- Email: [email protected]
Motherhood, ideology, and the power of technology
Wmcn’sStudieslnt. Forum. Vol. 13, No. 6. pp. 543-552, 1990 Printed in the USA.
0217J395/5w 53.00 + .rm 0 1990 Pngamon PEES6plc
MmHERHOOD, IDEOLOGY, AND THE POWER OF TECHNOLOGY In Vitro Fertilization Use by Adoptive Mothers LINDA s. WILLIAMS Department of Sociology, ‘Dent University, Peterborough, Ontario, Canada K9J 7B8
Synopsis-Although in vitro fertilization (IVF) is generally presented as a procedure that enables childless couples to become parents, a significant percentage of the couples who use this technology already have biological or adopted children. This paper examines what motivated three women to seek biological motherhood through IVF after they had already become adoptive mothers. These three case studies show that while the experience of social motherhood did provide some of the rewards that led these women to seek motherhood in the first place, it did not provide all of them. In order to try and achieve the rewards of biological motherhood, these women turned to IVE The author concludes that IVF will continue to be sought by some adoptive mothers who value the particular aspects of motherhood that are not attainable through adoption.
In 1978, the world’s first so-called test-tube baby, Louise Brown, was born in England. Since that time it has been estimated that approximately 5000 IVF babies have been born worldwide (Klein, 1989a). IVF clinics currently operate in almost every country where Western medicine is practiced (Holmes, 1988). In vitro fertilization was originally developed to enable women whose fallopian tubes are blocked to bear children. IVF works by bypassing a woman’s defective fallopian tubes. Her ovaries are stimulated with strong fertility drugs to produce multiple eggs, which are surgically removed. Her partner then produces a sperm sample by masturbation, and the eggs and sperm are combined in a glass dish. If fertilization occurs, the resulting human embryos are returned to the woman’s uterus. If they implant in the uterine wall, a pregnancy will begin, and the woman will give birth nine months later if she does not miscarry. The miscarriage rate for IVF pregnancies is 30 to 50% (Klein, 1989a). A single IVF attempt lasts approximately three weeks, and is extremely physically stressful because it involves surgery, repeated ultrasounds, and blood drawing. The fertility drugs that are essential to the procedure can produce a wide range of distressing and potentially dangerous side effects. IVF is also very emotionally stressful, since it may fail at
any point in the procedure, and the attempt cancelled. It is also very expensive. Most North American and Australian clinics charge $3000 to $6000 per attempt, and most couples make several attempts. IVF is also notoriously unsuccessful. Recent research has shown that IVF leads to the birth of a baby only 5 to 10% of the time (Klein, 1989a; Pappert, 1988; Raymond, 1988).’ Despite its unrelenting stress and low success rate, IVF is generally presented to the public by the doctors and scientists who practice it as a boon to infertile couples unable to have their own biological children. This public image of IVF has been greatly enhanced worldwide by innumerable newspaper and magazine articles that picture beaming couples with their newborn IVF infant (or infants) conceived after years of fruitless attempts to alleviate their infertility. This public image is emotionally compelling, but it contradicts the fact that some couples who seek IVF already have children. Some have children from a previous marriage; some have biological children from their current marriage, but are suffering from secondary infertility.2 And finally, some couples who seek IVF already have an adopted child or children. Prior to the development of in vitro fertilization, adoption was usually the end of the road for infertile women who wanted to have 543
LINDAs. wULL4MS
544
a baby. It was generally undertaken when all medical attempts to overcome a woman’s infertility had failed, and biological motherhood seemed unlikely. In vitro fertilization, however, does not fii the problem that causes a woman’s infertility, it attempts to bvpass it. Although the IVF success rate is extremely low, an initial IVF failure does not necessarily mean that a subsequent attempt might not result in a live birth. Consequently, in vitro fertilization allows infertile women to keep trying to become biological mothers even after they have exhausted the conventional gamut of infertility cures and become social mothers through adoption. This paper will examine what motivated three infertile women to seek biological motherhood through in vitro fertilization after they had already become adoptive mothers. An examination of this aspect of IVF is useful for several reasons. First, it can help us to understand the meaning of motherhood for women by allowing us to separate the social aspects of motherhood from its biological aspects and evaluate their relative importance. Second, it may help us to understand the way in which IVF alters women’s perceptions of motherhood, adoption, and infertility and their responses to these experiences. And finally, an examination of these women’s stories may also help to partially explain the continued growth of this expensive and controversial technology, and the social context in which it thrives. ADOPTIVE VERSUS BIOLOGICAL MmHERHOOD Numerous writers have pointed out that women are expected to bear children as part of their female role (Blake, 1974; Gimenez, 1984; Rich, 1976). Childbearing is also expected to take place within the confines of legal, heterosexual marriage (MacIntyre, 1976). Married women who fail to bear children are often viewed as unfeminine and deviant (Veevers, 1980). Miall (1985, 1986) has shown that married women who are childless due to infertility often internalize these societal perceptions and view their infertility as stigmatizing. For many infertile women, adoption is a way of fulfilling both pronatalist social norms and their own desire to parent.
Adoptive motherhood, however, may not be viewed as the equivalent of biological motherhood either by society or by adoptive mothers themselves. In most societies, the blood tie between parents and children represents the essence of the parental bond, and adoption is sometimes seen as second best (Kirk, 1964; Schneider, 1968; Snowden, Mitchell, & Snowden, 1983; Ward, 1981). Miall (1987) found that a majority of adoptive mothers in her study believed that adoptive parenthood was socially devalued due to the lack of a genetic tie between parent and child. Some adoptive mothers themselves may also view adoption as second best. For some women, having their own biological child may be important as proof of their femininity (Bell, Bancroft, & Philip, 1985), or they may have a strong desire to ensure their own genetic continuity (Rowland, 1985). For infertile women, the desire to experience pregnancy, childbirth, and breastfeeding may be a crucial factor in wanting to become a biological mother (Menning, 1980). For some women, then, “producing” a child may be more important than the actual experience of raising one. As Matthews and Matthews have pointed out, for such women “the experience of social parenthood may not be sufficient to resolve their desire for biological parenthood” (Matthews 8c Matthews, 1986, p. 648). All of these factors can play a role in the desire of adoptive mothers to attempt in vitro fertilization following their adoptions. IN VITRO FERTILIZATION USE BY WOMEN WHO ALREADY HAVE CHILDREN Very little is known about women with children who seek IVF other than the fact that such women do exist. Freeman et al. note in their follow-up study of 156 women who had undergone IVF that 71% of the couples were childless; 15 % of the women had biological children (12 % from the present marriage, 3 % from previous marriages); another 7 I of the men had biological children from previous marriages; and 7% of the couples had adopted children prior to applying for IVF (Freeman et al., 1987). If these data are even roughly representative of the client populations of other IVF clinics (and there is no
IVF and Adoptive Mothers
reason to believe that they are not), then women who already have children would seem to constitute a significant but unexamined proportion of the IVF client population.3 Information on women seeking IVF can be found in two disparate sources: popular articles and books and scholarly publications. The popular literature will occasionally mention a case in which a woman or couple seeking IVF already has an adopted or biological child, but this literature tends to focus almost exclusively on childless infertile couples. (See Brown & Brown, 1979; Eagan, 1987; Gold, 1985; Greenwalt, 1988; Singer 8c Wells, 1985; Tilton, Tilton, 8z Moore, 1985; Wallis et al., 1984.) A growing literature exists which attempts to evaluate the psychological state of IVF participants prior to, during, and following IVF so that counselling assistance can be provided. A few of these studies have noted that some IVF couples already have biological or adopted children (Applegarth, 1986; Freeman et al., 1987), but most do not provide this information (Fagan et al., 1986; Given, Jones, & McMillen, 1985; Hearn et al., 1987; Leiblum et al., 1987). An even smaller body of sociological and/ or feminist literature examines women’s and couples’ experiences with IVF and discusses some of the social aspects of this technology. Crowe (1985) and Bomricksen (1988) interviewed women who had undergone IVF and Holmes and Qmstra (1987) conducted a survey of Dutch IVF patients, but these studies do not state whether any of these women already had adopted or biological children. Klein (1989b) interviewed 40 former IVF patients in Australia and found that 7 women had a biological child from a previous relationship, and 3 from their current marriage (these women were suffering from secondary infertility). Five of the husbands of women in this study had children from previous relationships. To the best of my knowledge, only two sociological studies have included the husbands of women who have undergone IVF. Lorber and Greenfeld (1990) conducted telephone interviews with 20 women and their husbands. No information is provided as to whether any of these couples already had adopted or biological children before under-
545
