they can feel more skilled and familiarwith the telling. For same-sex couples or for single parents by choice,understanding that their feelings will change over time is also important.For the non-genetic parent in a same-sex couple, similar issues about fearsof attachment to, and relationship with, the child exist. Single parentsmay also have to mourn the absence or loss of a partner with whom theycould have shared the parenting experience.

Part of the disclosure decision is also whether and how to tell family,friends and others. In many respects, this decision flows from the choiceof the age at which the child is told. If parents tell their child at a veryyoung age they need to be prepared to be open with others. Youngchildren cannot and should not be expected to edit their information.Indeed, if they are told their donor story in a positive way, there wouldbe no reason that they might not share this information with others.Intended parents are encouraged to see disclosure as a process withpragmatic elements as well as personal choices. Single parents and same-sex couples are usually confronted with the decision to disclose veryearly on as the lack of the gamete provider is publicly apparent. Parentsshould also receive support that their disclosure skills will grow over timejust as their ability as parents in general will grow over time. Ultimately,


disclosure becomes integrated into the tasks of parenthood rather than aseparate, dramatic and potentially frightening event.

It’s a small world after all: technological influenceson disclosure

Along with changes in how the family is perceived and conceptualised,there are also changes in the way people communicate resulting fromtechnological developments. These developments have had a significantimpact on the issues of connectedness and relatedness in third-partyreproduction and the implications of disclosure, alongside the question-ing of anonymous gamete donation and changing legal frameworks.

There has been an international trend towards making gamete dona-tion non-anonymous. A number of jurisdictions (for example, the UK,the Australian State of Victoria and the Netherlands) have changed theirlaws and stipulated that all gamete donation should be non-anonymous.In 2011, Washington State passed a law that mandated that all donoroffspring should be allowed access to the medical history of their donorat age 18, and access to identifying information subject to the donorallowing it. This is an important piece of legislation and is the first suchlaw in the USA. It is significant that it allows donor offspring accessto medical information: in other states this is not guaranteed as donormedical records may be destroyed or not made available to offspring.However, it only allows the offspring to know the identity of their donorif the donor agrees, so is not as far-reaching as the law in the UK forinstance, where all donors whose gametes were used from 2005 onwardshave to agree to the release of their identity on request when any resultingoffspring reach the age of 18. In Victoria, Australia, the parliamentaryLaw Reform Committee (2012) has gone further and recommendedretrospective non-anonymity for donors (see Freeman et al., Chapter15). Under these recommendations, offspring who were conceived usinganonymously donated gametes (before 1998) would be able to find outtheir donor’s identity with the proviso of a contact veto. This radicalmove was justified on the grounds that the welfare and interests of thesechildren are paramount and trump any interests the donor may have.

Alongside these legal changes, the Internet has provided other ways foranonymity to be circumvented. The concept of a global community hastaken on a new meaning since the introduction of the Internet. Only afew decades ago, the telephone was the predominant choice for commu-nication other than letter-writing, and long-distance calling to family orfriends was prohibitively expensive. Consequently, communication wastypically limited by expense or delay. Now families can be half a world


away and yet can be a part of each other’s daily lives through telephonecalls, Skype, texting or instant messaging.

In this way, the concept of community has expanded through virtualnetworks and new concepts of relatedness have emerged. In the past,donor anonymity was aided by the inability of individuals and familiesto make connections. Facebook has contributed to changing viewpoints.Not only does this type of social media make anonymity an increasinglyunlikely prospect since considerable amounts of personal informationand photographs are available, but it has also changed the idea of whatconstitutes a relationship. ‘To friend’ someone has entered our vocabu-lary as a new verb.

Registries such as the Donor Sibling Registry and websites like Choice-moms or Singlemothersbychoice have allowed recipients of the samedonor to meet through informal contact via chat rooms and web boards.Contact with egg donors may be more challenging, partly because USprogrammes may be smaller and may not assign donor numbers. Unlikesperm banks where donors can be identified through a donor number,egg donor programmes may use internal identification numbers, ficti-tious names or initials. If a donor moves to another programme, there isno identifier that would follow her. Whether these are deliberate obfusca-tions of identity, the fact remains that forging independent connectionsbetween egg donors, recipients and the donor conceived is challenging.For many donors and recipients, however, connecting via the Internet isnow an option and, as discussed earlier, this allows for new family formsto be created.

Conclusions

What constitutes a family and the importance of genetic connections aredeeply contested issues that are bound up with the social, cultural andtechnological context in which they are enacted. There can never be aset answer to these questions, and the challenge for fertility physiciansand counsellors is to give intended parents sufficient information andsupport to enable them to navigate these difficult areas with a degreeof confidence. At the same time, it is also important to reflect on theassumptions about families and genetic relatedness that underpin pro-fessional discourse in third-party assisted reproduction, and the role thatclinical practice may play in shaping the decisions available to parents.The welfare of the children created from gamete donation and surrogacyis increasingly being seen as the key factor in policy-making and practicein this area, and how to do this and how to gather evidence on what


promotes the best interests of the child are important questions for bothpractitioners and researchers.

References

Appleby, J.B., Blake, L. and Freeman, T. (2012). ‘Is disclosure in the bestinterests of children conceived by donation?’, in M. Richards, G. Penningsand J.B. Appleby (eds.), Reproductive Donation: Practice, Policy and Bioethics.Cambridge University Press.

Blyth, E., Crawshaw, M., Jones, C. and Frith, L. (2012). ‘The psycho-socialimplications of not knowing the identity of your gamete donor’. Journal ofLaw and Medicine, 19, 769–89.

Braverman, A.M., Taylor, D., Galen, B., Nicholson, R. et al. (2010a). ‘Doesmental health and nursing counseling influence ovum donor recipients’ pref-erences for their donors?’. Fertility and Sterility, 94, Supplement, S67.

(2010b). ‘Donors’ interactions with nursing and physicians affects immediatewillingness to donate again and attitudes one year post retrieval?’. Fertilityand Sterility, 94, Supplement, S33.

Carsten, J. (2004). After Kinship. Cambridge University Press.Frith, L., Sawyer, N. and Kramer, W. (2012). ‘Forming a family with sperm

donation: a survey of 244 non-biological parents’. Reproductive BioMedicineOnline, 24. 709–18.

Gottlieb, C., Lalos, O. and Lindblad, F. (2000). ‘Disclosure of donor insemina-tion to the child: the impact of Swedish legislation on couples’ attitudes’.Human Reproduction, 15. 2052–6.

Hudson, N., Culley, L., Johnson, M. and Bharadwaj, A. (2009). ‘Public percep-tions of gamete donation: a research review’. Public Understanding of Science,18, 61–77.

Isaksson, S., Svanberg, A.S., Sydsjo, G., Thurin-Kjellberg, A. et al. (2011). ‘Twodecades after legislation on identifiable donors in Sweden: are recipient cou-ples ready to be open about using gamete donation?’. Human Reproduction,26, 853–60.

Law Reform Committee (2012). ‘Inquiry into access by donor-conceived peopleto information about donors’. Parliament of Victoria Parliamentary Paper,No. 120, session 2010–12.

Milsom, I. and Bergman, P. (1982). ‘A study of parental attitudes after donorinsemination (AID)’. Acta Obstetrics and Gynecology Scandinavia, 61, 125–8.

Nordqvist, P. (2012). ‘“I don’t want us to stand out more than we alreadydo”: lesbian couples negotiating family connections in donor conception’.Sexualities, 15, 644–61.

Price, F. (1997). ‘Matchmaking in the clinic: gamete donation and the manage-ment of difference’, in A. Clarke and E. Parsons (eds.), Culture, Kinship andGenes. Basingstoke: Palgrave Macmillan.

Rodino, S., Burton, P.J. and Sanders, K.A. (2011). ‘Donor information consid-ered important to donors, recipients and offspring: an Australian perspec-tive’. Reproductive BioMedicine Online, 22, 303–11.


Strathern, M. (1992). Reproducing the Future: Essays on Anthropology, Kinship, andthe New Reproductive Technologies. Manchester University Press.

Thompson, C. (2005). Making Parents: The Ontological Choreography of Repro-ductive Technologies. Cambridge MA: MIT Press.

Wilson, S. (1997). ‘Identity, genealogy and the social family’. International Journalof Law, Policy and the Family, 11, 270–97.

Children’s book list

Celcer, I. (2007). Hope and Will Have a Baby. New York: Graphite Press.Cirisan, W. and Schultz, S. (2005). The Very Special Ducklings (A Very Simple

Story About Egg Donation). Manchester: Trafford Press.Clay, G.A. and Krebs, L. (2008). Why Don’t I Have A Daddy? A Story of Donor

Conception. Bloomington, IN, Author House.Gordon, E. (1992). Mommy, Did I Grow in Your Tummy? Where Babies Come

From. Santa Monica, CA: EM Greenberg Press.Grimes, J. (2004). Before You Were Born . . . Our Wish for a Baby. www.xyandme.

com.Infertility Research Trust. (1991). My Story (donor sperm); (2002). Our Story.

www.Infertilitysheffield.org.uk.Nadel, C. (2007). Mommy, Was Your Tummy Big? Arlington, VA: Mookind Press.

http://www.xyandme.com

http://www.xyandme.com

http://www.Infertilitysheffield.org.uk

Part II

Experiencing relatedness

8 Defining connectionsGender and perceptions of relatedness inegg and sperm donation

∗

Rene Almeling

Introduction

One potential outcome of egg and sperm donation is children, or ‘off-spring’ in the parlance of fertility programmes. Scholars and the publicalike have been fascinated by the kinship permutations made possibleby reproductive technologies, which can result in the splitting of moth-erhood and fatherhood into genetic, gestational and social components.Despite the increasing attention to issues of kinship, there is still verylittle known about how donors understand their position in these bravenew families. To what extent do egg and sperm donors feel a connectionto the children born of their donations, and how do they define thatconnection?

Generally speaking, there is a societal expectation that women donatingeggs will feel more of a connection than men donating sperm. Thisexpectation is driven by a cultural belief in ‘maternal instinct’, whichforms from an amalgam of biological and cultural assumptions aboutwomen and their bodies. One influential version of this belief derivesfrom evolutionary psychology. It contends that women have fewer eggsthan men have sperm, that it takes more biological effort to produce eggsand bear children, and thus women are more ‘invested’ in offspring thanmen are (see Trivers, 1972).

This is certainly the view of some of the most prominent fertilitydoctors in the United States. When I asked a former president of theAmerican Society for Reproductive Medicine what he thinks of as “openquestions” in gamete donation, he said it is important to know moreabout “what happens on the other side of the door. What happens to thedonors? Do they forget it, or is it part of their life for the rest of theirlives?” He went on to speculate:

∗This chapter draws on material published in Almeling (2011).

147

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physician . I would suspect that this is very different in women than in men.The sperm donors probably couldn’t give a hoot about what happened tothose kids. They did it for the money. It was easy to collect the sperm and[then] good-bye. The women, I think, will have an investment.

author . Where does that investment come from?physician . Because women have children. Women relate very differently to

children than men.

In this view, biology is at the root of gender differences in how egg andsperm donors relate to offspring: female bodies bear babies and thuswomen are more invested in children.

Social scientists challenge the idea of maternal instinct as overly relianton a deterministic view of biology, arguing that biological ties in therealm of kinship can be understood differently depending on social con-text. Marilyn Strathern (1992) initially raised this point in the context ofreproductive technologies, suggesting that they might change the waysin which biology is mobilised in defining relatedness. The studies thatfollowed have demonstrated just how malleable the meaning of biologi-cal ties can be (see Strathern, 1992; Edwards et al., 1993; Franklin andMcKinnon, 2001). Depending on which element – genetics or gestation –is being provided by someone other than the intended parents, that par-ticular element is downplayed.

As egg and sperm donors, women and men make parallel contributionsto reproduction: each provides cells filled with genetic material, but theywill not carry the pregnancy or care for the child once it is born. Thisraises the question of whether egg and sperm donors understand thisgenetic contribution in the same way. In fact, they do not. In directcontrast to notions of maternal instinct, egg donors insist that they arenot mothers to children born of their eggs, but sperm donors have astraightforward view of themselves as fathers. In this chapter, I arguethat this surprising disjuncture results from gendered expectations aboutwomen’s and men’s connections to offspring and recipients.

Drawing on interviews with egg and sperm donors,1 I examine howthey define their connections in this realm, including the extent to whichthey make distinctions between biological and social parenthood. I pointto the ways in which donors’ views are influenced by organizationalpractices, namely the emphasis on recipients in egg agencies and thelack thereof in sperm banks. I conclude by discussing how donors’ per-ceptions reflect broader cultural norms around procreation, particularly

1 This chapter is based on research conducted at six donation programmes in the UnitedStates between 2002 and 2006. In total, I interviewed forty-five staff members, nineteenegg donors and twenty sperm donors. The donors ranged in age from 19 to 47 and were indifferent stages of the donation process. All people and programmes have been assignedpseudonyms. More details about the methodology are available in Almeling (2011).

Gender and perceptions of relatedness 149

the long-standing tradition in Western culture that identifies the malerole in reproduction as primary.

“I’m a father!”

Most sperm donors define themselves as fathers to children born oftheir donations.2 Such definitions appeared throughout my interviewsand ranged from flippant quips to more serious and subtle discussionsof the dimensions of this paternal relationship. Flippant references weremore likely to come from younger donors, such as Paul, a 20-year-oldcollege student who described one of his considerations in deciding tobecome a donor. “It was like a week and a half or two trying to thinkeverything over, whether or not I actually wanted to have children thatI didn’t know about [laughs]”. Referencing their participation in thebanks’ identity-release programmes (in which donors agree to futurecontact with offspring), several men echoed Isaac, a 22-year-old studentwho noted that one day there could be someone who “shows up on mydoorstep saying, ‘Hey, Pops, how you doing?’”.

Older sperm donors also defined themselves as fathers, but their under-standing of this role reflects the changing life experiences of men in their30s and 40s. For example, a few months after our interview, Ethan, a39-year-old graduate student, found out his wife was expecting their firstchild. He contacted me to say that, as a result, some of his views aboutbeing a donor had changed. He described his thoughts after his wife’spositive pregnancy test:

A lot of stuff goes through your mind the next few days. One of them was, ‘Ohyeah, there’s other children out there. Maybe that was a mistake, that identity-release.’ I can’t remember exactly what felt funny, but it just felt funny for amoment where it never felt funny before. Before it felt fun and interesting thatI might meet these children some day. But this, all of a sudden now, when youhave your own children, when you’ve got your own family and world going on

2 More than half the men I interviewed explicitly stated that offspring are their children,yet just a tenth of the women said this. Nearly 60 per cent of women explicitly stated thatthe offspring are not their children, while just 15 per cent of men did. Another indicator ofhow donors think about their relationship to offspring is the use of kinship language (e.g.donors referring to themselves as parents to the offspring or referring to their parentsas grandparents to the offspring); 85 per cent of men used kinship language comparedto just 42 per cent of women. Moreover, these two indicators are generally consistent.All of the donors who considered offspring to be their children as well as donors whohedged by saying that offspring are not really their children, used kinship language. Mostdonors who said that offspring are not their children did not use kinship language. Andthe donors who did not specify their relationship to offspring generally did not usekinship language. I merge these two indicators to categorise all donors as conceptualisingoffspring as their own children (fifteen men and five women) or not (five men and fourteenwomen).

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here, that seemed like such an extraneous thing that I did that shouldn’t comeback and involve itself in your family.

He described this as his initial reaction, but after some time passed,he spoke with the donor manager at Western Sperm Bank and “cameback down to earth. It’s all good. [The donor manager] explained tome some of the neat things. The kids were sending pictures, and they’restarting now to meet their parents”. In the first quote, Ethan distinguishesthe offspring, the “other children”, from his “own children” and his“own family” but in the second quote he still refers to sperm donors as“parents” to “kids” who are born from donation.

Another example of this shifting orientation toward offspring comesfrom Joe, who was in his late 40s. Fifteen years earlier, he began donatingafter being encouraged by his girlfriend, because neither was particularlyinterested in having children. As an engineer, he had no need for themoney from donation, and, in fact, he estimated spending more on fastfood in a month than he earned at the sperm bank. Years later, after therelationship and the donations had ended, he married a different woman,and they tried to have a child together:

When it turned out the odds were probably not going to be in our favour, therewas some resentment. I had done this [sperm donation], and she was not able toget pregnant.

As an identity-release donor, Joe expressed concern about how hiswife would react if the people he referred to as “offspring” contacted himin the future. This is a distinct possibility, having learned that severalrecipients have had children:

I was actually surprised at my feelings when I found out the first birth hadoccurred, stronger feelings than I expected, somewhat pride, somewhat joy, prob-ably a smaller subset of what an actual father feels when he and a partner have akid.

Although Joe distinguished his contribution as a sperm donor from thatof an “actual father”, he was curious to meet the offspring, explaining:

I have siblings, nieces, nephews, and so on. There’s always a question of whichtraits are inherited and which are learned, nature versus nurture, so it would bevery interesting to see which traits you recognise.

In fact, his curiosity was quite strong: he had considered moving to adifferent country to work or retire but put these plans off in part to bemore available to meet with offspring. At the same time, he said:

There’s also a definite limitation on my part as to how much of a relationship. Ihave my life. I am definitely interested, but I am also married.


Although several of the older donors had contemplated some sort ofmeeting in the future, Nathan was the only man I interviewed who hadactually met children born from his donations. In what the Gametes Inc.staff said was an extremely unusual turn of events, Nathan agreed to be intouch with several different recipients when their children were still quiteyoung. At the beginning of the correspondence, all letters went throughbank staff who excised any identifying information, but Nathan grewimpatient with this arrangement and asked if he could just email directlywith the recipients. Emails led to phone calls that led to conversationsvia webcam and then, the weekend before our interview, to a ‘familyreunion’ on a beach a few hours away. Nathan joined two families, bothheaded by lesbian couples, who had conceived children with his spermand were vacationing together. He recalled his initial conversations withthe children:

When we meet up, ‘You’re my dad?’ ‘Yes, I am.’ ‘I’m your son?’ ‘Yes, you are.’‘Well, let’s go play.’ And off we go. It’s like nothing to them. It’s readily accepted.

Like most other donors, Nathan was originally interested in the moneyhe could earn from donation. That was fifteen years ago:

I was in school, going to work, and I heard this advertisement on the radio onhow to make extra money. Great, no problem. Make extra money by just tossingoff. Fantastic! So there was no real thought of children or offspring down theline or consequences or benefits at all, from any of it. It was just a go-in-and-do-what-you’re-normally-going-to-do-at-night and get paid [laughs].

Within five or six years, however, he faced a “turning point” aboutwhether he wanted to continue donating sperm:

I don’t plan on getting married. I have no aspirations to get married. I haveno children of my own, and I’m not going to raise children by myself. So, thequestion was, do you really want to keep doing this? Do you want to have morechildren out there? Why not? I mean, it’s a great thing. So, I just kept on going.They still gave you money, but the money was no longer a deciding factor.

At 38, Nathan was unmarried and still working odd jobs. Althoughhe would like to have children of his own, he did not want to do it byhimself, nor did he feel financially prepared:

It wouldn’t be fair to the kids, because I couldn’t give them everything they need,not right now.

So as recipients were in and out of touch as their own lives changed,Nathan looked forward to meeting more offspring.

It kills me to know that there are more out there that I’ll probably never meet,because I want to see them when they grow up, how they progress, and how

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they change through life, if they go through the same things and handle the samethings that I did, the same way I did.

At the same time, he was very aware that his presence in the children’slives is at the discretion of their parents. In summing up his experiencesas a sperm donor, he said:

Getting letters and pictures, you’re elated. You’re happy. You got this new senseof being, this new purpose, but it’s just out of reach. You can’t do anything withit. I got kids. That’s great. I can go make more, but that’s as far as it goes. Fuck[laughs]. It kind of leaves you hanging, wanting more. You want the parents to becalling you right then and there going, ‘Hey little Nathan, [imitates a baby crying]that’s your kid’. You want to be a part of it, but you know you can’t, not unlessthey invite you into that world. And you have to be really careful once you’re in.You can’t step on toes and whatnot. And that brings it up to this point, whereI’m actually being kind of rolled into the fold. It’s like being rolled into a wave.You know where you are, you know your situation, but you’re not exactly surehow to kick yourself up left or right. It’s all new.

Nathan was very unusual among sperm donors in that he had met someof the children and placed so much emphasis on his relationship withthem, but he was not at all unusual in calling himself a father to thesechildren, in considering the children to be “his”. Although the concep-tualisation of this paternal role may change alongside a donor’s changinglife circumstances, younger men and older men, those who have chil-dren of their own and those who do not, are fairly uniform in identifyingthemselves as fathers to children conceived with their sperm.

“Just an egg”

Most egg donors, who have exactly the same genetic relationship tooffspring as sperm donors, come to the opposite conclusion: they are notmothers.3 In interview after interview, women used similar phrasing todefine their contribution as “just an egg”. Tiffany, a 25-year-old divorceewho had no children of her own, was in the earliest stages of donating.She was matched to recipients she was meeting the following week, butshe had not yet begun injecting fertility medications. Here, she relieson a comparison between eggs and blood in explaining why she felt no“attachment whatsoever”:

There is one friend that does not like the fact that I’m doing [egg donation].She said, ‘I don’t see how you can do that. There’s going to be a little Tiffanyrunning around.’ And I don’t consider it that way. I mean, I donate my blood. Idon’t consider my blood being out there in any way. I don’t feel an attachment

3 See footnote 2.


whatsoever. It’s not like I carried the kid. If I carried the kid, I could see anattachment, and I would consider it a little me running around. But just becauseit’s my egg, I don’t consider it me. I mean, it is a part of you, but you don’t havea bond with it. Like if you scrape yourself and you lose some blood, you’re notthinking twice: clean that up. You don’t think, ‘Oh my God, I’m leaking! That’spart of me. Get it all up, and save it.’ So that’s the same way I feel about theeggs. You don’t have a bond. You don’t want to save it. It hasn’t developed intoanything to love at that point.

The same age as Tiffany, Carla was married with a young child. Shewas going to school and working as a waitress in a cocktail bar when shesaw an ad offering $5,000 to become an egg donor. She had finished herfirst cycle about a year before our interview. Although she believed that“having kids is big and [I] would wish that for anybody”, she identified theoffspring as the recipient’s child, pointing to the importance of “giving”in explaining why she felt “no connection”.

carla . When it actually comes out of my body, it’s just a little seed. This wholething nine months later, I make no connection with that to me. That’s theirchild, and thank God they had that child.

author . How does it go from this little seed that comes from you to their child?carla . I don’t know. I think it’s just giving. I think if I went out and painted

somebody’s house, I put all the sweat and had the pride of doing that, butthen they live in it. It has nothing to do with me. That’s their house, and I’mso glad that they have a nice painted house. But I’m not going to drive byevery day and say, ‘Ooh, I painted that house.’ After that, it has nothing todo with me. I have the satisfaction of knowing that somebody is happy, andthat’s it.

There is a seeming contradiction between egg donors who describe whatthey are giving as a “huge” gift and then say in the very next breath that itis “just an egg”. Yet Carla’s quote makes clear that it is the possibility ofa child that makes egg donation “huge” while what it is that egg donorsgive – “a little seed” or “a couple of cells” – is small.

It follows logically that women who do not feel attached to their eggsas long as they are gestated in another woman’s body would find theprospect of surrogacy daunting. In fact, nearly three-quarters of the eggdonors mentioned surrogacy at some point in the interview, with mostechoing Kim in stating their absolute unwillingness to even consider thepossibility.

I think I would be too emotionally attached. I cannot imagine somebody growinginside of me and not keeping it. I would never consider being a surrogate. Ever.Not even for a brother or sister. I love them to death, but I don’t think I could dothat. Being an egg donor, it’s not a tangible thing. It’s not in me. I mean, it cameout of me, but it’s just like giving blood. You’re giving something away, and youdon’t see it again. It goes into somebody else’s body. It’s gone.

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Rosa, a 32-year-old mother of four, was the only egg donor I inter-viewed who had also been a surrogate mother. Rosa donated eggs throughOvaCorp, which is part of a company that includes a surrogacy agency.After Rosa’s two egg donation cycles, the donor manager at OvaCorpcalled to ask if she would consider becoming a gestational surrogatemother (and thus would have no genetic connection to the fetus she car-ried). She thought it over, discussed it with her husband, and decided tomeet the prospective recipient couple. As an egg donor, she had not metthe recipients, and she contrasts that experience with surrogacy.

[In egg donation,] you have a little cramping afterwards, and then okay, hey, well,that’s it. It’s less involved. You just went in for that reason to help somebody out,and that’s it. With the surrogacy, it was so different because of the process. Youmeet them. You get to know them. You go out with them. You email them. Fornine months, maybe a year, your life revolves around them, so you make sure tolet them know you’re doing fine. Because if I’m doing fine, then the baby is doingfine. Have you eaten, did you rest, did you sleep, are you okay? And of course,I’m just waddling. I was like this big old mama. It’s just a big experience.

Like many of the egg donors, Rosa distinguishes the eggs that go outsideof her body to become part of someone else’s child from carrying insideher body a child to whom she has no genetic connection. At no point didshe define herself as a mother to either of these children.

For the last several months of the surrogate pregnancy, Rosa was onbed rest because she was pregnant with twins. During a routine checkup,the clinicians found that one of the fetuses was in distress and orderedan emergency C-section. The recipient couple lived overseas and couldnot get there in time for the birth, so one of the psychologists fromthe surrogacy agency was in the delivery room taking pictures. Rosaexplained what happened.

We thought everything was going to be great, but the one that had all that stresshad Trisomy 18. She was not even going to be compatible [with life]; we justknew it from then on. She lived for three days, and [then] we had to let her go.I didn’t want her to go alone, so out of, I don’t know what it was. It was likea calling for me to be there for the baby. They had to unplug her. I told [thepsychologist], ‘I want to be there; the parents are not here yet. They can’t justlet her go. She needs some kind of dignity to leave this world.’ So I held her,and they gave me the little quilt to hold her in. She was so cute, just like a littledoll, so tiny. [The psychologist] told me I didn’t have to do that. It’s not part ofthe contract. There she goes with all the papers. I said, ‘You know what? Thisis just, it’s my duty to do it, because I carried this child. I want to be there tosay good-bye to her.’ It was one of the hardest things I ever did. I’d never seensomething like that in my life, to let go of a child like that, to just let it go. I justcried and cried.


Rosa continued to stay in touch with the recipients, and the first timethey saw each other after the birth was during a layover on their nexttrip to the United States. Their surviving daughter had just had her firstbirthday, and when I asked how it was to see her again, Rosa said:

I wanted to hug her! [laughs] I was just like, ‘Oh my God, I finally get to holdher again.’ The last time I held her was when she was newborn. She was alreadytrying to walk, and my reaction is just like wow, so fast, she’s already walking. Itjust grabs you. It just tugs at your heart to know that that little child was in meand to know that they finally have a child. It’s just, it’s a good feeling.

As an egg donor, Rosa downplayed her genetic connection and empha-sised the recipient’s gestational connection, noting the importance ofbeing able to carry the pregnancy and give birth. As a surrogate, shedownplayed her own gestational connection in favour of emphasising therecipient’s genetic connection, identifying the little girl as “their child”.Even in her description of the traumatic birth scene, the recipients are“the parents”. Indeed, the only time Rosa used familial language todescribe her relationships in this realm was in reference to the surrogacyrecipient, with whom she felt “kind of like a kinship, because I guess she’salways going to see me as a person that helped her have a child, and I’malways going to see her like the lady that I helped, so it’s reciprocal”.

Information, identity release and the future

Given that egg and sperm donors define their relationship to offspringin such different ways, with men identifying themselves as fathers butwomen not considering themselves mothers, it is surprising to find thatthey express similar feelings about potentially meeting the children atsome point in the future. Nearly all of the donors discussed this possibil-ity, and egg and sperm donors alike were willing to meet with those whorequested it.

For some women and men, the prospect of offspring is quite con-crete, yet others have no idea whether children have been born. This isbecause egg agencies and sperm banks vary in the extent to which theyshare information about offspring with donors. Sperm banks generallyprovide details only if the men ask, while staffers at the egg agenciesare more proactive, checking in with women about whether they wantto know the outcome of their donations. Several of the sperm donorswho said they finally decided to ask about offspring expressed surprise athow few births there had been. In fact, reproductive technologies haverelatively low success rates, so it might be the case that donors who arenot given concrete information are likely to assume that their donationshave resulted in children when that might not, in fact, be the case.

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Regardless of whether they knew that offspring actually existed, eggand sperm donors spoke about the possibility of meeting them in thefuture. Most exhibited a mild curiosity in seeing how the children “turnout”, especially what the children look like. About half the donors ref-erenced an imagined future for the children, ranging from images ofdelinquent teenagers who start fires to ideas that the offspring could belawyers, doctors or even president of the United States. A substantialminority of donors – about 40 per cent of the women and men I inter-viewed – said they felt some sense of responsibility to offspring. Mostdonors defined this sense of responsibility in terms of providing informa-tion, either medical history or family background. However, a few of thedonors did go so far as to say they would probably try to help if the childneeded financial assistance or a place to live.

For sperm donors, the idea that they might meet offspring at somepoint in the future is clearly tied to their participation in the banks’identity-release programmes. While Western Sperm Bank does not offeradditional compensation for this, Gametes Inc. pays 50 per cent more persample to identity-release donors than to anonymous donors. As a result,more Gametes Inc. donors are identity-release, describing it as a heftyfinancial incentive. Walt, a 19-year-old who was donating to make extramoney, responded to my question about what influenced his decision tobe identity-release by stating bluntly, “the money”. When I asked if it wasa difficult decision, he replied, “Not really, because I really don’t mindif they look me up or not.” Kyle, a 22-year-old student, agreed that thedecision was “not too difficult”.

I’d say on a [scale from] one to ten, with ten being the hardest, it was probablyabout a five or six. It wasn’t super hard. I thought the money is kind of likea weight on a scale, the difference between $65 and $100 [per sample]. Whenyou think about a whole week, I come Monday, Wednesday, Friday. I’m morea day-to-day person, and I’m thinking long term, eighteen years from now, theywould be able to call me. But if I don’t sell good, if you don’t get out enoughinformation, somebody might be kind of hesitant to buy your specimens. If youcan’t give them what they want to know, they won’t buy it, and then I wouldn’t beable to come in. [The sperm bank] might say ‘We’ve got enough stock.’ For me tomaintain my lifestyle, I need a steady paycheck coming in just like my other job.

In contrast, when Western Sperm Bank donors explained their rea-sons for being identity-release, they were more likely to reference the off-spring’s welfare. Andrew, who, like Walt and Kyle, signed on to donatefor the extra money, explained:

I am [identity] release, but that’s more toward the children’s benefit than anythingfor me. I can understand how there’d be curiosity, and not knowing where you


come from would be a question that children might have. That’s why I agreed todo it.

More and more sperm banks are creating an identity-release option toattract recipient clients. However, when banks provide monetary incen-tives for donors to sign on, it is likely to focus men’s attention on short-term gains rather than long-term ramifications. As a result, it remainsto be seen whether those donors who are paid to participate will be ascommitted to staying in touch with the bank and following through ontheir commitment to be in contact with offspring at least two decadesinto the future.

Sperm: father:: egg: not-mother

To return to the finding that sperm donors think of themselves as fathersand egg donors consider themselves not-mothers, the question remains:why does this difference exist, especially given that both women andmen are making parallel contributions to reproduction? Looking moreclosely at how donors discuss their connections to offspring reveals anexplanation that relies on a distinction between biological and socialparenthood (distinguishing between the person who provides the geneticmaterial and/or gestates the fetus and the person who raises the child).Nearly all of the egg donors made such a distinction, but just about halfof the sperm donors did.

When men do differentiate between the person providing sperm andthe person providing care, they do so not to say that they are not fathersbut that they are a particular kind of father. Dennis, a 24-year-old withno children of his own, explained,

The father’s the person who’s there, the one who’s doing the work, and Iabsolutely believe that environment greatly affects how a person turns out, nomatter what kind of genes they have. So the only way to be a true father is tohave a child and raise it, and there’s no way of doing that as a donor. And yetI’m really intrigued by the idea that someone may turn 18 and be like, ‘I knowthat I was donated sperm, and I’m curious to find out who my father was’,actually encountering the person who’s like, ‘Hey, I am the result of your geneticsystem.’ I think it’d be great to see how someone turned out. What environment,how did they grow up? What was their family like? How did they deal with beinga child of a donor? I would love to have that experience, which is why I’m anidentity-release person.

Dennis notes the role of nurture before returning to a more deterministicview of nature. The child is “donated sperm”, and there is no mentionof the recipient’s “genetic system” as playing a part. The rearing familyprovides an “environment”, but at base, the offspring is still the “child

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of a donor”. Later in the interview, Dennis employed kinship languagein defining his connection to the child.

Even though I may never meet this kid or I may run into them on the streetand never know it, but just the fact that there is that sort of connection. It’s alsosort of a fatalism thing. Figure get it out there [laughs], as crude as that sounds,because if something were to happen to me tomorrow, I might still have a kidout there who’s a Baby [Dennis’ last name]. Their name may not be the same,but they’re going to be a part of my dad, a part of my grandfather, a part of mymom. It’s going to be a part of the family, and I think it’s a damn good family.

When women distinguish biological and social parenthood, they doso in the service of defining themselves as not-mothers. There are twoaspects of this definition, both of which appear in each of the followingquotes. First, egg donors routinely break out reproduction into multiplestages, differentiating conception, pregnancy, birth and care giving. Sec-ond, as a result of the emphasis on recipients in egg agencies, womenevinced more awareness of the people to whom they were donating thandid men. In fact, nearly 70 per cent of the women pointed out that theirgametes would go into another woman’s body, a detail noted by just 5per cent of the sperm donors.

Susan, a 24-year-old with a young son, had donated twice throughGametes Inc. and described the offspring from her donation as follows:

This is not my baby, because she [the recipient] nourishes this baby for ninemonths. There’s an egg and there’s a sperm, which create a child, but everythingthat goes into her body is put into this child’s body. She’s making everything todo with this child. This baby is not mine.

Olivia, a four-time donor at Creative Beginnings, was about the sameage as Susan but had no children. She explained how her friends reactedto her decision to become a donor:

My friends thought I was crazy. They were like, ‘What are you doing? Technically,if a baby is born, that’s your baby.’ And I just thought, ‘No.’ I mean, it mighthave my physical characteristics, or it might have my genetics, but I’m not the onebearing that child. I’m not the one going to the hospital every couple of weeks tomake sure the pregnancy is going well. I’m not the one that’s going to be therewhen the child is born. I’m not the one taking care of the child once it is born.

Not only do women point to more stages in reproduction, they arealso more likely to refer to each stage as contingent, as possible but notinevitable. Egg donors are more likely than sperm donors to specify theirdonation as eggs, which are mixed with sperm, which might result in thecreation of embryos, which might implant in another woman’s uterus,which might result in a successful pregnancy, which might result in thebirth of a child. For egg donors, then, reproduction looks like this:


? ? ? ?Eggs→Fertilisation→Implantation→Pregnancy→Birth→Childrearing

Men, who hear less about recipients from sperm-bank staffers, draw amore direct line from sperm to baby and assign much less uncertainty tothe process. For sperm donors, reproduction looks like this:

Sperm → Baby

In part, these views, which are common to donors at different stagesin life and living in different parts of the country, are shaped by donationprogramme protocols. At egg agencies and sperm banks, staffers drawon cultural norms of maternal femininity and paternal masculinity torecruit and market donors, but they do not actually want donors to seethemselves as mothers and fathers, not least because this could lead tocomplicated and messy battles over custody. However, given that womenand men are providing genetic material in a society that defines biologicalties as significant and familial, this remains a distinct possibility.

While the last thing most donors would want is to be responsible foroffspring, staff take precautions to ensure that this does not happen,requiring donors to sign contracts giving up all parental rights and insist-ing that all parties to the donation remain relatively anonymous. Forexample, sperm banks require that offspring be at least 18 before receiv-ing identifying information about the donor. Egg agency staffers are lessadamant about anonymity, but they spend a lot of time coaching womenabout how to conceptualise their relationship to offspring, insisting thatwomen are “just” providing eggs, not becoming mothers.

In looking at the underlying causes of the donors’ views and the staffs’protocols, it appears that both are referencing age-old beliefs about therole of men and women in procreation. From the time of the ancientGreeks, there has been a long tradition of identifying the male contribu-tion as primary, a view of reproduction in which men provide the gener-ative seed and women provide the nurturing soil. Noting this distinction,anthropologist Carol Delaney makes the argument that maternity andpaternity are not purely physical relationships. Instead, she believes theyare ‘concepts’ that cannot be abstracted from the cultural systems inwhich they are made meaningful. She writes that in the West: ‘Pater-nity is not the semantic equivalent of maternity. Traditionally, even thephysiological contribution to the child was coded differently for menand women, and therefore their connexion to the child was imagined asdifferent. Maternity has meant giving nurture and giving birth. Pater-nity has meant the primary, essential, and creative role’ (Delaney, 1986:495).

160 Rene Almeling

Sperm donors who draw a short line from sperm to baby and spermbanks that institutionalise identity-release programmes are referencingjust this view of paternity, pointing to the man’s contribution as crucialin shaping who the child becomes. Likewise, egg donors and egg agenciesmobilise this view of maternity, de-emphasising the importance of the eggin favour of the gestational or care-giving components and pointing tothe recipient as the ‘real’ mother, the one who nurtures.

One corollary to the view that fathers are creators and mothers arenurturers is that men who do not nurture are still fathers, yet womenwho do not nurture are censured as bad mothers. Emotionally distantfathers, absent fathers, and other ‘deadbeat dads’ may not be held in thehighest regard, but they are still fathers. In contrast, there is enormouscultural pressure on women to practice what Sharon Hays (1996) calls‘intensive mothering’. Women who do not nurture their children, andparticularly those who are distant or absent, violate the cultural expecta-tion of maternal instinct and are considered nothing less than unnatural.For this reason, egg agencies and egg donors have a powerful incentiveto define egg donors as not-mothers. If egg donors were categorized asmothers, then culturally speaking, they would be the worst kind of moth-ers. Not only are they not nurturing their children, they are selling themfor $5,000 and never looking back.

Conclusion

It turns out that the former president of ASRM quoted at the begin-ning of this chapter was right: egg and sperm donors have very differentunderstandings of their relationship to offspring, but not quite in the wayhe expected. Men do “give a hoot”, considering the provision of spermto be essential in defining who is a father. Women, who do not show anysigns of slavishly responding to some internal maternal instinct, believethat there are too many intervening stages between the eggs they provideand the babies that result to consider themselves mothers.

These conceptualisations are buttressed by organisational practices.The gift rhetoric in egg agencies serves to highlight the importance ofwhat the egg donor is doing for the recipient, making it possible for herto have a child and become a mother. In contrast, the identity-releaseprogrammes in sperm banks work to underscore the significance of thedonor’s genetic contribution, making it difficult for men not to think ofthemselves as integral in the lives of offspring.

Egg and sperm donors’ orientations to offspring are also pro-foundly shaped by cultural depictions of motherhood and fatherhood intwenty-first-century America, depictions with deep roots in Westernphilosophical and medical traditions that are given a modern spin in


the realm of assisted reproduction. The elements of maternity are sep-arable, which makes it possible to associate (or not associate) genetics,gestation and care giving with motherhood. In contrast, the elements ofpaternity are not so easily partitioned; the sperm provider is still a fatherof some sort.

Indeed, this research reveals that the distinction between biological andsocial parenthood is gendered. Women and men must rely on gender-specific versions of this distinction, and, as a result, egg and sperm donorscan construct different definitions of their connection to offspring. Mencannot help but see themselves as fathers, because they are providingsperm in a culture that equates male genetics with parenthood. Womencan define themselves as not-mothers, because they are providing eggsin a culture in which it is possible to separate female genetics from par-enthood. This is more than just a possibility for egg donors though; it isa necessity given the censure of ‘bad mothers’.

People who donate eggs and sperm say that one of the questions theyhear most often is ‘What does it feel like to have kids running aroundout there?’ The fact is that women and men will answer this question indifferent ways. It is not that egg donors feel no connection whatsoever.Like sperm donors, they are willing to meet with offspring in the futureand are even curious to see who they become. But for women, the definingconnection is with recipients, not offspring. The opposite is true of spermdonors, who feel little connection to recipients but experience a definingconnection to offspring.

References

Almeling, R. (2011). Sex Cells: The Medical Market for Eggs and Sperm. Berkeley:University of California Press.

Delaney, C. (1986). ‘The meaning of paternity and the virgin birth debate’. Man,21, 494–513.

Edwards, J., Franklin, S., Hirsch, E., Price, F. and Strathern. S. (1993). Tech-nologies of Procreation: Kinship in the Age of Assisted Conception. ManchesterUniversity Press.

Franklin, S. and McKinnon, S. (2001). Relative Values: Reconfiguring KinshipStudies. Durham: Duke University Press.

Hays, S. (1996). The Cultural Contradictions of Motherhood. New Haven: YaleUniversity Press.

Strathern, M. (1992). Reproducing the Future: Anthropology, Kinship and the NewReproductive Technologies. New York: Routledge.

Trivers, R. (1972). ‘Parental investment and sexual selection’, in Campbell, B.(ed.), Sexual Selection and the Descent of Man. Chicago: Aldine.

9 The significance of relatedness for surrogatesand their families

Vasanti Jadva and Susan Imrie

Introduction

In recent years surrogacy has become a more widely used method ofassisted reproduction. This increase can be attributed to the greaterfamiliarity of surrogacy as a method of infertility treatment, helped inpart by media coverage of its use by celebrities (Markens, 2012). Surro-gacy is a process whereby a woman carries a pregnancy with the intentionof relinquishing the child to the intended parents who may be a heterosex-ual or same-sex couple or a single parent (Braverman, Casey and Jadva,2012). Although no official statistics exist on the prevalence of surro-gacy, estimates suggest that approximately 1000–1400 surrogates givebirth every year in the USA (Armour, 2012) and 149 Parental Orders1

were granted in the UK in 2011, although approximately a quarter ofthese surrogacy arrangements had taken place overseas (Crawshaw, Blythand van den Akker, 2012).

Surrogacy arrangements are inherently difficult to describe and theterminology used varies and can be both confusing and controversial.In this chapter we refer to a child born as a result of the surrogacy asthe surrogacy child and the woman who gives birth to the child as thesurrogate. As described in Chapter 3 (McCandless and Sheldon), in theUK the birth mother is the legal mother of the child. The intended par-ents (also known as the commissioning couple) must seek a ParentalOrder in order to transfer legal parenthood from the surrogate to them-selves. Surrogacy has a very long history and in its traditional practicea surrogate conceives the child with the intended father using artificialinsemination, either at a clinic or at home. Surrogates usually refer to thisas ‘straight surrogacy’, while in legal and academic discussion it can bereferred to as ‘partial’, ‘genetic’ (the surrogate’s own egg is involved) or‘traditional’ surrogacy. In this chapter we will use the last of these terms.

1 A Parental Order is the legal device whereby legal parenthood is transferred from thesurrogate to the intended parents. This occurs between six weeks and six months afterthe birth of the child and can only be granted to couples.

162

Relatedness for surrogates and their families 163

Since the advent of in vitro fertilisation (IVF) and egg donation a newform of surrogacy has become possible where the intended parents useIVF to make an embryo from their own gametes. This embryo is thenplaced in the surrogate. Surrogates usually call this ‘host surrogacy’ whileacademics refer to ‘full’ or ‘gestational’ surrogacy. We will use the lastterm. There is a further complication where intended parents may haveinfertility problems which mean they have to use donor eggs or spermfor the IVF. However, under current UK regulations (see McCandlessand Sheldon, Chapter 3) at least one of the intended parents’ gametesmust be used for them to qualify for a Parental Order to become the legalparents of the surrogacy child.