taking IVF. The second sociological study of IVF couples is my own research, which will be described below (Williams, 1988). THE STUDY The three case studies examined in this paper are part of a larger study of 22 women who had applied for or undergone IVF in the province of Ontario, Canada, between 1984 and 1987. The husbands of 20 of these women were interviewed separately, All interviews were tape recorded and transcribed. The purpose of this qualitative study was to examine the parenthood motivation of couples seeking in vitro fertilization to determine to what extent this motivation, and, hence, the market for IVF, is socially constructed. Respondents were located through contact with an infertility support group (n = 7), advertisements in IVF clinics (n = 2), a letter to a local newspaper (n = 22), a radio announcement (n = 4), and personal contact and word of mouth (n = 7). Sixteen of the 22 women were childless, having no biological, adopted, or stepchildren. Three had at least one biological child, and three had an adopted child. This paper focuses on the experiences and feelings of the three women who had adopted a child before attempting IVF. Since each woman’s situation is unique, they are presented as case studies. THREE WOMEN’S STORIES Sylvia Sylvia and Jim Ashford” married when they were in their late 2Os, and one year later they started trying to conceive their first child. After a year of trying with no success, Sylvia went to see an infertility specialist, and was told that she had pelvic inflammatory disease, a common cause of infertility.5 She underwent surgery to try to repair the damage, but was given only a 30% chance of ever becoming pregnant. A few months later, Sylvia and Jim began trying to adopt a baby privately, and within a few months they were successful.6 Although they were thrilled with their adopted son, they continued to hope that Sylvia might become pregnant. The doctor who had performed her tubal surgery was a member of the hospital’s IVF team, and
546
LINDA s. WlLLlAMs
said that he would recommend Sylvia for the procedure if she wished. She eventually underwent three unsuccessful IVF attempts. Sylvia and Jim had both always wanted to have children and both shared the view that childbearing is an essential part of marriage. Sylvia stated: I guess the first priority in my mind is to have a family, whether it be biological or adopted, and it’s just the way I grew up, I guess, the tradition I was brought up in, and my husband as well . . . But as far as having a biological child I just feel that I want to be able to do it, and I also want to be able to give my husband a child . . . And I hate to see him deprived of that because of me. I guess it’s a guilt thing or, it’s hard when the person you love most in the world you can’t give one of the things that you think is the most important thing to them. That’s about it, I guess. Plus I just want that experience [of pregnancy and birth]. I think it would be an interesting, probably painful, but interesting experience to go through. Later in her interview Sylvia said that one of the most stressful aspects of being infertile was [a] feeling of fear that I would maybe not lose Jim but that he wouldn’t love me as much, or something like that . . . At one point I was so ashamed and devastated that I kind of sort of offered to leave if he wanted to go off and find someone else, kind of thing. I just felt that horrid about it. But obviously that was feeling insecure and everything. He was able to reassure me that he still loved me even though I wasn’t a baby machine, things like that.’ Although Sylvia clearly felt an obligation as a wife “to give my husband a child,” and worried that Jim “wouldn’t love me as much” if she did not, Jim did not appear to be pressuring her in any way. When I asked him if having children was part of the reason why he and Sylvia had married, he replied, “I wouldn’t put it that way. I just couldn’t imagine living without her.” Later in his interview he also stated that even if Sylvia had been aware of her infertility at the time of their marriage he would have married her anyway.
For Sylvia, the connection between femininity and biological motherhood was also strong and compelling. When I asked her if she felt that having a biological child was part of her femininity, she replied: I do. I can’t get over that even though my husband reassures me, and I guess I need the reassurance that I am still a woman and feminine even though I have these problems. But you have this image of yourself as fertile and having no problems in that regard and then all of a sudden your legs are cut out from under you as far as that goes. There is a problem, I would say. I’m trying to overcome it . . . I don’t know if I ever will, but there is that feeling, definitely. Sylvia was of the opinion that she had wanted a child more strongly, but Jim stated, “Well we both did. I’m not sure you can quantify it.” Although Jim and Sylvia are very disappointed at not being able to have a biological child, the pain of infertility is very much lessened by the fact that they have their adopted son, Tremor, whom they dearly love. When I asked Sylvia and Jim if they were planning to try IVF again, they replied: Jim - “I think we will, maybe one more. I don’t think we would try indefinitely. I think we would try for the limit to how many times we did it. It’s a bit hard on Sylvia. The early mornings, the drug work. And it means we have to have Sylvia’s sister come over every time we try to take care of ‘Irevor. But part of the reason why we’re reaching that stage when we might decide not to try it again, is because we’re so happy with the child we already have, and we’re considering trying adoption again.” Sylvia - “I think . . . we want to pursue the IVP as far as we can take it and then if that doesn’t work then we certainly won’t hesitate to go for adoption again . . . I think I will give it a few more tries. See what happens.” Several months after our interview, Sylvia phoned me to say that she and Jim had decided not to try IVF again. She was worried
IVF and Adoptive Mothers
about the long-term effects of the drugs she had taken in her three unsuccessful attempts and did not want to put herself at risk once again. However, the main reason for this decision was the fact that she and Jim were very happy with their adopted child and therefore, “We just didn’t feel that desperate about it,” as Sylvia said. The Ashfords were once again pursuing private adoption and they had also contacted the Children’s Aid Society. Several months later, Sylvia wrote to tell me that they had adopted another child. Michelle Michelle and Guy Rossi are both in their early 30s. They have an adopted daughter, Amanda, who is almost 2 years old. The Rossis started trying to conceive after four years of marriage. A year later, Michelle sought treatment for infertility. When she did not become pregnant after surgery and several months of taking the fertility drug Clomid, her doctor informed her that there was nothing else he could do for her. By now two years had passed since Michelle sought medical help, and she was becoming seriously concerned about her inability to conceive. Around this time the Rossis began to consider adoption. They applied to their local Children’s Aid Society and were told that there was a six-year wait to adopt any child under the age of 5, so they turned their attention to private adoption. They were extremely lucky, for a few weeks later their family doctor informed them that a woman in his practice wanted to give up her child for adoption, and she agreed to let Michelle and Guy adopt her soon-to-be-born infant. While the Rossis were waiting for Amanda to be born, Michelle learned that Dr. Y. was planning to start doing in vitro fertilization in the near future, and she went to see him. Dr. Y. told Michelle that she did not seem to have any identifiable problem that would prevent her from becoming pregnant. Once again, she was told to keep trying. Although Michelle was extremely upset about her continuing infertility, her disappointment was tempered by the fact that she and Guy would soon have an adopted child. Finally their long wait was over, and a few days after Amanda was born, they picked her up at the hospital. Guy and Michelle were absolutely thrilled with their new daughter, and definitely want-
547
ed to have another child. They continued to seek another private adoption, but by this time Dr. Y. had opened his private IVF clinic, and Michelle went through the procedure 15 months after she and Guy had adopted Amanda. Michelle did not become pregnant, and she also suffered some dangerous side effects from the fertility drugs used in the procedure. Her ovaries became hyperstimulated and she developed ovarian cysts.* When I asked Michelle how she had felt about the possibility of never being able to have a biological child, she replied: I thought that if we could adopt it wouldn’t make any difference to me. The way I look at it, a baby is a baby. And now that I have Amanda, and know what it’s like to have a newborn, I can say it doesn’t make any difference. The only reason why now I would be trying to achieve a pregnancy is for the experience. I want to be able to achieve that. I want to try everything I can. I want to be able to say 10 years down the road, “Well, I tried everything. I did my best. If it didn’t happen, it didn’t happen.” But I know what it is like to love a baby, and I couldn’t love Amanda any more if I’d given birth to her myself. I just want the experience of the pregnancy and the birth. Later in her interview Michelle said: But then, you know, we have never really been told the reason for infertility. If someone said to me “Listen Michelle, this is why you can’t do it. You just can’t do it. You might as well stop trying.” Then I might stop. But no one has ever said to me, “It’s impossible. This is the reason why you’re not.” No one’s said that. So I have to do everything I can. Although Guy and Michelle are both delighted with Amanda, their quest for a biological child is not over. They both also agree that having a biological child is more important to Michelle than it is to Guy. When I asked them what they were planning to try next they replied: Michelle - ” . . . If nothing happens I’m gonna contact Dr. Y. and see if he will let
LINDA S. W~LUMS
548
me go down for the ultrasound, the bloodwork, and take some Pergonal and maybe some Clomid and try it that way without the IVF and see if that works. If it doesn’t then maybe try an insemination with Guy’s sperm, and then after that try the IVF again . . . ”
Guy- “My game plan, I’m sure is different from Michelle’s. My game plan is we will try it with her going on Clomid, which I don’t really want because it overstimulates her ovaries and cysts and all these things happen, and I don’t like that. She’s too important to me to risk any problems. So, if she wants to try it, let her try it . . . And I’d like to say maybe one more IVF, and if it doesn’t work, let’s adopt again. But Michelle’s side, as I’m sure she has said, is she’ll do that plus then maybe she’ll try another clinic, wherever. I understand there’s long lineups.” Not only were Guy and Michelle fortunate in being able to adopt Amanda, they were doubly blessed. Three months after I interviewed Michelle she became pregnant naturally and gave birth to a healthy baby.
Joanne Joanne and Peter Dubrick have an adopted son Matthew who is a year-and-ahalf old. They married when they were both in their early 3Os, and three years later they decided to try to conceive. After five months of trying, Joanne’s menstrual period was very late, and she suspected that she was pregnant. Although her period did eventually come, this episode plus the fact that she was now in her mid30s triggered her anxiety about possibly being infertile. Joanne then went to see her gynecologist and started a series of infertility tests which lasted six months. The Dubricks had already begun to consider adoption at this point, and Joanne made inquiries to their local Children’s Aid Society. Around this time they learned of the possibility of a private adoption, but it did not materialize. The process of trying to finalize this adoption encouraged the Dubricks to make further efforts, and within a very short time they were able to adopt Matthew. When I asked Joanne if the question of
not carrying on with her infertility investigation occurred to her once she had adopted a baby, she replied: No. No. And the reason was that having a baby and becoming a mother aren’t necessarily the same as coping with infertility. They weren’t to me. As I said, I felt that I had to pursue the whole thing just for my own interest, to know. I didn’t have the luxury of waiting five years and saying, “Well, maybe I’ll try now.” I knew that if I was going to do it I had to do it then, and check it out. I was certainly very happy with Matt and I didn’t look at having a real biological baby as a betterment of the situation, but I still considered we wanted two or more children anyway, so therefore it was prudent to continue the whole infertility thing. With me it was the ability to get pregnant. Tb have the infertility resolved. Then I could address the issue about how do you feel about being pregnant? How do you feel about giving birth? How do you feel about having a baby? I mean, those were all separate rather than one to me. By now Joanne was into her second year of trying to conceive, and went to see an infertility specialist who could not identify any reproductive problem. This doctor advised her to keep trying and wait and see. Around this time she learned about the IVF program at another hospital and obtained an appointment with one of the IVF physicians. Since Joanne had been trying to become pregnant for two years and no cause for her infertility could be found, she was admitted into the IVF program as a normal infertile.g She became pregnant on her first attempt, and when I interviewed her she was expecting her child in a few weeks. When I asked Joanne how she felt during the stressful two-year period when she was trying to get pregnant, she replied: I felt infertile, and I felt dreadful about it. But I didn’t ever feel it was finished yet. Like I felt that I would pursue it up until the point that I felt that that was as far as I could go . . . And also the aspect of the idiopathic10 infertility I think is an additional painful one. . . . ‘Cause you were
IVF and Adoptive Mothers
always thinking, well maybe I could get pregnant. Every month, maybe I could. Especially when you have these goons11 telling you the whole time that you can. . * . Let’s put it this way, it became most important to me when I found out I couldn’t. That I was having trouble. And then I got involved in the whole thing. I mean it’s fine to say that it doesn’t matter too much when you think you can. . . . When I asked Joanne if having a child was an important part of her femininity she replied: Not really. I think I found that the infertility I saw more in a general sense. Like for a male and for a female. Just the fact that I am being singled out as not part of the way it should be. Not necessarily that I’m a failure as a woman. I don’t think I felt that. But I just felt dreadful that I wasn’t like everyone. Peter and Joanne both agreed that she was the one who wanted to have a child more strongly. Joanne commented: . . . He would sit right down, and did on one occasion, and said to me, “You know it’s not the end of the world if we don’t have children. It’s you I love and our marriage is more important than that.” Whereas I never could move. quite that far. I might have, and I think I would have, but as I said, I felt that I had to completely exhaust all the possibilities first.
Joanne and Peter both felt that their family was now complete and they did not intend to try to have any more children, either adopted or biological. Peter described their situation in this way: We’ve been fantastically lucky. And I just cannot visualize that I’d want to put myself or have Joanne put herself [through IVF again] . . . I’m reasonably sure that she would not want to put herself through the same process, given the same odds, when we’ve got two children here. I think we should just be happy and pack her up and leave it at that.
549
DISCUSSION Why did these three women persist in their quest for a biological child through IVF even after they had become adoptive mothers? For Sylvia, the connection between motherhood and femininity was strong and compelling, and her inability to bear a child led to feelings of guilt, inadequacy, and embarrassment, but she also stated, “I’m trying to overcome it .” She experienced conflict between her culturally induced notions of femininity and her rational self. Sylvia was also concerned that her husband Jim would not love her as much if she could not “give him” a child, and had even offered to leave him so that he could find someone else with whom to have children. She needed his reassurance that she was still feminine and lovable even though she was not a “baby machine.” For Joanne, her inability to have a child did not make her feel less of a woman, but was experienced more as the loss of a normal human capacity (the ability to reproduce) rather than the loss of a specifically feminine attribute. Although all three women were social mothers and extremely happy with this aspect of motherhood, they still wished, in varying degrees, to experience pregnancy and childbirth, and this was one of the factors that led them to attempt IVF. The fact that Michelle and Joanne were “normal infertiles” also made it extremely difficult for them to stop trying to resolve their infertility. Since they had never been told why they could not become pregnant, they could not give up hope that they might one day conceive, and they felt that they had to “try everything.” Consequently, it therefore became necessary to continue the quest for biological motherhood in spite of the satisfying experience of social motherhood. These women’s stories also demonstrate the continuing social prejudice against onechild families that has been described in Hawke and Knox (1978). Sylvia and Joanne both explicitly stated that one reason for trying IVF even after they had adopted a child was a desire to have at least a two-child family. Although each woman was amazingly lucky in being able to adopt her child within a few months of starting to seek adoption, all three also recognized that private adoption
LINDAs. wILL.IAbIS
550
was an uncertain route to obtaining a second child. It therefore became prudent to also attempt in vitro fertilization. The fact that an IVF child would be a genetic offspring seemed less important than the fact that an IVF baby would be a second child, which would bring their families to their desired size. CONCLUSION Why do women who are already social mothers through adoption continue to seek biological motherhood through IVF? This analysis has shown that while the experience of social motherhood did provide some of the rewards that led these women to want to become biological mothers in the first place, it did not provide all of them. In order to try and achieve the rewards of biological motherhood, these women turned to IVF. Based on these women’s stories, what are some of the rewards that social motherhood does not provide? Adoption is not a solution for a woman who feels, correctly or incorrectly, that she must produce a biological child for her husband in order to remain lovable or to remain married to him. For women who believe that biological motherhood is an inherent and essential part of femininity, adoption is a second-rate option at best. It is essential to note that these rewards are socially constructed. They are based on culturally formed notions of a wife’s reproductive duty and the true nature of womanhood. Adoptive motherhood also cannot fulfill the strong desire of some women to experience pregnancy, birth, and breastfeeding. These rewards are obviously physical, but the perception of them as enjoyable, or at least worth experiencing, may also be socially constructed to a certain extent. Adoptive motherhood also does not help women whose infertility is undiagnosed to find out why they cannot have children. This points to the failure of the medical profession to determine and treat the causes of infertility. Because approximately 10% (Merming, 1977) to 60% (Sandelowski, 1986) of infertile women never learn why they cannot conceive, they continue to try. For an unknown percentage of these women, trying eventually leads to at least one attempt at IVF. The unpredictability of obtaining a sec-
ond child through private adoption was a motivating factor in IVF use for two of these women. This demonstrates how the current lack of adoptable babies, that is, white, healthy newborns, feeds the demand for IVF,n as does the continuing social prejudice against one child families (Hawke & Knox, 1978). The stories of Sylvia, Michelle, and Joanne are compelling, and they serve to broaden the range of questions that must be answered about IVF. We must determine what percentage of IVF clients already have adopted (or biological) children, and why they use IVF. Because these women are not childless, their reasons for attempting IVF may provide new insights into the nature of women’s desire for biological motherhood and the complex forces that shape it. We must also examine the way in which the adoption market and cultural values concerning adoption feed the demand for IVF in every country where it is practiced. Finally, we must examine the ways in which the possibility of continued attempts at IVF changes the adoption experience for some women and makes it difficult for them to accept their infertility even after they have happily adopted. As long as the many rewards of biological motherhood, some of which are socially constructed, continue to be important to women, I believe that in vitro fertilization will continue to be an attractive option for some adoptive mothers despite its emotional, physical, and financial costs. We must include these women in our feminist analysis of IVF. They have much to teach us. ENDNOTES 1. For a full description of the IVF procedure, see Gold (1985) or Williams (1986). First person accounts of women’s experiences with this technology can be found in Klein (1989a). 2. Secondary infertility is defined as the inability to conceive or carry a pregnancy after having successfully conceived and carried one or more pregnancies in the past. 3. There is some speculation that divorced and remarried women who have had a tubal ligation in their first marriage and who wish to have a child with their new husband may constitute a growing market for IVF. At a conference held in Montreal in 1987 entitled “Maternity in the Laboratory,” a Canadian IVF doctor stated that a large proportion-of his practice consisted of such women. He did not state the exact proportion.