This chapter will draw on empirical data from a study of surrogatesin the UK to examine how they view their relationship to the surrogacychild. It also examines the significance of relatedness for the surrogate’sfamily, specifically her partner and her children. The sample includes adiverse group of surrogates including both traditional and gestational sur-rogates, surrogates who were previously known to the intended parents,such as family members and friends, and surrogates who were previouslyunknown to the intended parents, i.e. those who met through a surrogacyagency or a mutual friend. Some surrogates had taken part in a singlesurrogacy arrangement whereas others were repeat surrogates, havingacted as surrogates for several couples. By exploring the narratives ofin-depth interviews with these gestational and traditional surrogates wehope to examine the significance of their genetic and/or gestational linkto the surrogacy child. A section of our analysis will also examine howsurrogates and their families define their relationship to the surrogacychild.

Traditional versus gestational surrogacy

In the UK both traditional and gestational surrogacy are practised. Ithas been argued that traditional surrogacy may lead to difficulties forthe surrogate in relinquishing a genetically related child and thereforethe surrogacy arrangement may be more likely to fail (Trowse, 2011).However, empirical evidence from the UK has found that both types ofsurrogacy can be successful. Golombok and colleagues, in their prospec-tive longitudinal study of the experiences and psychological well-being ofintended families, found that being conceived via surrogacy, whether tra-ditional or gestational, did not negatively affect the psychological healthof the surrogacy child in the first ten years of life (Golombok et al., 2004,2006a, 2006b, 2011, 2013).

A study of thirty-four surrogates by the same group of researchersfound few differences between traditional and gestational surrogates with

164 Vasanti Jadva and Susan Imrie

respect to motivations for surrogacy, psychological health and quality ofthe relationship with the intended parents (Jadva et al., 2003). The onlydifference found was in relation to telling the child about the surrogacy,with traditional surrogates more likely to say that the child should be toldabout the surrogacy compared with gestational surrogates.

From the intended parents’ perspective, intended mothers who wereable to use their own egg to conceive their child have been found to placemore importance on a genetic link to the child compared with intendedmothers who were unable to use their own egg and had used traditionalsurrogacy (van den Akker, 2000). Conversely, van den Akker (2003)found that surrogates who conceived with their own egg believed that agenetic link was not important to them, whereas gestational surrogateswere more likely to report that a genetic link was important to them(for a discussion of how egg donors view their connection to childrenborn as a result of their donation, see Almeling, Chapter 8). Surrogatesand intended mothers may define motherhood using psychological andemotional factors as well as genetic and social factors (Snowdon, 1994).A study of egg donors and gestational surrogates in the USA found thategg donors placed less importance on the role of genetics in determiningintelligence compared with gestational surrogates, though both groupsthought that the environment influenced characteristics such as weight,sense of humour, personality, values and ambition, thereby recognisingthe intended parents’ contribution to shaping their child’s development(Braverman and Corson, 2002). While western studies have found thatsurrogates de-emphasise the importance of their genetic and/or gesta-tional contribution to the child’s development, Pande (2009) found thatIndian gestational surrogates believed that their blood tie to the childcontributed to the baby’s identity more than genetics. She argued thatkinship ties can be viewed in alternative ways, to include the sharing ofbodily fluids such as blood, sweat and breast milk. In conclusion, thesestudies suggest that those involved in surrogacy form views and opin-ions that at times reinforce or de-emphasise their role in the process,thereby seeming to enable both traditional and gestational surrogacy towork successfully (see Edwards, Chapter 2, for a discussion of Thomp-son’s concept of ‘strategic naturalizing’ whereby various links betweenpersons are negotiated, affirmed or denied in the process of legitimatingthe chosen procedures and hoped-for outcome).

The experiences of UK surrogates and their families

The data presented here is part of a larger study looking at the experi-ences of surrogacy from the perspective of surrogates, their partners andtheir children. The majority of the sample had taken part in an earlier


investigation of surrogates who were interviewed one year following thebirth of their surrogacy child ( Jadva et al., 2003). The original study ofthirty-four surrogates found that surrogates maintained good relation-ships with the surrogacy families and many remained in contact withthe surrogacy child. However, just under half of the surrogates describedthe child as being special to them. Whether or not the surrogates felt aspecial bond with the surrogacy child did not differ according to the typeof surrogacy involved.

The current sample consisted of thirty-four surrogates: twelve tradi-tional surrogates, fourteen gestational surrogates and eight surrogateswho had completed both traditional and gestational surrogacies. Twentysurrogates had taken part in the 2003 study, and fourteen were recruitedduring the follow-up phase. Six of the surrogates had completed sur-rogacy arrangements for family members or friends and twenty-eighthad met the couple through surrogacy organisations, mutual friends oronline. Most surrogates had completed more than one surrogacy arrange-ment. The surrogates were asked questions in response to the surrogacyarrangement that they were interviewed about in the 2003 study. Thenew participants were asked about the surrogacy child that was closestin age to the children from the original study. The average age of thetarget surrogacy children was nine years. Seventeen of the children wereborn through gestational surrogacy, and seventeen through traditionalsurrogacy.

The significance of relatedness for surrogates andtheir families

The majority of the surrogates remained in contact with the surrogacychild and most were happy with their level of contact. Of the surrogateswho did not have any contact with the child, most had made a mutualdecision with the couple not to remain in contact either because thesurrogate believed that it was best not to be involved with the surrogacyfamily or because she agreed with the couple’s preference for no contact.Some surrogates who had no direct contact with the child remainedin touch with the couple and received updates about the child. Severalsurrogates remained in contact with some of their surrogacy children andnot others and attributed this difference to the strength of the relationshipthey had developed with the couple during the surrogacy.

For three surrogates, having no contact with the surrogacy child wasnot what they had agreed to at the time of the surrogacy; the surrogateswished to remain in touch but the couple had stopped contact. Theyexpressed sadness about the situation, as well as a desire to know howthe child was doing.


How do surrogates view their relationship to the child?

When asked to describe their relationship with the surrogacy child, sur-rogates’ responses ranged from having no relationship to expressing lovefor the child, with no clear division along genetic and gestational lines.

Several surrogates stated that they were not interested in having arelationship with the child:

I don’t want a relationship with [child], she’s not my child . . . and I couldn’thonestly say that I care anything for her because I don’t, she’s not like my children.(gestational surrogate)

However, the majority of surrogates reported a positive relationship withthe surrogacy child, with many describing a close relationship charac-terised by enjoyment of the child’s company and pleasure in watchingtheir development:

It’s really close, she gets really excited when we come down to see her, and shelikes introducing me to people. (traditional surrogate)

Several traditional and gestational surrogates also spoke about lovingthe child, although they drew a distinction between the love they felt forthe surrogacy child and the love they felt for their own children:

I mean I love her, not as much as I love [daughter] but there’s still a part of methat loves and cares for her. (traditional surrogate)

However, irrespective of the closeness of their relationship with the sur-rogacy child, the majority of gestational and traditional surrogates didnot view the surrogacy child as their own child:

It was like watching somebody else give birth . . . not that I didn’t feel connectedit was just I was so pleased for my friends that were having a baby, and even when[child], initially they put her on my stomach to cut the cord, and even when shewas sort of still connected and lying on my stomach she still didn’t feel like shewas mine. (traditional surrogate)

Metaphors emphasising the transitory nature of the surrogate’s rolein the child’s creation and downplaying any connection between thesurrogate and the foetus in utero were employed by some surrogates fromthe beginning of the arrangement, as was the idea of “looking after” thebaby and “giving the baby back” to its parents:

I was only ever going to be a hotel for the baby. I was never going to be anythingother than first-class accommodation. (gestational surrogate)

The idea of the surrogacy child as the intended couple’s child remainedconstant over time, with many traditional and gestational surrogates


describing the child as a “friend’s child” and explaining that they hadno maternal feelings towards the child:

My relationship with [surrogacy child] is no different to my relationship withany of my other friends’ children . . . I’m really proud of her because I think thatthey’re a family because we decided we were going to grow her but I don’t feelany attachment towards her. (gestational surrogate)

While the surrogates did not view the surrogacy child as their own,the question of how they did choose to describe their relatedness to thechild is of particular interest. Several gestational and traditional surro-gates used kinship terminology when defining their relationship, describ-ing the child as a niece/nephew despite there being no family connec-tion with the intended couple. The surrogate was, in some cases, alsoreferred to as an “auntie” by the surrogate child. Other terms included“special auntie” and “tummy mummy”. The three surrogates who hadcompleted gestational surrogacy arrangements for family members andtherefore were already related regardless of the surrogacy arrangementall described themselves as playing their kin role within the family, thatis, as an aunt or grandparent. In a few instances gestational surrogatesplayed an additional role in the surrogacy family’s life as the godmotherof the surrogacy child, and three of the intended couples were godpar-ents to their traditional surrogates’ children. This additional role adds aninteresting dimension to their perception of relatedness, because as wellas being a reflection of the closeness of some of the relationships createdbetween surrogates and intended parents, formalising the relationshipin this way could be interpreted as an attempt to strengthen the bondbetween families and ensure the relationship’s permanence.

For those surrogates who had completed both traditional and gesta-tional surrogacy arrangements, some variation was apparent with regardto how they viewed their relationship to their surrogacy children. Sev-eral surrogates did not describe any difference in their relationships tothe gestational and traditional surrogacy children. However, one surro-gate believed that she had a stronger bond with the traditional surrogacychild and one felt closer to the gestational surrogacy child. One surro-gate referred to the gestational and traditional surrogacy children in thesame way, as “my two surrogate sons”, but suggested that the handoverprocess was harder with the traditional surrogacy child. Another surro-gate thought that although the handover process was the same, stayingin contact with the gestational surrogacy child was less important thanwith the traditional surrogacy child. Interestingly, several surrogates sug-gested that the way they viewed their relatedness to the children may beinfluenced by factors other than the type of surrogacy involved, including


the gender of the child, the strength of the relationship with the child’sparents and the order in which the children were born.

What are surrogates’ views on the significance of geneticand gestational relatedness?

While previous research has suggested that the significance surrogatesascribe to genetic and gestational relatedness is a fixed position reflectedin their choice of surrogacy type (van den Akker, 2003), our findingssuggest that these beliefs may, in fact, be more fluid. In response to beingasked why they had originally chosen traditional or gestational surrogacy,the majority of gestational surrogates gave reasons related to the absenceof a genetic link with the child, in terms of the assumed benefits to boththe surrogate herself and the couple:

I didn’t want a biological connection to the child, because I always felt there thenwould be more of a torn feeling of, you know, basically giving my own child away,and I felt it was brilliant that a couple that used a surrogate would actually endup with their own biological child and I just thought that was probably better forthe couple as well. (gestational surrogate)

However, of the surrogates who cited an initial preference for gestationalsurrogacy, three had actually gone on to do traditional surrogacies anda further six said that they would have considered doing traditional sur-rogacy at the time or would consider it in the future. Their views on thesignificance of genetic relatedness may therefore not be fixed positions.Several surrogates mentioned that the relationship they had developedwith the couple would be an important factor in deciding whether ornot to undertake a traditional surrogacy, indicating that it may in factbe the relationship with the couple that holds more significance for thesurrogate than her concepts of genetic relatedness. One surrogate whohad been both a gestational and traditional surrogate for the same fam-ily described her original preference for gestational surrogacy, stating,“I didn’t mind carrying somebody else’s child, but I didn’t particularlywant a child of mine somewhere else that I didn’t know because I’dworry.”

However, once she had an established relationship with the couple andknew the environment in which the child would be raised, her view oftraditional surrogacy altered:

I know where [genetic surrogacy child] is. I know exactly which situation he’sin and you couldn’t, you couldn’t ask for better parents with [couple], theyabsolutely adore them kids.


Of the surrogates who had originally chosen traditional surrogacy, fiveexplicitly mentioned that their decision had been influenced by a beliefthat genetic relatedness was not significant:

I knew that I wouldn’t have a problem with sharing my genetics. (traditionalsurrogate)

However, the significance of genetic relatedness was not the only factorin surrogates’ decisions about which type of surrogacy to pursue. Otherreasons for choosing traditional surrogacy included a desire to avoid thehospitals and medication involved in gestational surrogacy; traditionalsurrogacy offering an ‘easier’ option with regards to travelling and timespent away from family; an awareness that traditional surrogacy was theonly option available to some couples due to the prohibitive cost of IVFtreatment and/or the intended mother’s medical situation. Furthermore,several surrogates chose their couple first and then decided which type ofsurrogacy to pursue based on the type of surrogacy the couple needed,suggesting that their desire to be a surrogate and the relationship with thecouple held more significance than whether or not they were geneticallyrelated to the child.

Although some traditional surrogates stated that their genetic link tothe child was of little importance, for others the significance of the geneticlink was more nuanced. Over half of the traditional surrogates had com-pleted a repeat surrogacy for the same couple. One of the reasons thesurrogates gave for doing this was that they believed it was important forsiblings to have the same genetic parents:

I just thought, by being involved they’ve got the same bloodline, you know, theyshare the same parent, which is I think quite important for brother and sister.(traditional surrogate)

However, the significance that surrogates placed on genetic relatednessbetween siblings should not be overstated. Over a third of the gestationalsurrogates had also completed a repeat surrogacy for their couples. Bothtraditional and gestational surrogates mentioned the benefits of carryingout repeat surrogacy arrangements with couples they knew and trustedrather than restarting the lengthy process of getting to know new couples.It is possible, therefore, that the success of previous surrogacy arrange-ments and the relationship with the couple during the surrogacy processmay also have some bearing on this decision.

Around half of the traditional surrogates mentioned physical similar-ities between the surrogacy child and the surrogate or the surrogate’schildren, and used these similarities to illustrate a variety of points. Onesurrogate thought that noticing similarities in her surrogacy children as


they grew older increased the significance of their genetic relatednessover time:

As the children grow up it becomes more of an issue actually . . . because theystart to look like you and they start to have features like you and you get phonecalls saying, ‘she’s just like you, she’s stroppy’ [laughs] and then you start to thinkactually that’s my child, that’s weird. (traditional surrogate)

Another surrogate and her children drew attention to the physical simi-larities between themselves and the surrogacy children as a way of high-lighting and explaining their genetic relatedness:

All the girls sort of look similar and so we say, ‘look, you’ve got the same hairas [surrogacy child] and you’ve all got a gap in your teeth and that comes frommummy, mummy had a gap in her teeth before I had braces’ . . . they know asmuch as a 5-year-old and a 3-year-old can understand genetics, they understandthat they are related. (traditional surrogate)

The significance of relatedness for surrogates’ partners

Twenty-two of the surrogates had partners at the time they were inter-viewed, fourteen of whom had been living with the surrogate at the timeof the target surrogacy. Eleven partners were interviewed and data aboutthe additional eleven partners’ contact with the surrogacy child werecollected in the surrogates’ interviews.

Two-thirds of the partners were in contact with the surrogacy child.Of the partners who were interviewed, eight had contact with the targetsurrogacy child. Of those who had no contact, two were happy with thearrangement because they felt that it was better not to be involved in thesurrogacy family’s life:

I think let them be, you don’t want to be interfering with their life I don’t think,let them get on with their own life. (partner of gestational surrogate)

However, one partner said that he would like more contact and wascurious about how the child was doing. All three had contact with thesurrogates’ other surrogacy children.

How do surrogates’ partners view their relationship to thesurrogacy child?

The majority of partners who had contact with the surrogacy child sawtheir relationship with the child as a positive one, characterised by enjoy-ment of the child’s company:

She’s smashing, she’s good fun, enjoys life I think. (partner of gestationalsurrogate)


The remaining partners who had contact did not classify themselves ashaving a relationship with the child. One viewed the child as similarto his children’s friends, and another said that he did not have a rela-tionship because the child was not genetically related to him. The twopartners of known, gestational surrogates who were interviewed saw theirrelationship to the child in terms of the kin role they played within thefamily, that is, as an uncle. One suggested that the surrogacy process hadbecome incidental to the current family relationships to the point wherehe sometimes forgot that the child had been born through surrogacy:

I haven’t felt any different from the day that we started the process to the daythat when [surrogacy child] pops round. I don’t feel, I don’t feel any different. Iknow he’s part of the family . . . It doesn’t, doesn’t even pop into my head that,that [surrogate] carried him any more. (partner of gestational surrogate)

Several partners of gestational surrogates who had met their couplesthrough a surrogacy organisation mentioned that the surrogacy childreferred to them as “uncle”, although only one explicitly said that hethought of the surrogacy child “like a nephew” and considered the sur-rogacy family to be an “extra arm to the family”. Several partners whowere referred to by the surrogacy child as “uncle” highlighted that theirrelationship was a step removed from the surrogate’s relationship withthe child:

I’m kind of an uncle really, I’m uncle [partner], but probably not as close asauntie [surrogate]. (partner of gestational surrogate)

How is the surrogate’s relatedness to the child seen fromthe partner’s perspective?

Partners’ preferences for surrogacy type were also revealing about theirviews on the significance of genetic and gestational relatedness. Just underhalf of the partners stated a preference for gestational surrogacy, with sev-eral saying that they did not feel “comfortable” with the idea of traditionalsurrogacy:

I said I’d agree to it only if it was biologically nothing to do with either of us, ’cosI wouldn’t be comfortable with, you know, any sort of half-siblings, that kindof thing, and that sounds, maybe sounds a bit selfish because there’s people outthere that are desperate to have kids and, um, they probably don’t mind if it’s notentirely theirs but I just feel strange about it. (partner of gestational surrogate)

One partner stated a preference for gestational surrogacy but said thattraditional surrogacy was something that he and the surrogate mightconsider in the future if gestational surrogacy attempts had failed andthey had a strong relationship with the couple. One partner stated a


preference for traditional surrogacy, the type of surrogacy undertakenby his partner, and three other partners showed no preference as tosurrogacy type, stating that the decision was the surrogate’s. The majorityof partners therefore believed it was up to the surrogate to ascribe the levelof significance given to the genetic or gestational ties with the surrogacychild.

The significance of relatedness for surrogates’ children

Thirty-six children of surrogates (fourteen male, twenty-two female) wereinterviewed as part of this study. They were aged between 13 and 25years old and were from twenty-three families. Fifteen were children ofgestational surrogates, fourteen were children of traditional surrogatesand seven were children of surrogates who had completed both typesof surrogacies. Twenty-seven were children of repeat surrogates. Themajority were in contact with a surrogacy child.

Where there was no contact with the surrogacy child, reasons for lackof contact varied but a common theme was the belief that the surrogacychild’s life and family were separate from their own:

I suppose he’s my half-brother but I don’t really look at it that way. He’s someoneelse’s child, I don’t know the parents, I don’t know the kid so no link. (child of atraditional surrogate)

Many of the surrogates’ children were content with their current situ-ation, believing that the surrogacy child was happy and that it would bebetter if they did not interfere with his or her life:

It wasn’t really too much to do with me personally I guess, I mean mum sortof gave them the opportunity to do something they’ve always wanted to do, andyeah obviously I’m just happy for them to sort of get on and sort of be a happyfamily. (child of a gestational surrogate)

Several mentioned that, while they did not currently have contact withthe surrogacy child, they could if they wanted to and they enjoyed hearinghow they were getting on.

How do surrogates’ children see their relationship to thesurrogacy child?

The significance of relatedness for surrogates’ children does not appear tobe clearly divided along genetic and gestational lines. Half of the childrenused kinship terminology to refer to the surrogacy child, using termssuch as “brother” or “sister”, “half-brother” or “half-sister” or “like acousin”. This may indicate that they saw the surrogacy child as part of


their family although the extent to which terminology reflects the natureof relationships should be interpreted with caution. Other terms usedby children of gestational surrogates included “surro-sister”, “tummy-sister” and “surrogate brother”, and one child of a traditional surrogatedescribed the relationship as “half-family”. The variety of terms usedby surrogates’ children to describe their relationship to the surrogacychild suggests that their relatedness can be difficult to define. Some useddifferent terms over the course of an interview and several explicitlymentioned that they were unsure how to classify the relationship usingpre-existing terms:

The other children um, they’re like, it’s almost like cousins or something, they’relike, you know, they’re really close but I don’t know, it’s a weird bond that youhave that you can’t really put, it’s not like, they’re not my brothers and sisters,but it’s just like your cousins that you get quite excited to see, or like niecesand nephews that kind of thing. (child of a surrogate who had undertaken bothtraditional and gestational surrogacy arrangements)

One child of a surrogate described feeling pressure from people outsidethe surrogacy arrangement to give a name to her relationship with thesurrogacy child. Defining the relationship may therefore not be as muchof a concern to the surrogates’ children themselves as to those outsidethe relationship:

If people say ‘so what’s your relationship?’ then you have to kind of, I think peoplefeel like they have to give it a name, so we did, we gave it an auntie and a cousin.(child of a surrogate who had undertaken both genetic and gestational surrogacy)

Despite having chosen a term to use before the child was born, on firstmeeting the surrogacy child this participant was able to reflect on howshe felt about the relationship and decide on a definition which felt rightfor her:

I sort of remember when we were driving up to see him . . . it sort of suddenlycrossed my mind, what if I do feel like he’s a brother and I feel like something’sgoing on wrong? And they gave him to me and I remember, I [laughs] they handedhim over so that I could have a little moment and I remember chatting to himand saying ‘oh you’re my cousin’ and I sort of explained to him what’s happenedand who I was and, obviously he was a baby he didn’t actually understand, but Iwas fine with it.

These findings suggest that, for surrogates’ children, the process ofattributing significance to their genetic or gestational relatedness is adynamic and reflective one (for a discussion of the terminology used bydonor relations to define their relatedness, see Freeman et al., Chapter16). Similarly, Mason and Tipper (2008), who conducted qualitativeinterviews with children from a range of socioeconomic, cultural and


ethnic backgrounds, found that even younger children from the age of 7to 12 years have creative ways of defining and understanding kinship andcan create ‘like-family’ kinship with unrelated others.

In several cases where the use of traditional surrogacy had not beendisclosed to a surrogacy child, a surrogate’s own children could findthemselves in an uneasy situation where they knew they were geneticallyrelated to the surrogacy child but the surrogacy child did not. For somechildren this could lead to some confusion in terms of the sort of relation-ship they should form with the surrogacy child. One such child, whenasked what the most difficult part of the surrogacy was for her family,replied:

child . Her not knowing who like who we actually are.inter viewer . And what do you think about that?child . I don’t like it, ’cos you can’t talk about it, you’ve got to keep quiet and

it’s horrible. (child of a traditional surrogate)

Half of the surrogates’ children used terms that highlighted theireschewal of genetic or gestational relatedness. Language used by chil-dren of both gestational and traditional surrogates included referring tothe child by name or as “mum’s surrogate child”. Other terms used bychildren of traditional surrogates included “mum’s friends’ kids” and“one of the surrogates”. In several cases a neutral or indifferent tonewas used when talking about the surrogacy child, perhaps indicating asense of separation from the surrogacy child. One child of a traditionalsurrogate described them as, “they’re just sort of kids out there”.

For several children of traditional surrogates genetic relatedness wasseen to hold little significance, with social motherhood deemed moreimportant:

Obviously [surrogacy child] has the right to be told, you know, [intended mother]isn’t your biological mum, but at the end of the day your mum’s somebody whopicks you up and gives you dinner and, you know, gives you kisses when you’renot feeling well and she is there for that, it’s not my mum. (child of a traditionalsurrogate)

Interestingly, one surrogate’s child, although not viewing genetics assignificant in terms of his own relatedness to the surrogacy child, believedknowledge about genetic relatedness could be important for surrogacychildren:

I think if you had two surrogate mums for like for two separate children for thesame people you might have to explain to both of them that they’re not reallylike related, well they are but, you know they’ve got different mums and I thinkit’s nice for them to come from the same. When you tell them you can tellthem together and tell them they came from that person. (child of a traditionalsurrogate)


The seven children of mothers who had been involved in both types ofsurrogacy varied in how they viewed their relationships to the traditionaland gestational surrogacy children. Several children said that they feltequally close to, and used the same terms to refer to, both kinds of surro-gacy children. However some were unsure about whether they viewed thesurrogacy children in the same way and found the relationships difficultto define.

Conclusion

This chapter has shown that perceptions of relatedness among surro-gates, their partners and their children are complex and varied. Whilesurrogates shared the belief that the surrogacy child was the intendedcouple’s child and not their own, definitions of relatedness were variedand ranged from describing the surrogacy child as “family” to describinghaving no relationship with the child at all. These varying definitionswere apparent regardless of whether traditional or gestational surrogacyhad been undertaken. However, as shown throughout this chapter, sur-rogates, their partners and children, as well as the surrogacy families,all struggled to find the ‘right’ terminology to describe their relationshipwith each other. The significance of these relationships is perhaps bet-ter understood by the way people experience and perceive them, ratherthan drawing direct meaning from the terms they use to describe eachother. For some surrogates, the importance of their relationship to thesurrogacy child seemed to be based more on the relationship with thecouple than on the genetic and/or gestational link to the child. Moreover,some traditional surrogates held conflicting views on the significance ofgenetic relatedness, downplaying their own genetic relatedness to thechild while also highlighting that the surrogacy child may value knowingother children with whom she shares a genetic connection, whether thatbe the surrogate’s own children or her other surrogacy children.

Children of surrogates showed similarly varied and nuanced percep-tions of relatedness. Some surrogates’ children used kinship terminologyassociated with family relatedness such as “brother” and “cousin”. Oth-ers did not seem to ascribe any significance to their genetic or gestationalrelatedness to the surrogacy child and chose to have no relationship withthem. In addition, children created their own terminology to describethis new form of connection such as “surro-sister” and “tummy-sister”,highlighting an attempt to define a relationship that existing terminologydoes not adequately describe.

By exploring and comparing the narratives of both traditional andgestational surrogates, this chapter has shown that it is too simplisticto suggest that all traditional and gestational surrogates have different


views of genetic relatedness that align with the type of surrogacy theychoose to engage in. Rather, it appears that the decision to act as atraditional or gestational surrogate is influenced by additional factorssuch as their relationship with the intended couple and the practicalities(e.g. time, cost) of engaging in each type of surrogacy. Thus, it appearsthat these surrogates’ views on relatedness were not static, but fluid andtransitory.

References

Armour, K.L. (2012). ‘An overview of surrogacy around the world’. Nursing forWomen’s Health, 16, 231–6.

Braverman, A. and Corson, S. (2002). ‘A comparison of oocyte donors’ andgestational carriers/surrogates’ attitudes towards third party reproduction’.Journal of Assisted Reproduction and Genetics, 19, 462–69.

Braverman, A., Casey, P. and Jadva, V. (2012). ‘Reproduction through surro-gacy: the UK and USA experience’, in M. Richards, G. Pennings and J.B.Appleby (eds.), Reproductive Donation: Policy, Practice and Bioethics. Cam-bridge University Press.

Crawshaw, M., Blyth, E. and van den Akker, O. (2012). ‘The changing profileof surrogacy in the UK – implications for national and international policyand practice’. Journal of Social Welfare and Family Law, 34, 267–77.

Golombok, S., Murray, C., Jadva, V., MacCallum, F. et al. (2004). ‘Familiescreated through surrogacy arrangement: parent-child relationships in the1st year of life’. Developmental Psychology, 40, 400–11.

Golombok, S., MacCallum, F., Murray, C., Lycett, E. et al. (2006a). ‘Surrogacyfamilies: parental functioning, parent-child relationships and children’s psy-chological development at age 2’. Journal of Child Psychology and Psychiatry,47, 213–22.

Golombok, S., Murray, C., Jadva, V., Lycett, E. et al. (2006b). ‘Non-geneticand non-gestational parenting: consequences for parent-child relationshipsand the psychological well-being of mothers, fathers and children at age 3’.Human Reproduction, 21, 1918–24.

Golombok, S., Readings, J., Blake, L., Casey, P. et al. (2011). ‘Families createdthrough surrogacy: mother-child relationships and children’s psychologicaladjustment at age 7’. Developmental Psychology, 47, 1579–88.

Golombok, S., Blake, L., Casey, P., Roman, G. and Jadva, V. (2013).‘Childrenborn through reproductive donation: a longitudinal study of child adjust-ment’. Journal of Child Psychology and Psychiatry, 54, 653–60.

Jadva, V., Murray, C., Lycett, E., MacCallum, F. et al. (2003). ‘Surrogacy: theexperiences of surrogate mothers’. Human Reproduction, 18, 2196–2204.

Markens, S. (2012). ‘The global reproductive health market: U.S. media fram-ings and public discourses about transnational surrogacy’. Social Science andMedicine, 74, 1745–53.

Mason, J. and Tipper, B. (2008). ‘Being related: how children define and createkinship’. Childhood, 15, 441–60.


Pande, A. (2009). ‘“It may be her eggs but it’s my blood”: surrogates and every-day forms of kinship in India’. Qualitative Sociology, 32, 379–97.

Snowdon, C. (1994). ‘What makes a mother? Interviews with women involvedwith egg donation and surrogacy’. BIRTH, 21, 77–83.

Trowse, P. (2011). ‘Surrogacy: is it harder to relinquish genes?’. Journal of Lawand Medicine, 18, 614–33.

van den Akker, O.B.A. (2000). ‘The importance of a genetic link in motherscommissioning a surrogate baby in the UK’. Human Reproduction, 15, 110–17.

(2003). ‘Genetic and gestational surrogate mothers’ experience of surrogacy’.Journal of Reproductive and Infant Psychology, 21, 145–61.

10 Frozen symbols of relatednessBelgian infertility patients and their decisions aboutunused cryopreserved embryos

Veerle Provoost and Guido Pennings

When reproduction moves from the private sphere to a medical setting,it gives rise to a whole set of new issues and decisions to be made. Severalof these decisions relate to the embryos created during in vitro fertilisa-tion (IVF) or intra-cytoplasmic sperm injection (ICSI) treatment. Theseembryos can, if their quality is good enough, be cryopreserved and storedfor use in subsequent treatment cycles. This improves patients’ chancesof becoming pregnant and avoids complications such as multiple preg-nancies. Patients who do not choose to use these embryos will haveto make a decision about what to do with them: they can discard theembryos or donate them for research or to others for reproductive use.Over the last decade there have been a growing number of empiricalstudies exploring the attitudes and choices of patients regarding thesedisposition choices. For most patients these decisions are difficult andstressful (de Lacey, 2005, 2007; Fuscaldo, Russell and Gillam, 2007;Provoost et al., 2009). In particular, qualitative studies focusing on themeaning infertility patients attach to their embryos have shown thatpatients’ perceptions of their embryos have implications for their viewsabout options for their disposition (McMahon et al., 2000; de Lacey,2005, 2007; Nachtigall et al., 2005; Parry, 2006; Fuscaldo, Russell andGillam, 2007).

In this chapter we discuss patients’ perceptions of their own cryopre-served embryos and their use in fertility treatment, as well as how theymake decisions about them. The chapter is largely based on three empir-ical studies that were conducted in collaboration with the Departmentof Reproductive Medicine at the Ghent University Hospital in Belgium.A full description of the methods of these studies can be found else-where (Provoost et al., 2009, 2011b, 2012b). In-depth interviews wereconducted with female patients and couples who had had a range ofprevious treatment experiences and were in various stages of IVF/ICSItreatment. All had signed an agreement allowing their supernumeraryembryos to be cryopreserved (Provoost et al., 2009). In order to explorethe full range of possible meanings that patients attach to their embryos,

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Decisions about unused cryopreserved embryos 179

we first analysed their ideas and experiences about these when talkingabout their treatment or answering more general and open questions. Inaddition, we surveyed all female patients whose embryos were in storagefor at least two years at the same department. A postal questionnaire tobe completed anonymously was sent together with the form from theclinic asking the women what they wanted to do with their embryos:continuing storage, donation for research or for reproductive use, or todiscard them. In this study, we also examined the moral status patientsattached to their embryos ranging from seeing these as a “collection ofcells” to giving them the status of a child or a person, as on the scaleused in theoretical ethics. In a third study, response forms from couplescollected over a period of fifteen years were analysed to look for trends inpatients’ decisions about their frozen embryos over time (Provoost et al.,2012b).

Stored embryos and kitchen metaphors

Embryos were perceived by the patients as something rather techni-cal, or as an object or ingredients that were used in their treatments(Provoost et al., 2009). The words patients used to describe their embryoswere influenced by the technical jargon used by the medical staff. Theyassociated their embryos with chances of success, or described them interms of the quality assessment carried out in the clinic laboratory. Thewidespread use of this technical language also indicates that the patients’principal focus was on their treatment and on their embryos as a meansto an end: the production of a healthy baby.

Most patients knew little about the medical or technical proceduresinvolved in treatments with cryopreserved embryos (Provoost et al.,2010). However, this was compensated for by a high level of confidencein the medical team reducing their need for information. When peo-ple are dealing with matters they do not fully grasp, they tend to fillthe gaps in their knowledge with information from other, more famil-iar, domains of experience. We found that infertility patients compen-sated for their lack of technical knowledge by using metaphors, mainlyfrom the kitchen. For instance cryopreservation and storage of embryosin liquid nitrogen tanks at a temperature of −196° Celsius was com-pared with freezing meat by the food industry or in the freezer at home.Such comparisons might seem harmless at first glance but they do entailsome dangers. Projecting characteristics of food or food storage (suchas the reduction in quality during storage time) onto embryo storageresulted in a belief that stored embryos had a best before or expirydate.

180 Veerle Provoost and Guido Pennings

hannah . Obviously, you shouldn’t let ten years go by. Now it has been aboutfive or six months. I don’t think that will be too much. If you look at the foodindustry [laughs] meat may be frozen for a maximum period of three, euhsix months. Preferably a little less . . . But yes, OK.1 (Provoost et al., 2010:708)

While in reality it is possible that embryos can be stored more or lessindefinitely without damage (in Belgium this is limited by law to fiveyears), some patients had doubts about the quality of their embryos aftera storage period of a few months. The use of previously frozen embryoswas sometimes perceived as weird and unnatural.

sandra . It is not natural, you know. Something that you have put in the freezerand later on [ . . . ] You know, it is something strange. (Provoost et al., 2010:708)

Moreover, some interviewees had doubts about the effectiveness of usingcryopreserved embryos as compared to fresh ones, or about the effects offreezing, storage and thawing on the health of their future children. Thesurvey showed that one in four reported worries about the future childdue to the cryopreservation of the embryo (Provoost et al., 2011b).

In contrast to these rather negative perceptions of embryo preservation,however, there were some positive expressions of awe and marvel aboutembryos “coming back to life again” during the thawing process. Someinterviewees even expressed a clear preference for a treatment using cry-opreserved embryos because this was seen as having major advantagesfor them in being less invasive and painful.

Moral status and/or instrumental value of embryos

In theoretical ethics, an entity’s place on the continuum from “collec-tion of cells” to the status of a child or person determines the rightsof and responsibilities for that entity. Our interviewees only occasion-ally mentioned the moral status of their cryopreserved embryos withoutprompting. When they did, their views ranged from seeing the embryoas a collection of cells to a person. Some participants perceived theembryos as children and imagined that all of them would result in babies,even naming them as they would children. Interestingly some patients’accounts also showed that they simultaneously held different views,

1 This and all other quotations in the chapter have been translated from the originalDutch.


suggesting that they (in contrast to professional ethicists) did not takea single position.

sandra . It is an embryo all right, but it’s no baby yet, right. At the end of theday, it is still just a little cell [ . . . ]. We have done three attempts, and thesecond time we had ten in the freezer. And I had something like . . . Whoa,ten little children!

inter viewer . . . . So in the beginning you saw them as little children?sandra . Yes yes, now still! (Provoost et al., 2009: 899)

Our survey indicated that having had children influences a person’sviews on the moral status of an embryo. Patients with children gener-ally attached a higher moral status to their stored embryos compared tothose without children.

We also looked at the instrumental value these cryopreserved embryosheld for the women. In contrast to an intrinsic moral status, this valuedepends on the instrumental use an object or entity has. In the inter-view study, this instrumental value was related to two main factors:first, the enormous physical and financial investment that had gone intocreating the embryo, and second, the existence and needs of potentialrecipients of donated embryos, namely infertile couples and scientificresearchers.

In contrast to the tendency in ethics discussions, attaching a highmoral value or personhood to an embryo did not preclude also attachinginstrumental value to it. Furthermore, these patients did not see theinstrumental use of an embryo as problematic. For some who were willingto donate embryos to others, there was even a partial overlap of reasonsfor doing so: seeing the embryo as a person who deserves to live (donationfor the sake of the embryo) and wanting the embryo to be used to achievethe goals of others, in accordance with the instrumental value it held forthem (donation for the sake of the recipients who wanted to create afamily).

Genetic links and the embryo as a symbol ofthe couple relationship

Some patients attached meaning to their embryos on the basis of thegenetic link between them and their embryos. When referring to thisconnection, patients talked about the embryo as being a part of someoneor belonging to someone, rather than using the language of the geneticlink that clinicians and ethicists employed. In our interview study, we alsoobserved another way of conceptualising the embryo that was confirmed


in our survey (Provoost et al., 2009, 2012a). Several interviewees talkedwith great emotion about their embryo as “something of the two of us”referring specifically to the specific combination of egg and sperm.

The meaning attached to the embryo went beyond the genetic linkto each of the partners separately. For instance, some patients in theinterview study said that they would be happy to donate their eggs onthe condition that they were to be mixed with another man’s sperm. Theresulting embryo would be genetically linked to them but it would notrepresent their own special relationship with their partner.

tessa . If it were just your egg that you would donate, I would not have a problemwith it. But the fact that it is an embryo, that I consider something totallydifferent altogether. That’s already something of yourself and your partner.(Provoost et al., 2009: 899)

beth . If it would be from, for example, just an egg of mine or just a sperm cellof his . . . That would be something else, but really . . . of the two of us? No.(Provoost et al., 2009: 899)

This indicates that the embryo had a special status when it derived fromthe couple’s own gametes. The embryo, as a symbol of their relationship,was perceived as something very personal and reflected a strong sense ofownership. Furthermore, patients who held this view believed that theirembryos were not transferable and often expressed a great reluctance todonate to others (as well as to receive embryos from others). For thesemen and women, in fact, the donation of such a symbol seemed almostbeyond belief.

linda . Because it is something personal! I mean, it is ours really. (Provoostet al., 2009: 899)

The subsequent survey results showed that, at least for female patients,this view was largely predominant: two-thirds of the female respondentsheld this view while only 12 per cent did not (Provoost et al., 2012a).It was more often seen in women who wanted to have a(nother) childand those whose last treatment cycle was more recent (less than threeyears ago), suggesting that it might not be a consistent view and couldbe linked to their wanting a child. These women were also more oftenreligious (mainly Catholic), had more education and tended to attacha higher moral status to their embryos. Interestingly, this view was notchanged if their relationship symbolised in the embryo had ended. Thissuggests that an embryo created from the sperm of the now ex-partnerdoes not necessarily cease to be a significant representation of that pastrelationship.


Feelings

The feelings patients expressed when talking about their embryos wereboth positive and negative and mostly linked to their medical-technicalperspective of the embryo as part of their treatment, for instance, rep-resenting their hopes for a successful outcome. A number of womentook this view to create an emotional distance from their embryos as aprotective coping strategy, preventing them from getting too emotionallyattached. Conversely, participants who mostly described their embryos aschildren expressed more positive feelings towards them. One intervieweespoke of her feelings towards her embryo: she gave it a name and talkedabout feeling sorry for it because it had not survived the thawing process.

Disclosure to future children

Most of the interviewees thought they would tell a future child thatthey had resulted from an IVF treatment with a cryopreserved embryo(Provoost et al., 2010). The heritability of the causes of infertility or sub-fertility was an important element in making that decision: if it was notheritable, some would choose not to tell a child. Others would informtheir child about IVF treatment in general and would only offer infor-mation about the cryopreservation of the embryo if this was requested.Some of the interviewees struggled with the idea of speaking about thecryopreservation to their children, referring to the kitchen freezer andsaying that it was a “weird” or “funny” thing to talk about.

Telling their child about the treatment was also a way to avoid secrets,which patients feared might create problems. Being open would avoidnegative reactions from the child. Patients who planned to tell referredto the child’s entitlement to this information, or their “right to know”.

Decisions about storage and use: embryos and emotions

The first decision patients need to make about their supernumeraryembryos is whether they want the unused ones to be cryopreserved.Interestingly, most of the interviewees did not see this as a decision thatwas theirs to make. Instead, it was perceived as a fixed and pre-establishedpart of the procedure. This perception was also found in relation to otheraspects of the treatment. One woman compared the process with beingon a train: what would happen on the way was something you chose tosubmit yourself to rather than something you could control. Once youstarted, you just did what was proposed, a woman said. Although noneof the interviewees felt coerced, they did not feel that they had a choice


in these matters. Possibly because of this, some participants even ‘forgot’some of what they had consented to, including signing the consent formfor cryopreservation.

In the survey, three-quarters of the patients reported that at the timeof cryopreservation, they intended to use their frozen embryos in a sub-sequent treatment cycle. However, the others had no clear intention atthat time and mostly acted upon professionals’ advice (Provoost et al.,2011b). Once embryos were cryopreserved, patients inevitably had todeal with a subsequent decision about their use (and the continuation ofthe storage in anticipation of this use). For most patients, the storage feewas not an important factor in this decision.

After an embryo storage period of at least two years, 40 per cent ofthe couples who were still together wished to continue storage of theirembryos, although half of them had no concrete plans for an embryotransfer. Only 27 per cent had such plans. The others wanted to postponethe decision, or to keep all options open. Patients who wanted to continuestorage had a significantly more emotional approach to their embryos,thought more often about them, and were more likely to have feelings ofanticipated regret. Such anticipated regret, being afraid that you mightlater regret the decision you make now, was reported by almost threetimes as many of the women who wanted to continue the storage of theirembryos than by other patients (Provoost et al., 2011b).

After two years, 60 per cent chose to end the storage, mostly becausepatients regarded their families as complete. Although the patients’ wishto have a child was the main factor in their storage decision, there weretwo interesting groups of women with distinct profiles who made deci-sions that were inconsistent with their wish for a child. One group wantedto continue storage while not wanting a(nother) child (7 per cent of thewomen with no wish for a child) whereas the other group, who hasreceived little attention in the literature thus far, wanted a(nother) childbut decided to end storage (25 per cent of the patients who wanted achild). Both these groups of women more often expressed emotionaldifficulties about their decision.

The reasons for the inconsistency between wanting a child and thestorage decision can be found in other factors related to the embryoor the disposition decision (Provoost et al., 2011b). In the first group,women who wanted to hold on to their embryos while not wanting a childdiffered in their emotional attitude towards the embryos or the decisionfrom those who decided to discontinue storage in this situation. Thesewomen were especially susceptible to feelings of anticipated regret. In thesecond group, there were some women whose decisions were associatedwith misconceptions and negative beliefs about the embryo (such asthose mentioned earlier), some saying that they did not want “these”


particular cryopreserved embryos. Other women’s decisions stemmedfrom a lack of information. Overall, it is important to note that thewomen who had doubts or mistrusted the use of cryopreserved embryosdid not talk to the medical staff about this, leaving staff largely unawareof this problem.

The disposition decision

Our fifteen-year trend analysis showed that donation of embryos to otherswas overall the least popular option, and it decreased in popularity overtime (Provoost et al., 2012b). Donation for research rose in popularitysince its introduction in 1997 and offered patients an alternative to dis-carding their embryos. Interestingly, a substantial number of patients didnot hold fixed disposition preferences over the years and there was greatvariability in individual couples’ choice scenarios.

During the interviews, participants talked with great emotion aboutthe possibility of donating their embryos to others and, in most cases,instantly took a stand: they were either resolutely in favour or resolutelyagainst. The latter group contained all interviewees who valued theirembryos on the basis of the genetic link to themselves, or saw the embryoas a symbol of their couple relationship. Further considerations, such ashelping others, also played a part in this decision. This was given as themost important reason why some chose to donate. It was easily overruled,however, by views related to their genetic link with the embryo, or theembryo as a symbol of their couple relationship.