IVF and Adoptive Mothers
4. Ail names used in this article are pseudonyms. 5. Sylvia had used an IUD for birth control prior to her marriage, which may have caused the infection that prevented her from conceiving. Seven of the 22 women in this sample had used an IUD for periods ranging from 6 months to 13 years. Several of these women attributed their infertility to problems associated with its use, or the subsequent medical mismanagement of those problems. As Gena Corea as pointed out, the medical profession sometimes prescribes contraceptives or performs therapeutic and diagnostic procedures which may actually impair women’s fertility. This can lead to a revolving-door situation in which women seek treatment for infertility from members of the same profession (and perhaps even from the same physicians) whose advice or treatment caused their infertility in the first place (Corea, 1985). 6. In the province of Ontario, one may adopt a child through the Children’s Aid Society, which is the agency which handles public adoption, or one may attempt private adoption through an agency or an individual (such as a lawyer or a social worker) who has been licensed by the Ministry of Community and Social Services to place children for private adoption. All private adoptions must be approved by the Ministry. 7. One other woman in this study also mentioned that she had offered to leave her husband so that he would be free to try and have children with a new wife. Crowe (1985) and Klein (1989a) also observed this phenomenon in their studies of Australian women who had undergone IVF. 8. Ovarian cysts are a serious gynecological condition. They may rupture, resulting in bleeding into the abdominal cavity, and may require surgery to remove ah or part of the affected ovary. Ovarian hyperstimulation can also lead to temporary or permanent ovarian dysfunction. In rare cases it may also cause death. 9. Normal infertile is the phrase used to describe persons for whom the cause of their infertility remains undiagnosed even after a thorough medical investigation. 10. Idiopathic infertility is the medical term for undiagnosed infertility. 11. Because of her previous experiences with doctors, Joanne is extremely negative about the medical profession. She was especially critical of the sexism she had encountered from male gynecologists. She also felt that most of the physicians she consulted were incompetent. 12. In the province of Ontario, almost 90% of unwed mothers now keep their babies; however, older children, nonwhite children, and children with handicaps are readily available for adoption. Most adoptive parents, however, wish to adopt healthy, white newborns (Children’s Aid Society of Metropolitan Toronto, 1984).
REFERENCES Applegarth, Linda D. (1986). Coping andptubiem-solving in in vitro fertilization patients: an emotional support group. Paper presented at the annual meeting of the American Society of Psychosomatic Obstetrics and Gynecology, April. Bell, Stephen J., Bancroft, John, & Philip, Alistair.
551
(1985). Motivation for parenthood: a factor analytic study of attitudes towards having children. Journal of Compamtive Family Studies, 16, 11l-l 19. Blake. Judith. (1974). Coercive nronatalism and American population policy. In Eilen Peck & Judith Senderowitz (Eds.), Pmnataltsm: the myth of mom and apple pie (pp. 29-69). New York: Thomas Y. Crowell. Bonmcksen. Andrea. (1988). Some consumer aspects of in vitro fertilization and embryo transfer. Birth, IS, 148-152. Brown, Lesley, Brown, John, & Freeman. Sue. (1979). Our miracle called Louise. London: Magnum Books. Children’s Aid Society of Metropolitan Toronto. (1984). All about us. Toronto: Author. Corea, Gena. (1985). The mother machine: reproductive technologies from artificial insemination to artificial wombs. Tbronto: Fitzhemy & Whiteside. Crowe, Christine. (1985). “Women want it”: in vitro fertilization and women’s motivations for participation. Women’s Studies International Forum, 8. 547552. Eagan, Andrea Boroff. (1987, August 25). Baby roulette. The Village Voice, pp. 16-21. Fagan, Peter J., Schmidt. Chester W., Rock, John, Damewood, Marian D., Halle. Ellen, & Wise, Thomas N. (1986). Sexual functioning and psychologic evaluation of in vitro fertilization couples. Fertility and Sterility. 46, 668-672. Freeman, Ellen W., Rickels, Karl, ‘lhusig, Jane, Boxer, Andrea, Mastroiamri, Luigi, Jr., & Bueck, Richard W. (1987). Emotional and nsYchologica1 factors in follow-up of women after I?FiET treatment: a pilot investigation. Acta Obstetricia et Gynecologica Scandinavica, 66.5 17-521. Gimenez, Martha E. (1984). Feminism, pronatalism, and motherhood. In Joyce lkebilcot (Ed.). Mothering: essays in feminist theory (pp. 2871313). Totowa, NJ: Rowan & Allanheld. Given, Jeannette E., Jones, Georgeanna S., & McMillen, David L. (1985). A comparison of personality characteristics between in vitro fertilization patients and other infertile patients. Journal of In Vitm Fertilization and Embryo Transfer, 2,49-54. Gold. Michael. (1985). The baby makers. Science. 85, 26-27,29-38: ’ Greenwalt, Julie. (1988, February 15). Thankful for five tiny blessings. People Magazine, pp. 92-100. Hawk& Sharr$, & Knox, David. (1978). The one-child family: a new lifestyle. The Family Co-oniinator, 27, 215-219. Hearn, Margaret T., Yuzpe, Albert A., Brown, Stanley E., & Casper, Robert F. (1987). Psychological characteristics of in vitro fertilization participants. American Journal of Obstetrics and Gynecology, 156,269-274. Holmes, Helen Bequaert, & ‘Iymstra, Tjeerd. (1987). In vitro fertilization in the Netherlands: experiences of Dutch women. Journal of In Vitm Fertilization and Embryo Tkansfer.4, 116-123. Holmes, Helen Bequaert. (1988). In vitro fertilization: reflections on the state of the art. Birth, IS, 134145. Kirk, David. (1964). Shared fate. Toronto: Collier-Macmillan. Klein, Renate D. (Ed.). (1989a). Infertility: women
552
LINDA
s.
soeak out about their exoeriences of mmductive medicine. London: Pandora Press. - _ Klein, Renate. (1989b). The exploitation of a desire: women’s experiences with in vitro fertilization. Geelong, Australia: Deakin University Press. Leiblum, Sandra R., Kemmann, Ekhehard, Colburn, Daniel, Pasquale. Samuel, & DeLisi, Ann Marie. (1987). Unsuccessful in vitro fertilization: a followup study. Journal of In Vitro Fertilization and Embryo i%znqfer.4,46-50. Lorber, Judith, & Greenfeld, Dorothy. (1990). Couples’ experiences with in vitro fertilization: A phenomenological approach. In Z. Ben-Rafael (Ed.), Proceedings of the sixth world congmss on in vitro fertilization and alternative assisted mptoduction (pp. %5971). New York: Plenum. MacIntvre. __ Sallv. _. (1976). Who wants babies? The social construction of “instincts.” In Diana Leonard Barker & Sheila Allen (Eds.). Sexual division and society: process and change. London: I’avistock Publications. Matthews, Ralph, & Matthews, Anne Martin. (1986). Infertility and involuntary childlessness: the transition to non-parenthood. -Journal of Marriage and the Family, 48, 641649. Menning, Barbara Eck. (1977). In&tility: a guide for the childless couple. New York:~Prentice-Hall. Menning, Barbara Eck. (1980). The emotional needs of infertile couples. Fertility and Sterility, 34, 313319. Miall, Charlene E. (1985). Perceptions of informal sanctioning and the stigma of involuntary childlessness. Deviant Behaviour, 6,383~403. Miall, Charlene E. (1986). The stigma of involuntary childlessness. Social Problems, 33,268-282. Miall, Charlene E. (1987). The stigma of adoptive parent status: perceptions of community attitudes toward adoption and the experience of informal social sanctioning. Family Relations, 36, 34-39. Pappert, Ann. (1988, February 8). Success rates quoted
WILLUMS
by in vitro clinics not what they seem. The Globe and Mail, p. A3. Raymond, Chris Anne. (1988). In vitro fertilization enters stormy adolescence. Journal of the American Medical Association, 254,464-465,469. Rich, Adrienne. (1976). Of woman born. New York: Norton. Rowland, Robyn. (1985). A child at any price? An overview of issues in the use of the new reproductive technologies, and the threat to women. Women’s Studies International Forum, 8,539-546. Sandelowski, Margarete. (1986). Sophie’s choice: a metaphor for infertility. Health Care for Women International, 7, 329-453. Schneider, D. M. (1%8). American kinship: a cultural account. Chicago: University of Chicago Press. Singer, Peter, & Wells, Deane. (1985). Making babies: the new science and ethics of conception. New York: Scribner. Snowden, R., Mitchell, G. D., & Snowden, E. M. (1983). Artificial reproduction: a social investigation. Winchester, MA: Allen & Unwin. Tilton, Nan, Tilton, Todd, & Moore, Gaylen. (1985). Making miracles: in vitro fertilization. New York: Doubleday. Veevers, Jean. (1980). Childless by choice. Toronto: Butterworths. Wallis, Claudia, (1984, September 10). The new origins of life. Time Magazine, pp. 40-44,49, 5 1. Ward, M. (1981). Parental bonding in older-child adoption. Child We&are, 60,24-34. Williams, Linda S. (1986). But what will they mean for women: feminist concerns about the new reproductive technologies. Feminist Perspectives Series, No. 6. Ottawa: Canadian Research Institute for the Advancement of Women. Williams, Linda S. (1988). Wanting children badly: an exploratory study of the parenthood motivation of couples seeking in vitro fertilization. Unpublished doctoral dissertation, University of Toronto.
0217J395/5w 53.00 + .rm 0 1990 Pngamon PEES6plc
MmHERHOOD, IDEOLOGY, AND THE POWER OF TECHNOLOGY In Vitro Fertilization Use by Adoptive Mothers LINDA s. WILLIAMS Department of Sociology, ‘Dent University, Peterborough, Ontario, Canada K9J 7B8
Synopsis-Although in vitro fertilization (IVF) is generally presented as a procedure that enables childless couples to become parents, a significant percentage of the couples who use this technology already have biological or adopted children. This paper examines what motivated three women to seek biological motherhood through IVF after they had already become adoptive mothers. These three case studies show that while the experience of social motherhood did provide some of the rewards that led these women to seek motherhood in the first place, it did not provide all of them. In order to try and achieve the rewards of biological motherhood, these women turned to IVE The author concludes that IVF will continue to be sought by some adoptive mothers who value the particular aspects of motherhood that are not attainable through adoption.
In 1978, the world’s first so-called test-tube baby, Louise Brown, was born in England. Since that time it has been estimated that approximately 5000 IVF babies have been born worldwide (Klein, 1989a). IVF clinics currently operate in almost every country where Western medicine is practiced (Holmes, 1988). In vitro fertilization was originally developed to enable women whose fallopian tubes are blocked to bear children. IVF works by bypassing a woman’s defective fallopian tubes. Her ovaries are stimulated with strong fertility drugs to produce multiple eggs, which are surgically removed. Her partner then produces a sperm sample by masturbation, and the eggs and sperm are combined in a glass dish. If fertilization occurs, the resulting human embryos are returned to the woman’s uterus. If they implant in the uterine wall, a pregnancy will begin, and the woman will give birth nine months later if she does not miscarry. The miscarriage rate for IVF pregnancies is 30 to 50% (Klein, 1989a). A single IVF attempt lasts approximately three weeks, and is extremely physically stressful because it involves surgery, repeated ultrasounds, and blood drawing. The fertility drugs that are essential to the procedure can produce a wide range of distressing and potentially dangerous side effects. IVF is also very emotionally stressful, since it may fail at
any point in the procedure, and the attempt cancelled. It is also very expensive. Most North American and Australian clinics charge $3000 to $6000 per attempt, and most couples make several attempts. IVF is also notoriously unsuccessful. Recent research has shown that IVF leads to the birth of a baby only 5 to 10% of the time (Klein, 1989a; Pappert, 1988; Raymond, 1988).’ Despite its unrelenting stress and low success rate, IVF is generally presented to the public by the doctors and scientists who practice it as a boon to infertile couples unable to have their own biological children. This public image of IVF has been greatly enhanced worldwide by innumerable newspaper and magazine articles that picture beaming couples with their newborn IVF infant (or infants) conceived after years of fruitless attempts to alleviate their infertility. This public image is emotionally compelling, but it contradicts the fact that some couples who seek IVF already have children. Some have children from a previous marriage; some have biological children from their current marriage, but are suffering from secondary infertility.2 And finally, some couples who seek IVF already have an adopted child or children. Prior to the development of in vitro fertilization, adoption was usually the end of the road for infertile women who wanted to have 543
LINDAs. wULL4MS
544
a baby. It was generally undertaken when all medical attempts to overcome a woman’s infertility had failed, and biological motherhood seemed unlikely. In vitro fertilization, however, does not fii the problem that causes a woman’s infertility, it attempts to bvpass it. Although the IVF success rate is extremely low, an initial IVF failure does not necessarily mean that a subsequent attempt might not result in a live birth. Consequently, in vitro fertilization allows infertile women to keep trying to become biological mothers even after they have exhausted the conventional gamut of infertility cures and become social mothers through adoption. This paper will examine what motivated three infertile women to seek biological motherhood through in vitro fertilization after they had already become adoptive mothers. An examination of this aspect of IVF is useful for several reasons. First, it can help us to understand the meaning of motherhood for women by allowing us to separate the social aspects of motherhood from its biological aspects and evaluate their relative importance. Second, it may help us to understand the way in which IVF alters women’s perceptions of motherhood, adoption, and infertility and their responses to these experiences. And finally, an examination of these women’s stories may also help to partially explain the continued growth of this expensive and controversial technology, and the social context in which it thrives. ADOPTIVE VERSUS BIOLOGICAL MmHERHOOD Numerous writers have pointed out that women are expected to bear children as part of their female role (Blake, 1974; Gimenez, 1984; Rich, 1976). Childbearing is also expected to take place within the confines of legal, heterosexual marriage (MacIntyre, 1976). Married women who fail to bear children are often viewed as unfeminine and deviant (Veevers, 1980). Miall (1985, 1986) has shown that married women who are childless due to infertility often internalize these societal perceptions and view their infertility as stigmatizing. For many infertile women, adoption is a way of fulfilling both pronatalist social norms and their own desire to parent.
Adoptive motherhood, however, may not be viewed as the equivalent of biological motherhood either by society or by adoptive mothers themselves. In most societies, the blood tie between parents and children represents the essence of the parental bond, and adoption is sometimes seen as second best (Kirk, 1964; Schneider, 1968; Snowden, Mitchell, & Snowden, 1983; Ward, 1981). Miall (1987) found that a majority of adoptive mothers in her study believed that adoptive parenthood was socially devalued due to the lack of a genetic tie between parent and child. Some adoptive mothers themselves may also view adoption as second best. For some women, having their own biological child may be important as proof of their femininity (Bell, Bancroft, & Philip, 1985), or they may have a strong desire to ensure their own genetic continuity (Rowland, 1985). For infertile women, the desire to experience pregnancy, childbirth, and breastfeeding may be a crucial factor in wanting to become a biological mother (Menning, 1980). For some women, then, “producing” a child may be more important than the actual experience of raising one. As Matthews and Matthews have pointed out, for such women “the experience of social parenthood may not be sufficient to resolve their desire for biological parenthood” (Matthews 8c Matthews, 1986, p. 648). All of these factors can play a role in the desire of adoptive mothers to attempt in vitro fertilization following their adoptions. IN VITRO FERTILIZATION USE BY WOMEN WHO ALREADY HAVE CHILDREN Very little is known about women with children who seek IVF other than the fact that such women do exist. Freeman et al. note in their follow-up study of 156 women who had undergone IVF that 71% of the couples were childless; 15 % of the women had biological children (12 % from the present marriage, 3 % from previous marriages); another 7 I of the men had biological children from previous marriages; and 7% of the couples had adopted children prior to applying for IVF (Freeman et al., 1987). If these data are even roughly representative of the client populations of other IVF clinics (and there is no
IVF and Adoptive Mothers
reason to believe that they are not), then women who already have children would seem to constitute a significant but unexamined proportion of the IVF client population.3 Information on women seeking IVF can be found in two disparate sources: popular articles and books and scholarly publications. The popular literature will occasionally mention a case in which a woman or couple seeking IVF already has an adopted or biological child, but this literature tends to focus almost exclusively on childless infertile couples. (See Brown & Brown, 1979; Eagan, 1987; Gold, 1985; Greenwalt, 1988; Singer 8c Wells, 1985; Tilton, Tilton, 8z Moore, 1985; Wallis et al., 1984.) A growing literature exists which attempts to evaluate the psychological state of IVF participants prior to, during, and following IVF so that counselling assistance can be provided. A few of these studies have noted that some IVF couples already have biological or adopted children (Applegarth, 1986; Freeman et al., 1987), but most do not provide this information (Fagan et al., 1986; Given, Jones, & McMillen, 1985; Hearn et al., 1987; Leiblum et al., 1987). An even smaller body of sociological and/ or feminist literature examines women’s and couples’ experiences with IVF and discusses some of the social aspects of this technology. Crowe (1985) and Bomricksen (1988) interviewed women who had undergone IVF and Holmes and Qmstra (1987) conducted a survey of Dutch IVF patients, but these studies do not state whether any of these women already had adopted or biological children. Klein (1989b) interviewed 40 former IVF patients in Australia and found that 7 women had a biological child from a previous relationship, and 3 from their current marriage (these women were suffering from secondary infertility). Five of the husbands of women in this study had children from previous relationships. To the best of my knowledge, only two sociological studies have included the husbands of women who have undergone IVF. Lorber and Greenfeld (1990) conducted telephone interviews with 20 women and their husbands. No information is provided as to whether any of these couples already had adopted or biological children before under-
545