Reasons for not donating to others were also related to considerationsabout the well-being of the child, of themselves as donors, and/or ofthe receiving couple. Participants talked about feelings of responsibilityfor the welfare of the potential offspring and the wish to protect theirinterests. Lack of control in this area was one of the reasons given notto donate. Others were fear of being confronted with the offspring in thefuture, or that the offspring would always be on their minds and theywould not be able to stop wondering about them. One woman who hadover ten unsuccessful transfers of both fresh and cryopreserved embryosdecided not to donate to others because she did not want to give thesepatients false hopes. She said donation would definitely have been anoption if she thought that her embryos were of good quality.

Interestingly, interviewees who attached a high moral status to theirembryo did not refer to this as a reason for choosing to donate to others.Instead, they referred to the instrumental value of the embryo in thatrespect: they could make someone happy through donation. For others,this instrumental value was the reason they donated to research. Somepatients valued these two options equally. The different outcome for the


embryo itself (certain destruction versus a chance for life) was not anissue in weighing these options.

Overall, more than 60 per cent described the disposition decision asemotionally loaded and more than one in four reported feelings of antic-ipated regret (Provoost et al., 2012a). The decision-making process forwomen who saw the embryo as a symbol of their couple relationship wasnot more difficult in general but it was more emotional and grief-laden.These women also thought about their embryos more often comparedwith others. The link between this view and the outcome of the decision-making process was confirmed in the survey: fewer women with this viewconsidered donation of either type, but they were especially reluctant todonate to others. These respondents considered the embryo to be toopersonal to give away and feared that they would think too much aboutthe child in the future. Some women with this view would not considerany of the three standard options.

Forgotten embryos

Each year, approximately a third of the forms sent in the mailing pro-gramme at the department in Ghent remained unanswered (Provoostet al., 2012b). Another 3 per cent of the forms could not be deliv-ered because the patients had moved without updating their addresses.Worldwide, this phenomenon leaves fertility centres with a substantialnumber of embryos in prolonged storage and difficult ethical questionsto address. In our survey, 12 per cent of the women admitted to benon-repliers, mostly because they could not reach a joint decision withtheir partner (Provoost et al., 2011a). These women had more often hada negative outcome in previous treatment cycles. They were somewhatolder, more often childless, and more susceptible to anticipated regretabout their disposition choice. They also valued their embryos mostlyin terms of the probability of use for their own treatment. This outlookcould explain the phenomenon of abandoned embryos, since the valueof the embryo can change as couples go through the treatment period.Embryos lose their original value the moment it is decided not to usethem. Another explanation lies in patients’ anticipated regret, knowingthat there is always a theoretical chance that their situation could changeand lead to using these embryos again. This also offers a possible explana-tion for why patients without a current wish for a child want to continuestorage. Apart from the four disposition options discussed so far, someauthors have suggested that patients may distinguish a fifth and sixthalternative. The fifth is to prolong storage as long as possible (McMahonet al., 2000). The sixth possibility is based on the idea that cryopreservedembryos have an expiry date (Provoost et al., 2009). In this scenario, the


decision is made by omission and the problem solves itself: once past theperceived expiry date, an embryo is no longer seen as a viable embryoand so has no further use. Both of these last two alternatives result ininaction and leaving the embryos in cryostorage (Bankowski et al., 2005).

Discussion

Having children through assisted reproduction takes patients on a jour-ney through an entirely new domain and confronts them with a numberof challenges, especially in the form of the decisions they are requiredto make about aspects of their highly specialised medical treatment.Although patients have access to information about their conditions andthe treatments offered at the clinic, they will need to make such decisionsas laypeople and not as experts. Therefore, it is essential to study theconcepts, principles and values in which their decisions are grounded.We found that patients were aware of their lack of knowledge about themedical and technical aspects of embryo cryopreservation but that theydid not express a need for more information. Rather, they complementedtheir limited knowledge with understandings drawn from other domains,thereby becoming prone to misconceptions, doubts and fears. Miscon-ceptions and negative beliefs about the effectiveness of treatment withcryopreserved embryos did not only have an impact on their decisionsabout the disposition of embryos they no longer wish to use but alsoabout their treatment in general. We saw that despite patients’ high con-fidence in the medical staff, they sometimes had questions about the useof cryopreserved embryos that led to inconsistent treatment decisionswith important consequences. For instance, some patients decided todiscontinue the storage of their embryos on the basis of negative beliefsabout frozen embryos while still wanting another child (Provoost et al.,2011b). In some cases, these women returned to the clinic for a newcycle of IVF to create new embryos some months after their decision todiscard their cryopreserved embryos. Apart from reducing their chancesof becoming pregnant, these decisions also give rise to extra (and poten-tially unnecessary) financial and emotional investment in their treatment.What is more, the fact that decision-making about embryos is a very per-sonal and private matter and patients seldom discuss their doubts andworries with the medical staff suggests that these patients’ difficulties gounnoticed by professionals.

Patients are not professional ethicists

The data described in this chapter are based on three studies that haveadded to the body of research about how patients deal with assisted


reproduction and with their cryopreserved embryos in particular. Start-ing from an exploration of patients’ conceptualisation of the embryo andstepping back from presuppositions about the views of infertility patients,these studies have provided several new insights into patients’ beliefs andviews that are important in their decision-making about the subsequentuse of cryopreserved embryos or the disposition of embryos that remainafter their treatments are completed. In this way, these studies meet someof the recent criticisms of bioethics for too often framing questions in anabstract way, and so failing to take account of the social contexts of deci-sion making (Corrigan, 2003; Hoeyer, 2003; Hedgecoe, 2004; Bahadur,Morrison and Machin, 2010). With such a view of bioethics, the patientis too often reduced to an agent in a rational-choice model who merelyresponds to the issues identified as relevant by ethicists (Corrigan, 2003;Hoeyer, 2003). The studies presented here were set up in an attempt toprovide the broader outlook that is needed.

We found that patients’ beliefs about embryos can differ greatly fromthose of professional ethicists. For instance, patients cannot be ascribedto a single point on a moral status continuum; a presupposition oftenimplied in the literature. Although there is a lot of discussion amongethicists about the moral status of the embryo, their disagreements arerelated to the place of that status on a continuum between a view of anembryo as a mere collection of cells to the embryo as having the status ofa person. The concept of such a continuum itself, and more especially thefact that an individual’s understanding of an embryo should in principlebe located, in a consistent way, to one specific point on the line, is notquestioned. Other empirical studies also have found widely divergentviews among participants (Nachtigall et al., 2005; Lyerly et al., 2006;De Lacey, 2007; Fuscaldo, Russell and Gillam, 2007), but there havebeen no descriptions of multiple understandings that may co-exist in thenarratives provided by the actors involved.

Findings like ours not only show how patients think about theirembryos, but also demonstrate something about the methods that arerequired for such research and the risks involved in imposing the analyticconstructs of professionals onto laypeople. Being aware of such pitfallscan prevent wrong conclusions and provide answers to long-standingquestions. One such question was reported in 1995 in the form of a seem-ingly irrational finding regarding patients who thought of their embryosas children, but then decided to discard these “children” (Laruelle andEnglert, 1995). By focusing on patients’ own constructs, we have revealeda way of conceptualising the embryo that has not been portrayed before,namely the symbolic value of the embryo as the embodiment of therelationship between the partners. This concept places earlier findingsin a new light: why patients who regard their embryos as children may


choose to destroy them rather than donate them to others, without seeingthis as morally inconsistent. We also found that the moral status of theembryo was hardly ever mentioned in our participants’ explanations oftheir choices about donation to others, showing the importance of avoid-ing the question of moral status as a starting point in studies of decisionsabout embryos. This is also underlined by the fact that patients can attachtwo values to the embryo at the same time; values that appear contradic-tory according to the literature on theoretical ethics: that the embryo is anentity with a high moral status, and as having a high instrumental value.

The embryo as a symbol

In the patient’s view, the embryo can have two symbolic meanings. Thefirst meaning is related to the treatment in which the embryo symboliseshope for success and a chance to have a child. The embryo stands forthe effort, time and resources that have gone into its creation and so itmay be seen as having a high instrumental value. The second symbolicmeaning is related to the relationship between the two partners. Thissees the embryo as the embodiment of the couple’s relationship and islinked to a reluctance to donate the embryo to others. For patients whohold this view, the embryo is something personal and unique. It is highlyvalued even when the patient decides that it will not be used to create achild, either in their own treatment or through donation to others. Thissymbolic value was identified as a key factor in patients’ decisions.

Interestingly, we found a connection between the way the embryo wasseen as a symbol of the relationship and its moral status: women with thisview tended to attach a higher moral status to their embryos. However,these patients did not prefer disposition options that would not lead tothe embryo’s destruction. We interpreted these patients’ unwillingness toconsider donation to others as more related to their personal feelingstowards the embryo (fear of being too preoccupied, viewing the embryoas something too personal to give away) than to the moral status of theembryo, a cognitive attitude.

Emotions as determining factors in embryo decision-making

The study of emotional aspects of patient choices has received very littleattention so far, although it appears to be an important aspect of theirdecision-making (Hershberger and Pierce, 2010). Feelings have gener-ally been seen as mere side effects of decisions related to embryos. How-ever, in contrast to professionals, patients may make their decisions withtheir feelings rather than more rational considerations: hearts, not minds.We have several examples in our studies emphasising this possibility.


The storage decisions, for instance, may be based more on feelings ofanticipated regret than on any clear plan for having children.

Another example of an emotional issue was the decision to donate toothers. Here the emphasis was on feelings associated with giving away avery personal and unique symbol rather than consideration of the moralstatus of the embryo. The concept of the embryo as a symbol of thecouple relationship is also clearly embedded in the women’s social con-text, namely their relationships with their partners. In fact, this showsthat patients do not only ground their decisions in strictly rational con-siderations (relating to their wish to have a child, their view of the moralstatus of an embryo, and so on) but also on their emotions and feelingsand considerations of their social context.

Getting a full picture of how patients deal with having cryopreservedembryos and making decisions about them will only be possible by tak-ing into account their feelings, conceptualisations, social contexts andthe emotional basis of their decision-making. Future research shouldtherefore not only focus on the emotive experience of making these deci-sions but also on emotion as a dimension in the decision-making itself.Studies based on this approach should carefully distinguish affective atti-tudes (such as the symbolic value of an embryo) from more cognitiveaspects (such as the theme of the genetic link between a gamete providerand the embryo). Our findings emphasise the importance of acknowledg-ing and clarifying the role of these affective conceptualisations in patients’decision-making.

References

Bahadur, G., Morrison, M. and Machin, L. (2010). ‘Beyond the “embryo ques-tion”: human embryonic stem cell ethics in the context of biomaterial dona-tion in the UK’. Reproductive BioMedicine Online, 21, 868–74.

Bankowski, B.J., Lyerly, A.D., Faden, R.R. and Wallach, E.E. (2005). ‘The socialimplications of embryo cryopreservation’. Fertility and Sterility, 84, 823–32.

Corrigan, O. (2003). ‘Empty ethics: the problem with informed consent’. Soci-ology of Health and Illness, 25, 768–92.

De Lacey, S. (2005). ‘Parent identity and “virtual” children: why patients discardrather than donate unused embryos’. Human Reproduction, 20, 1661–9.

(2007). ‘Decisions for the fate of frozen embryos: fresh insights into patients’thinking and their rationales for donating or discarding embryos’. HumanReproduction, 22, 1751–8.

Fuscaldo, G., Russell, S. and Gillam, L. (2007). ‘How to facilitate decisionsabout surplus embryos: patients’ views’. Human Reproduction, 22, 3129–38.

Hedgecoe, A.M. (2004). ‘Critical bioethics: beyond the social science critique ofapplied ethics’. Bioethics, 18, 120–43.


Hershberger, P.E. and Pierce, P.F. (2010). ‘Conceptualizing couples’ decisionmaking in PGD: emerging cognitive, emotional, and moral dimensions’.Patient Education and Counseling, 81, 53–62.

Hoeyer, K. (2003). ‘“Science is really needed – that’s all I know”: informedconsent and the non-verbal practices of collecting blood for genetic researchin northern Sweden’. New Genetics and Society, 22, 229–44.

Laruelle, C. and Englert, Y. (1995). ‘Psychological study of in vitro fertilization-embryo transfer participants’ attitudes toward the destiny of their supernu-merary embryos’. Fertility and Sterility, 63, 1047–50.

Lyerly, A.D., Steinhauser, K., Namey, E., Tulsky, J.A. et al. (2006). ‘Factorsthat affect infertility patients’ decisions about disposition of frozen embryos’.Fertility and Sterility, 85, 1623–30.

McMahon, C., Gibson, F., Cohen, J., Leslie, G. et al. (2000). ‘Mothers conceiv-ing through in vitro fertilization: siblings, setbacks, and embryo dilemmasafter five years’. Reproductive Technologies, 10, 131–5.

Nachtigall, R.D., Becker, G., Friese, C., Butler, A. et al. (2005). ‘Parents’ con-ceptualization of their frozen embryos complicates the disposition decision’.Fertility and Sterility, 84, 431–4.

Parry, S. (2006). ‘(Re)constructing embryos in stem cell research: exploring themeaning of embryos for people involved in fertility treatments’. Social Scienceand Medicine, 62, 2349–59.

Provoost, V., Pennings, G., De Sutter, P., Gerris, J. et al. (2009). ‘Infertil-ity patients’ beliefs about their embryos and their disposition preferences’.Human Reproduction, 24, 896–905.

Provoost, V., Pennings, G., De Sutter, P., Gerris, J. et al. (2010). ‘Patients’conceptualization of cryopreserved embryos used in their fertility treatment’.Human Reproduction, 25, 705–13.

Provoost, V., Pennings, G., De Sutter, P. and Dhont, M. (2011a). ‘The frozenembryo and its nonresponding parents’. Fertility and Sterility, 95, 1980–4.

Provoost, V., Pennings, G., De Sutter, P., Gerris, J. et al. (2011b). ‘To continueor discontinue storage of cryopreserved embryos? Patients’ decisions in viewof their child wish’. Human Reproduction, 26, 861–72.

Provoost, V., Pennings, G., De Sutter, P. and Dhont, M. (2012a). ‘“Something ofthe two of us”. The emotionally loaded embryo disposition decision makingof patients who view their embryo as a symbol of their relationship’. Journalof Psychosomatic Obstetrics and Gynaecology, 33, 45–52.

Provoost, V., Pennings, G., De Sutter, P., Van De Velde, A. et al. (2012b).‘Trends in embryo disposition decisions: patients’ responses to a 15-yearmailing program’. Human Reproduction, 27, 506–14.

11 Family relationships in gay father familieswith young children in Belgium, Spain andthe United Kingdom

Marcin Smietana, Sarah Jennings, Cathy Herbrandand Susan Golombok

Introduction

Over the last decade in Europe, a growing number of openly gay menhave become fathers, mainly through adoption, co-parenting or surro-gacy. This chapter will explore how gay men who became parents incountries relatively open to gay and lesbian parenting chose their specificroute to fatherhood and how they subsequently enacted family related-ness. Each option has its specificities, advantages and difficulties in termsof legal accessibility, financial costs, social acceptance and consequencesfor family structure and relationships. The analysis will highlight con-trasting views regarding relatedness and family norms among gay fathersand show that although socio-legal constraints and context shaped theirdecision to become parents, their choice of a specific means of havinga child was strongly influenced by the fathers’ priorities regarding theirautonomy as parents, the perceived importance of genetic links to theirchildren and sexually differentiated parental roles, and their moral viewon the different reproductive options available to them.

The chapter is based on three different qualitative research studieswhich were conducted with gay co-parents in Belgium, gay men in Spainwho used transnational gestational surrogacy with egg donation, and gayadoptive fathers in the UK. These three contexts are interesting at a legallevel as laws in favour of gay and lesbian rights have been adopted in thesecountries over the past two decades. Although legislation differs slightlyregarding surrogacy and domestic adoption, these countries have in com-mon a relatively open and tolerant culture for gay parenting, which canexplain some of the similarities found within the three studies. In eachcase, the specific social and legal context will be described before explor-ing the men’s perceptions of family norms, gendered parental roles andbiological relatedness within these different reproductive and nationalsettings.

192

Family relationships in gay father families 193

Gay parenting in Belgium, Spain and the UK:common characteristics and concerns

Although social mores and legislation are becoming ever more favourabletowards gay and lesbian people, it is important to keep in mind thathaving a child is still a struggle for gay men for subjective, social andeconomic reasons. Indeed, within Belgium, Spain and the UK, there arestill discriminations and taboos against gay men, especially when theywant to become parents. For instance, some adoption agencies remainreluctant to let a gay couple adopt a child, even when the law permits,and public opinion of surrogacy remains contentious.

At a more personal level, the initial challenge for many of the inter-viewed gay men who wanted to become parents was the task of integrat-ing parenthood with their gay male identity. Indeed, despite the fact thatmost men, or at least one in each couple, felt they had always wanteda child, they often went through a period of mourning, thinking theyhad to abandon this idea because of their gender, their homosexualityor because some aspects of gay culture distanced them from parent-hood:

I’d been always told the story that ‘if you’re gay, gay men can’t be fathers’.Such education influences one a lot. They start repeating this to you when you’rediscovering your sexuality at 15–16 and so you assume it as a part of the contract.(father by surrogacy)

These gay men therefore had to overcome internalised heteronormativityand homophobia which made them question whether same-sex parent-ing would negatively affect their prospective children. However, whethersexuality was experienced as a limiting factor varied amongst these gaymen, especially by age. Most of the younger men had a strong sense oftheir desire to become a parent from the outset and had decided thattheir sexuality would not prevent them from having a child.

For many men, the desire to have a child was prompted by socialchanges that brought gay fatherhood into their consciousness, such aschanges in the law and the growing representation of gay parents inthe media. It was also influenced by meeting a partner who stronglydesired fatherhood. However, particularly in the co-parenting arrange-ments, some of the interviewed gay men decided to become parentsindependently of their relationship status or their partner’s opinion. Thismeans that the interviewed fathers in the three studies included singlefathers, couples where both men were highly involved and couples whereone man was leading his partner into the parental project or conductingit in a more individualistic way.

194 Marcin Smietana, Sarah Jennings, Cathy Herbrand and Susan Golombok

Co-parenting arrangements

As a means of gaining access to parenthood, co-parenting enables a manand a woman who are not a couple to have a child together and to raise thechild in separate households. They might do so with their own same-sexpartner. One significant feature of such co-parenting arrangements is thatthe father plays an active parental role unlike most lesbian family projectsaccomplished by means of insemination with a known donor (Dunne,2000; Haimes and Weiner, 2000). They also usually involve more thantwo people who take care of the child and, unlike step-families, theseadults become actively involved in the project even before the child’sbirth.

The findings discussed here come from a broader sociological researchproject on multi-parenthood, which was based on the study of gay andlesbian co-parenting arrangements in Belgium (Herbrand, 2008). Theanalysis involved nine different co-parenting cases, each includingbetween two and six co-parents and between one and two children agedunder 15. Several couples connected and organised around differentchild projects: for example, if a lesbian couple could not conceive theirsecond child with the first child’s father and had to find another father.Thus the co-parenting cases in this research were each quite different.In total, extensive biographical interviews were conducted with twenty-six co-parents, comprising eleven women and fifteen men, all living inBelgium.

Social and legal context

From a socio-legal perspective, co-parenting is currently an easier routeto parenthood for gay men in Belgium than adoption and surrogacy.Although gay men in Belgium have had legal access to adoption since2006, it is still very difficult in practice for them to adopt a child, par-ticularly through international adoption. Surrogacy is not legally regu-lated and potential fathers have some leeway with respect to surrogacyarrangements. However, it can be very difficult for a single man or agay couple to come back to Belgium with a child who was born fromsurrogacy abroad and be recognised as the child’s legal parent(s). In thecase of co-parenting, however, fathers do not require approval from anyinstitution and are always designated as the child’s legal father from thestart, if they acknowledge the child at birth.1 This also means that the

1 As the child’s father is not married to the child’s mother, he needs to declare the child atthe Town Hall to be registered as the child’s legal father.


birth mother’s partner cannot have any legal parental position or rightsregarding the child, since legal parenthood is limited to two in Belgium.Despite this, the gay co-parents in this study rarely referred to legalreasons for choosing co-parenting. Some did not even know about therecent legal changes regarding gay and lesbian parenting. When legalchanges were mentioned, it was more to emphasise the impact they hadon public opinion towards gay and lesbian people or on the men’s deci-sion to enact their desire to have a child.

Family norms

Most gay co-parents in this study stated that having a child was not adecision taken lightly. Although they could have opted for other routes toparenthood, it was quite clear that they chose this type of family-buildingafter giving it much thought and for very specific reasons.

The need to have a ‘biologically’ related descendant was a core themein the interviews with the co-parents whose sperm was used to createtheir child (herein referred to as the ‘biological father’). Their wish was,in fact, not only to have a child but to have their ‘own child’ or biologicaloffspring. Many regarded the biological tie as synonymous with ‘realkinship’ and genealogical connection. For example, one biological fathermentioned, “I have to fulfil my need to create life”.2 Another biologicalfather said that he could not consider adoption, even if the inseminationsdid not work, “because I want it to be my child, and by that I mean abiological part of me”.

This idea of biological inheritance also represents generational trans-mission, wherein the continuity of family lineage passes through one’s“blood” or “flesh” (chair). In the case of many co-parents, adoption isrejected or regarded essentially as “a good deed” in order to save a child,rather than as a way of reproducing and continuing the family lineage.As expressed by one of the biological fathers:

If need be, I don’t exclude adoption but I would first like to conceive a childwho comes from myself, who really comes from my flesh (chair), from my familylineage with all my background. It might be a male vision of things but this is myperception. Then, possibly, once this step has been fulfilled, I might have somespace in my life. I might then feel like welcoming a child and adopting him as ahumanitarian gesture . . . So, as far as I’m concerned, fulfilling the need I have tocreate life, well adoption is not going to be the answer.

2 All quotations in this section on co-parenting are translations from interviews, conductedin French, with biological fathers and their partners involved in co-parenting arrange-ments.


Having a biological child was also a way of knowing who both the child’sprogenitors were. Indeed, most co-parents found it unthinkable not tohave access to this information and regarded it as important for the childfor many reasons, particularly concerning their identity and well-being.Knowledge of parentage was also deemed essential in terms of havingaccess to the child’s genetic history, both in case of health problems andto avoid risks of consanguinity due to possible incest.

On the whole, biological relatedness was crucial for most co-parents’conception of kinship, although it could be expected that gay and les-bian parents would be more open to social parenthood, given that bothpartners in a same-sex couple cannot be genetically related to their child.Indeed, many gay and lesbian activists and associations are questioningthe biological definition of kinship and ‘prioritise the notion of choicein defining kinship over the notion of biology’ (Weston, 1991). Forexample, when same-sex parental rights were on the political agendain Belgium, gay and lesbian activists claimed full legal recognition ofthe non-biological parent on the basis that parental involvement andcommitment are as important as biological factors (Herbrand, 2006).Nevertheless, many co-parents said they would not have been happywith adoption, even if they believed this alternative should be avail-able.

The gay co-parents in this study not only wanted to know who thechild’s progenitors were, but also believed that the presence of the bio-logical mother3 and biological father in the child’s life is of utmost impor-tance. Finding an accessible traditional surrogate who could supply thechild with information about origins was not sufficient, and the pos-sibility of using gestational surrogacy with egg donation was not evenmentioned by the interviewed fathers, as the significance placed on thebiological mother seemed to entail a close association between geneticand gestational origins. What many really wanted was for the child tobe raised by both biological parents, with whom the child would formspecific relationships. This was the main reason why the gay men whowere interviewed opted for co-parenting and often spent a long timelooking for potential female co-parent(s) with whom to conceive a child.They wanted a conventional family with two parents of the opposite sex.According to one of the biological fathers:

3 The category of ‘biological mother’ is problematic. For example, it is possible for bothpartners in a lesbian couple to have a biological connection to a child if one partnerprovides the egg and the other gestates and gives birth to the child. In this study, therewere no instances of this practice, partly because the conceptions took place outside theclinic, and therefore in this discussion, the term ‘biological mother’ refers to the womanwho has both a genetic and gestational connection with the child.


It makes it easier for the child . . . Especially with regard to the outside world,it gives a somewhat more traditional picture and it enables the child to avoidproblems he would otherwise encounter outside with regard to other children atschool, or to neighbours, or things like that.

Although the interviewed co-parents knew this idea could be regardedas “traditional”, “old-fashioned” or the “mum-and-dad” family, it wasthe one that made most sense to them while also allowing for social con-formity. For many, for a child to be raised by a biological mother and abiological father was the best way of becoming a family and reproducingthe family model that they themselves valued. This seemed particularlyimportant for the gay men who thought that a child needed to be breast-fed. The biological connection with the mother gained through breast-feeding was often valued highly by the fathers and in their view, increasedthe mother’s very specific and central role with respect to the child.

Parental roles and biological relatedness

Co-parents’ focus on the genetic tie and on the mother and father figuresled them to differentiate clearly between the biological parents and theirrespective partners. The biological father and mother were the only onesto be called ‘mum’ and ‘dad’ by the child. Indeed, biological relationshipswith the children were perceived and acknowledged by almost all theinterviewed co-parents as being specific and thus putting the biologicalparents in a privileged position with regard to the child and the widersociety. For example, in two cases, the father’s partner wanted to takepart in parenting as a second father from the very outset. However, inboth cases, they were hindered or prevented by their partner, who wantedto remain the main paternal figure for the child. One biological fatherexplained that he did not regard his partner as a full parent and did notallow him to make joint decisions regarding the child because, accordingto him, the genetic tie was “the only real one” and it gave some prioritytowards the child.

The involvement of the biological fathers’ partners was also usuallyless important than the mothers’ partners. Indeed, biological fathers’partners often played a secondary role, both with respect to parentalresponsibilities and daily care-giving. One of the reasons was that mostfathers’ partners did not want children, either because they thought itwas incompatible with their life as a gay man or because they did not feelready to raise a child. Also, the child usually spent the majority of theweek with the mother, going to the father’s house at weekends. This typeof living arrangement did not facilitate the fathers’ partners in taking


a child-rearing role and becoming more committed towards the child,especially during the early months and years.

These factors contributed to making the biological father approach theparental project more individualistically than the mother and her partner,even though he was living with someone. This does not mean, however,that co-parents did not value the relationship of the father’s partner withthe child nor want him to be socially recognised in his very specific role ofsocial co-parent that they were creating and legitimating in various ways(Herbrand, 2008).

Conclusion

Gay co-parents’ representations of kinship appeared to be deeply rootedin biological connections. This often went along with gendered parentalroles, whose extent and perceived ‘naturalness’ varied according to theindividuals concerned. This could especially be seen through their rejec-tion of other parenting options. Therefore, unlike gay fathers studied inother research, co-parents here did not attempt to ‘decentralize biologyin kinship’ as was the case for the ‘families of choice’ studied by Weston(1991). Nor did they attempt to ‘create equality between parents pre-cisely by establishing a figurative or literal sharing of blood between thenon-biological [parent] and her child’, as pointed out by Hayden (1995).Some of the gay men could have considered mixing their sperm beforeinsemination, in order to cloud the issue of genetic paternity. Anotherpossibility would have been for the biological father’s partner to becomethe legal father and thus rebalance the relationship. Yet, the men who wereinterviewed had never considered these possibilities. On the contrary,co-parents were keen to make a clear distinction between the biologicalparents and the social co-parents with regard to the child, even whenthe social co-parent became involved with the child to the same extentas the biological parent. Although co-parenting alters conventional fam-ily forms by creating and experimenting with multi-parenthood, it alsoshows that essentialist family norms based on biological father, motherand child remain of utmost importance and still have an influence onthese men. The family configurations offered by co-parenting arrange-ments can thus help to normalise these gay men’s parenthood, whichcould otherwise be seen as deviant.

Surrogacy

The findings discussed in this section focus on relatedness in gayfather families created by transnational surrogacy, drawn from in-depth,


semi-structured interviews carried out with twenty fathers in ten differentfamilies. The study forms part of a broader sociological research projecton gay father families, carried out in Spain (Smietana, 2011). The partici-pants were recruited from lesbian and gay family associations, communityannouncements and personal networks. They had carried out surrogacyin the United States and their children were aged between 1 and 6 years atthe time of the interview. All the families opted for gestational surrogacy(see Jadva and Imrie, Chapter 9, for a discussion of gestational versustraditional surrogacy), which involved in each case collaboration withan egg donor and a surrogate. Gestational rather than traditional surro-gacy arrangements were recommended by the clinics approached by thefathers. This advice confirmed the men’s own beliefs that gestational sur-rogacy would be preferential in order to safeguard their parenting rights,with the genetic connection with a traditional surrogate being viewed aspotentially threatening in this regard.


The fathers emphasised that the emerging legal acknowledgment andpossibilities of gay fatherhood, represented by the 2005 Bill of Gay Mar-riage in Spain and including same-sex adoption, had empowered them toseek parenthood. Nevertheless, many of them criticised the gender biasin the 2006 Spanish Bill of Assisted Reproduction, which opened accessto assisted reproductive technologies (ARTs) to all women regardless oftheir civil status and sexual orientation, but declared surrogacy arrange-ments as null and void. Moreover, due to the high economic cost oftransnational surrogacy (approximately 100,000 US dollars in 2013),only fathers from upper socioeconomic classes could afford it.

Here I do notice a difference between women and men. If women don’t want tobe with men they can get artificial insemination, but as men we aren’t allowed todo that. We have to look for other solutions to have children.4

The fathers therefore opted for transnational surrogacy in the USA,mostly in California, based on its liberal legislation and establishedtradition. Depending on the decisions of specific embassies and thehelp of lawyers, they came back to Spain with or without legal parent-ing rights for their partners. They subsequently faced the long processof obtaining legal parenthood and their children’s Spanish citizenship,

4 All quotations in this section on surrogacy are translations from interviews, conductedin Spanish or Catalan, with fathers by surrogacy. Quotes from both the ‘biological’ and‘non-biological’ fathers are included.


which sometimes ended up in Supreme Court appeals, differing in everyAutonomous Region of Spain. With a view to countering these prob-lems, in 2010 the Spanish government issued a directive enabling legallytrustworthy cases of transnational surrogacy to be recognised in Spain(Farnos Amoros, 2011). Also, surrogacy carried out in Spain could pos-sibly be legitimated on the basis of the biological father’s parenting rightsand his partner’s rights to co-adoption. However, this practice is virtu-ally non-existent due to the insecurity the commissioning parents wouldsuffer given the explicit prohibition of surrogacy in Spain and the child’sautomatic filiation to the birth mother.

Family norms

Despite participating in collaborative reproduction with egg donors andsurrogates, the fathers sought to become the only legal and de factoparents of their children. They desired to create what they describedas “normal families” ( familias normales) in which they could live withtheir children and raise them together on a daily basis, and which wouldalso cement the couple’s relationship. Therefore they either did not con-sider co-parenting with women or had rejected it due to the potentialcomplexities that might arise with respect to parental rights:

We thought co-parenting was a bit more complicated, that there could be somekind of conflict . . . If in Spain you look for a female friend who wants to do it, shemight later claim the child. The mother may say, ‘She is mine, let’s do a DNAtest’, and if the kid was for example my husband’s and hers, I wouldn’t meananything, because genetically I wouldn’t mean anything, and she would have theright. So we said no to this.

The choice of the egg donor and the surrogate was made by the fatherswith their desire to create a nuclear family in mind, supported by surro-gacy agencies or at least trusted lawyers so as to safeguard the fathers’exclusive parenting rights. The most important criterion in the fathers’choice of egg donors and surrogates, who were normally proposed byagencies, was their medical history. However, in the choice of egg donors,many of the fathers also emphasised the importance of an affinity in termsof physical appearance, character or education. With regard to the sur-rogates, the men sought good communication, which would allow themto be in contact during the pregnancy and to control the process.

Following the child’s birth, all of the fathers maintained contact withthe surrogate and, to a much lesser extent, with the egg donor. Thisusually consisted of occasional email and photo exchanges. Even thoughneither of these women considered herself to be the child’s mother, nor


were they considered so by the fathers, the relationship between thefathers and the surrogate tended to be much closer than with the eggdonor. According to the fathers, this discrepancy resulted from the factthat, during the pregnancy, the surrogate effectively agreed to take care oftheir child: during this period, the fathers stayed in regular contact withthe surrogate, mostly via Skype, and met her family. The fathers werealso usually present at the birth. On the other hand, legal circumstancescould have also cemented the fathers’ relationship with the surrogate,as despite the US surrogacy agreement, according to Spanish law shewas the child’s mother, at least until the embassy or court decision afterthe child’s birth. Maintaining later contact with the surrogate helped thefathers explain their origins to their children as early as possible and alsoenabled the children to meet the surrogate in the future if they wished.Although surrogacy was carried out on a commercial basis, the fathersalso emphasised the non-economic value of their relationship with theirsurrogate and expressed their gratitude in different ways:

We want to be in touch. We’ll explain to our daughter that she was her carrier andthat she looked after her for nine months. And she wants to have contact withour daughter, too . . . For us it is natural, in our life it’s a very important personwho helped us.

With regard to the egg donors, after the initial careful choice of the rightcandidate and the successful conception of the child, in most cases neitherthe fathers nor the donors showed any particular interest in maintainingcontact, apart from initial courtesy emails informing the donor about theprogress of the pregnancy. The tie created with the surrogates throughcare during pregnancy did not exist with the egg donors. However, themen were open to contact with the donors if there was a medically justifiedneed on either part or if the children wished to meet the egg donor in thefuture.


Despite this rather normative family structure, the interviewed surrogacyfathers performed non-normative male gender roles. Within these gayfather families, both male partners were the primary care givers of theirchildren, with whom they lived permanently. As one father described:

We have both acted as fathers (ejercemos como padres) equally, we have taken partin all the events held at school, although normally it is mothers who take partmore in all those things.


The fathers thus constituted new parental roles that incorporated andmerged aspects traditionally associated with mothering and fathering.They shared all parenting duties and household chores, their availabilityand preference being the only determinants of the division of labour.Moreover, in each family, both partners considered themselves to befathers, and were regarded as such by their children:

We are two fathers, or rather two people. We don’t do any mother or father rolesbecause we are two people and it’s more the person’s role. When you need to betough you are tough, when you need to be tender you are tender, when you haveto be permissive we are permissive, when you have to set some limits we set somelimits, and we do as we go.

Interestingly, contrary to the co-parenting fathers, genetic links to thechildren did not play a major role in the surrogacy fathers’ constructionof family relatedness. Not only did they emphasise this in their interviews,but also in the first instance they had considered or attempted adoption asa legally and economically more accessible route to parenthood. Adop-tion, however, was perceived to be burdened with disadvantages suchas the long process of gaining the requisite ‘parental suitability’ certifi-cate, the legal homophobia in international adoption,5 the subjective orideologically-based prejudices of some psychologists or officials involved,the age limits for parents, and the frequently older age and challengingbackgrounds of the children:

First, it seems weird to me if somebody says, ‘I want my own biological children’,(Quiero que mis hijos sean de mi sangre) and second, for the price of surrogacyyou could buy a house to live in with your children. The only thing that makessurrogacy possible is the fact that adoption doesn’t work well . . . If adoption hadbeen easy, I wouldn’t have used surrogacy.

The reason why none of the fathers stated a strong belief in the signif-icance of genetic ties in the interview may be because, while adoptionby same-sex couples has recently become possible in Spain, their use ofsurrogacy remains controversial. Indeed, most of the men said that whenthey were beginning to think about parenthood, they did not know aboutsurrogacy or rejected the idea:

I didn’t know anyone who would have done surrogacy then. Surrogacy belongedto the world of celebrity magazines, of those weird and unique cases. It seemedsomething neither viable nor possible, almost no one did it. Instead adoption wasknown.

5 The adoption agencies the interviewed fathers approached informed them that theycould not adopt internationally as no country would relinquish children to a formalisedgay couple at the time.


The insignificance of genetic ties in the fathers’ perceptions could alsobe seen in their lack of interest in maintaining relationships with the eggdonors, while they stayed in contact with the surrogates. This showedthat the men seemed to value more highly the relationships based oncare during pregnancy rather than the ones that could stem from sharedgenetic material.

Biological relatedness did, however, exert a certain impact on thefathers’ family construction. All of them opted for gestational ratherthan traditional surrogacy, as having a separate egg donor and surrogateavoided there being a traditional mother figure outside the gay fathernuclear family. The potential significance of biological relatedness wasalso revealed by the fact that some of the gay couples decided to createtwo embryos, one with each of their sperm, so as to avoid the primacyof either. What is more, some of the fathers admitted that surrogacyappealed to them as it offered the possibility of creating and raising achild from the very beginning, contrary to adoption which could bringchildren with difficult backgrounds.

Conclusion

The gay fathers in this study created their families within the norma-tive framework of the two-parent nuclear family. Therefore their useof gestational surrogacy and egg donation reinforced rather than chal-lenged the dominant representation of family structure (Thompson,2005; Pichardo, 2009). Surprisingly, however, these fathers framed sur-rogacy as a necessity rather than a choice and their use of ARTs was notbased upon a belief in the superior role of genetic links between parentsand children, although their family-building practices were not free ofits impact. The pioneering nature of these families was also revealed bythe fathers’ innovative interpretations of gendered parental roles and gayidentities. Thus although the surrogacy fathers generally followed thenormative family model as regards its nuclear structure, they showedcertain traits of the alternative ‘families of choice’ (Weston, 1991; Weeks,Heaphy and Donovan, 2001) from the viewpoint of biology as well asgender.

Adoption

The qualitative findings discussed here form part of an exploration ofparents’ motivations for adoptive parenthood ( Jennings et al., 2014),carried out during a broader study of parenting and child develop-ment in adoptive gay father families (Golombok et al., 2014). Interviews


were conducted with forty-one gay couples with adopted children aged4–8 years. The children were all adopted from social care within the UKand had been living with their adoptive parents for a minimum of twelvemonths. Families were recruited from across England, Wales and Scot-land, and were contacted about the study through adoption agencies andparenting organisations. The gay fathers’ responses reported here weredrawn from a short section of the interview in which semi-structuredquestions were asked regarding motivations for parenthood and adoption.


The Adoption and Children Act 2002, which came into effect in Decem-ber 2005 in England and Wales, made joint adoption by same-sex cou-ples possible and provided the first guarantee of legal equality betweensame-sex parents. Non-commercial surrogacy is legal in the UK andsince April 2010, gay fathers can apply for parental orders to gain equal,legal parenthood status once the child is born. Parenthood status inco-parenting arrangements is more complicated and depends on circum-stances; for example the legal father is not named on the birth certificateif the mother is married or in a civil partnership. In both of these familytypes, pre-conception agreements between gay men and birth mothersare not legally binding. Gay fathers in this study tended to perceivedomestic adoption from social care as the most secure option availableto them. The 2002 Act was also highly significant for gay fathers notonly in making adoption accessible and secure, but also as a symbol offormalised social acceptance. Although gay men technically could havecompleted adoption by one partner before this change in legislation,some gay fathers only considered parenthood once the law changed:

But we’d talked about it for years, but always in the sort of abstract and thenof course the law changed, which then meant that, you know, being a same-sexcouple couldn’t be the . . . a barrier to it and we’d succeed or fail on our ownmerits after that point, and then it was kind of like well we shall . . . shall we giveit a go.6

As domestic adoption in the UK is free of charge to prospective parents,financial accessibility was given as a reason for choosing adoption bysome who felt that international surrogacy was prohibitively expensive.With both the legal and financial factors in mind, some fathers in this

6 All quotations in this section on adoption are from interviews with adoptive fathers.Where people’s names are included, these are pseudonyms.


study selected adoption as it appeared the most predictable, secure andsimplest of the available options:

I think it was the most convenient. I mean I don’t have a womb, and renting oneis expensive . . . it’s very, very expensive and this was free. And I was like well wecan try it, I mean it doesn’t hurt to go through the process and be assessed andthen, and then it was like oh, here’s the kid, done.

Family norms

Beyond social and legal considerations, the adopting fathers’ approachto family-building was strongly normative and endorsed a traditionalnuclear model of two monogamous parents and their children, overwhom they had exclusive authority. Only one gay father stated that hehad considered having more than one romantic partner simultaneously,and a small number of fathers had considered co-parenting with another,usually lesbian, couple or individual. The fathers described constructinga family as the “natural progression” of a loving relationship and gavetypical reasons for wanting parenthood: wishing to give and receive lovewith a child and seeking the fulfilment children are expected to bring toadults’ lives. The men in this study discussed the importance of finding apartner who shared their desire for parenthood, and the need to negotiateparenthood when one partner was ambivalent about parenting.

Well it’s always been something that I’ve wanted to do personally, and . . . yeah,so . . . and James was . . . I think I was the driver and James kind of got on board.I mean I’d been in relationships with other people and they weren’t interested,so I knew that the relationship had no longevity, whereas when James and I gottogether it was something that he was open to from the start.

Reasons for favouring adoption over alternative family forms and paths toparenthood were varied, but sexuality and gender norms were influentialfor some. For one gay father, choosing adoption was felt to be “easier todigest by the general public” as it is a more socially acceptable practice fora family that may already encounter social disapproval. The gay fathersalso wished to challenge gender norms by becoming primary care giversto their children. As a result, co-parenting was not considered to be adesirable arrangement given the expectation that as men they would bepart-time parents:

To be frank, in relation to being gay men, there are plenty of lesbians who wantyour sperm, but give me a lesbian couple who don’t want the child to live withthem and want to look after it on the weekend, and then I’ll talk to them.


This participant also highlighted a key reason given by many fathers forselecting adoption: autonomy as parents. The men discussed their con-cerns about the role of a third-party egg donor or surrogate and potentialdifficulties in how this might be negotiated and maintained, particularlywhether their inclusion would infringe on the fathers’ autonomy. Similarconcerns were highlighted regarding co-parenting, which was viewed aspotentially fraught with difficulties. Although the trend towards contactwith birth families in adoption may seem to challenge gay fathers’ auton-omy as parents, the men in this study did not discuss it in this way. Thisis perhaps because interactions between the parenting couple and thirdparties are managed personally in co-parenting and surrogacy families,while contact with birth relatives in adoption is usually formally managedby social workers, at least during children’s early years, hence structuraldelineations are provided by an external authority.


The adoptive fathers were keen to stress that biological relatedness wasunimportant to them in fostering a loving relationship with their child,with the vast majority expressing no regret that they had no biological off-spring. Some fathers identified how their attitude towards non-biologicalparenthood explicitly contrasted with social ideals that prioritise geneticrelationships. They noted that on accepting their sexual identity, theyconsidered from the outset that parenthood, if possible, would not nec-essarily be biological:

I think it’s something, for being gay, I hadn’t really thought that I would have, soit’s not something that I kind of have really longed for or missed.

Of great importance for the adoptive fathers was the desire for equalityas parents, which was influential for many in their choice of adoption:

I mean we were looking into surrogacy and all that, but we found that adoption isthe best thing for us because we both will be equally the parents for the children.

Fathers felt that if both parents had a non-genetic relationship with theirchild there would be no hierarchy of relatedness, which they hoped wouldmean that greater security and stability would be guaranteed to them aspartners and parents:

We wanted it to be equal . . . I think in an argument you could potentially bringit up and some things you can’t take back.

Gay adoptive fathers described much of their reasoning for and againstthe different types of gay parenthood in terms of ethics, such as the feeling


that it is not “right” to ask a surrogate mother to relinquish a child, orconcerns over the morality of money changing hands: “paying for a childjust seems wrong, to be honest”. A common theme that emerged was themoral argument for becoming a parent by adoption:

It kind of like didn’t feel right to bring another child into the world just for uswhen there were so many out there who needed a family.

Some fathers discussed creating biological children as a selfish pursuit:

All you’re doing in my opinion is satisfying your own ego of having a child thatwas genetically yours.

They questioned the foundations of why genetic relationships are con-sidered important:

I think it’s a bit arrogant for me to [want a biological child] . . . You know, whyare my genes so . . . you know, what’s so special about me?

While fathers endorsed the value of creating children as symbols of thecouple’s relationship, they simultaneously rejected the traditional, patri-lineal value of genetic relationships as antiquated and irrelevant.

In addition, some fathers felt that it would not be right to exclude thosewith a genetic or gestational relationship to the child from family life, yetto include them was considered an undesirable option due to the potentialthreat the third party could pose to their kinship arrangement. Finally,some fathers did not expand on their feelings about alternative routes toparenthood other than expressing that they felt “uncomfortable” aboutthese options, or that ART was “weird”, which by contrast meant theyselected adoption “because it felt natural, it felt right to do”.

Conclusion

From a sociological perspective, adoption exposes like no other fam-ily form the socially constructed nature of kinship (Fisher, 2003), andso adopters are perhaps best situated to reflect on the (un)importanceof biological ties. For these fathers, their narratives are undoubtedlyinformed by their adoptive status; however, their feelings concerningbiological relatedness also seem to be informed by their sexual iden-tity. While genetic kinship may be perceived as stabilising in heterosex-ual families and by contrast adoption may be seen as a ‘risky venture’(Fisher, 2003), for these gay fathers the reverse was true. Although thefathers did not necessarily place a high value on biological parenthood,they did value having their ‘own’ child (Lesnik-Oberstein, 2008) in thesense of complete parental exclusivity. The fathers perceived this as best


achieved through equality of non-biological relationships, legally pro-tected parental rights and parental autonomy free from the involvementof third parties. Although financial considerations and accessibility weredecisive factors for some fathers in this study, the generally high socio-economic class of the sample and the narratives of fathers who had con-sidered surrogacy indicate that adoption was not only chosen due tothe constraints men experienced. Rather, adoption was selected becauseof the advantages this route to parenthood was perceived to providetheir family relationships as a male same-sex couple: advantages thatare strongly related to the unique legislative environment and adoptionsystem of the UK.

Discussion

The reasons gay fathers gave for their specific choice of parenthoodwere multiple, concurrent and interrelated, yet all were situated in, andinformed by, the social structure and historical circumstances in whichthey lived. The vast majority of fathers provided strongly normative nar-ratives of their motivations for parenthood and its enactment. These werestructured in each family type along four particularly salient dimensions:family structure, genetic links, gender and socio-legal access.

Family structure

Both adoption and surrogacy entailed constructing normative familystructures of a monogamous couple and their dependent children, overwhom both fathers in a couple had exclusive and autonomous authority.Conversely, co-parenting arrangements entailed a more open, diffuse andmultiple family structure, albeit firmly based on the perceived importanceof the biological mother and the biological father, that also included theirpartners.

Genetic links

The fathers in adoptive families, as opposed to those in co-parentingarrangements, held the conviction that genetic links were insignificantfor the relationship between parents and children. Surprisingly, this per-spective was also shared by fathers in surrogacy families, as most of themwould have initially preferred to adopt. However, both the surrogacy andadoptive fathers did not seem entirely free from the ideology of geneticsuperiority (Ryan and Berkowitz, 2009; Dempsey, 2013). For example,while they stated the unimportance of genetic relationships, some of


them simultaneously expressed anxiety about the inequality between abiological and non-biological father or a desire to create and take care ofthe child from the very beginning, so upholding a biological over socialparenting hierarchy.

Gender

It seems that the more traditional gay father families were in terms of fam-ily structure, the more alternative they tended to become in terms of gen-der. The nuclear adoptive and surrogacy families created parenting rolesthat merged traditional aspects of fatherhood and motherhood (Lamband Tamis-Lemonda, 2004), as the fathers both assumed and sharedall child-caring tasks and sought exclusive authority over the childrenwithout the participation of the biological mothers. On the other hand,although the gay fathers in co-parenting arrangements also assumed allchildcare when they had the child at home, on the whole their genderroles could be interpreted as more heteronormative, as they accordedmuch importance to the biological mother and biological father, and thenon-biological fathers were less involved with the child.

Socio-legal constraints

The family structures in the three gay father family types were shaped bysocial determinants such as the law, which helped to safeguard the rightsof the adoptive parents, while it protected biological ties in surrogacyand co-parenting. The findings also showed that the recent legal changesand growing social acceptance of gay and lesbian parenthood in theUK, Belgium and Spain facilitated the formulation and realisation ofprocreative consciousness in gay men (Berkowitz, 2007). Yet in spiteof this inclusive change, some of the gay fathers, particularly those insurrogacy arrangements, continued to face legal, social and economicbarriers on their route to parenthood. The socio-legal situation onlypartially enabled them to construct the legally and structurally securefamilies that they desired (Ryan and Berkowitz, 2009).

While earlier accounts of gay family life suggested that individuals wereconstructing ‘families of choice’ outside heterosexual norms (Weston,1991; Weeks, Heaphy and Donovan, 2001), it seems with the extensionof relational and parental legal rights, many gay fathers are choosingconventional kinship structures. The implication of this finding is thatthe non-traditional family forms created by gay men may not be simplycreative ‘experiments in living’ (Weeks, Heaphy and Donovan, 2001),but may have resulted from socio-legal limitations. Perhaps if greater legal


security was guaranteed for those with non-nuclear families, individualswould continue to explore more diverse patterns of kinship.

Although the studies discussed here do not represent all gay familytypes, certain normative motivations prevailed even across these threemodels. Yet within the normative framework discussed, being conven-tional stood for very different things to different gay fathers. For thefathers in adoptive and surrogacy families, it usually meant creating atwo-parent family based on the equality of parents, whereas for those inco-parenting arrangements the emphasis was on the importance of therebeing two biological parents of different sex for the child. This shows thatthere is no ‘gay type’ of parenthood, which makes it difficult to formulatecommon political claims for gay father families.

References

Berkowitz, D. (2007). ‘Gay parenthood: a sociohistorical analysis of gay men’sprocreative consciousness’. Journal of GLBT Family Studies, 3, 157–90.

Dempsey, D. (2013). ‘Surrogacy, gay male couples and the significance of bio-genetic paternity’. New Genetics and Society, 32, 37–53.

Dunne, G. (2000). ‘Opting into motherhood: lesbians blurring the boundariesand transforming the meanings of parenthood and kinship’. Gender andSociety, 14, 11–35.

Farnos Amoros, E. (2011). ‘Acceso a la reproduccion asistida por parejas delmismo sexo en Espana’. Derecho de Familia, Revista Interdisciplinaria de Doc-trina y Jurisprudencia, 49, 153–81.

Fisher, A. P. (2003). ‘Still “not quite as good as having your own”? Toward asociology of adoption’. Annual Review of Sociology, 29, 335–61.

Golombok, S., Mellish, L., Jennings, S., Casey, P., Tasker, F. andLamb, M. (2014). ‘Adoptive gay father families: parent-child relation-ships and children’s psychological adjustment’. Child Development. doi:10.1111/cdev.12155.

Haimes, E. and Weiner, K. (2000). ‘“Everybody’s got a dad . . . ”: issues for les-bian families in the management of donor insemination’. Sociology of Healthand Illness, 22, 477–99.

Hayden, C. (1995). ‘Gender, genetics and generation: reformulating biology inlesbian kinship’. Cultural Anthropology, 10, 41–63.

Herbrand, C. (2006). ‘L’adoption par les couples de meme sexe’. Courrier heb-domadaire du Centre de Recherche et d’Informations Sociopolitiques, 1911–12(Brussels).

(2008). ‘Les normes familiales a l’epreuve du droit et des pratiques: analysede la parente sociale et de la pluriparentalite homosexuelles’. UnpublishedPhD thesis, Universite Libre de Bruxelles.

Jennings, S., Mellish, L., Tasker, F., Lamb, M. and Golombok, S. (2014).‘Why adoption? Gay, lesbian and heterosexual adoptive parents’ repro-ductive experiences and reasons for adoption’. Adoption Quarterly. doi:10.1080/10926755.2014.891549.


Lamb, M. E. and Tamis-Lemonda, C. S. (2004). ‘The role of the father’, in M.E.Lamb (ed.), The Role of the Father in Child Development. Hoboken, NJ: JohnWiley & Sons.

Lesnik-Oberstein, K. (2008). On Having an Own Child: Reproductive Technologiesand the Cultural Construction of Childhood. London: Karnac Books.

Pichardo Galan, J. I. (2009). Entender la diversidad familiar: relaciones homosexualesy nuevos modelos de familia. Barcelona: Bellaterra.

Ryan, M. and Berkowitz, D. (2009). ‘Constructing gay and lesbian parent families“beyond the closet”’. Qualitative Sociology, 32, 153–72.

Smietana, M. (2011). ‘Family-based affirmative action? Subversion and resiliencestrategies of gay father families’. Unpublished PhD thesis, Universidad deBarcelona.

Thompson, C. (2005). Making Parents: Reproductive Technologies and their Onto-logical Choreography. MIT Press.

Weeks, J., Heaphy, B. and Donovan, C. (2001). Same Sex Intimacies: Families ofChoice and Other Life Experiments. London: Routledge.

Weston, K. (1991). Families We Choose: Lesbians, Gays, Kinship. New York:Columbia University Press.

Legislation

SpainBill of Gay Marriage (2005).Bill of Assisted Reproduction (2006).

UKThe Adoption and Children Act (2002).

12 Stories of an absent ‘father’Single women negotiating relatedness throughdonor profiles

Susanna Graham

This chapter explores the narratives of twenty-three women in the UKthinking about and embarking upon solo motherhood1 through the useof donor sperm. In doing so it attempts to illustrate that pursuing solomotherhood is a complex decision fraught with anxiety regarding theacceptability and ethicality of this route to motherhood. At the heart ofthis ambivalence is the knowledge that in attempting to have an ‘ownchild’ they are preventing this child from being raised by their biologicalfather.2 How will a child feel about being donor conceived and how,given their current constraints, can these women make this route tomotherhood the best it can be for their imagined child?

What sort of sperm donor should they choose? Is donor anonymitybeneficial or detrimental for a child? Do they feel happy with a clinic‘matching’ them with a sperm donor or should they choose a particulardonor themselves? What information is important to know about him?Will a child be interested in their donor and what terminology should beused to describe him? In contemplating such questions these women areforced to explore the complex meanings of motherhood, fatherhood andrelatedness as they rework these concepts into their ideals for family life.

As will be shown throughout this chapter, there is much uncertaintysurrounding the significance of the sperm donor, and he can take onmultiple, and often conflicting, meanings for these women as they pur-sue their journey to motherhood. By paying particular attention to theparticipants’ decision-making regarding the level and type of informationsought about the donor, the power for this person to become a visible

1 ‘Solo mothers’, also referred to as ‘single mothers by choice’ and ‘choice mothers’, arewomen who actively become mothers without the involvement of a partner. They canachieve motherhood in a number of ways but many do so through attending fertilityclinics for treatment with donor sperm (Jadva et al., 2009).

2 The term ‘biological father’ is used throughout this chapter to denote the male progenitor.When discussing sperm donation, terminology is difficult and controversial. As discussedlater in the chapter, the participants used a range of terminology when referring to thesperm donor. However, all agreed that a sperm donor is a ‘biological father’. Throughoutthe chapter I have endeavoured to use the participants’ own terminology.

212

Single women negotiating relatedness 213

actor, albeit symbolically, in this family form will be explored. However,regardless of the type of sperm donor chosen and the meaning attached tohim, this chapter endeavours to show that in pursuing solo motherhoodthese women have tried their best to place the welfare of their imaginedchild at the forefront of their decision-making.

The chapter draws upon data collected as part of a research projectexploring the experiences and decision-making of single women embark-ing upon motherhood through sperm donation.3 Twenty-three partici-pants were recruited to the study from the Donor Conception Network(DCN),4 Fertility Friends5 and the London Women’s Clinic.6 All werepursuing motherhood by accessing fertility clinics for treatment withsperm from an unknown donor. All participants identified as heterosex-ual and were aged between 33 and 46 years. Twenty-one participantsidentified as white, one participant as black (African) and one as Asian(Chinese). All were highly educated, in professional employment andfinancially independent.

Multiple interviews were held with the study participants over a one-year period, enabling an exploration of how their thoughts and decision-making changed over time. Three of the twenty-three participants didnot embark on fertility treatment during the study period, two decidedto stop treatment and six were continuing or considering their optionsfor further treatment when the study period ended. A total of twelveparticipants got pregnant and thirteen babies were born.

Due to the long and often complex nature of their treatment jour-neys, some participants undertook various fertility treatments at variouslocations. Eleven participants had intrauterine insemination (IUI) on atleast one occasion during their treatment journey, seventeen participantshad in vitro fertilisation (IVF) and three participants had IVF with donoreggs. Eighteen participants had some or all of their treatment in the UKand six participants had some or all of their treatment abroad.

3 This work was supported by the Wellcome Trust (grant number 087238/Z/08/Z).4 A supportive network for families conceived with donated sperm, eggs or embryos, those

considering or undergoing donor conception procedures and donor-conceived individu-als. An email requesting participants for the research project was sent to all members ofthe single women’s section of the DCN.

5 An online infertility community which has a forum for single women undergoing donorconception. A request for participants was posted on the ‘Media and research requests’forum.

6 The London Women’s Clinic is a private clinic providing IVF and fertility treatmentsto couples and individuals. It was one of the first clinics in the UK to treat lesbian andsingle women and is often described as the ‘fertility clinic of choice for single womenand lesbian couples’. Single women seeking treatment at the clinic were contacted by thesperm bank manager and asked if they would like to take part in the study.

214 Susanna Graham

Several of the participants had used sperm from different types ofdonors at different points in the process. Due to the removal of donoranonymity in 2005, the eighteen participants having treatment in theUK had to use sperm from an identity-release donor and any result-ing offspring would be able to access identifying information about theirdonor at age 18. Eleven of these eighteen participants imported spermfrom identity-release donors at large American or European sperm banksrather than using a UK donor. The six participants engaged in cross-border reproductive care (CBRC) went to Denmark or the Czech Repub-lic where they could choose between using anonymous and identity-release donors. Five of the six participants who went abroad for treatmentused sperm from an anonymous donor on at least one occasion.

Choosing motherhood

For all participants the decision to pursue solo motherhood was based ona deep-seated desire to become a mother. All had assumed they wouldone day become mothers to their own genetic children. However, theexpectation of motherhood had always been premised upon the assump-tion of a being in a long-term, stable relationship: they would be motherswithin the context of a nuclear family.

Studies have found that solo motherhood is only considered whenwomen are faced with limited prospects of finding a partner with whom tohave a child in the time frame their increasing age and decreasing fertilitywill allow (Mannis, 1999; Bock, 2000; Murray and Golombok, 2005;Hertz, 2006; Jadva et al., 2009). My own research further elucidates theambivalence many feel in pursuing this ‘choice’ (Graham, 2012). Singlemotherhood was never the plan but an option that had to be incorporatedinto their life trajectory if they were to pursue motherhood:

Maybe there are single women out there who are completely happy being singleand never want to be in a relationship but I think underneath it this is always eitherPlan B or C, or even Plan Z for most people. For me this is definitely Plan Z.(Catherine,7 considering embarking upon motherhood via treatment with spermfrom an identity-release donor)

Despite sadness at being unable to have the family they had imag-ined for themselves, being single and experiencing an “overwhelmingdrive” for motherhood led these women to consider pursuing mother-hood without a partner. They were faced with the options of adoption,

7 Pseudonyms have been used throughout this chapter and any potentially identifyinginformation has been removed or altered.


getting pregnant through casual sex or utilising sperm donation. Spermdonation also involved further options about the type of donor and treat-ment: whether to use a known8 or unknown donor, an identity-releaseor anonymous donor and whether to pursue treatment at a clinic or toself-inseminate at home. In choosing between these options, the conceptof having an ‘own child’ and the importance placed on knowledge ofone’s ‘genetic origins’ were important. In negotiating these concepts thewomen were trying to normalise their route to motherhood and to retainsome elements of traditional procreation and the nuclear family they hadimagined for themselves.

Having “a child of my own”

Adoption was considered by all participants and initially pursued by twoof the twenty-three women. Many saw adoption as a morally superiorand more socially acceptable route to motherhood: it would give a lov-ing home to a child in need rather than meeting their own desires by“selfishly” creating a child through assisted reproductive technologies(ARTs). Ultimately, however, adoption was seen as a last resort by thevast majority of participants. Indeed, both of the women who initiallypursued adoption decided to halt their application and explore spermdonation when realising they wanted to experience pregnancy and have“a child of my own”.

What having “a child of my own” actually meant to these womenproved difficult to define. Continuing the family line and providinggrandchildren for their parents seemed important for a few of the partic-ipants but for the majority having an ‘own child’ seemed to be as muchabout being pregnant, gestating a child and giving birth to it, as aboutpassing on their genes. Many participants described this desire in termsof a need to reproduce: becoming a mother was not merely about raisinga child but also creating that child. This deep-seated need was seen asirrational – all could list reasons why they should not have a child – yetconsidered part of the ‘natural’ course of a woman’s life. Anna explainedher desire for motherhood:

It’s just instinct, it’s in you. Procreation or whatever it is. I’ve longed for beingpregnant and giving birth, that whole thing. It’s just part of womanhood, part ofthe cycle of being a woman. It’s not logical. It’s a drive. I want life to come outof me somehow.

8 The term ‘known donor’ is used here to denote a man donating his sperm who is knownto the woman at the time of treatment. A known donor may have no role in the futurechild’s life or may take on a full parental role as a co-parent.

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The definition of an ‘own child’ was fluid and changeable, especiallyfor those women who contemplated using donor eggs during their questfor motherhood. Three of the twenty-three participants went on to havetreatment with double donation (i.e. using donor eggs and donor sperm),one participant was on a waiting list for donor eggs at the end of the studyperiod and another participant was investigating the option of a relativeacting as an egg donor for her. Although aware that a pregnancy withtheir own eggs was exceedingly unlikely, these women who were contem-plating or using donated eggs still wanted “a child of my own”. Theywere therefore left considering why they would go to the great emotionaland financial lengths of having a genetically unrelated child via IVF withdouble donation when they could also adopt a genetically unrelated child.The desire to experience pregnancy and childbirth, as well as being ableto care for a newborn baby, were important considerations. Internationaladoption, potentially enabling the adoption of a young baby, was seenas prohibitively expensive and the participants believed that if they weresuccessful in a domestic adoption application this would result in thembeing placed with an older, “damaged child”. As well as wanting the“baby experience”, as single women these participants did not feel theyhad the resources, either financially or emotionally, that such a childwould require. Moreover, egg donation, despite not providing a genetictie between themselves and the child, was still seen to provide the possi-bility of having an ‘own child’ through the biological relatedness involvedin gestating the pregnancy. When reflecting upon her use of donor eggs,Christina disclosed how she had initially felt like a “fraud” when peoplecongratulated her on her pregnancy. However, she went on to explainhow as the pregnancy progressed she felt more comfortable about havingused donor eggs, specifically how she began to be able to consider thebaby to be hers:

My feelings changed dramatically when I started to feel him moving becauseI suddenly thought, ‘He wouldn’t be this big if it wasn’t for me’. And yeah, itstarted to feel more like it was a baby and it was my baby. And I think I’ll alwaysfeel a bit sad about not being able to use my own eggs, but, yeah, that’s whenit changed in the pregnancy. It was really a massive difference and I was like,‘Oh my goodness, there’s a person in there, it’s not just an egg and it’s not justsperm’.

Solo motherhood via double donation was, however, a contentiousissue. Many participants who were still pursuing treatment, or hadachieved pregnancy with their own eggs, viewed double donation as “astep too far”. They felt they could perhaps contemplate donor eggs if ina relationship and able to use their partner’s sperm but not as a single


woman: it was seen as important for the child to be genetically related toat least one of their social parents. However, these women were not yet inthe position of needing to use donor eggs and were aware that their ethicalstance could well change. Several specifically mentioned that “despera-tion” for a baby, specifically the need for “a child of my own”, might forcethem into treatments with which they had previously felt uncomfortable.

A planned conception

In their quest to have an ‘own child’ many participants were encouragedby friends or family to engage in casual sex rather than spend the vastsums of money entailed in clinic-based ARTs. However, as well as thefear of sexually transmitted diseases, the realisation that it could takemany casual sexual encounters to conceive and the assertion that theywere just not “that type of person”, getting pregnant through casual sexwas dismissed on moral grounds: it was not “right” to trick a man intofathering a child, nor “fair” for a child to be conceived in that manner.All participants believed that it was best for a child to have knowledge of,and be able to trace, their biological father and it was thought that thiswould be difficult to maintain through a casual relationship. Moreover,all participants were keen to stress the planned nature of their routeto motherhood and building this into their child’s ‘conception story’was paramount in being able to justify their decision to parent alone.Louise explained why she had dismissed her friends’ suggestions to “getpregnant by accident” and instead was planning fertility treatment withdonor sperm:

I want it to be a conscious decision and for me to be able to sit down with mychild at some point and explain that I was still bringing them into this world outof love, not a cheap shag on my holiday.

A conception with donor sperm, although also not conforming to theidealised image of children “made from two people that love each otherand want to create a family together”, was seen as a more responsibleand justifiable route to motherhood than casual sex.

A stranger’s baby

Normalising the incorporation of sperm donation into their trajectoryfor motherhood proved difficult for most participants. Several womendescribed how they had joked with friends about resorting to donorsperm if single at a certain age but none had ever really considered theywould be “a woman who used a sperm donor”. Entangled in this notion

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was a self-imposed stigma, with connotations of failure and being “awoman who can’t get a man”. Moreover there was a sense of uneasinessregarding the unknown in sperm donation, namely the thought of havinga baby with “a stranger”:

You imagine the person who you’ll have a child with and they have all thesethings. They come with a history and friends. They come with stories and badhabits and they come with physical characteristics and favourite jumpers and thebazillion things that make up a person. And then I can strip everything away andI have some genetic fluid in a vial and that’s it. (Jessica, undergoing IVF withimported sperm from an identity-release donor)

Much of the ethical debate surrounding solo motherhood has focusedon the welfare of children and a child’s ‘need for a father’ (Graham andBraverman, 2012). However, although the participants believed that menand women parented in different ways and that a balance of male andfemale influence would be beneficial for a child, they did not feel thata child necessarily needed a father in order to provide this male-basedinteraction: other men in the child’s life could take on this role. As such,and in line with the existing solo motherhood literature (see Hertz andFerguson, 1997; Hertz, 2002, 2006; Jadva et al., 2009), all participantshad thought about men in their lives who could act as male role models fortheir children. Their concern regarding the absence of a father extendedbeyond the practical importance of a masculine influence to a moresymbolic importance that included knowing one’s father. At the heart ofthis concern was fear that a lack of information about one’s biologicalfather would be detrimental to a child’s sense of identity:

I just thought I couldn’t bring a child into the world where it doesn’t have that;it will only have half the knowledge not the whole of it. I felt it would be difficultfor the child not to be able to know half of itself. (Ruth, describing her initialdismissal of pursuing motherhood through donor sperm)

This fear seemed to stem from an understanding of identity that empha-sises the importance of genetic ties: the idea that it is important for aperson’s psychological well-being to have knowledge of one’s genitors(Wilson, 1997; see also Richards, Chapter 1; Lillehammer, Chapter 5).Participants made reference to adopted acquaintances who had alwaysfelt “something was missing”, as well as television programmes thatexplore people’s family history such as Who Do You Think You Are? andLong Lost Family, to emphasise the importance of genetics and knowingone’s ‘genetic origins’.

The desire for their child to ‘know’ themselves through ‘knowing’their genetic origins initially led some participants to consider a knowndonor who would play some role in the child’s life. Despite the legal


complexities inherent in known donation (see McCandless and Sheldon,Chapter 3), these participants felt it would be beneficial for a child togrow up knowing who their biological father is and to have some contactwith him. Abby explained why she initially preferred the idea of using aknown donor to conceive:

It’s not the ideal situation for me to remove the father from my child’s life andthat wouldn’t be an issue with a known donor. There would be a father figurefrom birth. They would know their dad’s name, they’d have pictures of him, theymight get letters and things in the post and every couple of years they’d be ableto hang out and get to know who this father figure was.

However, finding the ‘right’ known donor proved difficult. For many, thisperson was imagined to be a gay friend whom they had known for manyyears. However, some potential donors did not feel comfortable takingon a part-time father role and the women were wary of them wanting tobe “too involved”. Others were rejected because they did not take the roleseriously enough. All participants were therefore left with the option ofusing an unknown donor from a sperm bank. Nevertheless, the potentialchild’s well-being, and specifically a perceived need to know about one’sgenetic origins, remained at the forefront of their mind as these womenwent through the process of choosing a sperm donor.

Identity-release donors: a child’s right to know

Only one of the participants chose not to use sperm from an identity-release donor for their initial treatment cycle.9 If having fertility treatmentat a UK clinic, the use of identity-release sperm donors was mandatory.However, if seeking treatment abroad the participants also had the optionof using anonymously donated sperm. The vast majority of the womenfelt identity-release sperm donation was preferable to anonymous dona-tion. Indeed, many commented they would not have considered mother-hood through sperm donation prior to the removal of donor anonymityby the UK regulatory body, the Human Fertilisation and Embryology

9 One participant initially used anonymously donated sperm for IUI treatment in Denmarkbefore realising she could access fertility treatment in the UK as a single woman andmoved on to further treatment with identity-release donors. Although she initially felt thata child may find it “easier to cope with” being conceived with sperm from an anonymousdonor, rather than “setting them up for disappointment” through the expectation thatan identity-release donor “will do stuff for you and be involved in your life”, she laterdecided that a child may be “curious about their genetic material and where they camefrom” and therefore decided that identity-release donors were preferable. Interestinglyshe went on to import sperm from an identity-release donor at a large European spermbank so she had more information about the donor than available in the UK.

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Authority (HFEA). The preference for identity-release sperm donationwas based on the belief that a child may be curious about his or herdonor and should have the option of accessing identifying informationand making contact with him at a later date. Again, this assertion waslinked to a belief that information about one’s genetic origins is importantfor identity formation and self-knowledge. The majority of participantsfelt that it was their child’s “right” to know this information:

It has to be an open donor. That is absolutely key. My child has the right toknow where they come from and I couldn’t do it if that was not the case. Thebiggest factor for me is I’m going to be able to answer my child’s questions. Thatwhole thing about identity. That’s been the biggest challenge. (Vicky, embarkingon IVF with imported sperm from an identity-release donor)

The stance on donor anonymity taken by organisations such as theHFEA and the UK support group, the Donor Conception Network(DCN), as well as academic research with donor-conceived families,seemed to have influenced participants’ views on the importance ofdonors being identifiable. All the women had done substantial read-ing around donor conception and many had attended DCN workshopswhere they heard views of others using donor gametes, as well as thethoughts and feelings of donor-conceived individuals. All came awaywith the message that in terms of the welfare of children, identity-releasewas preferable to anonymously donated sperm.

Despite initial preference for identity-release sperm donors, four par-ticipants moved on to using anonymously donated sperm at some pointin their treatment journey. The move to anonymous donation was notprompted by a shift in the importance placed on the donor and infor-mation about him but due to a perceived inability to continue treat-ment using identity-release sperm donation. Financial considerationswere key for three of the participants: they felt forced to seek substan-tially cheaper treatment abroad.10 In Denmark, anonymously donatedsperm was cheaper than sperm from identity-release donors, and in theCzech Republic, only anonymous donors were available unless spermfrom identity-release donors was imported at great cost: anonymoussperm donation was seen as the only option due to financial cons-traints.

After a long, unsuccessful treatment history in the UK, including IUI,IVF with her own eggs and IVF with donor eggs, one participant sawgoing abroad for IVF treatment with anonymously donated eggs as a way

10 Only one participant received IVF treatment funded by the National Health Service(NHS). All other participants were self-funding patients at private clinics or NHS hos-pitals.


to maximise her chances of pregnancy.11 This participant was unique inemphasising the importance of equality of information about egg andsperm donors and therefore chose to use an anonymous sperm donorfrom the clinic’s own sperm bank rather than importing identity-releasesperm to use at the clinic. All other participants considering egg dona-tion differentiated between the importance of the egg and sperm donor.Although considering it ideal that both donors be identity-release, sim-ilar to Kirkman’s (2004) suggestion that in the absence of another manclaiming the role of father, the sperm donor is more likely to be pub-licly represented as the child’s father, these participants speculated thata child might be more curious about a sperm donor due to the absenceof a father in their family. However, despite planning to disclose the useof donor eggs as well as sperm to the child, the women thought the childmay place less importance on the role of the egg donor as the child wouldhave a mother in her family: they would be their children’s ‘mummy’.Moreover, regardless of their single status, with a gendered distinctionbetween biological and social parenthood (see Almeling, Chapter 8), thesymbolic link between a ‘genetic connection’ and fatherhood can leadto a sperm donor defining himself and being defined by others as a‘father’. However, women using egg donation can themselves claim bio-logical motherhood through the gestation of the pregnancy even thoughit would be the genes of another woman, the egg donor, which would bepassed on to their child: it is possible for egg donors not to be depictedas mothers (Almeling, Chapter 8).

It is important to note that all five participants using anonymouslydonated sperm had some regret over the decision. Paramount to thisregret was concern that they had made a decision not in the best interestof their child:

Even now it sits a little uncomfortably with me because I think it was the firsttime in the whole process where the pendulum had slightly swung and instead ofit being every decision I made was absolutely about what was right for the child, itbecame, this is kind of OK for a child but more importantly this is what it is goingto take for me to get pregnant. (Emma, pregnant after IVF with anonymouslydonated sperm and eggs)

These participants were concerned that growing up in a context wheredonor anonymity had been abolished would mean their child would becurious about their donor and expect access to identifying informationabout him.

11 In the Czech Republic where she was seeking treatment, egg donors who could ‘donate’their eggs anonymously and also be paid for their ‘donation’ were substantially youngerthan the older ‘egg-sharing’ identity-release egg donors who were available in the UK.This participant believed that eggs from a younger woman, who was not herself needingfertility treatment, would be more likely to be capable of producing a viable pregnancy.

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Choosing a sperm donor

The amount of choice participants had over the sperm donor theyused varied, as did the importance the women placed on having thischoice. Some UK clinics had their own pool of sperm donors and would‘match’ a recipient with potential donors based on physical character-istic requirements specified by the woman. However, other participantswere unhappy with this lack of choice and chose to import sperm fromEuropean or American sperm banks. In both instances the ideology ofnormalising donor conception, especially by mimicking traditional pro-creation, was used to justify the preferred method. Some participants feltcomfortable being assigned a donor and knowing little about him as theyfelt this reflected the “randomness” of falling in love:

It almost introduces that random element of the random man that you meet. Youwouldn’t line up ten men and decide which to marry. How you meet your partneris down to providence, chance, fortune, fate. So by leaving it up to the next batchof sperm that came up, it felt more natural. It felt more normal. (Natasha,undergoing IVF after having been ‘matched’ with a UK identity-release donor)

Being ‘matched’ with a donor also helped recipients overcome theconsumerist and ‘designer baby’ connotations of sperm donation: theydid not want picking a donor and buying his sperm to be equated withpicking and buying a baby:

I didn’t want to get into the shopping business. I’m not shopping for Mr Perfect.I’m hoping to have a child who will be my child whatever they come with. (Sally,waiting to be ‘matched’ with a UK identity-release donor)

However, those wanting to choose a particular donor took a differentstance: they did not just want “anyone” to be the biological father oftheir child. Needing to feel proud and happy with their choice of donorled these women to desire far more information than was available aboutUK donors.

Embodied sperm

All participants found the prospect of choosing a sperm donor and pur-chasing his sperm a bizarre and surreal process (see Layne, 2013, for adiscussion regarding the ‘uncanny’ in ‘sperm shopping’). It was at thispoint more than any other that they questioned whether it was “rightto be able to become a mother in this way”. It was again the unknownsurrounding the donor causing this uneasiness. Whether perusing hun-dreds of donor profiles on the websites of large European and Americansperm banks such as the European Sperm Bank (ESB) and Xytech, or


filling in their requirements to be ‘matched’ with a donor and choosingbetween those offered to them, all participants felt unsure as to how theywere meant to judge these “strangers”. Beliefs regarding ‘nature versusnurture’, how personal characteristics and attributes may or may not beinherited and whether a sperm donor had a greater significance than hisgenetic contribution, all played a role in how these women went aboutchoosing a donor.

The women using identity-release sperm donors from UK sperm banksand those who used anonymously donated sperm abroad were givenvery little donor information on which to base their choice. They wereencouraged to view the sperm donor as contributing DNA that wouldtransmit certain traits or phenotypical characteristics to a future child:

You get matched based on a couple of criteria and you get a limited amount ofinformation and you can say yes or no. They really encourage you to look at thisas DNA. You’re not picking a husband; you’re not picking a father; you’re notpicking a man. You’re picking DNA. (Karen, undergoing IVF with sperm froma UK identity-release donor)

However, the vast amount of information about donors available fromEuropean and American sperm banks, including not only physical char-acteristics, extensive medical and family histories, but also educationalachievements, hobbies and interests, baby photos, essays and audiorecordings of the donor talking about himself, allowed the women to feelthey were picking a man who was donating his sperm rather than DNAwith some imbued characteristics. Indeed, when talking about how theychose their particular donor, the participants who had imported spermfrom these sites spoke far more about the need to like this man, rather thanthinking about genetic traits and characteristics that might be passed onthrough his DNA. They were picking more than sperm; they were pickinga man with whom to have a baby.

The vast majority of participants, following advice from their clinic,began the process of choosing a donor based on the premise that heshould have similar physical characteristics to herself and her family.Although questioning the importance of this due to their single status,12

the majority thought it might be easier for a child if they did not lookoverly dissimilar to their mother. Mobilising the discourse of ‘resem-blance talk’ (Becker, Butler and Nachtigall, 2005), they thought this

12 Recipients of donor sperm are usually advised to match the sperm donor’s characteristicsto that of their par tner (see Braver man and Fr ith, Chapter 7). This is perhaps a relicof the history of sperm donation where it was practised in secrecy and the social fathercould ‘pass’ as the biological father. See Jones (2005), Mamo (2005) and Nordqvist(2010) for a discussion of sperm donor matching in lesbian partnerships.

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would provide the child with a sense of belonging as well as avoidingunnecessary questions about the child’s father:

. . . And then for someone with similar eye and hair colour and stuff. I did thinkabout whether that was really important but if they look totally different to methen you know people will be saying, ‘ooh do you look like your dad?’. (Rachel,describing how she chose the identity-release donor whose sperm she imported)

However, there was also a declaration that this was not “an immacu-late conception” and several participants ended up choosing a donorwith very different physical characteristics to themselves. This was againjustified by aligning the use of a donor with traditional procreation: theywould not date only men with the same hair and eye colour as themselvesso why should that be important with a donor?

Beyond physical characteristics the women were forced to considerother attributes that may be inherited and indeed whether such attributeswere important. Although medical history was seen as particularly impor-tant, all participants believed that a donor’s medical history would beunproblematic due to a sperm bank’s extensive screening programme.The participants were divided, however, on how relevant they viewedinformation such as the donor’s personality, educational background,interests and hobbies. Some participants questioned the importance ofchoosing particular characteristics in the hope they might be passed onto a future child believing the child would be unique and “you just lovethem anyway”. They also mobilised the idea that genetic inheritanceis unpredictable and a child would be a “mishmash of many differentthings, people and genetics”. Others took the view that “50 per cent of[their] baby will be predicted by the donor’s genes” and felt that if theyhad the option to choose a donor, then they had the duty to choose thebest for their child. However, despite the eugenic fears that such a viewmay ignite (see Pennings, 2000; Hanson, 2001), the participants werenot motivated to find the most attractive or intelligent donor. Althoughlooking for a donor with a “reasonable level of intelligence”, they sawtraits that may genetically predispose their child to a “happy life” such asbeing friendly, easy-going and optimistic as more important. Of coursewhat each participant viewed as ‘best’ for a child varied.

For those choosing a particular donor from the overseas sperm banks,it was the essays and audio recordings detailing the donor’s family life,hobbies and interests that were seen as most useful. This subjective infor-mation gave them an idea of what the donor was like and they basedtheir choice on this overall feeling for him. This included the need to feelattracted to the donor. Many participants likened the process of choosing


a donor to the process of internet dating. Although acutely aware theywere not entering into a relationship with the donor, they were still look-ing for traits they would find desirable in a partner: they wanted to feelthey could form a relationship, albeit platonic, with this man. Inherent tothis was feeling some sort of connection with the donor, and descriptionsof a “gut feeling” he was “the right one”, “fate” in finding him and “justsomething about [the donor]” speaking to them were abundant in theparticipants’ descriptions of how they chose their particular donor.

The similarity in the process of choosing a donor or a partner has beenhighlighted in other studies. Scheib and colleagues (1994; 1997) founduniversity students rated attributes similarly when choosing a hypotheti-cal sperm donor or long-term mate. Rodino, Burton and Sanders (2011),in a study exploring the importance of donor characteristics for Aus-tralian recipients of donor sperm, reported that single women placedhigher value on biographical traits and good character when comparedwith partnered lesbian or heterosexual women. They concluded thatsingle women’s choice of donor reflects a long-term mating strategy.Rodino, Burton and Sanders dismiss the possibility that single womenmay be more curious about donor information purely because of a needto explain an absent father figure: partnered lesbian women face the samedilemma yet their responses were more similar to heterosexual couplesthan single women. However, with reference to my own data, I wouldargue that single women may view knowledge of the donor, specificallywhat he was like as a person, as more important than partnered womendue to the absence of a second parent for their child, be that a socialfather or second social mother.

Indeed, liking the donor and feeling that he was a “nice man” wereimportant considerations for my participants due to the fact they werechoosing an identity-release donor: they wanted their child to be ableto find a “half decent bloke” when able to make contact with him atthe age of eighteen. Scheib, Riordan and Shaver (2000) also found thatsimilar issues were important when recipients were choosing identity-release donors. Again, single women in this study were more likely to careabout such matters than partnered women, suggesting a presumption thatchildren without a second parent in their day-to-day life may be moreinterested in making contact with their donor. Likewise, my own partic-ipants saw motivation for donating as important information with whichto assess donor profiles. An older sperm donor was seen as preferableto a student who might be “doing it for the money”: they thought anolder donor would have put more thought into his donation and be morelikely to be open to future contact with the child.

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Creating ‘father’ stories

The detailed donor information available from the European and Amer-ican sperm banks was certainly reassuring to the women who had accessto it but, more importantly to them, was seen as vital information fortheir imagined child. The perceived need to know one’s genetic originshad led to a preference for identity-release donors. Concern remained,however, that their child would be curious about his donor, specificallyabout what he was like, before legally able to obtain further informationand potentially meet him at age eighteen. Similar to Wilson’s (1997)concept of ‘narrative identity’, these women believed their child mayrequire biographical information about the donor and his family in orderto be able to “place themselves” and “understand who they are”. Thedetailed donor information accessed through importing sperm enabledthese women to tell their child about their ‘father’:

I’ll be able to fill in quite a lot of blanks. I know he’s a keen tennis player, I knowthe countries he’s been to, I know his favourite food. Because I can paint thatpicture and create some character for a father figure it doesn’t feel as bad as ifI had only four lines of stats. (Abby, pregnant after importing sperm from anidentity-release donor)

The potential child was at the forefront of the participants’ minds whenassessing the donor profiles. This led them to seek information that theythought might be interesting to a child. As such, anecdotal information,little stories about the donor and his family, as well as details about pets,favourite food and colours, were seen as important. By being able to“fill in the blanks” the participants were able to normalise their child’sconception, making it easier for the child to tell others about their ‘father’without having to disclose their donor-conceived status:

It’s easier for the child now. They can say, ‘My dad is a teacher and lives inAmerica’ rather than, ‘I don’t know what he does. I don’t know how tall he is’.(Anita, pregnant after importing identity-release sperm)

Access to detailed donor information enabled these women to feel theyknew the donor in some way. In turn they hoped that their child wouldat least be able to know about, if not know in person, their biologicalfather. They did not see solo motherhood as an ideal situation but hopedthat through knowing detailed information about her donor, their childwould feel comfortable with his or her donor-conceived origins and beable to form a positive self-identity.

It was clear, however, that the women importing sperm were awarethese ‘father’ stories were, at least in part, fictional. When asked if they


would like to meet the donor, the majority of participants were unsure:they were happy with the picture they were able to build of him butconcerned he may not live up to this in person. Surprisingly none ofthese participants mentioned a concern that in eighteen years time theirchild may also be faced with meeting a donor who did not live up to thestories they had been told about him.

Indeed the potential discrepancies between the images of a person onecan create through a donor profile and what that man may, in reality, belike caused some women to be wary of the extended profiles availablewhen importing sperm and content with the limited information theyhad about their own donor. These women were sceptical of the value thisextra donor information would bring, stating, “you can’t really know aperson from bits of paper”. Similar to the ‘fantasy fathers’ described byEhrensaft (2000) and Hertz (2002) (see also Freeman et al., Chapter16), the limited donor information these women had access to preventedthem from being tempted to build up a picture of a “perfect person whodoesn’t really exist”. However, even with only limited donor informa-tion, participants were still tempted to imbue their donor with positivecharacteristics. For those using donor sperm from the UK the fact thatthe donor had received no financial remuneration for his donation andwas willing to have identifying information released about him enabledthem to conclude that he was a “good, decent person”. It was with someregret that those using anonymously donated sperm in countries wherethe donor may also have been paid for their ‘donation’ were not able topersonify their donor in such a way.

Donors/daddies/fathers

As seen in the quotes included in this chapter, the participants usedmany different terms when talking about their sperm donor, especiallywhen discussing him in relation to their expected or imagined child. Attimes he was referred to as “dad” or “father”. At others this was clarifiedto be a “biological father” or “genetic father”. At other times he wouldbe referred to as “sperm donor” or merely “donor”. When questionedspecifically on the terminology they would use when talking about thisperson to their child, all participants expressed a perceived difficulty inexplaining the donor’s role and were unsure of what words to use todescribe him. Natasha’s response was typical:

I still have to find the right word because ‘dad’, ‘daddy’, ‘father’, has emotionalconnotations and this man is not that. He is a donor. ‘Father’ means more than

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sperm donor, especially ‘dad’ and ‘daddy’. So rather than keep stumbling overthe same words I will have to try and find a term that suits me. Donor is a sterilekind of a word. Clinical. But I don’t really want to go down the line of ‘specialman’ or ‘special person’ so I don’t know. I’m going to have to try and find myown way around that.

Even those who imported sperm and placed great importance on beingable to share detailed information about their child’s donor were unsurehow to refer to him. The majority settled on the term “father”, stating,“he’s a biological father, whether he is a father practically or not”. Theparticipants could distinguish between parental kinship terms, indicatingthat “dad” or “daddy” implied a social relationship with a child formedover time, one that would never be formed between a child and a spermdonor. However, their difficulty in knowing how to refer to the donorlay in the belief that a young child would not differentiate between suchterms: with an absent male parent these women believed that it would bea “daddy” their child would enquire about (see Blake et al., Chapter 15and Freeman et al., Chapter 16 for a discussion of the terminologychildren themselves use to describe their donor).

Unknowns remain

As has been seen throughout this chapter, although their decision-makingwas complex, and ambiguity regarding the meaning and role of a spermdonor abounded, all participants tried to think about what would be bestfor their imagined child, not themselves, in their decisions regarding solomotherhood. All believed a single mother family was not ideal but intheir quest for an ‘own child’, they seemed to be engaging in a processof ‘damage limitation’: given their current constraints, how could theymake this family form the ‘best’ they could for their child?