taking IVF. The second sociological study of IVF couples is my own research, which will be described below (Williams, 1988). THE STUDY The three case studies examined in this paper are part of a larger study of 22 women who had applied for or undergone IVF in the province of Ontario, Canada, between 1984 and 1987. The husbands of 20 of these women were interviewed separately, All interviews were tape recorded and transcribed. The purpose of this qualitative study was to examine the parenthood motivation of couples seeking in vitro fertilization to determine to what extent this motivation, and, hence, the market for IVF, is socially constructed. Respondents were located through contact with an infertility support group (n = 7), advertisements in IVF clinics (n = 2), a letter to a local newspaper (n = 22), a radio announcement (n = 4), and personal contact and word of mouth (n = 7). Sixteen of the 22 women were childless, having no biological, adopted, or stepchildren. Three had at least one biological child, and three had an adopted child. This paper focuses on the experiences and feelings of the three women who had adopted a child before attempting IVF. Since each woman’s situation is unique, they are presented as case studies. THREE WOMEN’S STORIES Sylvia Sylvia and Jim Ashford” married when they were in their late 2Os, and one year later they started trying to conceive their first child. After a year of trying with no success, Sylvia went to see an infertility specialist, and was told that she had pelvic inflammatory disease, a common cause of infertility.5 She underwent surgery to try to repair the damage, but was given only a 30% chance of ever becoming pregnant. A few months later, Sylvia and Jim began trying to adopt a baby privately, and within a few months they were successful.6 Although they were thrilled with their adopted son, they continued to hope that Sylvia might become pregnant. The doctor who had performed her tubal surgery was a member of the hospital’s IVF team, and
546
LINDA s. WlLLlAMs
said that he would recommend Sylvia for the procedure if she wished. She eventually underwent three unsuccessful IVF attempts. Sylvia and Jim had both always wanted to have children and both shared the view that childbearing is an essential part of marriage. Sylvia stated: I guess the first priority in my mind is to have a family, whether it be biological or adopted, and it’s just the way I grew up, I guess, the tradition I was brought up in, and my husband as well . . . But as far as having a biological child I just feel that I want to be able to do it, and I also want to be able to give my husband a child . . . And I hate to see him deprived of that because of me. I guess it’s a guilt thing or, it’s hard when the person you love most in the world you can’t give one of the things that you think is the most important thing to them. That’s about it, I guess. Plus I just want that experience [of pregnancy and birth]. I think it would be an interesting, probably painful, but interesting experience to go through. Later in her interview Sylvia said that one of the most stressful aspects of being infertile was [a] feeling of fear that I would maybe not lose Jim but that he wouldn’t love me as much, or something like that . . . At one point I was so ashamed and devastated that I kind of sort of offered to leave if he wanted to go off and find someone else, kind of thing. I just felt that horrid about it. But obviously that was feeling insecure and everything. He was able to reassure me that he still loved me even though I wasn’t a baby machine, things like that.’ Although Sylvia clearly felt an obligation as a wife “to give my husband a child,” and worried that Jim “wouldn’t love me as much” if she did not, Jim did not appear to be pressuring her in any way. When I asked him if having children was part of the reason why he and Sylvia had married, he replied, “I wouldn’t put it that way. I just couldn’t imagine living without her.” Later in his interview he also stated that even if Sylvia had been aware of her infertility at the time of their marriage he would have married her anyway.
For Sylvia, the connection between femininity and biological motherhood was also strong and compelling. When I asked her if she felt that having a biological child was part of her femininity, she replied: I do. I can’t get over that even though my husband reassures me, and I guess I need the reassurance that I am still a woman and feminine even though I have these problems. But you have this image of yourself as fertile and having no problems in that regard and then all of a sudden your legs are cut out from under you as far as that goes. There is a problem, I would say. I’m trying to overcome it . . . I don’t know if I ever will, but there is that feeling, definitely. Sylvia was of the opinion that she had wanted a child more strongly, but Jim stated, “Well we both did. I’m not sure you can quantify it.” Although Jim and Sylvia are very disappointed at not being able to have a biological child, the pain of infertility is very much lessened by the fact that they have their adopted son, Tremor, whom they dearly love. When I asked Sylvia and Jim if they were planning to try IVF again, they replied: Jim - “I think we will, maybe one more. I don’t think we would try indefinitely. I think we would try for the limit to how many times we did it. It’s a bit hard on Sylvia. The early mornings, the drug work. And it means we have to have Sylvia’s sister come over every time we try to take care of ‘Irevor. But part of the reason why we’re reaching that stage when we might decide not to try it again, is because we’re so happy with the child we already have, and we’re considering trying adoption again.” Sylvia - “I think . . . we want to pursue the IVP as far as we can take it and then if that doesn’t work then we certainly won’t hesitate to go for adoption again . . . I think I will give it a few more tries. See what happens.” Several months after our interview, Sylvia phoned me to say that she and Jim had decided not to try IVF again. She was worried
IVF and Adoptive Mothers
about the long-term effects of the drugs she had taken in her three unsuccessful attempts and did not want to put herself at risk once again. However, the main reason for this decision was the fact that she and Jim were very happy with their adopted child and therefore, “We just didn’t feel that desperate about it,” as Sylvia said. The Ashfords were once again pursuing private adoption and they had also contacted the Children’s Aid Society. Several months later, Sylvia wrote to tell me that they had adopted another child. Michelle Michelle and Guy Rossi are both in their early 30s. They have an adopted daughter, Amanda, who is almost 2 years old. The Rossis started trying to conceive after four years of marriage. A year later, Michelle sought treatment for infertility. When she did not become pregnant after surgery and several months of taking the fertility drug Clomid, her doctor informed her that there was nothing else he could do for her. By now two years had passed since Michelle sought medical help, and she was becoming seriously concerned about her inability to conceive. Around this time the Rossis began to consider adoption. They applied to their local Children’s Aid Society and were told that there was a six-year wait to adopt any child under the age of 5, so they turned their attention to private adoption. They were extremely lucky, for a few weeks later their family doctor informed them that a woman in his practice wanted to give up her child for adoption, and she agreed to let Michelle and Guy adopt her soon-to-be-born infant. While the Rossis were waiting for Amanda to be born, Michelle learned that Dr. Y. was planning to start doing in vitro fertilization in the near future, and she went to see him. Dr. Y. told Michelle that she did not seem to have any identifiable problem that would prevent her from becoming pregnant. Once again, she was told to keep trying. Although Michelle was extremely upset about her continuing infertility, her disappointment was tempered by the fact that she and Guy would soon have an adopted child. Finally their long wait was over, and a few days after Amanda was born, they picked her up at the hospital. Guy and Michelle were absolutely thrilled with their new daughter, and definitely want-
547
ed to have another child. They continued to seek another private adoption, but by this time Dr. Y. had opened his private IVF clinic, and Michelle went through the procedure 15 months after she and Guy had adopted Amanda. Michelle did not become pregnant, and she also suffered some dangerous side effects from the fertility drugs used in the procedure. Her ovaries became hyperstimulated and she developed ovarian cysts.* When I asked Michelle how she had felt about the possibility of never being able to have a biological child, she replied: I thought that if we could adopt it wouldn’t make any difference to me. The way I look at it, a baby is a baby. And now that I have Amanda, and know what it’s like to have a newborn, I can say it doesn’t make any difference. The only reason why now I would be trying to achieve a pregnancy is for the experience. I want to be able to achieve that. I want to try everything I can. I want to be able to say 10 years down the road, “Well, I tried everything. I did my best. If it didn’t happen, it didn’t happen.” But I know what it is like to love a baby, and I couldn’t love Amanda any more if I’d given birth to her myself. I just want the experience of the pregnancy and the birth. Later in her interview Michelle said: But then, you know, we have never really been told the reason for infertility. If someone said to me “Listen Michelle, this is why you can’t do it. You just can’t do it. You might as well stop trying.” Then I might stop. But no one has ever said to me, “It’s impossible. This is the reason why you’re not.” No one’s said that. So I have to do everything I can. Although Guy and Michelle are both delighted with Amanda, their quest for a biological child is not over. They both also agree that having a biological child is more important to Michelle than it is to Guy. When I asked them what they were planning to try next they replied: Michelle - ” . . . If nothing happens I’m gonna contact Dr. Y. and see if he will let
LINDA S. W~LUMS
548
me go down for the ultrasound, the bloodwork, and take some Pergonal and maybe some Clomid and try it that way without the IVF and see if that works. If it doesn’t then maybe try an insemination with Guy’s sperm, and then after that try the IVF again . . . ”
Guy- “My game plan, I’m sure is different from Michelle’s. My game plan is we will try it with her going on Clomid, which I don’t really want because it overstimulates her ovaries and cysts and all these things happen, and I don’t like that. She’s too important to me to risk any problems. So, if she wants to try it, let her try it . . . And I’d like to say maybe one more IVF, and if it doesn’t work, let’s adopt again. But Michelle’s side, as I’m sure she has said, is she’ll do that plus then maybe she’ll try another clinic, wherever. I understand there’s long lineups.” Not only were Guy and Michelle fortunate in being able to adopt Amanda, they were doubly blessed. Three months after I interviewed Michelle she became pregnant naturally and gave birth to a healthy baby.
Joanne Joanne and Peter Dubrick have an adopted son Matthew who is a year-and-ahalf old. They married when they were both in their early 3Os, and three years later they decided to try to conceive. After five months of trying, Joanne’s menstrual period was very late, and she suspected that she was pregnant. Although her period did eventually come, this episode plus the fact that she was now in her mid30s triggered her anxiety about possibly being infertile. Joanne then went to see her gynecologist and started a series of infertility tests which lasted six months. The Dubricks had already begun to consider adoption at this point, and Joanne made inquiries to their local Children’s Aid Society. Around this time they learned of the possibility of a private adoption, but it did not materialize. The process of trying to finalize this adoption encouraged the Dubricks to make further efforts, and within a very short time they were able to adopt Matthew. When I asked Joanne if the question of
not carrying on with her infertility investigation occurred to her once she had adopted a baby, she replied: No. No. And the reason was that having a baby and becoming a mother aren’t necessarily the same as coping with infertility. They weren’t to me. As I said, I felt that I had to pursue the whole thing just for my own interest, to know. I didn’t have the luxury of waiting five years and saying, “Well, maybe I’ll try now.” I knew that if I was going to do it I had to do it then, and check it out. I was certainly very happy with Matt and I didn’t look at having a real biological baby as a betterment of the situation, but I still considered we wanted two or more children anyway, so therefore it was prudent to continue the whole infertility thing. With me it was the ability to get pregnant. Tb have the infertility resolved. Then I could address the issue about how do you feel about being pregnant? How do you feel about giving birth? How do you feel about having a baby? I mean, those were all separate rather than one to me. By now Joanne was into her second year of trying to conceive, and went to see an infertility specialist who could not identify any reproductive problem. This doctor advised her to keep trying and wait and see. Around this time she learned about the IVF program at another hospital and obtained an appointment with one of the IVF physicians. Since Joanne had been trying to become pregnant for two years and no cause for her infertility could be found, she was admitted into the IVF program as a normal infertile.g She became pregnant on her first attempt, and when I interviewed her she was expecting her child in a few weeks. When I asked Joanne how she felt during the stressful two-year period when she was trying to get pregnant, she replied: I felt infertile, and I felt dreadful about it. But I didn’t ever feel it was finished yet. Like I felt that I would pursue it up until the point that I felt that that was as far as I could go . . . And also the aspect of the idiopathic10 infertility I think is an additional painful one. . . . ‘Cause you were
IVF and Adoptive Mothers
always thinking, well maybe I could get pregnant. Every month, maybe I could. Especially when you have these goons11 telling you the whole time that you can. . * . Let’s put it this way, it became most important to me when I found out I couldn’t. That I was having trouble. And then I got involved in the whole thing. I mean it’s fine to say that it doesn’t matter too much when you think you can. . . . When I asked Joanne if having a child was an important part of her femininity she replied: Not really. I think I found that the infertility I saw more in a general sense. Like for a male and for a female. Just the fact that I am being singled out as not part of the way it should be. Not necessarily that I’m a failure as a woman. I don’t think I felt that. But I just felt dreadful that I wasn’t like everyone. Peter and Joanne both agreed that she was the one who wanted to have a child more strongly. Joanne commented: . . . He would sit right down, and did on one occasion, and said to me, “You know it’s not the end of the world if we don’t have children. It’s you I love and our marriage is more important than that.” Whereas I never could move. quite that far. I might have, and I think I would have, but as I said, I felt that I had to completely exhaust all the possibilities first.
Joanne and Peter both felt that their family was now complete and they did not intend to try to have any more children, either adopted or biological. Peter described their situation in this way: We’ve been fantastically lucky. And I just cannot visualize that I’d want to put myself or have Joanne put herself [through IVF again] . . . I’m reasonably sure that she would not want to put herself through the same process, given the same odds, when we’ve got two children here. I think we should just be happy and pack her up and leave it at that.
549
DISCUSSION Why did these three women persist in their quest for a biological child through IVF even after they had become adoptive mothers? For Sylvia, the connection between motherhood and femininity was strong and compelling, and her inability to bear a child led to feelings of guilt, inadequacy, and embarrassment, but she also stated, “I’m trying to overcome it .” She experienced conflict between her culturally induced notions of femininity and her rational self. Sylvia was also concerned that her husband Jim would not love her as much if she could not “give him” a child, and had even offered to leave him so that he could find someone else with whom to have children. She needed his reassurance that she was still feminine and lovable even though she was not a “baby machine.” For Joanne, her inability to have a child did not make her feel less of a woman, but was experienced more as the loss of a normal human capacity (the ability to reproduce) rather than the loss of a specifically feminine attribute. Although all three women were social mothers and extremely happy with this aspect of motherhood, they still wished, in varying degrees, to experience pregnancy and childbirth, and this was one of the factors that led them to attempt IVF. The fact that Michelle and Joanne were “normal infertiles” also made it extremely difficult for them to stop trying to resolve their infertility. Since they had never been told why they could not become pregnant, they could not give up hope that they might one day conceive, and they felt that they had to “try everything.” Consequently, it therefore became necessary to continue the quest for biological motherhood in spite of the satisfying experience of social motherhood. These women’s stories also demonstrate the continuing social prejudice against onechild families that has been described in Hawke and Knox (1978). Sylvia and Joanne both explicitly stated that one reason for trying IVF even after they had adopted a child was a desire to have at least a two-child family. Although each woman was amazingly lucky in being able to adopt her child within a few months of starting to seek adoption, all three also recognized that private adoption
LINDAs. wILL.IAbIS
550
was an uncertain route to obtaining a second child. It therefore became prudent to also attempt in vitro fertilization. The fact that an IVF child would be a genetic offspring seemed less important than the fact that an IVF baby would be a second child, which would bring their families to their desired size. CONCLUSION Why do women who are already social mothers through adoption continue to seek biological motherhood through IVF? This analysis has shown that while the experience of social motherhood did provide some of the rewards that led these women to want to become biological mothers in the first place, it did not provide all of them. In order to try and achieve the rewards of biological motherhood, these women turned to IVF. Based on these women’s stories, what are some of the rewards that social motherhood does not provide? Adoption is not a solution for a woman who feels, correctly or incorrectly, that she must produce a biological child for her husband in order to remain lovable or to remain married to him. For women who believe that biological motherhood is an inherent and essential part of femininity, adoption is a second-rate option at best. It is essential to note that these rewards are socially constructed. They are based on culturally formed notions of a wife’s reproductive duty and the true nature of womanhood. Adoptive motherhood also cannot fulfill the strong desire of some women to experience pregnancy, birth, and breastfeeding. These rewards are obviously physical, but the perception of them as enjoyable, or at least worth experiencing, may also be socially constructed to a certain extent. Adoptive motherhood also does not help women whose infertility is undiagnosed to find out why they cannot have children. This points to the failure of the medical profession to determine and treat the causes of infertility. Because approximately 10% (Merming, 1977) to 60% (Sandelowski, 1986) of infertile women never learn why they cannot conceive, they continue to try. For an unknown percentage of these women, trying eventually leads to at least one attempt at IVF. The unpredictability of obtaining a sec-
ond child through private adoption was a motivating factor in IVF use for two of these women. This demonstrates how the current lack of adoptable babies, that is, white, healthy newborns, feeds the demand for IVF,n as does the continuing social prejudice against one child families (Hawke & Knox, 1978). The stories of Sylvia, Michelle, and Joanne are compelling, and they serve to broaden the range of questions that must be answered about IVF. We must determine what percentage of IVF clients already have adopted (or biological) children, and why they use IVF. Because these women are not childless, their reasons for attempting IVF may provide new insights into the nature of women’s desire for biological motherhood and the complex forces that shape it. We must also examine the way in which the adoption market and cultural values concerning adoption feed the demand for IVF in every country where it is practiced. Finally, we must examine the ways in which the possibility of continued attempts at IVF changes the adoption experience for some women and makes it difficult for them to accept their infertility even after they have happily adopted. As long as the many rewards of biological motherhood, some of which are socially constructed, continue to be important to women, I believe that in vitro fertilization will continue to be an attractive option for some adoptive mothers despite its emotional, physical, and financial costs. We must include these women in our feminist analysis of IVF. They have much to teach us. ENDNOTES 1. For a full description of the IVF procedure, see Gold (1985) or Williams (1986). First person accounts of women’s experiences with this technology can be found in Klein (1989a). 2. Secondary infertility is defined as the inability to conceive or carry a pregnancy after having successfully conceived and carried one or more pregnancies in the past. 3. There is some speculation that divorced and remarried women who have had a tubal ligation in their first marriage and who wish to have a child with their new husband may constitute a growing market for IVF. At a conference held in Montreal in 1987 entitled “Maternity in the Laboratory,” a Canadian IVF doctor stated that a large proportion-of his practice consisted of such women. He did not state the exact proportion.