It was the unknown surrounding sperm donation, namely their childnot knowing their male progenitor, that presented the biggest hurdlefor these women. While this was commonly expressed in terms of thechild not knowing his or her genetic origins, for many participants it wasnotions of the donor as a person that seemed to be more significant in thisregard than ideas around genetic inheritance. Getting to know a donorthrough the profile describing him was one way of reconciling the “weird-ness” of sperm donation and normalising it to align in some way to thenuclear family they had imagined for themselves. Through the snippets ofinformation provided in these profiles, the sperm donor was transformed,at least in part, from some “genetic fluid in a vial” to a “man with storiesand bad habits . . . physical characteristics and favourite jumpers and


the bazillion things that make up a person”. The personification of thesperm donor that this information allowed, along with the identity-releasenature of the donation, in many cases enabled these women to feel theywere doing their best to counter the potentially damaging effect theyfeared donor conception could have on a child’s identity and sense ofbelonging.

It is important to note that importing sperm from abroad was also themost expensive option available to these women. With private treatmentalready seen as astronomically expensive, this further expense was outof reach for some. It is particularly salient that three participants endedup conceiving with an anonymous sperm donor whom they knew verylittle about due to financial constraints. These women felt ‘forced’ togo abroad for cheaper treatment and feared that they had potentiallycompromised their child’s welfare by taking away their ability to learnabout their genetic origins. With solo motherhood via clinic-based ARTsalready a stratified possibility, it seems that access to detailed donorinformation is also dependent on financial means.

Regardless of how much donor information the participants hadaccess to, unknowns remained. The sperm donor seemed to be a vis-ible actor, albeit symbolically, when these women were choosing a donorbut appeared less important as they progressed through their treatmentjourney. Successive IUI and IVF treatments became about getting a pos-itive pregnancy test, just needing the sperm to “do their thing”, ratherthan thinking about the donor as a person and the ‘father’ of a potentialchild. However, upon pregnancy and the birth of their child the meaningof the donor and the potential impact of being donor conceived resur-faced. It was not a major part of their day-to-day life, with the majorityof the women’s concerns relating to being “a mother rather than a singlemother or a single mother by choice”. Nevertheless there was acknowl-edgment that donor conception would always be part of their, and theirchild’s, life:

I don’t know whether she will care about the nature versus nurture, the genesversus family ties being the people you grow up with regardless of genetic heritage.I don’t know how she is going to feel. I sort of think it never goes away doesit? Once you have done something like this it’s always there. Always. (Emma,reflecting upon her use of anonymously donated sperm and eggs)

With all participants having known, and the vast majority having beenraised by, parents they were genetically related to, they found it difficultto imagine what being donor conceived would be like for a child. All wereunsure how their child, whether still imagined or now a reality, would

230 Susanna Graham

react to the absence of a biological father in his or her life but they hopedthey had done enough to ensure that their decision to become a motherand the methods with which to achieve it were “OK” for a child.

References

Becker, G., Butler, A. and Nachtigall, R.D. (2005). ‘Resemblance talk: a chal-lenge for parents whose children were conceived with donor gametes in theUS’. Social Science and Medicine, 61, 1300–9.

Bock, J. (2000). ‘Doing the right thing? Single mothers by choice and the strugglefor legitimacy’. Gender and Society, 14, 62–86.

Ehrensaft, D. (2000). ‘Alternatives to the stork: fatherhood fantasies in donorinsemination families’. Studies in Gender and Sexuality, 1, 371–97.

Graham, S. (2012). ‘Choosing single motherhood? Single women negotiatingthe nuclear family ideal’, in D. Cutas and S. Chan (eds.), Families: Beyondthe Nuclear Ideal. London: Bloomsbury Academic.

Graham, S. and Braverman, A. (2012). ‘ARTs and the single parent’, in M.Richards, G. Pennings and J.B. Appleby (eds.), Reproductive Donation: Prac-tice, Policy and Bioethics. Cambridge University Press.

Hanson, F. (2001). ‘Donor insemination: eugenic and feminist implications’.Medical Anthropology Quarterly, 15, 287–311.

Hertz, R. (2002). ‘The father as an idea: a challenge to kinship boundaries bysingle mothers’. Symbolic Interaction, 25, 1–31.

(2006). Single by Chance, Mothers by Choice. How Women are Choosing Parent-hood Without Marriage and Creating the New American Family. New York:Oxford University Press.

Hertz, R. and Ferguson, F. (1997). ‘Kinship strategies and self-sufficiency amongsingle mothers by choice: post modern family ties’. Qualitative Sociology, 20,187–209.

Jadva, V., Badger, S., Morrissette, M. and Golombok, S. (2009). ‘“Mom bychoice, single by life’s circumstance . . . ”: findings from a large-scale surveyof the experiences of single mothers by choice’. Human Fertility, 12, 175–84.

Jones, C. (2005). ‘Looking like a family: negotiating bio-genetic continuity inBritish lesbian families using donor insemination’. Sexualities, 8, 221–37.

Kirkman, M. (2004). ‘Saviours and satyrs: ambivalence in narrative meanings ofsperm provision’. Culture, Health and Sexuality, 6, 319–35.

Layne, L. (2013). ‘“Creepy”, “freaky” and “strange”: how the “uncanny” canilluminate the experience of single mothers by choice and lesbian coupleswho buy “dad”’. Journal of Consumer Culture, 13, 140–59.

Mamo, L. (2005). ‘Biomedicalizing kinship: sperm banks and the creation ofaffinity ties’. Science as Culture, 14, 237–64.

Mannis, V.S. (1999). ‘Single mothers by choice’. Family Relations, 48, 121–28.Murray, C. and Golombok, S. (2005). ‘Going it alone: solo mothers and their

infants conceived by donor insemination’. American Journal of Orthopsychi-atry, 2, 242–53.

Nordqvist, P. (2010). ‘Out of sight, out of mind: family resemblances in lesbiandonor conception’. Sociology, 44, 1128–44.


Pennings, G. (2000). ‘The right to choose your donor: a step towards commer-cialization or a step towards empowering the patient?’ Human Reproduction,15, 508–14.

Rodino, I.S., Burton, P.J. and Sanders, K.A. (2011). ‘Mating by proxy: a novelperspective to donor conception’. Fertility and Sterility, 96, 998–1001.

Scheib, J.E. (1994). ‘Sperm donor selection and the psychology of female matechoice’. Ethology and Sociobiology, 15, 113–29.

Scheib, J.E., Kristiansen, A. and Wara, A. (1997). ‘A Norwegian note on “spermdonor selection and the psychology of female mate choice”’. Evolution andHuman Behavior, 18, 143–9.

Scheib, J.E., Riordan, M. and Shaver, P. (2000). ‘Choosing between anony-mous and identity-release sperm donors: recipient and donor characteris-tics’. Reproductive Technologies, 10, 50–8.

Wilson, S. (1997). ‘Identity, genealogy and the social family: the case of donorinsemination’. International Journal of Law, Policy and the Family, 11, 270–97.

13 Infertility, gamete donation and relatednessin British South Asian communities

Nicky Hudson and Lorraine Culley

Assisted reproductive technologies (ARTs) disrupt ideas about conjugal-ity, monogamy, family lineage and genetic continuity and thus providefertile ground for discussions of relatedness. Studies in several parts ofthe world have shown how understandings of such technologies andwillingness to engage with them may be complex, culturally configuredand local (Cepaitiene, 2012). In the UK, however, little attention hasbeen paid to public perceptions of ARTs and how understandings mayvary among different ethnic communities. As a result, there has beenextremely limited research examining how members of minority ethnicgroups engage with ARTs and with gamete donation in particular (Cul-ley, Hudson and Van Rooij, 2009). While some studies have begun todemonstrate the acceptability of some forms of ARTs, the use of donorgametes remains contentious in a number of contexts (Hudson et al.,2009). This chapter explores perceptions of infertility and of relatednessin third party assisted reproduction among members of British SouthAsian communities. Specifically, we consider how ideas about ethnicity,religion and gender shape such understandings.

Conceptualisations of ‘race’ and ‘ethnicity’ remain contested in bothlay and academic discourse. The idea that there exist groups of people sodistinct from each other that they form separate races has long been dis-credited by biologists (Culley and Demaine, 2006). Nevertheless, ‘race’remains highly relevant as a social and discursive construct since racismcontinues to legitimate social exclusion by claiming the grounding ofsocial difference in genetic and biological differences (Goldberg, 1993).Many sociologists have adopted a conceptual distinction between ‘race’,which evokes a biological and genetic referent, and ‘ethnicity’, which isseen as grounded in cultural practices, language and ancestry rather thanbiology (Fenton, 1999; Culley and Demaine, 2006). However, severalwriters have challenged this binary distinction, arguing that the biologi-cal referent is never completely absent from discourses of ethnicity either:biological markers such as skin colour have also, they suggest, been usedto connote social and cultural differences between groups (Brah, 1996;

232

Relatedness in British South Asian communities 233

Smaje, 2000). As Hall argues: ‘The more “ethnicity matters”, the moreits characteristics are represented as relatively fixed, inherent within agroup, transmitted from generation to generation, not just by cultureand education, but by biological inherences, stabilized above all by kin-ship and endogamous marriage rules that ensure that the ethnic groupremains genetically, and therefore culturally “pure”’ (2000: 223). Thesedebates demonstrate the persistent complexity of untangling the biolog-ical and the social within conceptualisations of race and ethnicity, whichremain contested yet highly salient social categorisations.

In attempting to understand lay perceptions of ethnicity in relationto third-party assisted reproduction in this chapter, we follow the workof sociologist, Steve Fenton, who proposes that ethnicity, like race, is asocial construct which has real, material effects for people’s lives (2003).An important effect, and central to the data discussed in this chapter, isthe way in which it is used by individuals to identify themselves and othersas belonging to a particular ethnic group. Fenton, drawing on culturalanthropology, suggests that ethnic identity is representative of ideas aboutboth descent and culture. He suggests that people do not just ‘possesscultures or share ancestry; they elaborate these into the idea of a communityfounded upon these attributes’ (2003: 3, original emphasis). Rather thanbeing a fixed social characteristic, ethnicity is one that entails a complexset of social processes where ideas about belonging and relatedness arelived out. Ethnic identity in this conceptualisation is about the way inwhich people negotiate boundaries of inclusion and exclusion and decidewho is ‘one of us’. In this chapter we use discussions about desire forchildren, donor selection, donor matching and relatedness, conducted aspart of research about infertility in British South Asian communities, toexplore meanings of ethnicity and identity.

The three sociological studies on which the chapter is based werecarried out between 2002 and 2008 with female and male membersof three main South Asian ethnic groups in the UK: Indian, Pakistaniand Bangladeshi (Culley et al., 2004, 2006a; Hudson, 2008). The term‘South Asian’1 is commonly used to describe those with ancestral rootsin India, Pakistan and Bangladesh. These groups collectively currentlyrepresent 5.3 per cent of the population (3 million people) in England and

1 While the use of the term South Asian is justified in some contexts, where the emphasisis on the many shared elements of culture, it is also recognised that this category encom-passes communities with many different norms and beliefs (Culley and Hudson, 2009a).One important area of difference is religion. UK national data indicates that Pakistaniand Bangladeshi groups are overwhelmingly Muslim (92%), while the Indian group ismore heterogeneous, with Hinduism (45%), Sikhism (29%) and Islam (13%) being themost common faith groups (Peach, 2006).

234 Nicky Hudson and Lorraine Culley

Wales (ONS, 2013). Though there is still mig ration on mar r iage, SouthAsians are largely settled communities, with approximately half of thepopulation having been born in the UK (Ali et al., 2006; Peach, 2006).

The data presented in this chapter are drawn from 28 lay focus groupswith 193 members of British South Asian communities (130 women and63 men who were not necessarily themselves infertile) and in-depth inter-views with 51 South Asian women and 14 South Asian men with personalexperience of infertility, a small number of whom had used, or were con-sidering using, donor gametes.2 The focus group participants, recruitedmainly through a number of community-based organisations, ranged inage from 18 to 60+ years.3 In terms of ethnic group identity, the peo-ple in the focus group sample were Indian (57%), Bangladeshi (27%)and Pakistani (16%). Their religious identity was reported as Muslim(49%), Hindu (27%), Sikh (23%) and ‘other’ (1%). The intervieweeswere recruited via infertility clinics and community contacts. The major-ity were Indian (68%), then Pakistani (18%), Bangladeshi (9%) and‘other Asian’ (5%). The interviewees reported their religious identity asMuslim (38%), Sikh (31%), Hindu (28%) and ‘other/no religion’ (3%).

We begin the chapter by first exploring data relating to the significanceof childbearing and infertility in British South Asian communities to pro-vide a wider context for understanding perspectives on using and choos-ing donor gametes in fertility treatment. The chapter then considers howattributes commonly associated with ethnic difference were perceived asimportant in choices about donors. We demonstrate how people viewedthe selection of a gamete donor as involving a consideration of charac-teristics that would ensure the outward appearance of both ‘biogenetic’4

and ‘social’ continuity within a family. At the same time, decisions aboutdonation were also seen to be mediated by gender, and the chapter thusdiscusses ideas about the relative significance of the sperm and the egg inconveying important aspects of inheritance and relatedness. The chapter

2 Interviews (not reported here) were also carried out with twenty-eight ‘key informants’from South Asian communities, nine infertility support group representatives, five infer-tility counsellors and twenty-six healthcare professionals involved in the provision ofARTs (embryologists, andrologists, clinicians, nurses).

3 Focus groups were carried out with participants who already knew one another and inmost cases, with individuals who shared ethnic group identity and/or religion with oneanother. See Culley, Hudson and Rapport (2007) for a full description of the focus groupmethod used in these studies. Discussions took place in English (n=14), Sylheti (a dialectof Bengali) (n=6), Punjabi (n=4), Urdu (n=3), or Gujarati (n=1), were fully transcribedand where relevant translated into English by the facilitator who had conducted thegroup.

4 We use the term ‘biogenetic’ throughout the chapter to refer to the way in which relat-edness is conferred from parent to offspring via the processes of reproduction (Bestard,2004).


concludes with a discussion of the possible implications of these findingsfor clinical practice in infertility clinics.

Infertility, childlessness and assisted reproduction inBritish South Asian communities

In all the communities studied, children were highly desired, parenthoodwas culturally mandatory and childlessness socially unacceptable. Vol-untary childlessness was almost unheard of. Marriage was described asalmost universal and parenthood was seen as the natural consequence ofmarriage. Children were seen as important for religious, cultural, social,economic and emotional reasons, which included the transference ofinheritance, the continuation of lineage and the performance of religiousrituals for deceased parents (Culley et al., 2006b). The dominant dis-course of mandatory parenthood was evident in all the focus groups andalso in the individual interviews with infertile couples who described the“pressure” to have children, which they felt was stronger in South Asiancommunities than in families within the white majority population.

Childlessness was seen as a legitimate area of social concern, notan issue confined to the couple themselves. Within pro-natalist com-munities, the visibility of childlessness becomes more pronounced andeven relatively newly married childless couples were regularly questionedabout their childless state, especially at social events and family gather-ings:

I mean, literally, for a couple of years, I just didn’t socialise at all, and, to bigfunctions and parties, when I couldn’t have [a child], because the pressure was sogreat. People just looked at me, like, you know, she’s no use to this community,she’d rather be off somewhere else. (interview, Pakistani woman, IVF own eggs,husband’s sperm)

I did isolate from the whole sort of community as well, because of the questions.(interview, Indian woman, IVF own eggs, husband’s sperm)

While there was resistance to early childbearing from some couples(Culley and Hudson, 2006, 2009a), parenthood was nevertheless adesired and anticipated status among young South Asian women andmen. Infertile couples often described going to great lengths to concealproblems with fertility due to the considerable stigma associated withfailed reproduction (Reissman, 2000; Culley et al., 2004, 2006b). Thestigma of infertility, however, was highly gendered (Culley and Hudson,2006). While men did not escape social questioning about possible fer-tility problems, and most people were aware that male factor infertilityexisted, the ‘fault’ was invariably placed with the woman. Men were


shielded from the full impact of infertility and their identities were per-ceived to be less affected by childlessness.

I mean basically in any Muslim family if the couple goes so long without gettingpregnant, it’s always the woman’s fault. (interview, Pakistani man, IVF ownsperm, wife’s eggs)

The negative social consequences of childlessness were especially harshfor women. In addition to being the subject of gossip, some child-less women also reported feeling excluded from the family and havingreduced moral worth in the wider community. Women articulated thatthey were not considered a full member of the family until they had pro-duced a child, or several children, and especially a son. The focus groupsalso demonstrated that a preference for male children was still stronglyfelt and for some of the women we spoke to, not having a male child wasconsidered a form of social infertility. In the focus groups, it was felt thatnot producing a child would be considered ‘good grounds’ for a man todivorce his wife. However, many of the infertile women we interviewedactually spoke of supportive husbands, although several had experiencednegative behaviour from their husband’s family.

The significance of children and the anticipated unhappiness of child-lessness meant that there was generally much sympathy for the quest ofchildless couples expressed in the focus groups, and general support forthe use of medical technologies to assist couples to conceive. Most par-ticipants in all the studies were broadly supportive of fertility treatmentin general, though in some cases little was known about what these treat-ments involved (Culley et al., 2007) and most felt that their use would notbe disclosed outside the immediate family context. Third-party assistedreproduction however, was regarded as socially unacceptable and theview was widely expressed that children conceived using donated gameteswould not be well accepted into the wider family and community. Theuse of donated gametes was perceived almost unanimously as morallycontentious, raising fundamental questions about monogamy, lineageand familial boundaries (Culley et al., 2006a; Culley and Hudson, 2007;Culley, Hudson and Rapport, 2013). Given this local moral context(Kleinman, 1992), all participants agreed that infertile couples wouldwork hard to conceal the use of donated gametes from others, since therisks of social ostracism and stigma would be considerable:

There is also this big fear of rejection by the other members of the communityand family as well. Of, of, well, therefore we’re gonna cut our ties because this[donor conception] is what you’ve done and so that’s one big thing and the fearof that happening . . . So they would rather keep that quiet and hold on to their


close-knit community and family . . . pretend everything’s A-okay and nothinghappened, and carry on as normal. (focus group, Indian woman)

If someone finds out about this [use of donor sperm] nobody will marry that child,because this child is not their father’s, the Nikah (Islamic marriage contract) isnot proved so nobody will propose to that child when it grows older. (focus group,Pakistani woman)

Suspicions about the origins of gametes seemed to relate to expressedconcerns about IVF generally. Certainly most of those undergoing fer-tility treatment had gone to great lengths to conceal this and those whohad been successful in IVF, even with their own gametes, spoke of need-ing to keep treatment secret for fear of repercussions on the couple andthe child. Use of donor gametes was considered to carry serious socialconsequences for the donor conception family, should this be revealed.Therefore, physical resemblance took on a particularly heightened impor-tance, since it was perceived that one way in which the use of a donorcould be effectively concealed was through the careful matching of donorwith recipient couple. When prompted to consider a scenario includingthe use of donated gametes in fertility treatment, the focus group par-ticipants discussed at some length the criteria that may be drawn uponfor actively choosing or rejecting egg and sperm donors when creating anew family or community member, as well as the boundaries and risksof using gametes from ‘other’ ethnic contexts. These complex and some-times contradictory constructions were highly pertinent in illuminatingideas about relatedness and shared ethnic identity.

Gamete donation and relatedness

The importance of physical resemblance

In her work on the significance of ‘race’ for donor selection processesin the USA, Quiroga (2007) suggests that the rationale for ‘match-ing’ donors and recipients for physical characteristics is precisely relatedto social contexts such as that described above in which children arerequired to be defined unquestionably as the biogenetic offspring of theirparents. She suggests that this matching work is done within the clinicwith the aim of concealing the fact of donation to the outside world. Thismatching work is seen to: increase the probability that a child will looksimilar enough to pass as the biogenetic offspring of the social parent;mimic physical attributes of the biogenetic family; and maintain secrecyso that a child cannot be mistaken as a product of a mother’s infidelity.Physical similarity between parents and children was indeed a matter of


great concern to our participants: it was thought that a donor-conceivedchild should physically resemble his or her parents to be perceived asbelonging. This was seen as important for all concerned (parents, child,family, community) because it allowed the family to be integrated withinthe community and avoid the social risks, such as social ostracism andstigma, that visible difference was seen to carry. In considering the bestway to achieve a physical ‘match’ between parents and children, the useof family members as donors was discussed and was considered by someto be the best option:

They should go for maximum matching and for that they should look among theirown family in order to achieve maximum resemblance. (focus group, Pakistaniman)

Intrafamilial donation was seen by some as providing a good substitutefor a couple’s own gametes, since not only was this perceived as ensuringphysical resemblance but also as maintaining an important biological –or what was commonly referred to as “blood” – relationship betweenthe family, wider kinship group and the child. However, intrafamilialdonation was also seen to present two key dilemmas: exposing the highlystigmatised issue of infertility and raising concerns about the possibilityof the donor wanting to “interfere” in a child’s upbringing, thus creatingdifficulties for both parents and child.

For these reasons, participants considered the benefits of using ananonymous (at the point of donation) donor. Here too, the need forphysical similarity remained: it was seen as important for a child to “fitin” physically with the family, as well as the wider community. This wascommonly expressed as being “Asian”.5 Phenotypical markers believedto be signifiers of “being Asian” were therefore desired, including haircolour (dark brown or black), skin colour (dark brown or olive), and eyecolour (brown):

All depends on the colour. If they’ve got two parents of like, Asian skin and thenthe child’s born with much lighter skin or different hair, or different eyes [it wouldbe a problem]. (focus group, Indian woman)

I think certain characteristics . . . It does help if you match your hair colour, youknow, whatever, because it makes it easier for the child to grow up. (focus group,Indian woman)

5 In some contexts, participants used the term “Asian”, thus reproducing a quasi-legalor official terminology as used for example in the Census, and on other occasions,participants used more definitive categorisations to signal group membership, such as“Indian”, “Bengali” or “Muslim” ( Jenkins, 2008).


These examples reflect the need for relatedness to be apparent and taken-for-granted, with no explanation required (Becker, Butler and Nachti-gall, 2005; Konrad, 2005). Biogenetic connection, expressed here inthe form of particular physical traits, signals reference to a ‘mutual his-tory’ (Edwards and Strathern, 2000), demonstrating the way that skincolour in particular may operate as a visible and unchanging marker of‘racial’ group identity (Tyler, 2005, 2007). These accounts draw on thesymbolism of race to articulate what it means to belong, thereby par-ticipating in the maintenance of racial categories as markers of groupidentity and relatedness. Shared colour carries the symbolic meaning ofsameness and relatedness, and colour difference symbolises exclusion ornon-relatedness (Ragone, 2000). As many authors have argued, resem-blance, especially in racial/ethnic terms, confers belonging, both to afamily and to the wider ethnic group beyond (Price, 1997; Quiroga,2007; Thompson, 2009).

When introduced to the fact that ‘Asian’ donors were in short supply,some participants considered the scenario of a couple using a ‘white’donor’s gametes. Here participants demonstrated some elasticity in theboundaries around sameness/difference in permitting the use of a physi-cally different donor. They suggested that this would not raise too manyconcerns, so long as such matching did not stretch the boundaries toofar.

If a husband and wife are both fair, right, colour-wise, then they should have noproblem. (focus group, Indian woman)

Therefore a ‘white’ donor with dark hair, dark skin and dark eyes couldbe considered just about acceptable for a South Asian couple, whereas ablonde-haired, blue-eyed donor (a pervasive symbol of racialised ‘white-ness’) would be considered too risky. One couple, faced with an impos-sibly long delay of treatment due to the shortage of ethnically matchedegg donors at their local clinic, were actively considering using a whiteegg donor:

We asked the doctor, we are prepared to take English [white] donor, becauseI want to have IVF as soon as possible . . . I don’t want to lose this chance.(interview, Pakistani woman, IVF with donor eggs, husband’s sperm)

These examples suggest a degree of flexibility in considerations aboutwhat constitutes ‘Asian-ness’ and illustrate the ways in which cate-gories that appear immutable and beyond change are stretched andadapted to fit current circumstances, especially by those experiencingwhat was commonly perceived as the very real trauma of infertility. As an


explanation for this apparent contradiction in allowing a ‘white’ donor tobe used for an ‘Asian’ couple, people also often drew on well-rehearsedlay discourses around the aesthetic value of lighter skin in South Asiancommunities (Nakano Glenn, 2009).

The transmission of religious identity

In the previous section, the importance of ‘matching’ donors and recipi-ents was described at a physical level, foregrounding a form of racialisedbiogenetic relatedness, albeit one that allowed for a degree of flexibilityin its constitution. However, other characteristics were also discussed inrelation to donor selection. Religious identity was considered as one pos-sible feature of a donor that should be selected when deciding what kindof donor might be desirable. In some of these discussions, it emergedthat religion was seen to be inherent in the gamete of the donor.

Religion is important here because, firstly I mentioned before, where the spermcame from [is important] . . . Now if a Muslim lady carries the sperm of a Chris-tian, what will happen to this child? As it is accepted that the baby is born fromthe father’s sperm, then this baby will be a Christian in the house of a Muslimlady. (focus group, Bangladeshi Muslim man)

The importance of the religious identity of the donor varied betweenreligious groups in our research. While participants who described them-selves as Sikh rarely identified religion as important in donor selection,Muslim and Hindu participants were more likely to give religious identityas a defining characteristic. For many Muslim participants in particular,the religion of the donor was highly significant and using a non-Muslimdonor was not considered an acceptable option. Religion appeared to beperceived as part of the essence of the donor and thus transmitted viatheir gamete (especially the sperm, as in the example cited above), andnot something that is later conferred by upbringing. Islam in particularwas not seen as something which was simply lived, but as somethingmuch more central to a person’s ethnic constitution (Modood, 2005).Whoever else the donor might be, they could not be Hindu if the recipi-ents were Muslim, and vice versa. Religion was seen in these examples tobe as significant as skin colour for constituting ethnic identity, and couldtherefore not be easily categorised as a socially conferred characteristic.For one male participant this would extend to a child who, on finding outthat his/her donor was not of the same religion in which s/he had beenraised, would have doubts about his or her religious identity:

What if he finds out? And he wants to go back to his religion? (focus group,Indian Hindu man)


In these discussions of what might be “passed on” from donors, there wasa great deal of elision between ideas about what might, in other contexts,be thought of as social similarities (religion) and biogenetic similarities(phenotype). Gametes were seen to transmit elements of both in a wayin which professionals may not commonly consider: as one fertility nursewe interviewed described, “I had no idea sperm could have a religion”.Biogenetic material was perceived as a proxy for the person donatingand strongly anchored to its generative origin (the donor and his or hercultural roots). Therefore work was needed in the matching process toalign the recipient and donor as closely as possible in cultural terms,particularly with regards to religion.

These findings about donor selection reflect those from research withrecipients in other communities where there is an apparent desire on thepart of some to select donors who describe themselves as holding particu-lar social or psychological characteristics such as educational excellence,altruism, or musical or sporting talents (Konrad, 2005; Mamo, 2005).It is not clear in our data, nor indeed in other studies, whether this isbecause recipients want to imagine the donor as a kind and/or talentedperson in a generalised sense, or whether they consider these assumeddonor traits would be somehow biogenetically passed on to the resultingchild.6 In either case, as Konrad suggests, the importance recipients andclinics place on a ‘credible genetic substitute’ allows the assertion of thesocial identities of children as their ‘own’ (2005: 150).

Not all participants agreed that such characteristics were biogeneticallytransferred however, and in other exchanges this position was resisted,with religion seen instead as conferred only through socialisation. Someparticipants felt therefore that while matching might be important at aphysical level, beyond that, it did not matter who the donor might be, asthe recipient couple would be responsible for shaping a donor-conceivedchild’s social identity:

When the parents bring up the child . . . then perhaps it does not matter whetherthere is such a link or not. It’s the love which comes first. (focus group, IndianSikh man)

6 In our research it was not suggested that donors with particular attributes would besought in order to incorporate these into a conception story for donor-conceived chil-dren. Decisions about donor choice were primarily seen to be related to concerns aboutinadvertent disclosure to the wider community and the resulting implications for fami-lies. See Braverman and Frith (Chapter 7), Smietana et al. (Chapter 11) and Graham(Chapter 12) for further discussion of donor selection in different contexts. Views aboutwhether a child should or should not be told about the nature of his or her conceptionwere mixed.


I’m Indian because my parents have brought me up that way. (focus group, IndianHindu woman)

Gender, gametes and relatedness: the importance of biogeneticmotherhood and fatherhood

In exploring the issue of relatedness in these accounts, we were also struckby the significance of gender. In the process of third party conception,using donated eggs and using donated sperm were not considered in thesame way. This was commonly expressed through discussions about therelative contribution of the egg and the sperm and the significance ofgestation to the constitution of the offspring. In this section, we explorewhether it was considered more important for a South Asian child to bebiogenetically related to his or her mother or father.7 In the focus groups,participants were asked to consider scenarios for treatment requiringegg donation and for treatment requiring sperm donation. While thesedebates were complex, in general it was felt that egg donation would beless problematic for couples than using donated sperm. There appearedto be two main reasons for this. First, gestation was seen as granting a‘biological’ connection between mother and child, regardless of whoseeggs were used. Gestating and giving birth to a child enables a ‘bloodrelation’ to be established, whereas in sperm donation the social fatherhas no biological tie to the child (Konrad, 2005). Second, using donatedsperm was seen to disrupt the patrilineal connection, a link deemed moreimportant to family relatedness and lineage than matrilineal continuity.This view was expressed in the focus groups as well as by three coupleswe interviewed who were seeking treatment with donor eggs:

If you take egg donor, yeah, father is same and the mother is the same becauseshe bonds with that child. But if sperm donation . . . your partner has nothingto do with that child, no relation. (interview, Pakistani woman, IVF donor eggs,husband’s sperm)

However, this does not mean that using donor eggs was perceived asunproblematic. It was thought treatment with egg donation could causesignificant emotional distress to the couple, especially the woman, andthat the technique itself was contentious due to its perceived transgressionof conjugal boundaries. However, as egg donation was perceived to offera means of conferring a form of biological relatedness for both parents,it was deemed less culturally and morally problematic than the use of

7 For a fuller discussion of the role of gestation and genes in relatedness, see Culley andHudson (2009b).


another man’s sperm. Both male and female participants suggested thatthe ‘social’ father would find it more difficult to accept a child to whichhe was not biogenetically related. The perception was that there was littlelinking him to a child to whom he had not contributed any biogeneticsubstance, and that men, viewed as innately less nurturing than women,would have difficulty accepting such a child. Conception with donatedsperm could also be symbolically conflated with adultery as it carriedhighly sexualised and morally risky connotations (Haimes, 1993; Nash,2004). In addition, several female participants expressed the view that theneed for a child to be connected to its biogenetic father was representativeof broader gender inequalities within South Asian communities, withmales being more highly valued than females and women’s reproductivecapacities being subject to stronger regulation:

Yeah, it [egg donation] would probably be more acceptable as well because insome communities, you know, the male is valued more than the woman anyway[laughter]. (focus group, Indian woman)

I think, in tradition, whether a child has his mother’s characteristics doesn’tmatter much, but it, he, the child, has to have the father’s characteristics. Andfather’s side, family characteristics. (focus group, Bangladeshi woman)

As we have suggested elsewhere, this appears to confirm the view that bio-genetic paternity is of considerable significance for male authority moregenerally (Culley and Hudson, 2009b). It also reflects long-standing pro-creative beliefs which see the male contribution as generating, rather thanmerely gestating, life (see also Almeling, Chapter 8).

While in all focus groups biogenetic fatherhood was seen as moreimportant than biogenetic motherhood, this had a particular manifes-tation within the Muslim groups, since the importance of a paternalconnection is often articulated within Islam. Most Muslim men andwomen framed ARTs through a discourse of risk, primarily shaped bySunni8 Islamic views about rights and responsibilities (Clarke, 2011).There was much talk among our Muslim participants about the religiousacceptability of using third-party sperm and most felt that it was unlikelythat a Muslim couple would follow this route. Islam mandates biogeneticinheritance, preserving the nasab or biogenetic origins of a child, andthird-party conception is seen to confuse issues of descent and lineage.Using third-party sperm was therefore seen as particularly problematicfor relatedness here, as it was regarded as zina (adultery) (Inhorn, 2005;

8 Sunni Islam is the dominant form in British Muslim communities and was the branchwith which participants in our research identified.


Clarke, 2011), and a child conceived this way would be viewed as illegit-imate in Islamic law:

It’s classed as adultery . . . not that you’re having bodily contact, but it’s classedas adultery . . . You’re not allowed to hide the name of the biological father, it’snot allowed in Islam. (focus group, Pakistani Muslim woman)

As this quote illustrates, the concealment or non-disclosure of spermdonation could present particular difficulties. There was less clarity andconsensus around the Islamic acceptability of using donated eggs. Incommon with other groups, and as discussed above, participants felt thatthis might be a more acceptable solution to infertility due to the gesta-tional link to the mother and the biogenetic link to the father. However,Muslim participants stated that its acceptability would need to be clarifiedwith religious scholars (Culley and Hudson, 2009b). By contrast, whileparticipants who identified with other faiths (Hinduism and Sikhism) orno faith were far less likely to discuss any specifically religious objectionsto third-party assisted reproduction, they nevertheless regarded this as aculturally unacceptable practice (Blyth and Landau, 2009).

Conclusion

This chapter has considered the importance of understandings of eth-nicity, religion and gender for shaping the meanings people attribute toARTs. In doing so we have attempted to reveal the ways in which relat-edness is constructed in everyday talk about egg and sperm donation.Anthropologists have long argued that ARTs offer a helpful lens throughwhich to explore ‘lay’ perceptions of kinship and of what it means tobelong (Strathern, 1992; Franklin and Ragone, 1998; Edwards et al.,1999). Jeanette Edwards, in this volume and elsewhere, argues that whatpeople perceive as ‘biological facts’ are brought into being and mademeaningful through social practices of kinship (see also Edwards, 2012).In this chapter we demonstrate how the ‘biological facts’ of ethnic sim-ilarity and gendered relatedness are constructed in relation to donorconception. Our analysis suggests that, while both social and biologicaldiscourses are present in discussions about donated biogenetic material,when asked to talk about the importance of ethnic identity, there was aconsiderable foregrounding of the biological over the social.

While we have suggested an absence of scientific evidence about theexistence of biological races, it is clear from our data that people never-theless conceive of some notion of ‘race’ as if it were real. Lay under-standings of ethnicity remain clearly inflected by biological qualities, withideas about a distinct ‘Asian’ racial group, defined by an individual’s


identity, parentage and ancestry, and indicated by a person’s physicalappearance, strongly present (Tyler, 2005). These findings lend weightto the call from some sociologists to retain a conceptualisation of ‘race’(albeit a critical one) since this construct remains very real in its effects inpeople’s lives. Minoritised groups, such as the British South Asian dias-pora, have long been subject to racialisation (the marking out of visibleminority groups as politically and categorically ‘other’), through mate-rial processes of slavery, colonisation, and racism (Miles, 1989). Thesepoliticised processes have shaped the ways in which members of thesegroups define the boundaries of belonging, and identify how this is notthe case for the white majority, who are deemed ethnically neutral. It isthese powerful discourses of racialised identity which are at play in theaccounts presented in this chapter.

Religion, usually conceived of as a feature of cultural or social identity,was also often biologised in the accounts discussed. For some partici-pants, religious identity was an essential part of a person’s ‘ethnic’ con-stitution and not something passed on socially or culturally. While therewas more debate and disagreement about this than in discussions aboutphysical attributes such as skin colour, it tells us something importantabout the formulation of identity and about who can be considered anacceptable donor for South Asian couples. ‘Being Muslim’ was in par-ticular perceived of as an inherited identity which should be matched inthe donation process and which was biogenetically constituted.

The gender of the person whose gametes were being substituted hadclear implications for the identity of the future child and his or her placingwithin established kinship networks. The severing of the connection toa child’s father had greater implications for whether that child could beconsidered as related to the family and the wider kinship group than ifhe or she were not biogenetically related to their mother. This was alsoshaped by other factors, such as the possibility of some kind of maternalbiological connection conferred during gestation and the conflation ofsperm donation with adultery, which carried more sexualised and morallydeviant associations than the crossing of conjugal boundaries implicit inegg donation. Both of these factors seemed to shore up the idea of eggdonation as a less risk-laden option than sperm donation for couplesseeking donor conception and contributed to a gendering of relatednessin these discussions. This finding was particularly pertinent in relationto Muslim participants who described clear religious mores around thesignificance of paternal lineage.

By focusing our discussion on minoritised ethnicities, we are not sug-gesting that matching of donors and recipients is only important for suchgroups. On the contrary, we wish to highlight that, while decisions about


matching donors and recipients are significant for all groups, they areoften differently conceptualised. For example, with white couples, dis-cussions about matching commonly include both phenotypical featuresand ideas about the heritability of individual attributes, such as eye colourand sporting or musical ability (see Braverman and Frith, Chapter 7).Collective notions of ethnicity or culture, or the continuation of an eth-nic group, are less commonly expressed. Rather, ‘whiteness’ conceals anassumed racial, ethnic and cultural neutrality in which race is only fore-grounded by the small number of high profile clinic mix-ups in which‘black’ and ‘white’ gametes are mistakenly used together in a couple’streatment (Tyler, 2007; see also Richards, Chapter 1). In these cases,racialised ideas of heritability are exposed and group identity becomessignificant. Understanding relatedness in relation to race and ethnicity(whether biologically or socially constructed) is of relevance for bothminority and majority groups, though it may only be made visible andnamed when it becomes problematised, or when it is highlighted byresearch which includes members of racialised minority groups.

The issues raised by this research have significance for clinical prac-tice in three important and related ways. First, professionals should bealert to the potential desire for recipients to select a donor based oncriteria extending beyond phenotypic characteristics. Selecting a donorprimarily due to his or her religion for example, may challenge currentassumptions and clinical practices surrounding matching, but may relateto perceptions of religious identity as an important feature of ethnic orracial ‘essence’. Second, clinicians should also understand that someflexibility exists in the possible options that infertile couples may accept.This is particularly important in the context of on-going shortages ofdonors from minority ethnic groups in the UK (HFEA, 2011). If thereare no ethnically matched donors available, couples may be willing, ormay wish, to choose a donor from a different ethnic group (a white donor,for example). Treatment-seeking individuals of all ethnicities continuallyextend the boundaries of what might be considered acceptable duringthe infertility journey, despite the existence of culturally bound normsand morals. In addition, the role of health professionals in the process ofdonor-matching in the context of identifiable donation is an issue worthyof further research. Third, the reported practice of clinic staff suggestingto patients, where there are donor shortages, that they bring their owndonor (i.e. a friend or family member) is also potentially problematic incommunities where infertility is heavily stigmatised and disclosure of theuse of donated gametes in particular is seen as something to be avoidedat all costs. The disclosure of third-party assisted reproduction needs to


be viewed not just as a decision by parents about whether to tell theirchildren about the use of donor gametes but as a decision encompassingfurther decisions and dilemmas about how much information about theconception should be shared with wider family and community networks(see Blake et al., Chapter 14; Nuffield Council on Bioethics, 2013). Thisis the case in all communities (see Nordqvist and Smart, Chapter 16)but may be particularly challenging for parents in communities where theimplications of infertility and childbearing extend well beyond the indi-vidual couple. It is important to recognise that ‘openness’ about donorconception as currently advocated in the UK and beyond may have dif-ferent meanings and consequences in different cultures and for differentminority ethnic groups. The ethnocentric manner in which these dilem-mas are often discussed within professional contexts further contributesto the discursive and political marginalisation of certain sections of soci-ety with regard to the use of ARTs. Clinicians need to be mindful of thesubsequent (but rarely acknowledged) inequality and burden placed onmembers of minority ethnic communities who may be effectively deniedaccess to ARTs if clinics fail to consider such issues.

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14 Families created by assisted reproductionChildren’s perspectives

Lucy Blake, Sophie Zadeh, Helen Statham andTabitha Freeman

Introduction

An increasing number of children are conceived using third-party assistedreproductive techniques (ARTs). Although we are beginning to under-stand more about the psychological well-being of these children andthe functioning of their families, little is known about the thoughts andfeelings of children conceived in this way. While policy on assisted repro-duction in the UK and elsewhere has been guided by the ‘best interestsof the child’, the voices and experiences of children themselves are notwell documented. As a result, assumptions about what may or may notbe important for children might not accord with their own experiencesof family life. It is therefore essential to gain an understanding of howchildren conceived using ARTs come to know, interpret and developnarratives about their conception and family relationships, and how theyfeel about others involved in their creation: the egg donors, sperm donorsand surrogates that Ehrensaft (2008) describes as ‘birth others’.

This chapter will outline the limited empirical evidence on children’sperspectives in families created by donor insemination (DI), egg donation(ED), and surrogacy (SU), in families headed by heterosexual couples,lesbian couples and single mothers. In particular, the chapter will draw onfour recent UK studies, referred to here as: the UK Longitudinal Study,1

a study of DI and ED families over a ten-year period; the AdolescenceStudy,2 a study of DI families with adolescents aged 10–14 years; the Dif-ferent Families Study,3 a study of donor-conceived children and youngadults aged 4–19 years growing up in same-sex couple families; and theSolo Mother Study,4 an on-going study of DI families headed by singlewomen with children aged 4–8 years.

1 See Golombok et al. (2011). The first three phases of the study were funded by TheWellcome Trust and the latter two phases by The National Institutes of Health (NIH).

2 See Freeman and Golombok (2012). This study was funded by The Nuffield Foundation.3 See Guasp (2010). This study was funded by Stonewall.4 See Zadeh, Freeman and Golombok (2013). This study was funded by The Wellcome

Trust.

251

252 Lucy Blake, Sophie Zadeh, Helen Statham and Tabitha Freeman

Context and challenges to understandingchildren’s perspectives

Traditionally, research on family relationships and family functioning hasbeen adult-centred, focusing on the perspectives and experiences of par-ents (and in particular, mothers). However, children have been increas-ingly recognised to be active agents who shape the nature and quality offamily interaction, and the parent–child relationship has been acknowl-edged to be bidirectional, based on mutual responsiveness between par-ent and child. The existing literature on children’s perspectives on theirfamilies forms part of a relatively new research tradition that has reposi-tioned children from being the subject to the object of research (Chris-tensen and James, 2008; Dunn, 2008). This research has shown thatchildren define and create kinship in highly creative ways (Smart, 2003).It has been suggested that children may use functional rather than struc-tural definitions to identify who is kin and who is not. For example,children may not include ‘absent’ fathers in their descriptions of familyif they perceive them to be uncaring, unloving or no longer a sourceof support (O’Brien, Alldred and Jones, 1996). At the same time, chil-dren seem to be aware of ‘an [adult] nomenclature for defining what aproper relative is’ (Mason and Tipper, 2008: 444). Children’s perspec-tives on family relatedness have therefore been identified as an outcomeof a co-constructive process of ‘kin-making’ or ‘kin-keeping’ by adultsand children.

Research examining the perspectives of children in assisted reproduc-tion families is rare. In part, this is because very few donor-conceivedchildren were aware of the nature of their conception until relativelyrecently. During the 1980s and 1990s, the majority of parents chose notto tell their children about having used a donor (Golombok et al., 1996);as such, these families were shrouded in secrecy and difficult to access.Now, the notion that parents ought to ‘disclose’ to their children theirdonor origins seems to be an idee fixe (Smart, 2003) in both policy andclinical practice relating to ART families in the UK (Richards, Chapter 1)and parents are encouraged to tell their children that they were conceivedusing an egg or sperm from a donor (HFEA, 2004). This cultural transi-tion from secrecy to openness about gamete donation provides a formalbackdrop to understanding children’s perspectives on kinship in ARTfamilies (Mason and Tipper, 2008).

While recent studies reveal that the rate of disclosure about donorconception is growing, the majority of parents in heterosexual couplesstill choose not to tell (Golombok et al., 2011). Gaining access to thesefamilies thus remains difficult. Even in families where children are aware

Children’s perspectives 253

of their donor conception, parents may be reluctant to participate inresearch as they may consider their use of a donor to be a private, sensitiveissue. Others may not identify their use of a donor as significant, andresearchers should be mindful not to assume that assisted reproductionwill always be a salient aspect of family life.