IVF and Adoptive Mothers
4. Ail names used in this article are pseudonyms. 5. Sylvia had used an IUD for birth control prior to her marriage, which may have caused the infection that prevented her from conceiving. Seven of the 22 women in this sample had used an IUD for periods ranging from 6 months to 13 years. Several of these women attributed their infertility to problems associated with its use, or the subsequent medical mismanagement of those problems. As Gena Corea as pointed out, the medical profession sometimes prescribes contraceptives or performs therapeutic and diagnostic procedures which may actually impair women’s fertility. This can lead to a revolving-door situation in which women seek treatment for infertility from members of the same profession (and perhaps even from the same physicians) whose advice or treatment caused their infertility in the first place (Corea, 1985). 6. In the province of Ontario, one may adopt a child through the Children’s Aid Society, which is the agency which handles public adoption, or one may attempt private adoption through an agency or an individual (such as a lawyer or a social worker) who has been licensed by the Ministry of Community and Social Services to place children for private adoption. All private adoptions must be approved by the Ministry. 7. One other woman in this study also mentioned that she had offered to leave her husband so that he would be free to try and have children with a new wife. Crowe (1985) and Klein (1989a) also observed this phenomenon in their studies of Australian women who had undergone IVF. 8. Ovarian cysts are a serious gynecological condition. They may rupture, resulting in bleeding into the abdominal cavity, and may require surgery to remove ah or part of the affected ovary. Ovarian hyperstimulation can also lead to temporary or permanent ovarian dysfunction. In rare cases it may also cause death. 9. Normal infertile is the phrase used to describe persons for whom the cause of their infertility remains undiagnosed even after a thorough medical investigation. 10. Idiopathic infertility is the medical term for undiagnosed infertility. 11. Because of her previous experiences with doctors, Joanne is extremely negative about the medical profession. She was especially critical of the sexism she had encountered from male gynecologists. She also felt that most of the physicians she consulted were incompetent. 12. In the province of Ontario, almost 90% of unwed mothers now keep their babies; however, older children, nonwhite children, and children with handicaps are readily available for adoption. Most adoptive parents, however, wish to adopt healthy, white newborns (Children’s Aid Society of Metropolitan Toronto, 1984).
REFERENCES Applegarth, Linda D. (1986). Coping andptubiem-solving in in vitro fertilization patients: an emotional support group. Paper presented at the annual meeting of the American Society of Psychosomatic Obstetrics and Gynecology, April. Bell, Stephen J., Bancroft, John, & Philip, Alistair.
551
(1985). Motivation for parenthood: a factor analytic study of attitudes towards having children. Journal of Compamtive Family Studies, 16, 11l-l 19. Blake. Judith. (1974). Coercive nronatalism and American population policy. In Eilen Peck & Judith Senderowitz (Eds.), Pmnataltsm: the myth of mom and apple pie (pp. 29-69). New York: Thomas Y. Crowell. Bonmcksen. Andrea. (1988). Some consumer aspects of in vitro fertilization and embryo transfer. Birth, IS, 148-152. Brown, Lesley, Brown, John, & Freeman. Sue. (1979). Our miracle called Louise. London: Magnum Books. Children’s Aid Society of Metropolitan Toronto. (1984). All about us. Toronto: Author. Corea, Gena. (1985). The mother machine: reproductive technologies from artificial insemination to artificial wombs. Tbronto: Fitzhemy & Whiteside. Crowe, Christine. (1985). “Women want it”: in vitro fertilization and women’s motivations for participation. Women’s Studies International Forum, 8. 547552. Eagan, Andrea Boroff. (1987, August 25). Baby roulette. The Village Voice, pp. 16-21. Fagan, Peter J., Schmidt. Chester W., Rock, John, Damewood, Marian D., Halle. Ellen, & Wise, Thomas N. (1986). Sexual functioning and psychologic evaluation of in vitro fertilization couples. Fertility and Sterility. 46, 668-672. Freeman, Ellen W., Rickels, Karl, ‘lhusig, Jane, Boxer, Andrea, Mastroiamri, Luigi, Jr., & Bueck, Richard W. (1987). Emotional and nsYchologica1 factors in follow-up of women after I?FiET treatment: a pilot investigation. Acta Obstetricia et Gynecologica Scandinavica, 66.5 17-521. Gimenez, Martha E. (1984). Feminism, pronatalism, and motherhood. In Joyce lkebilcot (Ed.). Mothering: essays in feminist theory (pp. 2871313). Totowa, NJ: Rowan & Allanheld. Given, Jeannette E., Jones, Georgeanna S., & McMillen, David L. (1985). A comparison of personality characteristics between in vitro fertilization patients and other infertile patients. Journal of In Vitm Fertilization and Embryo Transfer, 2,49-54. Gold. Michael. (1985). The baby makers. Science. 85, 26-27,29-38: ’ Greenwalt, Julie. (1988, February 15). Thankful for five tiny blessings. People Magazine, pp. 92-100. Hawk& Sharr$, & Knox, David. (1978). The one-child family: a new lifestyle. The Family Co-oniinator, 27, 215-219. Hearn, Margaret T., Yuzpe, Albert A., Brown, Stanley E., & Casper, Robert F. (1987). Psychological characteristics of in vitro fertilization participants. American Journal of Obstetrics and Gynecology, 156,269-274. Holmes, Helen Bequaert, & ‘Iymstra, Tjeerd. (1987). In vitro fertilization in the Netherlands: experiences of Dutch women. Journal of In Vitm Fertilization and Embryo Tkansfer.4, 116-123. Holmes, Helen Bequaert. (1988). In vitro fertilization: reflections on the state of the art. Birth, IS, 134145. Kirk, David. (1964). Shared fate. Toronto: Collier-Macmillan. Klein, Renate D. (Ed.). (1989a). Infertility: women
552
LINDA
s.
soeak out about their exoeriences of mmductive medicine. London: Pandora Press. - _ Klein, Renate. (1989b). The exploitation of a desire: women’s experiences with in vitro fertilization. Geelong, Australia: Deakin University Press. Leiblum, Sandra R., Kemmann, Ekhehard, Colburn, Daniel, Pasquale. Samuel, & DeLisi, Ann Marie. (1987). Unsuccessful in vitro fertilization: a followup study. Journal of In Vitro Fertilization and Embryo i%znqfer.4,46-50. Lorber, Judith, & Greenfeld, Dorothy. (1990). Couples’ experiences with in vitro fertilization: A phenomenological approach. In Z. Ben-Rafael (Ed.), Proceedings of the sixth world congmss on in vitro fertilization and alternative assisted mptoduction (pp. %5971). New York: Plenum. MacIntvre. __ Sallv. _. (1976). Who wants babies? The social construction of “instincts.” In Diana Leonard Barker & Sheila Allen (Eds.). Sexual division and society: process and change. London: I’avistock Publications. Matthews, Ralph, & Matthews, Anne Martin. (1986). Infertility and involuntary childlessness: the transition to non-parenthood. -Journal of Marriage and the Family, 48, 641649. Menning, Barbara Eck. (1977). In&tility: a guide for the childless couple. New York:~Prentice-Hall. Menning, Barbara Eck. (1980). The emotional needs of infertile couples. Fertility and Sterility, 34, 313319. Miall, Charlene E. (1985). Perceptions of informal sanctioning and the stigma of involuntary childlessness. Deviant Behaviour, 6,383~403. Miall, Charlene E. (1986). The stigma of involuntary childlessness. Social Problems, 33,268-282. Miall, Charlene E. (1987). The stigma of adoptive parent status: perceptions of community attitudes toward adoption and the experience of informal social sanctioning. Family Relations, 36, 34-39. Pappert, Ann. (1988, February 8). Success rates quoted
WILLUMS
by in vitro clinics not what they seem. The Globe and Mail, p. A3. Raymond, Chris Anne. (1988). In vitro fertilization enters stormy adolescence. Journal of the American Medical Association, 254,464-465,469. Rich, Adrienne. (1976). Of woman born. New York: Norton. Rowland, Robyn. (1985). A child at any price? An overview of issues in the use of the new reproductive technologies, and the threat to women. Women’s Studies International Forum, 8,539-546. Sandelowski, Margarete. (1986). Sophie’s choice: a metaphor for infertility. Health Care for Women International, 7, 329-453. Schneider, D. M. (1%8). American kinship: a cultural account. Chicago: University of Chicago Press. Singer, Peter, & Wells, Deane. (1985). Making babies: the new science and ethics of conception. New York: Scribner. Snowden, R., Mitchell, G. D., & Snowden, E. M. (1983). Artificial reproduction: a social investigation. Winchester, MA: Allen & Unwin. Tilton, Nan, Tilton, Todd, & Moore, Gaylen. (1985). Making miracles: in vitro fertilization. New York: Doubleday. Veevers, Jean. (1980). Childless by choice. Toronto: Butterworths. Wallis, Claudia, (1984, September 10). The new origins of life. Time Magazine, pp. 40-44,49, 5 1. Ward, M. (1981). Parental bonding in older-child adoption. Child We&are, 60,24-34. Williams, Linda S. (1986). But what will they mean for women: feminist concerns about the new reproductive technologies. Feminist Perspectives Series, No. 6. Ottawa: Canadian Research Institute for the Advancement of Women. Williams, Linda S. (1988). Wanting children badly: an exploratory study of the parenthood motivation of couples seeking in vitro fertilization. Unpublished doctoral dissertation, University of Toronto.