The scarcity of research examining children’s perceptions in familiescreated by ARTs is also due in part to the numerous practical and ethicalchallenges in conducting research of this nature. Ensuring that childrenfeel comfortable and relaxed is integral to allowing the researcher toestablish a rapport with the child. Some children may feel more at easewith a parent present – and some parents may prefer this too – althoughthis may influence their child’s responses. In addition to ethical princi-ples that apply to studies with adults, such as voluntary participation andinformed consent, there are further ethical issues to consider in researchwith children (Morrow and Richards, 1996). For example, children’svarying levels of comprehension and competency may have implicationsfor the consent process. The issue of protecting participants from poten-tial harm may be complicated by the inherent difference in status andpower between children and adults, and by children’s greater vulner-ability.

This chapter presents both parents’ and children’s accounts of theirconversations about assisted reproduction. It focuses on how and whenparticular information is presented by parents and how children respond,exploring how these ideas are understood and appropriated by childrenin their narratives about their origins and families. While the main focusis on children’s accounts, the use of parents’ reports is more frequent ininstances where children were considered too young to be asked directlyabout their conception, not least due to their limited comprehension andlinguistic abilities.

Children’s perspectives in heterosexualtwo-parent families

Donor insemination and egg donation

How do parents explain donor conception?Most heterosexual couples start the process of telling their child thatthey were conceived using donated gametes by the time he or she is4 or 5 years old (MacDougall et al., 2007). These parents want theirchildren to have ‘always known’ about their donor conception and forthere never to be a time when this information is new or surprising.Others start this process when their children are slightly older, at around


7 or 8 years, although parents’ views on the ‘right time’ vary (Kirkman,2003). These parents wait for their children to be old enough to have abasic understanding of reproduction, and to have a sense of discretionas to the significance of this information and who should or should nothave access to it. Some parents have been found to ‘partially disclose’,telling their children that they were conceived using fertility treatmentbut not that donated gametes were used (Readings et al., 2011; Freemanand Golombok, 2012). Other parents may intend to tell their childrenbut never do so.

In families headed by heterosexual couples, the disclosure of donororigins is typically initiated and maintained by mothers (Jadva et al.,2009; Blake et al., 2010). Mothers commonly explain donor conceptionto their child in a simple, story-like manner, although some give moredetailed and scientific explanations of the basics of reproduction, as thefollowing descriptions (from Blake et al., 2010) illustrate:

I didn’t have any eggs and . . . some very kind person very kindly gave them to us,because we wanted you so much and that we’ve, you know, got you, which is themost wonderful thing. (Mother of 7-year-old girl, ED family)

From Daddy you need the sperm and from Mummy the egg, and then we saidthat Daddy doesn’t make any sperm so we couldn’t manage to make you, wecouldn’t manage to have a baby, so we needed help so we went to the hospital,and we had to borrow it from someone else. (Mother of 7-year-old girl, DI family)

Some parents emphasise to their child that they are special, or a ‘miraclechild’ (Rumball and Adair, 1999), and report books such as My Story(Cooke, 1991) to be useful (Lycett et al., 2005; Hargreaves and Daniels,2007). Some couples produce their own scrapbook about their family’s‘special conception’ (Rumball and Adair, 1999; Hargreaves and Daniels,2007).

How do children respond to disclosure?Children’s reactions to first learning of their donor origins have beenfound to vary from curiosity to neutrality to no response at all (Lalos,Gottlieb and Lalos, 2007; Blake et al., 2010). Some parents reported thattheir children expressed sadness, or asked, “Does this mean you are notmy real mother/father?”, although parents did not find this experience tobe as painful as they had feared (MacDougall et al., 2007).

In the Adolescence Study, ten out of thirty DI adolescents (aged 10–14) had been informed of their donor conception (Freeman and Golom-bok, 2012), of whom nine were interviewed about their feelings about thedisclosure process. All except one adolescent reported positive or neutral


responses to learning of their donor conception, with the predominantdescription being one of indifference:

I just felt the same. It doesn’t make a difference how I got here. (Adolescentfemale, DI family)

The adolescent who reported a more negative response had learnt abouttheir donor conception at a later age and under difficult family circum-stances. This reflects the more general finding that children’s responsesto being told about their donor conception may be affected by factorssuch as their age and the manner and context in which this information isimparted, with disclosure in early childhood being associated with morepositive outcomes (Jadva et al., 2009).

What do children understand about being donor conceived?In the UK Longitudinal Study, interviews were conducted with childrenwho were aware of their donor conception at two time-points, whenchildren were age 7 (Blake et al., 2010) and age 10 (Blake et al., 2013).With their parents’ consent, children were asked open questions suchas, ‘Your mum/dad told me that a man/woman helped them to makeyou. Can you tell me more about that?’ and ‘What did your mum/dadtell you about the man/woman who helped them to make you?’. Thesequestions took place within the context of a longer interview about theirfamily life, and children did not always provide answers to each of thequestions in this section. This may have been due to feelings of confusion,uncertainty or feeling uncomfortable about what was being asked. In suchinstances the interviewer endeavoured to alleviate children’s discomfortby moving on with the interview or changing the topic of conversationaltogether.

At age 7, most children appeared to have little understanding of whattheir parents had told them about their donor origins. By age 10, mostof those who responded to the interviewer’s questions demonstrated abasic understanding of their donor conception (Blake et al., 2013). Forexample:

She [Mum] had the eggs put into her and then my dad’s sperm mixed it up and,and then I got created, and then she said like, about all the particles and stuffthat like, run about and make stuff. (10-year-old boy, ED family)

Interpreting the children’s level of understanding from these interviews isdifficult. The children’s responses may be a true reflection of their currentlevel of understanding, or repetition of what their parents have told them.The children’s longer and more detailed responses at age 10 may have


partly been due to their familiarity with the researcher, who visited thesame families both times and had developed a rapport with them.

At early adolescence, children are likely to have developed a fullerunderstanding of their donor conception. Those interviewed in the Ado-lescence Study demonstrated an awareness of the implications of beingdonor conceived with regard to their lack of biological or ‘genetic’ related-ness to their father, while perceiving this to be insignificant in determiningtheir feelings towards him. There was no confusion as to the identity oftheir father and there was no allusion to the sperm donor in these terms.As one adolescent said of her father:

He is always going to be my dad. (Adolescent female, DI family)

How do children feel about being donor conceived?In the UK Longitudinal Study, children were asked how they felt aboutbeing donor conceived. At age 10, most of those children who respondedhad neutral feelings, or described their donor conception in a positiveway. For example:

I’m fine . . . I don’t feel any differently, I’m just carrying on with my life. I don’treally think about it much, because there’s much more like, special on my mind,like cooler things. So I don’t really care about it much. (10-year-old boy, DIfamily)

The children were asked to describe how they felt when they first learnt oftheir donor conception. Children’s responses ranged from feeling amazedand/or shocked, to feeling fine:

Just a little bit shocked really . . . Yeah I just didn’t realise that it was like that. Ithought it was just the normal way of people getting made. (10-year-old boy, EDfamily)

I was quite happy. It felt a bit strange. Like weird, or maybe I didn’t understand.(10-year-old girl, DI family)

Most 10-year-olds reported that they did not discuss their donor concep-tion with their friends, which could be indicative of feelings of discomfortor embarrassment:

That’s the only secret that I haven’t told any of my friends because I don’t reallywant anyone to know. (10-year-old girl, DI family)

However, children may feel more comfortable talking to friends aboutthis issue as they grow older. In an American study of sperm donoroffspring aged 12–17 years, most reported having told their friends abouttheir donor conception (Scheib, Riordan and Rubin, 2005). However,the adolescents in this study were conceived using an identity-release


donor and had grown up knowing that they would be able to accessidentifying information about him on reaching adulthood, which mayhave influenced their comfort with this knowledge and its dissemination.

How do children feel about the donor? Children have generallybeen found to refer to their sperm or egg donor in positive terms, descri-bing this person as being “nice” and/or “kind”, or simply stating that theydid not know him/her. At adolescence, feelings about sperm donors havebeen found to range from a lack of interest to curiosity about the donor’scharacteristics, such as physical appearance and personality (Freemanet al., Chapter 15). As one child in the Adolescence Study described:

I’m curious but on the other hand I don’t really want to know about him [thesperm donor] because it doesn’t really affect me at all. (Adolescent female, DIfamily)

There was little indication that the adolescents in this study had a deeperinterest in their sperm donor beyond this sense of curiosity, particularlyregarding possible resemblances and inherited traits. Neither did theyexpress a desire to establish any form of relationship with him, werethis possible. Furthermore, there was no evidence from this study tosuggest that a child’s increased understanding and awareness of theirsperm donor conception results in their rejection of the father as the‘non-genetic’ parent; a finding that should be reassuring to DI parentsin heterosexual partnerships who often fear that a child’s knowledge oftheir donor conception may have a detrimental impact on the father–childrelationship.

There is not yet enough empirical data to draw comparisons betweenhow offspring conceived by donor egg or by donor sperm may feel abouttheir donors. While the relatively greater number of those searching forinformation about their sperm donors than egg donors may indicate anincreased interest in the former, this is a highly complex issue, with factorssuch as a child’s age, gender and family type as well as their feelings aboutbeing donor conceived coming into play (Freeman et al., Chapter 15).

Surrogacy

How do parents explain surrogacy? Almost all heterosexual par-ents in families created by surrogacy have been found to be open withtheir child about their use of a surrogate. In the UK Longitudinal Study,data was obtained from thirty-three surrogacy families when childrenwere aged 10. At this time, 91 per cent of parents had disclosed theiruse of a surrogate to the child, and the remaining 9 per cent intended todo so in the future. This high rate of disclosure is likely due to the fact


that couples in surrogacy families have to explain the arrival of a baby tofriends and family in the absence of a pregnancy. Parents may thereforewish to avoid disclosure by a third party, or feel the child has a right toknow or see no reason not to tell (MacCallum et al., 2003). The follow-ing quote from the UK Longitudinal Study gives an idea of the languageand stories that parents use to explain surrogacy to their children:

Mummy’s tummy was broken and [surrogate] offered to help us and so thedoctors gave daddy some special equipment and he put his seeds in there andthen [surrogate] put the seeds inside her so you could grow. (Mother of 7-year-oldgirl, SU family)

Of the surrogacy families participating in the study when children were 10years old, twelve were gestational surrogacy families where the embryoof the intended parents had been transplanted in the surrogate, andtwenty-one were traditional surrogacy families where the surrogate hadused her own egg. As in gamete donation families, some parents in tra-ditional surrogacy families have been found to engage in ‘partial dis-closure’ (Readings et al., 2011), telling their child some informationabout the way in which they were conceived (i.e. that they used a sur-rogate), but not all of the information (i.e. that the surrogate’s egg wasused). When children were aged 10, 42 per cent of parents in traditionalsurrogacy families had engaged in such partial disclosure, the majorityplanning to tell the child about the use of the surrogate’s egg in the future(Jadva et al., 2012). That parents engage in partial disclosure might indi-cate that the involvement of a surrogate in the gestation and birth ofa child is easier to disclose to young children than the use of donatedgametes.

What do children understand about being created by surrogacy?When children in the UK Longitudinal Study were interviewed at bothage 7 and age 10, most children demonstrated an understanding of hav-ing been born via surrogacy (Jadva et al., 2012). For example:

Well my mum’s womb, I think [ . . . ] well it was a bit broken, so [surrogate]carried me instead of my mum. (10-year-old boy, SU family)

That children in surrogacy families were better able to answer ques-tions about the circumstances of their birth compared to those chil-dren in donor insemination and egg donation families may indicate thatthe process of surrogacy is more straightforward for children to grasp.However, further research is needed before conclusions can be reached.Further data is also required in order for differences in the narratives of


children conceived using a traditional or gestational surrogate to be teasedapart.

How do children feel about their surrogacy origins?Jadva et al. (2012) examined how children feel towards the surrogate.Findings indicated that at age 10, most children felt indifferent aboutbeing born through surrogacy. For example:

I feel fine. I don’t feel bad or cross in anyway. It’s just pretty much nature so Ican’t do anything about it. I wouldn’t like to do anything about it. (10-year-oldgirl, SU family)

How do children feel about the surrogate?Most children reported that they liked their surrogate, describing her as“nice” or “kind”, at both ages 7 and 10 (Jadva et al., 2012). However,these children were all born using non-commercial surrogacy, payment tosurrogates being prohibited in the UK. How children will feel if their sur-rogate was financially recompensed is not known. It is also not clear howchildren will feel if their surrogate lives in a different country or speaksa different language (Jadva et al., 2010).

Children’s perspectives in lesbian two-parent families

How do mothers explain donor conception?

While there are higher rates of disclosure in DI families headed by les-bian couples than those headed by heterosexual couples, the process oftelling children about their conception appears to be fairly similar. Inlesbian couple families, mothers tend to incorporate information abouttheir child’s conception into their everyday lives, adapting the story totheir child’s capacity for understanding (Vanfraussen, 2001). For somechildren growing up in these families, however, the use of donated spermmay be less striking or significant than the absence of a father and pres-ence of two mothers.

How do children respond to disclosure?

The Different Families Study gives some insight into the thoughts andfeelings of donor-conceived children growing up in families headed bylesbian mothers. Previously unpublished data reported here derives frominterviews with twenty-four children and adolescents, aged between 4 and19, who were conceived by women in lesbian relationships using anony-mous sperm donation (Guasp, 2010). The participants were not directly


asked about the ‘donor’, their ‘dad’ or a ‘father’; it was left to themwhether to mention the donor or not, and to describe him using theirown terms. One child, aged 8, talked of knowing something was “differ-ent” from an early age:

I first knew something, you know, something . . . that was actually different aboutme . . . when I was about 2 and a half, so pretty young, but that was when I didn’tknow how it happened, I didn’t know anything about it, but I just realised therewas something different. (8-year-old boy, DI family)

In Vanfraussen’s (2001) study of forty-five lesbian mothers, nonereported that their child reacted negatively to disclosure. Similarly, nochildren in the Different Families Study reported negative responses tolearning of their donor origins, although some lacked confidence in dis-cussing their family with others, even though their parents may havethought them well informed:

Well a boy in Year 6 . . . came up to me and said have you got a dad? And Isaid . . . I was quite afraid to say it, and I said no. And he said . . . well that’s stupidisn’t it, and I was like . . . no. . . . He said yes it is, and he started . . . he tried tochase me and . . . he got me once and he kicked me. (7-year-old girl, DI family)

Some children, however, were confident enough to deal with the issue offather absence and talk about the donor:

Well they think . . . well sometimes they say . . . you know, everybody’s got a dad,he must be dead, or something . . . I say no, he’s not dead. All I’ve got is a donordad and sometimes I get teased by them calling me . . . calling my dad a donordad, donut dad. (8-year-old boy, DI family)

These children’s experiences of teasing relate to Scheib, Riordan andRubin’s (2005) finding that the offspring of lesbian parents may experi-ence less positive reactions from friends and teachers about their donorconception than children in other family types.

How do children feel about the donor?

In the Different Families Study, some of the older participants describedfeeling curious about their sperm donor but did not appear distressed orupset about the nature of their conception. Some described wanting toknow their “dad” and wondering what he was like as a person, while forothers this became less important over time. For example:

I would like to know who my dad is. I would just like to meet him and maybehave a conversation with him. I mean I probably could become a secret detective,


but I’m not going to go to those kinds of lengths, because he doesn’t want tobe contacted, so I wouldn’t . . . Just like, it’s always something like – it would beinteresting. (19-year-old male, DI family)

Sometimes I used to wish that I knew my dad, but I don’t really any more. It’snot like an important thing in my life for now, I have two parents, I don’t feel theneed to find a third, my father. I used to wonder what he was like, whether I waslike him. (18-year-old female, DI family)

The children of these lesbian couples identified ‘family’ as their twomothers, any siblings, aunts, uncles and grandparents, and did notinclude the sperm donor or refer to a biological father. This may partlyresult from having two parents, with other studies also finding less inter-est in sperm donors amongst offspring in two-parent families, whetherheterosexual or lesbian, than single-mother families (Scheib, Riordanand Rubin, 2005; Freeman et al., 2009).

How do children feel about being donor conceived?

Some of the children in the Different Families Study were interested inthe experience of having a father. They did not appear to think of theirsperm donor as a potential father figure but rather, it was more a case ofwishing to see what having a father was like, or to be like other people.For example:

I used to pretend that I had this dad. I never really told anyone about it but Ipretended I had . . . to make myself sometimes feel better. I said but I have a dadcalled Ian who lives in India, but that’s what I told myself. Yes he’s coming backone day, but . . . I just made that all up. (9-year-old girl, DI family)

I think because I’ve grown up with it [two mothers] from the day I was born, Ijust treat it as perfectly normal. I sometimes think what would it be like to havea dad as well, I can’t imagine it. It just seems weird to me. (15-year-old male, DIfamily)

These children’s sentiments seemed to reflect their experiences of grow-ing up in a lesbian couple household rather than their feelings aboutbeing donor conceived.

Children’s perspectives in single-mother families

How do mothers explain donor conception?

The process of disclosure in single-mother DI families seems to be simi-lar to that which occurs in heterosexual and lesbian two-parent families.


Most have used the ‘seed planting’ approach, emphasising the signifi-cance of their children having always had some information about theirdonor conception. However, disclosure has been found to occur at anearlier age in both single-mother and lesbian couple families comparedto heterosexual two-parent families (Jadva et al., 2009). This may bebecause single mothers and lesbian couples feel expected to explain whythere is not a male parent in their family, and thus find disclosure morestraightforward and less easy to postpone or avoid (Scheib, 2003; Jadvaet al., 2010). However, some single mothers remain undecided aboutwhether to tell their children about their donor conception, and othersare unsure about when and how to do so (Landau and Weissenberg,2010; Zadeh, Freeman and Golombok, 2013).

Most single mothers who do share this information begin explain-ing donor conception to their children as part of a family narra-tive which above all emphasises their wish for a child. Like mothersin other family types, many single mothers make use of books suchas Our Story (Baxter, 2002) and employ the scripts offered by suchresources both to begin and continue the conversation about concep-tion. Previously unpublished data reported here is from the ongoingSolo Mother Study in which heterosexual single mothers were askedabout their experiences of disclosing to their children aged 4–8 years.The following example is typical of mothers’ first discussions with theirchildren:

I’ve told her that if you don’t have a dad in your family, and you really really wanta baby, you can go to the hospital and they can help you, and a very kind mancalled a donor gave me two seeds, and one of the seeds got put inside me to make[child], and then I was so happy with my lovely [child], I had the other seed putinside me to make a little sister for you, and that was [child’s sister]! That’s ourstory. (Mother of 4-year-old girl)

Other mothers were initially prompted by their children to explain theabsence of a father in their family (see also Landau and Weissenberg,2010), as the following quote from the Solo Mother Study illustrates:

I quite distinctly remember me coming home from work when [child] was about2 and a half, and he was just saying to me . . . she’s got a daddy . . . she’s got adaddy, and she’s got a daddy and I haven’t, and I just said that’s right, and hesaid why?[ . . . ] Um, so that was probably the first time that we had any sort ofdiscussion. (Mother of 7-year-old boy)

It is perhaps unsurprising that details about the donor feature in singlemothers’ accounts of donor conception more frequently than in those of


mothers in heterosexual couples in particular, due to the absence of afather in the former family situation (Hertz, 2002; Grace and Daniels,2007). Single mothers are also more likely to use the terms “father”and “daddy” to describe the donor than their heterosexual or lesbiancouple counterparts, although some reference a donor and explicitly nota father (Ehrensaft, 2000; Landau and Weissenberg, 2010). Still othersuse a hybrid between the two, explaining to their children about the“donor daddy” who helped them to become a parent.

How do children respond to disclosure?

Children in single-mother families have expressed feeling special, curi-ous, confused, neutral and disinterested when being told about theirdonor conception (Hertz, 2002; Jadva et al., 2009; Landau and Weis-senberg, 2010; Beeson, Jennings and Kramer, 2011). These reactionsare similar to those of children in heterosexual two-parent families. Onestudy found that children of heterosexual single mothers reported feelingmore confused about their donor origins than children of lesbian singlemothers (Beeson, Jennings and Kramer, 2011). However, such findingsemerged from retrospective accounts of initial reactions to disclosure feltmany years prior to this particular study, and must therefore be consid-ered with caution. It is also worth noting that such feelings of confusionreportedly dissipated over time.

It is not clear whether neutral responses to disclosure result from chil-dren’s lack of understanding about their donor conception or lack ofstrong feelings about the issue. Such initial responses may, however, putmothers at ease. One mother in the Solo Mother Study described herchild’s response to the Our Story book (Baxter, 2002):

[He’s] not interested. He thinks that the figures are hilarious, there are little stickmen and girls and boys and babies, he quite likes those ones [laughs]. (Motherof 5-year-old boy)

Feelings of confusion among some children of single mothers may, how-ever, be a response to particular facts about their donor conception; forexample, that the donor is anonymous:

The conversation was along the lines of why can’t he know the sperm donorthat we used, was used, conceived him, and I sort of had to explain that he wasanonymous . . . I was explaining that we know that the sperm donor is a very kindman, and his comeback was how do you know? You’ve never met him, which Ithought was very sensible. And he also said, if he was so kind and nice, why can’tyou just marry him? (Mother of 7-year-old boy)


How do children feel about being donor conceived?

Young children and adolescents in single-mother families have beenfound to be more likely to feel positively about their donor origins thanthose in heterosexual two-parent families (Beeson, Jennings and Kramer,2011). Differences may result from single mothers’ earlier disclosure totheir children (Jadva et al., 2009), and may also be explained by thefinding that single-mother offspring are more likely to experience posi-tive reactions from others about their donor conception (Scheib, Riordanand Rubin, 2005). It could also be the case that for the children in thesefamilies, their feelings about their donor origins do not have an impacton their understanding of existing familial relationships.

At the same time, however, mothers’ reports from the Solo MotherStudy suggest that children would often prefer to have a traditional two-parent family set-up:

If you talk to her now she’ll probably say well I, I’d um, well I would rather likea daddy, but I’m happy. (Mother of 6-year-old girl)

Findings also indicate that some children may be more uncomfortablewith their donor conception at certain times of year, such as Father’sDay, or in certain contexts, such as at school. Many mothers reportedthat their children construct ‘fantasy fathers’ (Ehrensaft, 2000; Freemanet al., Chapter 15), or otherwise embellish the information they haveabout their donors, as this example illustrates:

She’d been going around telling people at school that her donor daddy was 7 foottall, which he’s not, um, and I did wonder whether that was ‘oh my donor daddy’sbigger than your real daddy!’. (Mother of 6-year-old girl)

As with children in lesbian two-parent families, it is useful to distinguishbetween children’s feelings about their donor conception and their feel-ings about their families being without a father figure. When asked byresearchers, however, none of the children in the Solo Mother Studyexpressed a desire to change their families in any structural way.

How do children feel about the donor?

Initial insights from the Solo Mother Study indicate that some childrenwith single parents may be interested in knowing more about the donor,a fact that mothers who used an anonymous donor sometimes struggledwith:


I’d be really happy for him to meet him. But it does cause me a problem in thatI think he would have liked to, but can’t. (Mother of 7-year-old boy)

However, mothers typically described their children as indifferent to thedonor. Although young children seem to be making a distinction betweenthe donor and a father, the majority of children nevertheless describe thedonor as their “father” or “dad”, even when this term is not used bymothers. Others use the terms “donor daddy” or “donor” or are notreported by mothers to use any term in particular when describing thedonor.

At adolescence, this trend appears to continue. Adolescents fromsingle-mother families most often call the donor “father” or “biologi-cal father”, and do so more often than their counterparts in heterosexualand lesbian two-parent families. However, like children in two-parentfamilies, they do not describe themselves as wanting a father–child rela-tionship with the donor at this age. They are mostly curious about himand his reasons for donating, and are more likely to wonder whether thedonor is like them than their two-parent family counterparts (Scheib,Riordan and Rubin, 2005; Jadva et al., 2009).

Adolescents in single-mother families are also more positive about,and appreciative of, the donor than those in families headed by lesbiancouples (Scheib, Riordan and Rubin, 2005). Another study based onthe reports of adolescents and adults found that the offspring of singlelesbians were most likely to want to establish a relationship with theirdonor (Beeson, Jennings and Kramer, 2011). Why this may be the case,and what, in general, children feel about the donor as they grow older, isyet to be systematically studied.

Conclusions

We are just beginning to discover how children and adolescents whoare told they were conceived using third-party ARTs think, feel and talkabout their families and the ‘birth others’ involved in their creation. It isclear from the findings presented here that there are differences in chil-dren’s perspectives across different family structures and constellations,although some common themes emerge. Despite concerns of parents,policy makers and others, children seem able to assimilate informationabout their donor conception and/or surrogacy into their family narra-tives with ease and, often, indifference, particularly when told from anearly age. The trope of the donor or surrogate being a ‘nice’, ‘kind’ personappears to be integrated into children’s narratives, part of a rhetoric that


parents commonly use in disclosing information about assisted reproduc-tion to their child. However, children’s cognitive and emotional under-standing of their reproductive origins and ‘birth others’ is likely to changeover time, a process that seems to be further shaped by the structure ofthe family they are growing up in.

From the evidence considered in this chapter, it seems that chil-dren conceived by sperm donation in single-mother and lesbian cou-ple families tend to be more positive about their donor conception thanthose in heterosexual couple families. However, for children in single- ortwo-mother families, understanding the fact of donor conception takesplace alongside the management of being part of a father-absent fam-ily, a situation that might explain their increased curiosity about thedonor. Although those in single-mother families were more likely torefer to the sperm donor as ‘dad’ or ‘father’, these children were pos-itive about their families and did not identify the donor as a potentialfather figure. Children in heterosexual couple DI families also did notrelate to the donor in these terms, and there was no indication thatparental disclosure leads to a rejection of the father as the ‘non-genetic’parent.

These findings therefore add complexity to previous research whichhas suggested that children may use functional rather than structuralattributes to define kin. The greater interest in the sperm donor amongthose in father-absent families, particularly those with one parent,suggests that structural attributes are not entirely insignificant in shapinghow children view ‘birth others’. Although the culture of disclosureseems to be in the process of shifting from secrecy to openness,donor-conceived children themselves appear to be more focused onwhat they – and others – may see as visibly different about their families,that is, the absence of a father.

The ability to generalise based on findings reported here is limited bythe relatively few children who have taken part in this type of researchto date. It may also be the case that the parents of children who arestruggling with information about their donor conception are less likelyto agree to their child participating in research. Despite these limita-tions, our findings suggest that children can integrate the informationpresented by their parent(s) with relative ease and lack of concern. Fur-ther factors may influence the thoughts and feelings of children aboutwhich we know little. It will be important for future research to exploresimilarities and differences in the perceptions of children raised in spermdonation compared to egg donation families, boys as opposed to girls,those conceived using an anonymous donor compared to those conceived


using an open-identity or krown donor, only children compared to chil-dren with siblings, and children conceived with unpaid compared to paiddonors and/or surrogates. In conclusion, there is much work in this fieldto be done.

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15 Making connectionsContact between sperm donor relations

Tabitha Freeman, Kate Bourne, Vasanti Jadvaand Venessa Smith

Introduction

One of the most significant recent developments regarding families cre-ated by assisted reproduction is that some donor-conceived people areseeking and making contact with their donor and with other offspringconceived using the same donor. This phenomenon reflects an increas-ing openness around donor conception in some countries, including Aus-tralia, the USA and the UK which are the focus of this chapter, and maybe expected to rise in future years with the introduction of open-identitydonation in these jurisdictions and elsewhere.1 Thus far, such contact hasmostly involved ‘donor relations’ connected by sperm, rather than egg,donation, with growing numbers of sperm donor offspring and parentsobtaining the identity of their sperm donor and genetic half-siblings.2

There are also increasing numbers of recipient parents choosing some-one already known to them to provide sperm or eggs, which likewisebrings new forms of relatedness to the fore.

1 It is important to note that the increasing openness in policy and practice regardinggamete donation is not a global phenomenon, and that there may be discrepanciesbetween public rhetoric and individual experiences. There is great variation in the reg-ulation of donor conception, with some jurisdictions banning gamete donation entirelyor only allowing anonymous donation, while others are implementing various systems ofopen-identity donation. The regulation of egg and sperm donation may also differ fromone another within any given jurisdiction. For a policy review of jurisdictions that allowaccess to donors’ identities, see Blyth and Frith (2009). For a discussion of the impact ofthe introduction of identity-release donation on parents’ openness about gamete dona-tion with their children, see Blake et al. (Chapter 14) and Freeman, Appleby and Jadva(2012).

2 In policy and research in this area, the focus has been almost exclusively on the half-sibling relationship between donor offspring conceived with the same donor’s gametesgrowing up in different families, sometimes referred to as ‘donor siblings’. However, thereis clearly an equivalent relationship, at least in ‘genetic’ terms, between a donor’s ownchildren and any donor offspring conceived with his/her gametes. This illustrates someof the complexities of terminology in this area. In this chapter, we use the term ‘half-sibling’ or ‘half-sibling by donation’ to describe donor offspring with the same donor anddifferent social parents.

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Contact between sperm donor relations 271

Despite the growth in contact between donor relations, very little is cur-rently known about how these connections are being defined and experi-enced by those involved. This chapter provides new empirical insights byexploring how these connections are being negotiated in practice withindifferent cultural and regulatory contexts. The main case study will be‘donor-linking’ in Victoria, Australia, one of the first jurisdictions world-wide to implement policies enabling donor identification: specifically,the chapter will draw on practice insights of a counsellor (KB) workingwith parents, offspring and donors seeking contact through the publiclyregulated medium of the Donor Registers, where the vast majority ofcases concern sperm rather than egg donation. Victoria provides an illu-minating case study, not only in terms of having gone furthest downthe path towards open-identity donation in policy terms, but also as aregulatory and cultural environment characterised as both child-focusedand reflecting a wider interest in, and sensitivity to, genealogical ori-gins. To provide additional data and points of comparison, we will drawupon two further empirical examples. From the UK, the chapter utilisesthe practice experience of the donor services coordinator (VS) at theLondon Women’s Clinic (LWC), which has an established ‘known dona-tion’ programme as well as being the largest UK provider3 of sperm, tohighlight issues raised when prospective parents bring people they knowalong to the clinic to donate their sperm. We will also report primaryresearch (TF, VJ) conducted with the Donor Sibling Registry (DSR), aUS-based global registry website which, in contrast to the other empiricalexamples, enables potentially unmediated contact between donor rela-tions, in order to provide data on contact between half-siblings by spermdonation and on actual meetings between sperm donor relations. Again,these examples also have different regulatory and cultural settings: donorconception provision in the UK being highly regulated and orientedtowards achieving a balance between children’s best interests and parentalchoice, while the US fertility industry is a largely unregulated commer-cial market driven by consumer choice. Through examining differentcontexts in which connections between donor relations are being initi-ated from the vantage point of professionals closely involved, this chapterexplores the emerging discourses around relatedness and the practical,psychological and ethical issues raised. While our focus throughoutthis chapter is on sperm, rather than egg, donation, thus reflecting

3 More specifically, the London Women’s Clinic works in association with the LondonSperm Bank which is currently the largest UK provider of sperm.

272 Tabitha Freeman, Kate Bourne, Vasanti Jadva and Venessa Smith

the current disparity in levels of contact between these different typesof donor relations, critical consideration will also be given to this issue.

Context: policy and cultural landscape

The rising numbers of donor relations seeking contact is part of a moregeneral cultural shift in Australia, the UK, the USA and some othercountries towards enhancing public openness about donor conception.This is exemplified by the removal of donor anonymity4 and a move inprofessional practice away from advising parental secrecy about donorconception to advocating disclosure in early childhood (see Bravermanand Frith, Chapter 7), and is underpinned by a wider public discoursearound the significance of ‘genetic identity’ and an individual’s rightto knowledge of his or her origins. The call for transparency aroundgamete donation has also prompted awareness of the ‘genetic connec-tion’ between individuals in different families conceived using the samedonor. This trend can be illustrated by UK policy: in October 2009,the entitlement for donor-conceived individuals conceived after April2005 to access identifying information about their donor at the age of18 was extended to include their right to seek identifying informationabout genetic half-siblings. At present, this refers to donor-conceivedhalf-siblings only: while in principle donor-conceived individuals alsohave a half-sibling connection with the donor’s own children, this cur-rently presents something of a blind spot in policy and legal frameworks.

The facilitation of information exchange and communication betweendonor offspring, parents, donors and half-siblings can be seen as anext step in this process. The Australian State of Victoria has beenamongst the first jurisdictions to forward this agenda by legislating for therelease of donor information and establishing a central Donor Register.Under the Infertility (Medical Procedures) Act 1984, donor-conceivedadults, parents and donors were able to apply for identifying informationabout each other that could be released with the other party’s consent.The Infertility Treatment Act 1995 (Vic) enhanced the entitlements ofdonor-conceived people as consent requirements from the donor wereno longer necessary, reflecting the central focus on the best interestsof the child. All persons donating under this Act did so on the under-standing that their identifying information would be released if requested

4 In addition to the Australian states of Victoria, New South Wales and Western Australiaand the UK, jurisdictions which do not allow donor anonymity include: Sweden, theNetherlands, Norway, Austria, Switzerland, New Zealand and Germany. In the USA,both open-identity and anonymous donation is available, as is the case in Belgium forexample.


by their donor offspring. Voluntary Registers were also created to allowfor information exchange between other parties, including half-siblings,parents who have used the same donor and descendants of donors, recip-ients and donor-conceived people (Johnson, Bourne and Hammarberg,2012).

In the commercially driven US fertility industry, by contrast, there arepresently no public donor registries. Indeed, gamete donation remainslargely unregulated and un-monitored, one important corollary beingthat the gametes of one donor may be used to conceive large num-bers of children.5 The demand for information about donor relationsunderpinned the foundation of the DSR in 2000 by Wendy Kramer andher donor-conceived son; an online enterprise which has enabled sev-eral thousand sperm donor offspring from the USA and elsewhere toconnect with half-siblings and, more rarely, their (formerly anonymous)sperm donors. In a similar vein, some jurisdictions now allow anony-mous donors the option of re-registering as identifiable. Again, Victo-ria has proposed potentially ground-breaking legislation, with a recentReport of the Law Reform Committee (2012) recommending retrospec-tive access for donor-conceived people to information about their donors,including a contact veto system and contact preference forms.6

Lastly, for those conceived using known donation,7 the donor’s identitymay be available from the outset, with parents therefore acting as theprincipal gatekeeper to informing a child about their donor. Indeed, thereis evidence that parents are demanding greater choice about the donorthat they use, particularly through obtaining information that may beaccessible before their child reaches adulthood. At the London Women’sClinic, for example, there has been a significant increase in the use ofknown donors, donor recruitment websites and imported sperm in recentyears, trends that are reflected more widely across the UK.8

5 While the guidelines issued by the American Society for Reproductive Medicine limit thenumber of children to be conceived from one donor to 25 live births per population areaof 850,000, in practice, the numbers may be far higher. In our research, the largest siblinggroup reported was 55 (Freeman et al., 2009) and there have been several larger groupsidentified, with the largest approaching 200 (Wendy Kramer, personal communication).

6 This system would enable a donor to lodge a contact veto which would prohibit directcontact from the donor-conceived person with penalties applying if it was breached.The donor-conceived person would still be eligible for identifying information about thedonor however. The contact preference form gives options for the donor to indicate theirpreference for contact.

7 As will become apparent, ‘known donation’ is a broad category covering a range ofdifferent types of donation where the donor is known to the parents prior to conception.

8 For example, with regards to the use of imported sperm, the UK regulatory body, theHuman Reproduction and Embryology Authority (HFEA) registered 89% UK and 11%overseas sperm donors in 2005, compared to 76% UK and 24% overseas sperm donors


Although various opportunities for making contact with donor rela-tions are emerging regardless of whether the donation was anonymous,identity-release or known, it is important not to lose sight of the manydonor-conceived individuals who will not wish, or will not be able,to obtain this information. Moreover, despite professional and publicrhetoric to the contrary, the silent majority of the donor-conceived remainunaware of the nature of their conception, with levels of parental disclo-sure appearing to remain low, at least within heterosexual couple families(Appleby, Blake and Freeman, 2012). Once more, the Australian State ofVictoria has taken a radical and proactive stance towards disclosure, boththrough educational campaigns and major changes to birth certificatesfor donor-conceived people to indicate that further information abouttheir birth is available on their request.

The overwhelming majority of donor relations who have sought con-tact via the Victorian Donor Registers and the DSR are linked by sperm,rather than egg, donation; a situation that is also reflected in the availableUK data (Crawshaw et al., 2013). For example, the DSR is the largestregistry and currently has just a handful of recorded links between eggdonor offspring and their half-siblings compared to several thousandhalf-siblings with the same sperm donor; likewise, less than 10% of theapproximately 700 people linked with their donor or donor offspring arein offspring-egg donor matches (Wendy Kramer, personal communica-tion, 2013).9 In many senses, this is unsurprising given the considerablyhigher number and age of sperm donor offspring compared to egg donor

in 2010. Importing sperm may enable greater levels of donor information than using UKdonors (see Graham, Chapter 12). In terms of donor recruitment websites, at the time ofwriting (August 2013), Pride Angel, a leading UK-based connection website for spermand egg recipients and donors, has over 23,000 registered members with public profilesfrom the UK and other countries, comprising approximately 4,500 sperm donors, 500egg donors, 15,000 sperm recipients, 750 egg recipients and 3,000 male and femaleco-parents.

9 Whilst the greater number of half-sibling matches compared to matches between offspringand their donors on the DSR is often interpreted as indicative of a greater interest in half-siblings than donors, it is important to note that this is context specific and that there aresignificant practical, psychological and ethical differences between seeking contact withhalf-siblings and donors (Freeman, Appleby and Jadva, 2012). In the most immediatesense, as the name suggests, the Donor Sibling Registry may be more likely to attractthose with an enhanced interest in half-siblings. Indeed, by contrast, very few contactsbetween half-siblings have been made via the Victorian Donor Registers relative to thenumbers of links between offspring and donors. However, it is of interest that similarpatterns with regards to family type were also observed in relation to the Victorian DonorRegisters, with higher levels of interest in contact between parents who had used the samedonor being apparent amongst single and lesbian-couple mothers, partly because of theperceived support this might provide for themselves and their children. In a similar vein,Freeman et al. (2009) found that half-sibling connections were more commonly soughtby parents of lone children.


offspring: not only was the first child conceived with donor eggs born in1984, a century after the first recorded use of donor insemination, butthe number of children born through sperm donation continues to out-weigh significantly those born through egg donation, despite the steadynarrowing of this gap.

In addition to these quantitative differences, there may be further prac-tical reasons for this discrepancy between rates of interest in egg andsperm donor relations. A significant proportion of egg donation involvesknown donation; for example, for the past decade the fertility clinics inVictoria have not had clinic-recruited programmes. In known donation,the child may or may not be aware of his or her genetic relatednessto the egg donor, but in either case, they would not be seeking con-tact through registries. In the context of the USA, Braverman and Frith(Chapter 7) provide a further explanation for the lower level of con-tact with egg donors concerning their lack of the type of fixed, uniqueidentification number that is used to connect with sperm donors on theDSR. It is also important to contextualise these discrepancies in levels ofinterest between egg and sperm donor relations in relation to the familytypes of those recipients and offspring seeking contact: for example, themembership of the DSR is currently 49% single mother families, 33%lesbian/gay/bisexual/transgender families and 18% heterosexual couplefamilies.10 Not only does this distribution of family types mean a higherrate of sperm than egg donation, but there are also indications that chil-dren growing up in single mother and lesbian couple families may showgreater interest in their sperm donor (see Blake et al., Chapter 14).

As this last point suggests, there may be further qualitative reasonsunderlying the discrepancy in contact rates between egg and sperm donorrelations concerning the different attitudes that egg and sperm donor off-spring, recipients and donors may have towards each other (see Richards,Chapter 1). For example, in this volume, Almeling (Chapter 8) reportsthat egg donors tend not to regard themselves as mothers of their donoroffspring while sperm donors view themselves as fathers; a gender differ-ence that is encouraged by the clinics. This finding reflects wider culturaland legal meanings and definitions of motherhood and fatherhood; forexample, the association between mothering and ‘nurturing’ and father-ing and ‘originating’ is embedded in the legal identification of the motherand father as the person who gives birth and who provides sperm respec-tively (see Freeman, Introduction; Richards, Chapter 1; McCandless andSheldon, Chapter 3). While there is little empirical data, it is possible thatthese gender differences may also be apparent in children’s and parents’

10 Figures taken from DSR website, August 2013.


attitudes towards egg and sperm donation: in sperm donation families,particularly where there is no social father, a sperm donor may take ongreater significance than an egg donor in egg donation families wherethere is a birth mother present.11 Although it is too early to say if andhow such gender differences may shape the meaning of contact betweendonor relations, it is important to view this phenomenon within its widercultural context, with the symbolic link between ‘genetic connection’ andfatherhood being echoed more widely by socio-legal and cultural signifi-cance ascribed to paternity and the traditional definition of kinship alongpatrilineal lines (Freeman and Richards, 2006; Freeman, Introduction).

Connecting donor relations in practice: the VictorianDonor Registers

The Infertility Treatment Authority (ITA) in Victoria, Australia (now theVictorian Assisted Reproductive Treatment Authority), was the first pub-lic body to operationalise the complex process of linking donor relations.From 2001 to 2009, the ITA managed the Donor Registers that recordinformation about donor conceptions. Sperm and egg donor-conceivedpeople, parents and donors could apply for information, with the ITAacting as a mediator for its release. From 2010, the Registry of Births,Deaths and Marriages managed the registers. There are two registers:the Central Register, where an application results in an outreach to theother party, and the Voluntary Register, where outreach will only occurif there is a corresponding link. Since the legislation was introduced,over 5,500 donor-conceived children have been recorded on the Victo-rian Donor Registers. To date, applications to the Donor Registers havebeen low relative to the number of donor-conceived people. There were118 Central Register applications from January 1999 to June 2012 and386 Voluntary Register applications from January 2001 to June 2012, ofwhom 174 (45%) were donors, 142 (37%) were recipient parents and 70(18%) were donor-conceived persons.12

There are various possible reasons for what might appear to be lowlevels of take-up, including the historically low rates of parental

11 Indeed, even in egg donation families where there is no birth mother present, as isthe case in families headed by gay father couples who have children using gestationalsurrogacy and egg donation, there appears to be less interest in having contact with theegg donor than the surrogate (see Smietana et al., Chapter 11).

12 Data supplied by the Registry of Births, Deaths and Marriages, Victoria. These fig-ures include both sperm and egg donation because it was not possible to access datafor each donation type. Thus in this chapter, where we use inclusive terminology like‘donor-conceived’, this can potentially refer to both sperm and egg donation, althoughin practice, the majority of cases we are discussing concern sperm donation. Whereinformation about the type of donation is available, this will be highlighted.


disclosure, the lack of publicity about the Donor Registers and the factthat donor-conceived people need to be aged 18 to make an applica-tion in their own right. Also, applying to the Donor Registers may raisedifficult and ambivalent feelings for donor-conceived people, and somemay not wish or feel ready to make this unknown and potentially fright-ening step. It is very likely that numerous donor-conceived people havenot applied through wanting to protect their parents: for example, con-cerns about perceived disloyalty, particularly towards a ‘non-biological’parent, may lead some to delay until their parents have died. Searchingfor information requires a degree of ego-strength and courage, espe-cially because of the risk of rejection, and people are likely to waituntil their lives are relatively stable or are starting a family themselves.Some may perceive social stigma, while others may simply not wantto know about their donor.13 Such reasons are consistent with findingsfrom adoption reunion studies, although further research is needed toexplore this issue regarding the donor-conceived population (Crawshaw,2002).

The ITA set up an intermediary service to support people making, oraffected by, applications to the Donor Registers, including offering inter-mediary counselling on a routine basis. Following a paradigm pioneeredby the adoption reunion model (Johnson, Bourne and Hammarberg,2012), the role and professional ethos of the intermediary counsellorincludes: taking on the role of mediator, not becoming the advocate forone party over another but supporting both parties, maintaining confi-dentiality at all times and supporting ‘the principle that people affectedby donation may have an interest in requesting information or makingcontact with their donor, genetic offspring, or genetic half-siblings, andsuch interest in information or contact is to be treated as normal andresponded to positively’.14 A letterbox service was also introduced sothat people wishing to communicate anonymously could exchange con-fidential letters via an intermediary. Over time as parties got to know andtrust each other, they could choose to reveal their identity and commu-nicate independently.

Donor-conceived perspectives

I’ve always been serious to find out more about the whole process and who mydonor was . . . it was always this suspended wonder, oh well I’ll find out eventually.But I used to wonder . . . what he looked like . . . I had always thought about, you

13 Discussions of the indifference that donor-conceived people may feel towards their donorare given in Lillehammer (Chapter 5) and Blake et al. (Chapter 14).

14 See Australian and New Zealand Infertility Counsellors Association (2012).


know, seeing an older man on a railway station, or something like that. Did helook like me? (Sperm donor-conceived person)15

Through a very supportive and professional process my biological father hadbeen located and agreed to be contacted. I was elated, scared and confused. Tobe honest my first thought was, ‘what if he’s a criminal and is in prison?’ This wassoon followed by, ‘what if I don’t like him?’, ‘what if I feel more of a connectionwith him than my father?’. (Sperm donor-conceived person)

Typically donor-conceived people were highly apprehensive aboutwhether to apply for information about their donor. It was very com-mon for people to make enquiries about the process and not act onthis information, or to leave long gaps, often years, between their initialenquiry and making an application. While there is little research focusingon egg donor offspring, research into sperm donor offspring’s motiva-tions for seeking information about their donor via the DSR suggests thatcuriosity, particularly regarding the donor’s appearance and personality,is often central, with issues relating to their identity, genetic ancestry andmedical background also being key (Jadva et al., 2010; Beeson, Jenningsand Kramer, 2011). This was also the experience of the ITA counsellorwho found that common questions among sperm donor-conceived peo-ple included: Who am I? Who am I related to? Who is my donor? Whatdoes he look like? What is his personality like? Do we share any physicalcommonalities or character traits? Are there any medical issues I need tobe aware of?

Offspring regularly described fantasies of what their sperm donormight be like; a phenomenon also noted by Ehrensaft (2000). Thesemight be very positive (e.g. handsome, intelligent, doctor) or quite neg-ative (e.g. arrogant, uncaring, ugly) constructs. They also commonlyquestioned the donor’s motivations and attitude. Was the donation purelyaltruistic or for money? Does the donor know about me? Does heever think about me? Some donor-conceived people had sketchy non-identifying details provided to their parents at the time of treatment, andoften generalised these in an attempt to flesh out what the donor mightbe like in reality.

When enquiring about their sperm donor, offspring were often unclearabout the nature of information exchange, contact or relationship theywould wish for, partly because they were conscious that no informationmight be available; for example, through a lack of records, the absenceof a match on the Voluntary Register or the donor’s unwillingness torelease information. For self-protection, offspring typically had minimal

15 Unless stated otherwise, the quotations in this chapter are taken from interviews withdonor-conceived people, parents and donors available as podcasts on www.varta.org.au.

http://www.varta.org.au


expectations and did not dwell on what they would ideally hope for. If thedonor did agree to information release, this was characteristically a highlyanxious yet exciting time. Contemplating contact with the donor was anexhilarating experience, and offspring often had difficulty sleeping andconcentrating. They commonly described concerns of ‘not measuringup’ to perceived expectations and found the initial correspondence verydifficult to write, not knowing what details to include about themselvesor what questions to ask of the donor. They wanted to avoid requestinginformation that might be considered too personal, intrusive or inappro-priate, and demonstrated great sensitivity and respect towards the wishesof the donor and his family.

Offspring were also very sensitive about the implications of their appli-cation for their parents. Some were concerned that it might upset them orbe seen as an act of disloyalty. As a result, not all offspring informed theirparents of their search, as also found by Jadva et al. (2010). This appearsto repeat the cycle of secrecy offspring themselves had commonly expe-rienced in not being told about their donor conception until later in life.Consequently they could feel quite isolated from support and unable toconfide in siblings or friends. Offspring were usually very clear that theirinterest in finding out about the donor did not alter their relationshipwith their parents, whether this was positive or negative. As one youngwoman who had been conceived by sperm donation states:

Despite this strong connection with my biological father, I am very protectiveof my relationship with my social father and ensure there is a clear distinctionbetween the bond I have with my social father and my relationship with mybiological father. (Sperm donor-conceived person)

Interestingly, the counsellor observed a high incidence of people seekinginformation about their sperm donor who described having a poor rela-tionship with their father. Future research is needed to confirm whetherthis is an underlying factor for offspring with heterosexual parents whosearch for donor information. Possible explanations could be that thesefathers have withdrawn emotionally from their children, perhaps throughnegative feelings that they are not ‘the real father’, the fear of beingrejected, or ongoing shame and insecurity about their infertility.

Issues can arise within families if one sibling expresses a keen interestin finding out about their donor while another is more reluctant. The‘keen’ sibling may then choose to delay their own search or go aheadwithout their sibling’s support. If information is found, it may then benecessary to negotiate whether the other sibling should know. Siblingsmay also have a different donor; this may be discovered as a result of theenquiry and can lead to a questioning of their relationship, as in the case


reported by Blyth (2012). How much of their relationship is based on‘blood ties’ or on shared experiences of growing up together?

Parent perspectives

My first child has asked about it so in my own mind I was obliged to follow upany leads that I could. I just didn’t want it to become a big deal for her whenshe became 18. Doing it early makes it feel like it’s a normal thing; it’s not a bigdeal. When she’s 18 if she happens to find him then it may be a big letdown. Ididn’t want it consuming her and now it’s just part of her everyday life. (Motherof child conceived by sperm donation)

Almost 37 per cent of Voluntary Register applications were from par-ents of donor-conceived children. The large majority of these were fromparents of children conceived by sperm donation and again this is ourfocus here. A principal reason for applying to the Register was to thankthe donor. Parents were also interested in obtaining information whiletheir children were young so they could grow up with some knowledgeof the donor. Some parents sought the sperm donor’s first name to usewith their children, to humanise him and make talking about him morepersonal. Some were interested in the donor’s appearance and wanted aphotograph, sometimes from childhood rather than an ‘identifying’ adultone. Some parents wished to ascertain whether the donor was preparedto give information to prepare their child if he was not. Others expressedfears of losing the opportunity to find out about the donor; for example, ifhe got ‘hit by a bus’, became less willing to assist if approached by severalfamilies, or became untraceable. Other parents thought they should onlyapply for information about the donor at their child’s request.

As with offspring, numerous parents expressed fantasies of what thedonor might be like extrapolated from information in the donor’s profile.Many explained choosing their sperm donor on the basis of his descrip-tion of his personality, interests and motivations and whether he wasopen to making contact in the future. They too wondered: What doeshe look like? Does my child resemble him? Are there any health issuesto be concerned about? Would I like him as a person? Many expresseddeep gratitude and positive associations: as their child was wonderful,they deduced the donor must be too. There were also subliminal sex-ual undertones that were difficult to discuss. For example, as reportedby Ehrensaft (2005), some single women wondered if they might feelattracted to the sperm donor (see also Graham, Chapter 12).

Again there was marked trepidation for parents about who they mightfind: was the sperm donor a ‘nice person’ and would he agree to givinginformation? As many children were young, parents were understandablyprotective and did not want to risk their child’s safety and happiness or for


them to be unclear about the donor’s role. Parents experienced a similarmixture of anxiety and excitement if the donor agreed to informationexchange, finding it difficult to know how to initiate contact and whatmight be considered inappropriate or intrusive. Interestingly, they alsoexpressed a pressure to ‘measure up’ to expectations, and to reassure andprove to the donor that they are ‘good parents’.

Donor perspectives

At times I feel quite anguished that I have seven other children somewhere in theworld who carry a part of me and my genetic and family background but overwhose lives I have no direct influence at all. I wonder if they are alive, if they arehealthy, happy, well cared for and loved. I hope that they are but all I can do ishope. One day I may meet some of them – maybe all. Who knows? Or maybe Iwill meet none and will forever wonder about them. (Sperm donor)

Of all applications to the Voluntary Register, donors16 represent thelargest proportion (45 per cent). This counters the commonly held beliefthat donors, and sperm donors in particular, are reluctant to provideinformation or be contacted. Rather, reflecting the Law Reform Com-mittee Report’s (2012) finding that ‘most donors empathise with theneeds of donor-conceived people, but some express concern about thepotential for their family life to be affected should identifying informa-tion about them be released’, these donors expressed an interest in theoutcome of their donation combined with a lack of clarity and concernabout the implications of information exchange. Most donors in contactwith the ITA were unclear about how the donor legislation affected them.They desired further clarity about their rights and responsibilities regard-ing information they were entitled to, for example, how many childrenhad been born as a result of their donation and what options did they haveregarding accessing information about these children, as well as wantingto know what rights their offspring had in applying for information aboutthem. Many who had donated before legislation was enacted in 1988 hadnot received counselling as this had not been required.

Despite having donated anonymously, obtaining information aboutoffspring conceived with their gametes was important to donors, a find-ing also reported by Jadva et al. (2011) in their study of sperm andegg donors.17 The ITA was routinely able to provide donors with non-identifying information, such as the number of offspring that had been

16 Again, this includes both sperm and egg donors. Although we do not have informationon the numbers of each, the majority were sperm donors.

17 See Almeling (Chapter 8) for further discussion of potential similarities and differencesbetween sperm and egg donors’ interest in, and feelings about, offspring conceived withtheir gametes.


born, their gender and age. Donors who had no previous knowledge ofthe outcome of their donations were often stunned to learn about theseoffspring, especially those who discovered large numbers. Conversely, anumber of donors who assumed they would have offspring were veryshocked and disappointed to learn that they did not. Rather than ini-tiating contact, donors preferred to ‘wait in the wings’ and make theirinformation accessible should offspring or parents wish to access it, withthe large majority opting to provide information on the Voluntary Regis-ter. In the counsellor’s experience, donors were extremely respectful andsensitive to the needs of donor-conceived people and their families anddid not want to intrude upon their lives.

As well as wanting to know the outcome of their donation, donorswere interested to know more about their offspring, commonly wonder-ing whether they shared any physical resemblances, personality traits orinterests, or had a good life with a nurturing family. Some donors wereconcerned that a young adult might be angry with them for not beingavailable during their childhood, or that offspring might not like them orbe disappointed if they fell short of expectations. If the donor had chil-dren of his own, it caused him to think through the implications for hissons and daughters. How would they feel about having new half-siblings?Would they be shocked, excited, or angry? Would they feel threatened?Would they too share resemblances in appearance and personality traits?If the donor had not already told them, how would he inform them abouthis donation experience? If donors did not have any of their own children,this could be a highly significant event for them. These donors could bemore curious about their genetic offspring and unsure about what sortof relationship, if any, might develop.18

Central Register applications: moral dilemmas and responsibilities

Applications to the Central Register illustrate the ethical complexities ofdonor-linking and the moral responsibilities of intermediary counsellors.Between 2008 and 2010, four sperm donors and one egg donor made aCentral Register application for information about their offspring. Underthe legislation, donors could apply for the donor-conceived person (ifover age 18) to be contacted directly by letter, asking if he or she wishedto consent to information release. In most cases, the donors initiallywanted to do this to ensure that the donor-conceived person was awareof their origins and able to make an informed decision about whether

18 A fascinating narrative of a US sperm donor, Nathan, who has no children of his own,meeting his donor offspring is given in Almeling (Chapter 8).


they would like more information. In the donor’s counselling session,the counsellor tried to present neutrally the potential implications of thedonor-conceived person discovering by letter that they were donor con-ceived. In all cases, donors decided this could have very negative impli-cations for their offspring and so chose to direct the application to theparents instead. The parents in turn could agree or disagree to pass onthis information to their child, although if they did not do so, the donorcould apply for the donor-conceived person to be contacted directly inthe future.

The parents were highly apprehensive about being contacted, and noneof them had disclosed to their now adult children. They were also veryangry, feeling that their family’s privacy had been invaded. These parentsneeded extremely sensitive and lengthy counselling, in some cases overseveral years, in order to come to terms with the disclosure process. Theparents usually eventually agreed, albeit reluctantly, to tell their childrenabout their conception and the donor’s application for information. It isnot known what long-term impact this disclosure has had on these youngadults or whether they went on to exchange information or have contactwith their donor.

There was only one instance of a donor applying to contact a donor-conceived person following previous unsuccessful approaches to the par-ents. This was because the egg donor had a terminal condition andwanted to convey important genetic information to the young person,to alert him to the risk of developing the same terminal condition andto take appropriate screening measures. In this case, the counsellor sup-ported the donor’s right to make an application and regarded this asbeing based on good intentions. The donor also likely wished that thedonor-conceived person might be interested to exchange information ormeet before she died, although this did not occur.

By 2009, forty-three donors had been contacted by the ITA becauseof an application to the Central Register by a donor-conceived personor parent. Donors, and sometimes their partners, were often initiallyconcerned about the applicant’s motives. Some feared intrusion intotheir personal life and were very worried about the potential impact ontheir partner or children. Concerns were also raised about legal claimsto their estate, although the donor-conceived person could have nosuch claim. Once the applicant’s motives were clarified and the donor’slegal rights, responsibilities and potential choices explained, the vastmajority of donors agreed to make their information available. Veryfew refused, some of whom would have welcomed contact but did notproceed due to their partner’s, or other family member’s, concerns.Donors had often expected an enquiry although, if the children were


young, they may have anticipated this at a much later date. They fre-quently described expecting a ‘knock at the door’ and appreciated beingapproached by an intermediary who could assist in negotiating this newterritory.

Meetings between sperm donor relations

Initiating contact

Linking donor-conceived people and parents to their donors does notalways lead to contact. Indeed, it is not yet known what proportion ofdonor-conceived people who access information about their donor maywish to seek contact and/or meet them. For those who do go on to seekcontact, the process from obtaining information about their donor tomeeting them may be a long and complex journey, and there may beseveral points at which any party may stop, pause or change directionalong the way. In the context of the Victorian Registers, the counsellor’sobservations highlight how donor-conceived people, parents and donorsshare similar feelings and concerns about heading into the unknown ter-ritory of making contact: excitement and mutual fascination, especiallyregarding potential resemblances, anxieties about meeting up to expec-tations, and respecting the privacy of the other parties involved. There isno available ‘cultural script’ for negotiating contact between donor rela-tions; no one knows how they ‘should’ be feeling or behaving, and howbest to proceed.

Communication concerns were discussed in all intermediary coun-selling sessions. What is the ‘etiquette’ of initial contact? What is the‘appropriate’ amount of information to convey? Parties were advisedto communicate clearly and honestly about their expectations and thepotentially different boundaries of each person. For example, somewanted medical information only, others wished to meet, while oth-ers hoped for friendship or a familial relationship, with the majoritybeing unsure. If one party wanted a high level of contact and the othernone or only very limited information exchange, this could lead to dis-appointment for both parties and the necessity to mediate a compro-mise. The counsellor had a role to play in preparing the parties for thispotentiality and negotiating a mutually satisfactory arrangement if pos-sible. The risks of communicating with a person who, despite sharinggenetic material, is essentially a stranger was also a frequent appre-hension, particularly for young donor-conceived adults and parents ofsmall children. The letterbox system was chosen by the large majorityof parties to initiate contact as it gave greater privacy and protectionthan meeting. Some parties experienced the opposite and needed to be


encouraged not to rush too quickly and risk jeopardising the potentialrelationship.

Most parties heeded the intermediary counsellors’ advice to take theprocess of making contact slowly, allowing for, and accepting, time forreflection and delays. All demonstrated acute awareness of the feel-ings of each party and their respective families, especially regardingnon-biological parents, and habitually wondered how they might, or weresupposed to, feel about the other person. What are we to each other? Arewe allowed to care? Will we feel anything if we meet? Love, a sense of‘connection’ or nothing at all?

First meetings

On the day of the meeting I was really just sort of curious. There was also a feelingof mystery. The whole thing’s bizarre. I had a little bit of a feeling of having missedout on this person’s life. It was all very odd. Obviously it’s not a usual situationso it’s hard to know how to react. (Sperm donor-conceived person)

It was just the culmination of a lot of curiosity and a lot of excitement andanticipation . . . It wasn’t one of those shatter points in your life where everythingturns upside down. It was a moment that I very keenly enjoyed. And I remembergoing into the room and . . . how we immediately could see the physical side ofthings. I was looking into my own eyes. (Sperm donor-conceived person)

The early indications are that contact between donor relations often haspositive outcomes for all involved. This was the experience reported tothe ITA counsellor and is reflected by the limited available research. Todate, very few studies have included face-to-face meetings with donors,with those that have reporting on experiences of unmediated contactwith sperm donors facilitated by the DSR (Freeman et al., 2009; Jadvaet al., 2010, 2011; Beeson, Jennings and Kramer, 2011; a descriptionof a US sperm donor’s individual experiences of contact with his donoroffspring is given in Almeling, Chapter 8). In these studies, most meet-ings between sperm donor offspring and their donor were found to bemutually beneficial. The large majority noticed and enjoyed perceivedsimilarities, particularly in terms of physical appearance, which in somecases contributed to a sense of connectedness. Prior anxieties were fre-quently allayed by meeting in person, and the reality of the meeting couldexceed anticipations and be an emotional and ‘bonding’ encounter forall. However, while vitally important, first meetings are just one stagein the complex process of forming connections between donor relations.ITA counsellors advise that such meetings may not lead to an instantrevelation but rather be experienced as an ‘ah ha’ moment when puzzlepieces begin to be put into place, and may feel ‘bizarre’ or ‘strange’.


For example, one sperm donor with no children of his own describedwondering if he would instantly ‘bond’ or feel a deep connection whenmeeting his biological daughter for the first time and was surprised whenhe did not.

It is not yet known whether, and how, these relationships will developover time. The counsellor observed issues common in adoption reunion.Strauss (1994) describes five stages of adoption reunion: ‘fantasy’, wheneach party imagines what the other might be like; ‘first encounters’,which is often a time of euphoria and highly charged emotion; ‘the morn-ing after’, when everything settles down and there is an exploration ofexpectations of the relationship; ‘limbo’, when one side may step backleaving the other to wonder why; and ‘reconciliation’, which is continualand involves considering how the new person will be assimilated intothe other’s life and whether there will be an ongoing relationship. Fur-ther research is needed to explore whether these stages are common todonor-linking experiences.

Although there have been few half-sibling links on the Victorian Reg-isters, the counsellor observed similarly positive contact experiences inthese cases, as evident in the available research (Scheib and Ruby, 2008;Freeman et al., 2009; Jadva et al., 2010; Hertz and Mattes, 2011; Blyth,2012). The discovery of a half-sibling relationship is commonly viewedas more straightforwardly beneficial than connecting with a donor. Manyparents and offspring report the formation of close bonds between fami-lies who share the same donor, with a search that was frequently initiatedby curiosity leading to a sense of ‘family’ connection (Freeman et al.,2009). As one mother who had sought contact with her child’s “sibs” viathe DSR described:

I was actually just curious about what the sibs might be like (personalities, looketc.). After connecting with the other moms it turned out to be a more wonderfulexperience than I’d ever imagined . . . We’ve become a family of sorts of ourown and share a special bond. It wasn’t why I sought the sibs but it was acompletely wonderful surprise. (Mother of child conceived by sperm donation,DSR member)19

So far, there have been few reports of negative outcomes of contactinvolving donors or half-siblings, with those who meet tending to get onwell and stay in touch (Freeman et al., 2009; Jadva et al., 2010, 2011).From the ITA counsellor’s experience, when things go wrong, peopleusually had good intentions to start with but encountered problems, suchas: rushing first face-to-face meetings with little prior communication,

19 Quoted in Freeman et al. (2009).


potentially leading the relationship to ‘crash and burn’; no discussion ofexpectations or hopes for the future; hidden agendas or, on rare occa-sions, dishonesty; role confusion or poor boundary clarification, espe-cially sexual.

It is also important to consider the ripple effect of contact potentiallyhaving an impact on other family relationships in both positive and neg-ative ways. Problems could arise if parents or other family members werenot informed or involved, or were unsupportive or threatened by thenew relationships. Furthermore, multiple links can be made which canbecome very complex as new parties become involved. What informationis private and what can be shared? Will the donor feel overloaded if multi-ple people seek information? Findings suggest that, when large numbersof half-siblings are discovered, donors, offspring and parents are exercis-ing a degree of choice over which, and how many, families they are incontact with (Jadva et al., 2010; Hertz and Mattes, 2011); for example, asperm donor may decide that he is happy to be contacted by say five off-spring conceived with his gametes, thus opening up the possibility of notacknowledging, or ‘de-kinning’ (Edwards, Chapter 2), a sixth offspringshould they seek contact. More positively, meetings between donor rela-tions can open up new paths to family connections across the extendedfamily network; for example, parents of sperm donors may warmly wel-come the discovery of genetic grandchildren, especially if they previouslyhad none. However, even when outcomes are more favourable, nego-tiating relationships that may evolve when donor relations meet raisescomplex psychological and ethical issues concerning perceptions of relat-edness, including issues around parentage and terminology.

Who is the ‘real’ parent?

A sperm donor-conceived child brought up by a heterosexual coupleessentially has three ‘parents’: the ‘biological’ male parent (sperm donor),the ‘biological’ and ‘social’ female parent (mother) and the ‘social’ maleparent (father) (see also Ehrensaft, 2005). While each of these ‘parents’contribute to the creation of a child, their relative significance can beminimised and maximised. Meetings between these parties can throwsuch issues to the fore. Is a ‘biological’ parent more ‘important’ or ‘real’than a ‘social’ parent, or is a ‘social’ parent more significant? Adop-tion reunion research indicates that ‘blood is not thicker than water’:although highly significant for all concerned, relationships betweenadoptees and their ‘birth parent(s)’ are generally not of a parental nature(Triseliotis, Feast and Kyle, 2005). However, adoptive parents com-monly feel threatened by a child’s relationship with their birth parent(s).


The counsellor observed concerns of a similar nature in the case of donorconception, particularly for non-biological parents. It remains a challengefor all parties to relate to each person in the equation comfortably andnot feel intimidated by the additional relationship.

What do we call one another?

I don’t know what you call each other because being called a ‘sperm donor’is dreadful! I mean in context of dealing with another human being ‘biologicalfather’ is not too bad . . . I think it’s even worse for the biological offspring ofsperm donors. They can be called ‘biological children’ or ‘biological offspring’. Idon’t know what to call them either. I don’t think anyone’s come up with a goodname have they? I don’t think there is a good name . . . It’s a little bit outsidenormal human language. Words for relations and friends are deeply embeddedin our language and psyche so with something odd like this it’s really hard toknow what to do . . . how to describe it. (Sperm donor)

Language and the problem of how to describe each other and their rela-tionships was identified by the counsellor as a real difficulty for all parties.What do I call my sperm donor? Donor, biological father, genetic father,father, real father, donor dad, progenitor, dad? What do I call peoplecreated with the same donor? Donor siblings, genetic half-siblings, half-brothers/sisters, brothers/sisters, sort of siblings, kind of cousins? Howdoes a sperm donor describe a person conceived with his donatedgametes? Biological son/daughter, donor son/daughter, offspring, child?How does a donor-conceived person introduce their donor or half-siblingby donation to a stranger? Are we family, special friends or something inbetween?

Findings from the DSR studies indicate that a variety of terminologyis used when donor relations talk about each other, borrowing from con-ventional language of familial relatedness or developing a hybrid. Thiswas particularly apparent for offspring describing their sperm donors:descriptions ranged from the relatively functional and detached label,‘donor’, to the more emotionally charged ‘daddy’ or ‘dad’, with alterna-tives such as ‘donor dad’ or ‘biological father’ also being used (Freemanet al., 2009; Jadva et al., 2010; see also Blake et al., Chapter 15). Formany, the language used to describe other parties evolved over time,just as their relationships, and their understanding of these relationships,did. This co-evolution of language and relationships was most markedfor half-siblings, especially as these connections were frequently initiatedfrom an early age. Indeed, while many half-siblings came to describeeach other as ‘brother’ or ‘sister’, in the early stages, they often met as‘friends’, being unaware of, or unable to understand, the ‘genetic con-nection’ between them:


My sons are still so young that they don’t quite register the meaning of sharing adonor with this other little boy they sometimes play with. My oldest knows thisother boy has the same donor and that it is important, but he has not attachedthe word ‘brother’ to him yet. (Mother of children conceived by sperm donation,DSR member)20

They call each other ‘brother’ and ‘sister’ – not half-brother or half-sister. There isan indescribable relationship there. Much more than distant relatives but differentthan if they had grown up together as full siblings. The kids will be better atdefining this relationship as they move forward. (Mother of children conceivedby sperm donation, DSR member)21

The personal circumstances of offspring, parents and donors are likelyto have an impact on their perceptions of donor relations and the lan-guage they use to describe each other. For example, it has been foundthat there may be a greater interest in donor relations in families withno social father, with single mothers in particular wanting informationabout sperm donors and their children being more likely to use parentaldescriptors such as ‘dad’ or ‘father’ (Scheib, Riordan and Rubin, 2003,2005; Jadva et al., 2010; Beeson, Jennings and Kramer, 2011; Blakeet al., Chapter 15). Also, in line with adoption research which suggests agreater interest in birth families among females (Howe and Feast, 2000),the DSR research revealed a greater number of donor-conceived femaleoffspring to be searching for their donor and half-siblings than males(Jadva et al., 2010).

Known donation

Many issues raised by mediating contact between donor relations arebrought into sharp relief by known donation; a particular case of ‘con-necting’ donor relations that presents new and complex formulationsof the ‘donor conception triangle’ between donors, offspring and par-ents. While there are limited data available concerning the prevalence ofknown donation,22 it appears to be a visibly growing trend in some localcontexts; for example, the London Women’s Clinic (LWC) has seen a sig-nificant increase in the use of known sperm donors since 2007 in a periodwhich follows removal of donor anonymity in the UK in 2005 and theincreased access to ARTs by single women and lesbian couples.23 There

20 Quoted in Freeman et al. (2009). 21 Quoted in Freeman et al. (2009).22 Part of the reason for this lack of data is that much known donation may occur outside

the clinical context. In this chapter, our discussion is confined to known donation withinthe clinic.

23 It is important to note how local factors may underpin wider trends in gamete donation.In the UK, for example, some of the additional factors that may have an impact on the


are two main types of known donors: non-related donors (a friend or adonor recruited privately or via a website) or family members. For spermdonation, the majority of family donors are brother- or father-in-law tothe female recipient, thus maintaining a genetic connection to their part-ner, although other scenarios have occurred: for example, in one caseinvolving egg donation, the recipient’s father offered to provide spermto enable a genetic link between mother and child. The main recipientgroups of known sperm donation at the LWC are lesbian couples andsingle (heterosexual and lesbian) women.

Known donation raises many psychological and legal concerns. Nego-tiating relationships between known donors, recipients and resulting off-spring requires consideration of anticipated futures about which littlecan be known at the pre-conception stage: in particular, conflicts canemerge around desired levels of donor involvement in the child’s life, andlatterly, their actual involvement, which may also vary with the child’sage. For example, should the donor have any input into the child’s nameor schooling? There are different professional contexts in which suchdiscussions can take place; for example, by voicing concerns throughindividual and joint counselling sessions within the clinic, taking legaladvice about parental rights or drawing up letters of intention. However,the regulatory framework is still relatively undefined and insights fromclinical practice suggest that, even when preparing for treatment, thechanging relationship between donors and recipients is highly complex.At the LWC, a far higher number of non-familial known sperm donorshave withdrawn consent for use of their samples than the main spermdonor population, while the drop-out rate is virtually non-existent for theintrafamilial group. While reasons for this remain unclear, it appears thatnon-familial donors’ relationships with the recipient are more problem-atic than being a donor per se, because the majority go on to donate theirsamples to the main sperm bank. Although prospective parents oftenemphasise the importance of a ‘friend’ being the provider of sperm, theymay also decide against continuing with known donation and opt to usesperm from the sperm bank if, for example, they face the possibility ofneeding IVF due to the known donors’ sperm quality. Feedback fromthe rejected donors is often of devastation. In intrafamilial donation, thesituation may also be psychologically fraught: although there are highlevels of compliance, this often appears attributable to donors’ feelings

use of known donors include the costs and availability of clinic-recruited donors. Thisis particularly the case with egg donation, where the use of family members may be seenas a way of avoiding long waiting lists for treatment.


of guilt and obligation rather than purely a willingness and commitmentto help family members.

A donor’s sexual orientation may also have an impact on their attitudetowards the donation and expectations about the relationship with anyresulting offspring. While historically, the experience at the LWC wasthat the majority of known donations were undertaken by gay men whofelt this was their only means of ‘fathering’ a child, the increased avail-ability and uptake of surrogacy by gay men has led to a decline in thistype of donation. Rather, there has been a notable increase in hetero-sexual men donating to close single female friends, often known sincechildhood. While these men typically find the decision to donate fairlystraightforward, their female partners often feel uncomfortable, particu-larly if they have not yet had children of their own. There are currently anumber of known donors attending counselling with their partners whoare struggling to accept the actual or potential existence of a child. Inknown donation involving non-relatives, there appears to be great varia-tion in resulting relationships, with the experience of the LWC being thatgay donors have tended to build close relationships with the child whileheterosexual donors usually have much less contact.

Concluding comments

Family can be defined in many ways: relationships are the most important. Some-times families click, other times they don’t. As the saying goes, ‘you can pickyour friends, but you can’t pick your relatives’, so I think they [half-siblingsby sperm donation] would all feel more like the relationship was more of achoice than a requirement. (Mother of child conceived by sperm donation, DSRmember)24

We are still at a very early stage in understanding perceptions of related-ness between donor-conceived people, donors, half-siblings and theirrespective families. Our discussion has explored how these emerg-ing connections are being actively sought, constructed and defined indifferent empirical settings, focusing on the example of the DonorRegisters in Victoria, Australia. Our discussion has shed light onsome of the ways that the emotional dynamics and kinship languageunderpinning these experiences are unfolding, highlighting how dif-ferences in the personal circumstances and the socio-legal and cul-tural context of those involved may come into play. While there isstill much research to be done, it appears likely that family struc-ture, the presence or absence of a social father, the age and gender of

24 Previously unpublished quote from the DSR parents’ survey (Freeman et al., 2009).


offspring and the age at which they found out about their donor concep-tion may all impact on how contact between donor relations is experi-enced and defined. Likewise, donors’ experiences of contact may alsodiffer according to their sexual orientation and marital status, andwhether they have a partner who is supportive of contact or have childrenthemselves. Significantly, very little is known about potential differencesand similarities in contact experiences between sperm donor relationsand egg donor relations. One of the reasons for this lack of understandingis the disproportionate number of sperm donor relations seeking contactin comparison to the scarcity of reported cases involved egg donationwhich in itself raises interesting empirical questions. In this chapter, wehave touched upon some potential reasons for this disparity and it wouldbe interesting to explore further how this develops over time: will anincreasing number of egg donor-conceived offspring seek contact withtheir egg donor and half-siblings if the concept of seeking connectionsbetween donor relations becomes more familiar and more accessible?Or will this remain a terrain shaped by individual, socio-legal and cul-tural perceptions of the significance of ‘genetic’ connections transmittedthrough sperm?

In making connections with donor relations, there is a perception ofindividual choice and agency at every stage: from decisions about whetherto pursue the identity of donor relations to whether to initiate contactand on what terms. Although the phenomenon of donor-conceived indi-viduals seeking to connect with donor relations is based on what maybe perceived as a pre-existing genetic connection alone, the unfoldingexperience reflects the changing meanings and significance ascribed to‘genetic’ and ‘social’ relatedness: from initial curiosities about poten-tial inherited resemblances to offspring’s reflections on their relation-ships with their ‘non-biological’ father and sperm donor. The ‘donorconception triangle’ is itself embedded within a web of social relation-ships, and the perspectives of parents, offspring and donors cannot eas-ily be detached from the personal contexts in which these connectionsare formed. Indeed, the lived experience and emotional substance ofconnections between donor relations ultimately underpin how they areperceived. As a mother describes:

I could not love this child [her child’s half-sibling by sperm donation] more even ifshe was my biological child. In every way, I feel that she is my daughter. (Motherof child conceived by sperm donation, DSR member)25

25 Quoted in Freeman et al. (2009).


By telling these stories from the viewpoint of counsellors, clinicians andresearchers in the field within different cultural and social contexts, thischapter further illustrates how contact between donor relations does nottake place within a vacuum. Listening to people’s experiences is clearly avital part of understanding the nature of these relationships but it is alsoimportant to reflect on how professional and clinical discourse aroundconnecting donor relations and the socio-legal and cultural context inwhich this occurs may shape the meaning of these experiences. Despitethe public rhetoric around openness in gamete donation and the posi-tive stories of making connections that have risen to the fore, variationin people’s experiences acts as a pertinent reminder that treading intothe unknown territory of connecting donor relations requires cautionand care. Sensitivity, goodwill, trust, honesty and a ‘leap of faith’ arerequired to navigate any new relationship, and those who seek to turn‘genetic’ connections into ‘social’ connections require these qualities inabundance.

References

Appleby, J.B., Blake, L. and Freeman, T. (2012). ‘Is disclosure in the best inter-ests of children conceived by donation?’, in M. Richards, G. Pennings andJ. Appleby (eds.), Reproductive Donation: Practice, Policy and Bioethics. Cam-bridge University Press.

Australian and New Zealand Infertility Counsellors Association (2012). ‘Guide-lines for professional standards of practice: donor linking counselling’, TheFertility Society of Australia, Melbourne. Available at: www.fertilitysociety.com.au/anzica/policy-documents/.

Beeson, D.R., Jennings, P.K. and Kramer, W. (2011). ‘Offspring searching fortheir sperm donors: how family type shapes the process’. Human Reproduc-tion, 26, 2415–24.

Blyth, E. (2012). ‘Genes r us? Making sense of genetic and non-genetic rela-tionships following anonymous sperm donation’. Reproductive BioMedicineOnline, 24, 19–26.

Blyth, E. and Frith, L. (2009). ‘Donor-conceived people’s access to geneticand biographical history: an analysis of provisions in different jurisdictionspermitting disclosure of donor identity’. International Journal of Law, Policyand the Family, 23, 174–91.

Crawshaw, M. (2002). ‘Lessons from a recent adoption study to identify some ofthe service needs of, and issues for, donor offspring wanting to know abouttheir donors’. Human Fertility, 5, 6–12.

Crawshaw, M., Gunter, C., Tidy, C. and Atherton, F. (2013). ‘Working withpreviously anonymous gamete donors and donor-conceived adults: recentpractice experiences of running the DNA-based voluntary information

http://www.fertilitysociety.com.au/anzica/policy-documents/

http://www.fertilitysociety.com.au/anzica/policy-documents/


exchange and contact register, UK DonorLink’. Human Fertility, doi:10.3109/14647273.2012.731714.

Ehrensaft, D. (2000). ‘Alternatives to the stork: fatherhood fantasies in donorinsemination families’. Studies in Gender and Sexuality, 1, 371–97.

(2005). Mommies, Daddies, Donors and Surrogates: Answering Tough Questionsand Building Strong Families. New York: Guilford Press.

Freeman, T. and Richards, M. (2006). ‘DNA testing and kinship: paternity,genealogy and the search for the “truth” of our genetic origins’, in F. Ebtehaj,B. Lindley and M. Richards (eds.), Kinship Matters. Oxford: Hart.

Freeman, T., Jadva, V., Kramer, W. and Golombok, S. (2009). ‘Gamete donation:parents’ experiences of searching for their child’s donor siblings and donor’.Human Reproduction, 24, 505–16.

Freeman, T., Appleby, J.B. and Jadva, V. (2012). ‘Identifiable donors and siblings:implications for the future’, in M. Richards, G. Pennings and J. Appleby(eds.), Reproductive Donation: Practice, Policy and Bioethics. Cambridge Uni-versity Press.

Hertz, R. and Mattes, J. (2011). ‘Donor-shared siblings or genetic strangers:new families, clans, and the internet’. Journal of Family Issues, 32, 1129–55.

Howe, D. and Feast, J. (2000). Adoption, Search and Reunion: The Long-TermExperience of Adopted Adults. London: The Children’s Society.

Jadva, V., Freeman, T., Kramer, W. and Golombok, S. (2010). ‘Experiencesof offspring searching for and contacting their donor siblings and donor’.Reproductive BioMedicine Online, 20, 523–32.

(2011). ‘Sperm and oocyte donors’ experiences of anonymous donation andsubsequent contact with their donor offspring’. Human Reproduction, 26,638–45.

Johnson, L., Bourne, K. and Hammarberg, K. (2012). ‘Donor conception leg-islation in Victoria, Australia: the “time to tell” campaign, donor-linkingand implications for clinical practice’. Journal of Law and Medicine, 19,803–19.

Law Reform Committee (2012). ‘Inquiry into access by donor-conceived peopleto information about donors’. Parliament of Victoria Parliamentary Paper,No. 120, session 2010–2012. Available at: www.parliament.vic.gov.au/lawreform/article/1468.

Scheib, J.E. and Ruby, A. (2008). ‘Contact among families who share the samesperm donor’. Fertility and Sterility, 90, 33–43.

Scheib, J.E., Riordan, M. and Rubin, S. (2003). ‘Choosing identity-release spermdonors: the parents’ perspective 13–18 years later’. Human Reproduction, 18,1115–27.

(2005). ‘Adolescents with open-identity sperm donors: reports from 12–17year olds’. Human Reproduction, 20, 239–52.

Strauss, J. (1994). Birthright: The Guide to Search and Reunion for Adoptees, Birth-parents, and Adoptive Parents. New York: Penguin.

Triseliotis, J., Feast, J. and Kyle, F. (2005). The Adoption Triangle Revisited: AStudy of Adoption, Search and Reunion Experiences. London: British Associa-tion for Adoption and Fostering.

http://www.parliament.vic.gov.au/lawreform/article/1468

http://www.parliament.vic.gov.au/lawreform/article/1468


Legislation

UKHuman Fertilisation and Embryology Act 1990, as amended.Human Fertilisation and Embryology Act 2008.

Victoria, AustraliaThe Assisted Reproductive Treatment Act 2008 (Vic).Infertility (Medical Procedures) Act 1984 (Vic).The Infertility Treatment Act 1995 (Vic).

16 Relational lives, relational selvesAssisted reproduction and the impact on grandparents

Petra Nordqvist and Carol Smart

Introduction

The birth of a grandchild is an important family event. Culturally, per-sonally and emotionally a new grandchild inhabits a special place in therelational network of kin; a grandchild is always already connected to,and inscribed in, a grandparent’s world and family life. A grandchildbeing born can also change everyday life for grandparents because thetransition can result in a new and extensive investment of time, care andemotions (e.g. Fuller-Thomson and Minkler, 2001; Mason, May andClarke, 2007; Statham, 2011; Wellard, 2011). He or she might also beperceived as a carrier of hopes, dreams and aspirations for the futureand can be seen as providing both purpose and fulfilment for the grand-parents. Much is therefore invested in the idea of one’s children havingtheir own children. Grandparents have a stake in their children’s repro-ductive choices and although, as we shall discuss, they are rarely entitledto influence their children’s reproductive decisions, they are nonethe-less likely to be much affected by them. So while intergenerational rela-tionships constitute vital and important bonds in personal life, this isparticularly so at the point at which a new generation is born into thefamily.

It is therefore somewhat paradoxical that grandparents appear to beinvisible in most research on assisted reproduction and donor conception.Although heterosexual couples undergoing treatment have been the focusof study (e.g. Franklin, 1997; Becker, 2000; Thompson, 2005) and, to alesser extent, lesbian couples and single women (e.g. Murray and Golom-bok, 2005; Almack, 2006; Mamo, 2007; Golombok and Badger, 2010;

We are grateful to the UK Economic and Social Research Council for funding the researchon which this chapter is based. The project was entitled ‘Relative strangers: Negotiatingnon-genetic kinship in the context of assisted conception’ (RES-062–23–2810). We alsoextend our thanks to all those who participated in the research process.

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Assisted reproduction and the impact on grandparents 297

Nordqvist, 2011), the impact of donor conception on relationships in thewider family appears to be overlooked. In this chapter we explore how acouple’s desire to become parents and their decision to pursue assistedreproduction affect intergenerational relationships. The focal point ofthis chapter is thus living with and through infertility treatment, and forreasons of space, it does not explore how grandparents perceive particu-lar treatment regimes or the issue of donation per se (for more in-depthexplorations of these issues see Nordqvist and Smart, 2014a). This alsomeans that our concern here is mainly with heterosexual parents, andtheir parents in turn, because it was they who battled with infertilityproblems and their consequences. Lesbians may of course face infertilityissues but they are more likely to resort to donor conception because theydo not have a suitable male friend or a suitable known donor (Nordqvist,2011). So while kin relationships matter a great deal to both lesbianand heterosexual couples (e.g. Nordqvist and Smart, 2014a, 2014b),our focus on the significance of grandparents during fertility treatmentmeans that we draw on only this part of our data.

Parent and grandparent relationships are infinitely complex. We willtherefore focus on just three salient themes that emerge from our studyinto donor conception and family relationships. First, we explore par-ents’ notions of privacy surrounding assisted conception and how expec-tations about this privacy are compromised by the need to disclose toparents or other kin. Second, we examine how ideals of independenceand non-interference shape the parent–grandparent relationship. Third,we consider how notions of dependency and support come into playand frame ways of relating across the generations. Focusing on thesethree dimensions, we show that they can be understood as principlesof relating that shape the way in which parents and grandparents con-duct their relationships. In our final section we explore how these threeprinciples often conflict with one another, producing relational dilemmasand ambivalences which have been largely overlooked in studies of donorconception.

To this end, we use interview data derived from both parents andgrandparents of donor-conceived children in England and Wales. Theseinterviews formed part of a larger study designed to investigate the ways inwhich donor conception is negotiated within wider family relationships.The study sought to understand how donor conception and genetic andnon-genetic relatedness have an impact on family relationships acrossgenerations in a British context, particularly where one or both partnerslack a genetic relationship with the child. We gathered data from bothheterosexual and lesbian parents, as well as grandparents. In total we con-ducted seventy-four interviews, comprising twenty-two with heterosexual

298 Petra Nordqvist and Carol Smart

parents, twenty-two with lesbian parents and thirty with a grandparent(usually a grandmother) or grandparents together, of whom fifteen spokeof donation in a heterosexual family context and fifteen of donation ina lesbian family context.1 For ethical reasons we did not interview twogenerations of a single family but instead recruited the parents and grand-parents separately. This avoided the possibility of imparting informationinappropriately and also, we hoped, would allow the two generations tospeak a little more frankly about each other. Thus we have data fromthe grandparent generation on their relationships with their adult chil-dren and also from the parent generation about their relationships withtheir own parents or in-laws. It was mainly grandmothers who agreedto be interviewed, and they spoke mostly of relating to a daughter ordaughter-in-law going through infertility treatment. And so, although wealso present the voices of grandfathers, the main conduits of support werebetween mothers and daughters and this is reflected in the data. For easewe will refer throughout this chapter to grandparents and parents eventhough our respondents are talking about the time before a grandchildwas actually born.

In order to capture the richness and complexity of the lives that wecame across, and to grasp the ways in which relationships between parentsand grandparents can produce subtle layers of meaning, we utilise thetheoretical framework of relationality. This approach introduces a wayof thinking about being kin, and about the meaning of being related, asemerging from the everyday ‘doing’ of family life over time. Thus Finchand Mason (1993, 2001) and Smart (2007) suggest that rather thanunderstanding family life as bound by rules or obligations, it should beunderstood as shaped through the negotiation of relationships over time.Some relationships, such as those between parents and grandparents,might be said to come with particular sets of expectations (Luescher andPillemer, 1998; Connidis and McMullin, 2002; Mason, May and Clarke,2007). Indeed these may form an important part of how we imagine thatfamily life should be conducted (Gillis, 1996). But although they might bestrong in shaping the way in which parent and grandparent generationsunderstand and seek to conduct their relationships, we suggest that theseexpectations do not shape or translate into practice in a straightforwardway. This means that we interpret our interview data as instances of howthe generations negotiate with each other in a context where there areno fixed rules but instead a mixture of hopes and aspirations, habituated

1 A total of 119 men and women took part in the study as a whole, and of these 99 identifiedas White British/Scottish/Welsh/English and 13 as White European/American/Australian.Four people identified as mixed British and three as Asian.


modes of conduct, broad principles of parenting and personal grief orneed as well as the wider cultural and social milieu. Moreover, havinginterviewed both the parent and the grandparent generation, it becomespossible to see the relationships from different perspectives, giving rise toinsights into the complexities of these interwoven lives. The stories thatthe two generations tell do not necessarily diverge greatly, but throughhearing them both it becomes possible to see how much is required ofthe grandparents ( particularly grandmothers) and how taken for grantedintergenerational support and particular expectations on relationshipscan be. As we note above, it is also possible to discern the key principlesthat emerge to guide action while at the same time observing how suchprinciples may be regularly breached.

First principle: maintaining privacy

While events like the birth of a child are typically regarded as causes forfamily-wide celebration, details about actual conception are more pri-vate matters. The process of getting pregnant invokes a very different setof cultural understandings compared with the arrival of the child somenine months later. The inability to create a child, however, producessituations where these typically private matters of sexual behaviour andsexual prowess start to creep into the semi-public domain. The absenceof a child for a heterosexual couple may, for example, mean that friendsand relatives begin to doubt the male partner’s ‘manhood’. Cultural con-fusions between a low or absent sperm count and virility may lead tofeelings of stigma. Equally, a female partner’s inability to become preg-nant may be seen as a cause for pity or even family shame in a contextwhere proper womanhood is synonymous with motherhood (e.g. Riess-man, 2002; Culley and Hudson, 2006). The older generation, hopingfor the arrival of grandchildren, may add pressure to this situation bydropping hints or withdrawing into a leaden silence. The heterosexualcouple can therefore find that they are in a culturally ambivalent place.They are somehow expected to explain their ‘failure’ to produce childrenwhile, at the same time, they may resist strongly ‘going public’ on matterswhich are normally held to be highly private and of course personal, evenbetween close family members.

MacCallum and Golombok (2007) have shown from their interviewswith a clinic-based sample of heterosexual couples that the people whoare most likely to know that a couple are having infertility treatment aremothers (or sometimes mothers-in-law). In other words women under-going treatment (whether for their own or their partner’s infertility) typ-ically feel the need to share the burden with at least one close relative,


usually a person they can really trust. This is nonetheless a breach in thenormal expectations surrounding sexual privacy; culturally and socially,matters of a couple’s intimate or sexual life are seen as private concernsand are not usually topics discussed more publically. Talking about prob-lems of infertility breaches these conventions of private life and may onlyarise because the process of infertility exploration and treatment is sostressful and so seemingly endless. Exploring the processes of undergo-ing IVF, Franklin (1997) notes how IVF treatment throws patients intoan emotional rollercoaster of managing hope in the face of recurrentdisappointment. A parent from our study initially went through a seriesof unsuccessful IVF treatment cycles which caused her huge difficultiesover a number of years:

I just didn’t feel like I could kind of talk to people, many people about it so Iprobably [ . . . ] I mean no more than a handful, I mean a small handful, like threepeople I’d say. I talked to my mum, I talked to one of my closest friends whohas also gone through IVF treatment and probably maybe one, maybe two otherpeople but not in such depth. So this one close friend and my mum probably arethe people that I spoke to most about it and, simply because you know I just, Iwas, I got in such a state that you know it was kind of impossible for them to [not]realise that something was going on and I just had to kind of talk to somebodyabout it. (Erin, one daughter heterosexual egg donation)

Keeping infertility procedures a secret is hard precisely because the pro-cess is so invasive and because frequent bitter disappointments are hardto disguise. It is clear from this quotation, however, that there is a reluc-tance to be open about such experiences and, if it were not for a strongneed for support, women like Erin might prefer to keep it all private.

Some of the couples we interviewed were able to share this informationwith their parents more easily. For example, where an illness like cancerhad caused infertility, this might already be known to close family mem-bers. Lesbian couples were in a slightly different situation because theywere not (necessarily) facing infertility per se, yet they too had to dealwith the issue of what (and how much) to tell parents about the processof becoming pregnant. For some this could be very sensitive informationto impart, particularly if the couple was not going through a clinic set-ting. But no matter how hard or easy couples found it to tell parents suchintimate details about their personal lives, it quickly became apparent tothem that this telling – even to trusted others – led to further concernsabout privacy. Typically, on confiding with a mother or mother-in-law(or sometimes a sister or close friend), the person sharing the intimateinformation then swore the receiver to secrecy. This meant that while theinfertile daughter (for example) could share her burden and disappoint-ment with another person, the recipient of the burden was not allowed


to share it with anyone else. The grandparents became the keepers ofinformation they were not allowed to share, they could only guard it. Asthe grandmother of a sperm donor-conceived child, said:

When [my daughter] told me she said ‘Look mum I don’t want you to tell anyone’.Obviously [ . . . ] I just kept it to myself. [ . . . ] I find it, it’s much easier to knownow that [other] people know, ’cos I’m not very good at keeping secrets. I find itquite a burden. ( Joyce, one grandchild heterosexual sperm donation)

In this case, the information Joyce was guarding became more widelyknown in the family so she was relieved of her burden. But it is possibleto see how hard it can be for grandparents who are fearful of lettinginformation slip inadvertently or who find they actually have to tell lies inorder to keep things secret. The safeguarding of another person’s privacyis a heavy responsibility and yet the grandparent generation, particularlygrandmothers, were simply expected to honour the silence because it wasa taken-for-granted duty of parenthood. No matter how much the oldergeneration might wish the secret had not been shared with them, theyfelt duty bound to keep the faith until such times as the couple chose tobe more open.

In some instances the grandparents asked if they could tell other peo-ple. Where, for example, they had very intimate relationships with a thirdparty they might want to share their experiences and their own misery.This is because the infertility of their child was also a source of unhap-piness to them because they had to witness her or his suffering and theymight even feel partly to blame for (inadvertently) passing on a problemdown the generations. One of the mothers we interviewed, who had twochildren by sperm donation, encountered the issue of whether to allowher parents to share the information with their own close friends:

It’s interesting actually ’cause we had, well we had the case of my parents. I thinkthey quite wanted to tell some very close family friends who [my partner] didn’tknow at all. And they weren’t people who we saw now, even though I knew themvery well as a child and they’re very, very dear friends of my parents. But we, wesort of said, ‘Look we’ve got to draw the line somewhere’ [ . . . ] And my mumfound that quite difficult. She’d say, ‘But you’ve known them all your life, youknow, and we know some very private things about their children’, she’d sort ofsay. And I’d say, ‘Well, you know, it’s not tit for tat. You know, it’s kind of is therea need for them to know? Will they need to support the children? No. So theydon’t need to know really.’ (Victoria, two children heterosexual sperm donation)

It might be anticipated that those grandparents who did not wish tobe burdened with such a secret would go ahead and share it anyway.However, the vast majority of our participants, as far as we could tell,kept the secret for their adult child despite finding it difficult to do so.


The reasons for doing so were undoubtedly complex. Feelings of loyalty,emotional connectedness built up over time, and the ethics of keepingfamily matters secret might bear on these decisions. Moreover, we foundthat they tied in with other significant principles that guided the way inwhich these families conducted and understood their relationship.

Second principle: maintaining independence

The idea of independence was one such important principle that framed,in significant ways, how the generations related to one another. It wasimportant for both generations that the grandparents treated their adultchildren as separate, self-determining actors. This meant that they werenot expected to interfere in decisions about treatment. According toMason, May and Clarke (2007: 691) ‘interference’ equates with badgrandparenting because ‘good parenting is about facilitating your adultchildren’s transition from dependence to independence and autonomy’.Not interfering in turn also reflects on the grandparent him- or herselfas somebody who has achieved ‘good’ parenting in the past. This means,in the context of infertility treatment, that grandparents are unable tovolunteer opinions on a whole range of decisions, from whether to stopor continue treatment, whether to embark on donor conception, who tochoose as a donor and whether the child should be told about her orhis donor origins. Grandparents might, for example, be very supportivethroughout a number of IVF cycles and yet have serious ethical reserva-tions if donor gametes were involved. Equally they might foresee manyproblems surrounding choosing a known donor rather than opting forthe anonymity and legal protections provided by a clinic. But in all ofthese cases they know they are not allowed to voice, let alone, imposetheir views.

The sentiment that the decision about donor conception was an expres-sion of an adult child’s independence emerged with some force in ourinterviews with grandparents:

I feel very strongly that it is their life and I don’t have very strong thoughtsabout [the donor conception]. (Alice, four grandchildren heterosexual eggdonation)

I say, I, I’m sorry it sounds silly but, I’m afraid it’s none of my business so tospeak. It’s their life, they wanted to do it. They wanted a child and I’m delightedthey’ve got one. ( Joanne, one grandchild heterosexual egg donation)

We just treated it as completely matter of fact, didn’t we, I think? And sort oftotal support, whatever they decided to do. (William, one grandchild heterosexualsperm donation)


In the eyes of the grandparents in our study, any decision associated withbecoming a parent or specifically donor conception was perceived to betheir children’s alone.

This expectation in turn affected the way parents and grandpar-ents managed the donor conception within their relationships. First, itresulted in expectations about initiating conversation about the concep-tion process. The grandparents were not supposed to ask questions, orto appear ‘too interested’. They could only obtain information aboutwhat their adult children were going through when such information wasoffered to them. This was illustrated in our interview with Abigail andJonathan, who were the parents of a son by egg donation. They were bothaware that the paternal grandmother was longing to know more aboutthe donor and for that reason they were particularly guarded with her.They felt that she wanted to know too much:

jonathan . I think my mum would want to talk about it more.abigail . Your mum would love to talk about it all the time.jonathan . Yeah. Yeah. [laughter] You just don’t want to talk about it first.abigail . No. Well, I don’t mind, you know, I mean I don’t . . . I don’t know

what her . . . [laughter] she likes to be involved doesn’t she? Really, she’d loveto be involved, deeply involved, with everybody really. That’s her position.And um, so you sort of have to have some personal boundaries with her[laughter] um, it’s not that I won’t talk about it. I mean if anybody mentionsit, it’s not a taboo – it’s not a taboo subject. It is treated a bit [with her] likeit’s a taboo subject.

Abigail and Jonathan’s account highlights the subtle ways in which infor-mation was shared in the family. They were both aware that the grand-mother was longing to be privy to more information, and yet they wereuncertain about the effects that more openness would have on their rela-tionship. In this case it appears that the grandmother’s willingness to beinvolved was felt to border too much on the intrusive. In this short pas-sage what becomes apparent is that ‘not asking’ emerges as a subtle butimportant principle framing the relationship between the parents and thegrandmother.

Second, the grandparents could not be directive in interacting withtheir adult children. If we return to Erin, for example, she reflects onhow her mother appeared to be far less opinionated than usual:

I had kind of talked to [my mother] a lot about it when I was thinking about it andshe sort of helped me, not helped me but listened to me when I was offloadingabout how I felt about things. And she never, ever, ever gave an opinion, whichwas astonishing because my mum can be quite an opinionated person. But, youknow she has never said, ‘I don’t think you should do this’.


This expectation was also endorsed by the grandparents we spoke to.But as the experience of Abigail and Jonathan implies, it might not bealtogether easy for a grandparent to follow this normative expectation.This is illustrated in Lisa and Roger’s account about their daughter andher male partner starting donor insemination treatment:

lisa . Until they started being proactive it was a little bit frustrating.roger . (’Cos the biological) clock was ticking.lisa . Yeah. I mean [our daughter] was then . . . I mean she’s forty-one now [ . . . ]

so she was thirty-nine when she had [our granddaughter]. And it . . . to us itwas a bit of hmm, get on with it, wasn’t it really? And we . . . both of us tendto be get-on-with-it sort of people really. But we tried not to let [them] seethat. (Two grandchildren heterosexual sperm donation)

Although grandparents might disapprove, disagree or feel impatient withan adult child, they would be careful not to interfere in her life or let theirown feelings be known.

Third principle: enduring support

Expectations about privacy on the one hand and independence on theother, sat alongside a third set of potentially contradictory expectationsto do with dependency and support. As the parent generation struggledwith the emotional and practical impact of trying to conceive, the grand-parent generation often allowed an adult child to depend on them as asource of both practical and emotional support. The intensification ofmother/daughter relationships at the time of pregnancy and childbirth iswell documented and it is this ‘moment’ that is often most testing forthe principles of non-interference since both advice and comfort mayoften be sought (e.g. Sollie and Miller, 1980; Belsky and Rovine, 1984;Szinovacz, 1998). A grandmother, in particular, is required to be bothinvolved and yet not too involved.

Many of the grandparents (particularly grandmothers) in our studybecame deeply involved in supporting their adult children and their part-ners as they went through infertility treatment. Annette, for example, wasthe non-genetic grandmother of a little boy born to her daughter’s femalepartner Emma. It had taken Emma a long time to conceive, and thecouple had tried various avenues before Emma successfully conceivedin an informal arrangement with a donor. Annette had been activelyinvolved in the process at every stage, and in the extract from her inter-view below, she reflects on a time when the couple had tried to conceive ina clinic and when she had accompanied Emma there. In her account she


demonstrates her engagement in her daughter’s and her partner’s repro-ductive journey.

I went with [Emma] one day when she went for a test, and, and it was alright butyou could see that if you were a bit nervous and upset that it wouldn’t be quitethe place that you’d think, you know, I’d really like to have a baby here, sort ofthing [laughs]. (One grandchild lesbian sperm donation)

Annette went on to explain why it was that the clinic waiting room mightfeel like a difficult space, which to her seemed stressful and tense:

You know it wasn’t very warm. And there was sort of pictures of all these littlebabies that had been achieved, which was perhaps a bit overwhelming if youwanted a baby and you saw all these babies’ pictures. [ . . . ] And there were sortof other mothers sitting there crying and, and you know, you could sort of seethere was all, all the different tensions going on of wanting to have a baby andthen getting pregnant and they were all sort of coming in this clinic, you know,which, [was] quite difficult.

This account illustrates the emotional intensity of attending IVF clinicswhich several of the grandparents we interviewed experienced first-hand.In this way they became positively immersed in the process rather thanobserving it or simply hearing about it. It is possible to say that thesegrandparents lived the experience alongside their daughters or daughters-in-law.

Such supportive practices led to an increased embeddedness of grand-parents in the reproductive lives of their children. Seeing the growingsadness, grief and desperation in a daughter who was eager to conceivecould become a great burden to grandparents who felt that they wantedto help in any way they could. But offering support could be a com-plicated task. If it was the male partner who was infertile and rejectedthe idea of sperm donation, for example, the grandparents might haveto negotiate supporting a daughter who was longing intensely for a childwhile recognising the difficult feelings of the partner. This was the situa-tion that Sarah and Norman found themselves in for some time. Beforethe situation was resolved,

it became quite topical family concern [ . . . ]. I suppose in some ways that . . . seebeing [our daughter’s] parents rather than her husband’s we possibly saw herpoint more than we saw his. I mean I could understand how he felt. I couldunderstand what a blow it must have been [for him to find out that he wasinfertile] to his morale and self-esteem etcetera, etcetera. And I can understandwhy he found it difficult to see why it was so important for [our daughter] togo ahead with it. But it was a time of sort of conflict. (Norman, one grandchildheterosexual sperm donation)


Decisions over donor conception came to form a large part of the grand-parents’ lives and could be emotionally draining for them as well. Lisaand Roger, for example, were deeply affected by their daughter and hermale partner’s prolonged frustrated desire for children.

To be perfectly honest, I think for those three or four years or whatever it was[ . . . ] personally, it was my biggest issue in life. It was the thing I was worriedabout more than anything. [ . . . ] It was at the back of your mind all the time.Are they ever going to have a family they so desperately wanted and was it goingto work for them? (Lisa)

Roger and Lisa were another grandparent couple who accompaniedtheir daughter to the clinic, who offered emotional support and whowould have given money to cover treatment if it had been necessary. Thisaccount highlights the extent to which the struggle to conceive can be feltmore widely than just by the infertile couple and how costly just ‘beingthere’ could be. In this process the older generation can be seen as re-engaging as parents again, comforting a child and trying to absorb theirdistress. In these moments, intense parental relationships were re-ignitedand principles of autonomy and privacy became far less significant. How-ever this was not always a comfortable position for grandparents whomight begin to feel that the proper course of intergenerational (inde-pendent) relationships had become unbalanced by the neediness of theiroffspring.

Relational dilemmas and ambivalences:principles in conflict

The parents and grandparents we interviewed spoke extensively aboutthe parents’ need for support during treatment while at the same timetrying to safeguard the cherished aims of independence and privacy. Yet,as indicated above, there were clearly times when this balance went awry.It might be assumed that this would be due to grandparents failing torespect their children’s autonomy or privacy. While this no doubt occurs,in this section we focus on what it means for grandparents when theiradult children impinge too much on their own lives. It is a paradox thatchildren are allowed independence, yet parents (no matter how old) canbe expected to relinquish their lives and plans to support their childrenin need. This is possibly one of the starkest ethical dilemmas of intergen-erational relationships because caring attentiveness is expected to flowdown the generations but not necessarily back up the chain – at least notuntil much later if infirmity strikes.


This dilemma is demonstrated by Sally, whose daughter struggled toconceive for almost a decade. Her daughter was very guarded about herfertility problem and, for many years, Sally was her only confidante. Shewas therefore the only person to whom the daughter could and wouldturn for support and comfort beyond her male partner.

It’s been absolutely terrible. It has been terrible. My poor daughter, you know.I’ve been counsellor, you know, everything and because I was the only personwho knew for the first [five years], then it would just be me and the phone wouldring and I would think ‘Oh no’. Then she would just start and she would cryand hate herself and hate, you know, hate the world, ‘Why me?’. (Sally, onegrandchild heterosexual embryo donation)

Sally went on to suggest that her daughter’s partner was not always able todeal with her distress, which also meant that her role in offering supportbecame more pronounced:

I wished I could, but I couldn’t actually say to [my daughter], you know, ‘Get agrip.’ I just couldn’t. You know, she needed me too much. Because of course [herpartner], bless him, did not actually want to hear it all. He wanted a solution,but he didn’t want all that emotional trauma and crying, which actually is why Ithink he learnt to fly because she couldn’t get at him while he was up in the sky.[Laughs] I said to [my partner], ‘He’s gone flying again,’ I said, ‘he’s gone flying’cause he knows that she’s going to be crying and sobbing,’ I said, ‘so he’s goneto leave me to it.’ And he would say to her sometimes, ‘Ring your mum, ringyour mum ’cause I can’t deal with you’ because he just couldn’t.

Sally’s semi-humorous account is suggestive of the intense feelings ofdistress generated by her daughter’s frustrated desire for a child and herneed for support. But at the same time she observes that the partneroffloads the required emotional work onto his mother-in-law, therebyintensifying her caring role.

Many of the grandparents found it taxing to deal with the dilemmasproduced by the demand for confidentiality when their own lives weretaken over by their children’s problems. Joyce’s account illustrates thistension between involvement and keeping things private:

When you’re watching your eldest child that you love going through all the anxietyand the grief you need to share and, you know, I have some close friends andI would have, it would have helped me just to be able to just talk it through intotal privacy with friends and I knew I couldn’t, and I found that quite difficult.Because although this was ostensibly affecting them it actually [ . . . ] trickledthrough to the wider [family], and I’m very, very aware that I needed to shareand talk it through with my very closest friends and couldn’t.

In a similar vein Shirley noted how disloyal she felt towards her cousinwho was a very close friend:


Betty and I are so close and [I] feel [as though I am] keeping a secret from her,but, yeah. I don’t know really, it’s strange but . . . I feel somehow that it’s a bitdisloyal to Betty; I don’t know really. It used to, it’s very, it was a big part of mylife when [my daughter] had [her son] by egg donation and not to tell Betty ofsuch an important event that she was actually was going to have this baby by eggdonation [ . . . ] seemed, you know, not quite as honest and open, really, as Bettyand I are with each other. (Shirley, one grandchild heterosexual egg donation)

What these accounts indicate is that the process of assisted conceptionand donation acquire such a powerful presence in the life of the grand-parents that they in turn want to (and need to) share with others andalso need support. As noted by Mason, May and Clarke (2007), there isno small degree of ambivalence between ‘being there’ for an adult child,and yet also being a person in one’s own right. The grandparents foundthemselves in a double bind between offering support and respecting pri-vacy as the combination of the two meant that they were unable to seeksupport themselves by sharing with a third party. Resolving this para-dox inevitably meant not honouring either their own need to disclose oran adult child’s independence and chosen privacy. The conflict of prin-ciples also gave rise to problems for the couples themselves who oftenfound that parents or in-laws knew much more about their private livesthan would normally be acceptable or desirable. The delicate balance ofrelationships between generations could be put under intense strain.

Concluding remarks

This chapter has explored infertility and donor conception from the pointof view of wider family relationships, investigating how couples and theirclose family members experience infertility and the processes of assistedconception. We have provided a rare insight into how grandparents expe-rience these events because, while their adult children struggle to becomeparents, grandparents can feel strongly committed to the birth of grand-children. They may long for their ‘own’ grandchildren and become hugelyinvolved in the actual lives of each grandchild once born. Our interviewssuggest that grandparents have a very important place in supportingtheir adult children when conception does not materialise, and when itis replaced by problems of infertility, medical investigations and cycles oftreatment.

The study of infertility and donor conception can function as a lensonto family relationships and reveals how these processes set in motionpainful expectations and surprising ambivalences (e.g. Mason, May andClarke, 2007). On the one hand, both parents and grandparents speakof the important principle of independence and so grandparents are


expected not to interfere with their adult children’s decisions. Equallyadult children do not expect to become emotionally dependent on theirparents and find their own neediness disturbing. Meanwhile, grandpar-ents typically feel constrained when it comes to asking questions, steeringdecisions about assisted conception, or offering opinions and advice. Onthe other hand, the accounts we heard indicate that the parent–adultchild relationship is shaped by a great deal of emotional and sometimesfinancial dependency, with grandparents becoming active parents overagain. Thus the grandparents in our study often offered huge amounts ofsupport to their children as they struggled with the impact of infertilityand treatment.

The delicate balance between independence and dependence is gov-erned by broad cultural principles of autonomy and self-determinationwhich largely shape norms of intergenerational relationships in the UK.Principles may look different within ethnic minorities in the UK (e.g.Hudson and Culley, Chapter 13), and in other cultures, however in thecontext of our study, it became clear that infertility and assisted con-ception added a special dimension to these values. Parents who strug-gled with the frustrated desire to conceive found themselves in a cultur-ally ambivalent place and were reluctant to make their situation morewidely known. Fertility treatment was so physically and emotionally tax-ing that would-be parents found that they had to seek some support,and the grandparents were often their first port of call. Privacy, however,remained an important principle, and so would-be parents who werethemselves unable to keep the process completely private would ask thegrandparents to do this for them. This meant that grandparents whoallowed a daughter or daughter-in-law to depend on them through cyclesof treatment, who gave up a great deal of their own lives to ‘be there’,and who were also themselves hugely emotionally invested in the pro-cess, could feel exhausted and miserable. Many of the grandparents wespoke to felt a duty of support yet felt utterly unsupported themselves.The unfortunate mixture of ideals of independence and privacy, com-bined with the unavoidable need for support, produced an irresolvabledilemma for the grandparents. Our study thus highlights how infertilityand donor conception can affect the relationship between parents andgrandparents, and also the lives of the grandparents themselves.

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Index

adaptive preference formation 108, 110adoption 11

Belgium 194child’s need to seek genetic parents 86fast-track 68–9gay parents and 193, 203–8international 216kinning of transnationally adopted

children in Norway 47–8, 49–50, 58legislation 123, 124matching 135perceptions of 202reunion 286, 287socio-legal perspective 204–5solo mothers and 215in UK 203–8

Adoption and Children Act (UK, 2002)64, 204

adultery 34, 51Almeling, R. 34American Society for Reproductive

Medicine (ASRM) 137, 147, 160anonymity see donor anonymityartificial insemination (AI) 1, 21, 162

British policy and practice (history)22–7

artificial insemination by donor (AID)21–7, 39–40

attempts to criminalise 24–5British Medical Association inquiry 27Feversham Committee Report 26–7and perceptions of kinship 244Wand Commission 24–5, 26, 28see also donor insemination

artificial insemination by husband (AIH)23

ARTs see Assisted ReproductiveTechnologies

assisted reproduction 1–2, 15–18and biological connections 4–10, 15ethics of 108ethnicity and 232, 235–7, 244

and genetic ties 90–3and kinship 44–6and ‘own child’ 10–13, 31–2, 131–7,

195see also own child

Assisted Reproductive Technologies(ARTs)

conflicting messages of 84–93in Israel 50–2issues of control 132–3transparency and openness 56understanding of in ethnic communities

232–5Australia, legislation 140

Benatar, D. 83Bill of Assisted Reproduction (Spain,

2006) 199Bill of Gay Marriage (Spain, 2005) 199bioethics 187–9biogenetic connection, importance of in

South Asian communities 239, 242–4biological father 105, 196–8, 208, 209,

212biological inheritance 195biological mother 6–10, 16, 53, 196–8,

208, 209biological parenthood 2, 7–10, 148,

157–60, 161, 221, 287–8biological parents 97, 103biological relatedness 4–10, 168, 242–4

gay fathers and 192–210gendered 6–10

birth 16Blake, L. 11, 138, 259blood ties 5, 8, 80–1, 87–8, 164,

242Blyth, E. 37, 280Bourne, K. 271Braverman, A. M. 275Burton, P. J. 225Butler-Sloss, Dame E. 33

312

Index 313

Cahn, N. 88Callahan, D. 81–3candidate parenthood 85Canterbury, Archbishop of,

1945 Commission 24–5Carbone, J. 88Carsten, J. 25, 130Casey, P. 259Catholic Church 23Child Support Act (1991) 32children

best interests of 110, 118–20, 137,221

conception story 217, 253–4disclosure to 183feelings regarding donor conception

256–7, 264knowledge of genetic origins 218need for father 218–19perspectives on families 252–3response to disclosure 254–5rights of 118–21, 219–21understanding of donor conception

255–6welfare 86–90, 93

choice mother see solo motherChoicemoms (website) 141Cinderella effect 88Clarke, L. 302, 308clinic, parents’ presentation at 131–2cloning 91conception

metaphors of 7, 35, 46, 159solo mothers on method of 217see also donor conception

co-parenting 3, 193–8in Belgium 194–5family norms 195–7parental roles and biological relatedness

197–8socio-legal perspective 194–5

counselling 137–8Creative Beginnings (donor egg agency)

158cross-border reproductive care 45, 68Culley, L. 34, 135

de-kinning 9, 46–54, 287Delaney, C. 159designated beneficiary agreement

(Colorado) 124Different Families Study 251, 259–61disclosure 252–3, 272

children’s response to 254–5, 259–60,263

and clinical practice 137–40donor’s identity 117heterosexual couples and 253–4infertility treatment and 114lesbian couples and 259partial 254, 258single mothers and 261–3surrogacy 257–8technological influences on 140–1

DNA 8, 37nuclear (nDNA) 71–5tests 32–4, 40see also mitochondrial DNA

donorchild’s interest in 257, 260–1, 264–5donor offspring’s perspectives on

contacting 277–80identification of 117–18identity-release 149–50, 156, 157,

219–21information on 223, 226–7, 229importance of physical resemblance to

recipient(s) 237–40medical history of 200, 223, 224, 278perception of donor offspring 130–1,

147–9, 152–5, 274–6preferred characteristics of 136–7recipient’s interest in 9, 13, 222recruitment of 135sexual orientation of 291shortage of in minority ethnic groups

246–7unknown 117see also egg donor; sperm donor

donor, known 218–19, 270–2, 273,289–91

legal recognition/rights of 116–17types of 290

donor anonymity 140, 159and the genetic connection 36–9removal of 2, 30, 137, 214, 219, 272South Asian couples and 238

donor-conceived familiesresearch into children’s perspectives in

252–3and US family law 114–25

donor conceptionchildren’s feelings about 251, 256–7,

261, 264grandparents involvement with 302–4,

306regulation of 271–2

Donor Conception Network (DCN) 213,220

donor insemination 1, 5

314 Index

donor linking 271, 284–9ethics of 282–4

donor matching 135–7, 222, 237–8,245–6

donor profile 135–6, 223–4, 226–7donor registries see Victorian Donor

Registers see Donor Sibling Registry(DSR)

donor selection 13, 133–7, 217–19, 222–5ethnicity and 246–7religious identity and 240–2, 246

Donor Sibling Registry (DSR) 117, 131,141, 271, 273, 274–5, 278, 285, 286

donor siblings 51genetic relatedness and 131rights of 118–21, 272–7see also half-siblings

donor spermfrom Czech Republic 220from Denmark 220imported 16from UK 16

double donation 9, 216

Edwards, J. 5, 244egg donation 29–30

in Jewish communities 52perceptions of 34–6, 39, 52, 158, 242–4solo mothers and 216–17, 220–1in South Asian communities 242–4

egg donorcontact with 141feelings of relatedness towards offspring

130–1, 147–9, 152–5links to offspring 274–6as not-mother 152–5, 157–60perceptions of nature vs. nurture

regarding 164Ehrensaft, D. 278, 280embryo donation 185–6, 190embryos

cryopreservation of 178, 179–80, 183–5,187

disposition of 178, 185–6, 187, 190feelings expressed towards 183, 189–90forgotten 186–7genetic link and 181–2instrumental value of 181, 189legal access to 67–8moral status of 180–1, 188–9perceptions of 179–80storage and use 183–5, 187, 190symbolic meaning of 189

ethics 108donor linking and 282–4

donor matching and 135embryos and 187–9mtDNA donation and 72

ethnicity 232–3, 244–6European Society for Human

Reproduction and Endocrinology(ESHRE) 137

European Sperm Bank (ESB) 222

Facebook 141Fairchild, L. 38family, changing perceptions of 129–31Family and Medical Leave Act (FMLA)

124family law 114–25

and donor siblings’ rights 118–21and parent–child relationship 114–17

fatherabsent 98, 252biological 16, 105, 196–8, 208, 209,

212child’s need for 218–19child’s right to know 219–21genetic 16legal 62, 63–4, 69–71responsibility of 81–3sperm donor as 148–52, 157–60stories of 226–7see also gay fathers

fatherhood 6–10biogenetic 242–4legal 62, 63–4, 69–71

female parenthood 64, 67–8Fenton, S. 233Fertility Friends (website) 213fertility tourism see cross-border

reproductive careFranklin, S. 57, 300Freeman, T. 11, 35, 138, 173, 279,

281Frith, L. 134, 275Fuscaldo, G. 84–5

gamete donationanonymous 140clinical practice 135–7commercialisation of 9, 34, 156–7, 160,

271gender differences in perceptions of

34–6, 242–4importance of physical resemblance in

237–40intrafamilial 29, 238parents’ feelings/concerns regarding 133policy 22–7, 272–6

Index 315

regulation of 13–14, 29–30, 68–71,114–25, 140, 270

perceptions of in Jewish communities of51–2

perceptions of in South Asiancommunities 236–7

gamete donor see egg donor; sperm donorGametes Inc. (sperm bank) 151, 156,

158gay father families

adoption and 205–6, 208co-parenting and 195–7, 198, 208surrogacy and 200–1, 208

gay fathers 192–210adoption and 194, 203–8co-parenting and 193–8insignificance of genetic ties and 202–3parenting 2–3, 193–210perceptions of biological relatedness

203socio-legal constraints 209–10socio-legal perspectives on 192, 194–5in Spain 198–203surrogacy and 194, 198–203

genderbias 199and donor selection 13and genetic links 67–71injustice 89–90norms 205roles 201, 209

gender differences 8–9, 16, 234, 245contact between donor relations 275–6donors’ relations with offspring 147–9,

157–60, 161, 275gamete donation and 34–6

genealogy 32, 56, 103–11generational transmission 195genetic connection 4–5, 6–13, 30–4, 39,

79–93, 272donor anonymity and 36–9gay fathers and 208–9gendered assumptions and 6–10gendered significance of 67–71importance for siblings 169and legal kinship (US) 113–25legal parenthood and 64–7surrogacy and 168–70

genetic father 16genetic identity 13–15, 36–9, 86–7, 272genetic links see genetic connectiongenetic mother 29, 70, 73–4genetic narrative view 86genetic origins 13–15, 218

need to know 226

genetic parenthood 65, 71, 73–4, 75, 91genetic relatedness 4, 15, 79, 131, 141,

282, 297and children’s welfare 86–90, 93and reproductive responsibility 80–6significance for surrogates and surrogate

children 168–70, 174–6genetic ties see genetic connectiongermline therapy 75gestational connection 5, 6–10, 242gestational relatedness 168–70gestational surrogacy 9, 154–5, 163–4,

199importance of genetic link 164reasons for choosing 168–70surrogate’s children’s relationship with

surrogacy child 172–5surrogate’s relationship with child

166–8surrogate’s view of own children 172

Golombok, S. 9, 163, 259, 279, 281,299

grandparents 296–309independence from/involvement in

treatment 302–4, 306–8sharing of information with 300–2,

306–8support from 304–8

Haimes, E. 34Halakha ( Jewish religious law) 51–2half-siblings 131, 270, 272–7

links 286–7see also donor siblings

Hall, S. 233Haraway, D. 57Haslanger, S. 88Hayden, C. 198Hays, S. 160Herbrand, C. 9Hindus 240, 244Hirsh, E. 34Home, Sir E. 22Howell, S. 47–8, 49Hudson, N. 34, 135Human Fertilisation and Embryology Act

(1990) 30, 44Human Fertilisation and Embyrology Act

(2008)legal parenthood under 62–4, 66–7,

68–71and mtDNA donation 72–3

Human Fertilisation and EmbryologyAuthority (HFEA) 30, 72, 219

Hysser, R. 28

316 Index

ICSI see intra-cytoplasmic sperm injectionidentity-release gamete donation

programmes 149–50, 156, 157, 160,219–21

Imrie, S. 9, 34in vitro fertilisation (IVF) 2, 21, 28–30,

178clinic experience of 304–5sharing information on 300solo mothers and 220, 229in South Asian communities 237and surrogacy 163Warnock Report 28–30, 36

incest legislation 66–7Infertility (Medical Procedures) Act (Vic.,

1984) 272Infertility Treatment Act (Vic., 1995)

272Infertility Treatment Authority (ITA, Vic.)

276–7, 281–2, 283infertility

emotions surrounding 132and relationship between parents and

grandparents 296–309in South Asian communities 235–7

intended parents 1, 63–4, 129, 131–4,137–9, 141, 162–4, 167

intensive mothering 160Internet

formation of kinship ties and 131the global community and 140–1

intra-cytoplasmic sperm injection (ICSI)11, 32, 178

intrafamilial donation 29, 238intrauterine insemination (IUI) 220,

229Israel 50–2IUI see intrauterine inseminationIVF see in vitro fertilisation

Jadva, V. 9, 34, 173, 259, 279, 281Jefferson, President T. 32Jennings, S. 9Johnson, M. 135Jones, E. O. 23–4

Kahn, S. M. 50–2Kids are All Right, The (film) 130kinning 46–54

of transnationally adopted children inNorway 47–8, 49–50, 58

kinship 4, 44–6, 57–8, 164, 244children’s definitions of 252co-parents’ perception of 196genetic 56–7, 121

legal (US) 113–25in Papua New Guinea 49through food 5, 48–9circle 117vocabulary 16–17Zumbaguan 48–9, 57

Kirkman, M. 221Konrad, M. 53, 241Kramer, W. 134, 273, 279, 281

LaFollette, H. 83Law Reform Committee (Australia, 2012)

140Law Reform Committee report (Vic.,

2012) 273, 281legal fatherhood 62, 63–4, 69–71legal motherhood 62–3, 64, 67, 69–71, 74,

162legal parenthood 61–76legislation

of gamete donation 140and parents’ disclosure patterns 137and policy, in UK 140, 272–7and policy, in USA 140, 273

lesbian couples 5co-parenting and 3legal parenthood status of 64, 67–8sharing information on assisted

reproduction 300support from grandparents 304–5

lesbian families 194child’s feelings about 260–1child’s response to disclosure 259–60disclosure of donor conception 259

London Women’s Clinic (LWC) 213, 271,273

MacCallum, F. 299McKinnon, S. 57Maclennan v. Maclennan (1958) 26Martin, E. 57Mason, J. 173, 302, 308maternal instinct 147–8, 160May, V. 302, 308media representations 162, 193Mertes, H. 75milk kinship 5, 49, 81, 164mitochondrial DNA (mtDNA)

disorders 92donation of 11, 61, 71–5regulation of 71–5transfer 45, 52

motherbiological 6–10, 16, 53, 196–8, 208,

209

Index 317

genetic 29, 70, 73–4legal 62–3, 64, 67, 69–71, 74, 162not-mother 152–5, 157–60social 174see also solo mother

motherhood 6–10, 30, 62–3, 67, 69–71,164, 212, 214–15, 242–4

mtDNA see mitochondrial DNAMuslims 240, 243–4, 245

narrative identity 38, 226National Health Service (NHS) 27natural conception 13, 71natural law 24–5nature vs. nurture 134, 157, 164, 223Nelson, J. 86non-biological parents 11, 13, 134, 196,

198, 209, 277, 285, 288, 292non-disclosure 244nuclear DNA (nDNA) 71–5nuclear family ideal 1, 6, 10, 17, 31,

88–90, 121, 125, 130Nuffield Council on Bioethics (NCB) 72,

73–4numerical identity 103

O’Brien, M. 8open-identity donation 270–2 see also

donor, identity-release; donor, knownorigin essentialism 103OvaCorp (donor egg agency) 154own child 10–13, 31–2, 131–7, 195

double donation and 216solo mothers 215–17

Oyama, S. 57

parental order 68–9, 162–3parental roles

adoptive gay fathers and 206–7and biological relatedness 201–3gendered 197–8, 209

parenthoodbiological vs. social 2, 7–10, 148,

157–60, 161, 221, 287–8candidate 85female 64, 67–8genetic 65, 71, 73–4, 75, 91genetic vs. biological 16legal 61–76non-marital 114social see social parenthood

paternity 6–10biogenetic 243–4see also father; fatherhood

paternity tests 32–4

Peel, Sir J. 27Pennings, G. 75practical identity 100

self-understanding and 101, 102–11pregnancy

experience of 11, 215–17desire for 11, 215–17

Price, F. 135privacy about reproduction 299–302,

306–8procreative responsibility 81–6Public Morality Council 23–4

Quiroga, S. 237

race 232–3, 244–5and donor selection 237–40

relatedness 2–4, 15–18in clinical practice 130–1significance for surrogates’ partners

170–2surrogates and 130, 165–70see also biological relatedness; genetic

relatednessreligion 245

and ARTs 243–4and donor selection 240–2

religious identity 240–2reproductive autonomy 83reproductive others 1, 2, 10Richards, M. 8, 117Riordan, M. 225, 260Rodino, I. S. 225Rothman, B. K. 8Rubin, S. 260

Sahlins, M. 48same-sex couples, legal parenthood status

of 64, 67–8 see also gay father families;gay fathers; lesbian couples; lesbianfamilies

Sanders, K. A. 225Sawyer, N. 134Scheib, J. E. 225, 260sexual family 65Shaver, P. 225Sheldon, S. 33sibling registries 124–5 see also Victorian

Donor Registers; Donor SiblingRegistry (DSR)

siblings, importance of a genetic link169

Sikhs 240, 244Silverstein, Shel 89–90single mother by choice see solo mother

318 Index

single-mother familieschildren’s feelings about donor 264–5children’s feelings about donor

conception 264children’s responses to disclosure

263disclosure to children in 261–3Donor Sibling Registry and 275

Singlemothersbychoice (website) 141Smietana, M. 9Smith, V. 173social media 140–1social parenthood 2, 7–10, 148, 157–60,

161, 221, 287–8solo mother 134, 212–14

choice of sperm donor 222–5decision to become 214–15desire for ‘own child’ 215–17identity-release donation and 219–21planned conception 217

South Asian communities (British) 232,233–5

childlessness and infertility 235–7Sparrow, R. 91sperm donation

anonymous vs. known 219–21incentives 151, 156irresponsibility and 81–3perceptions of 34–6, 39single women’s perceptions of 217–19South Asian perceptions of 242–4

sperm donorattributes 224connections with offspring 148–52,

274–6as father 148–52, 157–60genetic relatedness and 14–15information regarding 223, 226–7,

229Jewish 51known 218–19, 289–91physical characteristics of 223–4selection of 217–19, 222–5terms used to describe 227–8

sperm donor relationscontact between 270donor-offspring’s perspectives on

277–80donors’ perspectives on 281–2meetings 284–9parents’ perspectives on 280–1policy and culture 272–6terminology used for 288–9

Statham, H. 11, 138Steinberg, A. 51

Stopes, M. 22straight surrogacy 162 see also traditional

surrogacystrategic naturalising 52, 164Strathern, M. 57Strauss, J. 286Sunni Islam 243surrogacy 2, 162–76

in Belgium 194commercial 201gay fathers and 198–203in India 54–5non-commercial 204, 259parents’ disclosure of 257–8regulation of 30, 68–71see also gestational surrogacy; traditional

surrogacy; transnational surrogacysurrogacy child

feelings of 259relationship with surrogate’s own

children 172–5similarities with surrogate’s children

169–70understanding of surrogacy 258–9

surrogatechild’s feelings about 259contact with child 165de-kinning of 53legal status of 62–3, 162own children 172partners of 170–2perceptions of relatedness 130,

165–70relationship with surrogacy child

166–8Switch, The (film) 130

test-tube babies 25, 28Thompson, C. 52–3, 132, 164Tipper, B. 173traditional surrogacy 162–4

own children’s relationship withsurrogacy child 172–5

reasons for choosing 168–70relationship with surrogacy child 166–8view of own children and 172

transnational surrogacy 198–203socio-legal perspective (Spain) 199–200in USA 198–203

transubstantiation 47–8

Uniform Law Commission (ULC) 115Uniform Parentage Acts (UPA, 1973,

2002) 115Unnithan, M. 54

Index 319

van den Akker, O. B. A. 164Vanfraussen, K. 260Velleman, D. 86–7Victoria (Aus.), information exchange

policy 271, 272–3, 274–5 see alsoVictorian Donor Registers

Victorian Donor Registers 271, 272–3,274, 276–87, 291

Central Register 276Voluntary Register 273, 276, 278, 281,

282–4virtue/virtuous achievement 101–2,

104

Wand, J.W.C. 24–5, 26, 28Warnock, M. 28–30, 36Warnock Committee 28–30, 36Weismantel, M. 48Western Sperm Bank 150, 156–7Weston, K. 198Who Do You Think You Are? (TV

programme) 56, 218Wilson, S. 135, 226

Xytech (sperm bank) 222

Zadeh, S. 11, 138

Documents

Tabitha Freeman, Susanna Graham, Fatemeh Ebtehaj, Martin Richards-Relatedness in Assisted Reproduction_ Families, Origins and Identities-Cambridge University Press (2014)