- Email: [email protected]
The social and psychological consequences of secrecy in artificial insemination by donor (AID) programmes
Sot. Sci. Med. Vol. 21, No. 4, pp. 391-396, Printed in Great Britain
0277-9536/85 S3.00 + 0.00 Pergamon Press Ltd
1985
THE SOCIAL AND PSYCHOLOGICAL CONSEQUENCES OF SECRECY IN ARTIFICIAL INSEMINATION BY DONOR (AID) PROGRAMMES ROBYN ROWLAND* School
of Humanities,
Deakin
University,
Victoria
3217, Australia
Abstract-The assumption that secrecy is of paramount importance in AID programmes has arisen in order to protect the three parties involved: donor, recipient couple and offspring. Due to the uncertain legal position. the medical profession has also been concerned to protect itself against possible litigation. Recent calls for an abolition of all secrecy have been motivated by the knowledge and experience of workers in the field of adoption. The similarities and differences between adoption and AID as ways of creating a family are discussed, with the resulting conclusion that, although the two have much in common they do present different experiences and problems for parents and offspring. The experiences of donors and recipient couples are then discussed based on data gathered to date from 67 donors and 93 couples in an AID programme at the Melbourne Family Medical Centre. It is stressed that many statements in the past regarding secrecy have not been informed by the opinions and intentions of participants themselves. and further information is needed in this area. Furthermore, it is clear that all members of a society are affected by the codes of secrecy currently operating an.d the ‘rights’ of all members of that society need to be considered.
The assumption that secrecy is of paramount importance in AID programmes has arisen in order to protect the three parties involved: recipient couple, donor and offspring. This secrecy has been supported by the medical profession because of its own fears concerning possible legal liability and because of what it considers to be binding agreements of anonymity with both donors and couples. The current discussion of secrecy often uses the adoption system as a model. In the past, adopted babies were secretly acquired by parents who often never revealed to the offspring any information regarding their adoptee status or their origins. In most cases. adopting couples knew nothing of the child’s birth parents. This secrecy in adoption resulted in some adult adoptees undertaking a painful and frustrating search for their birth parents. They experienced what Sants [I] called ‘adoption stress’, a factor of which is ‘genealogical bewilderment’. Sants described the genealogically bewildered child as one who either has no knowledge of or only uncertain knowledge of his ‘her birth parents. The confusion and uncertainty which this creates in the child can fundamentally undermine his/her security of self and mental health. For some it may become an obsessional search. The resulting possible disappointment if the birth parent fails to ‘measure up’ and the frustration and despair experienced if the search is impeded or unsuccessful, can prove undermining for the individual. The reasons adoptees were not told of their origins revolved around social taboos of the time. Children were often ‘illegitimate’. Young girls were forced by social pressure and lack of social supports to relinquish babies conceived out of wedlock; and were often financially pressured to relinquish within wed*Currently:
Visiting Research Fellow. Institute
lation Studies. University De\on. England.
of Exeter.
Exeter
of PopuEX4 6DT.
391
lock. Secrecy was intended to protect the child from the dark knowledge of her/his origins, and so avoid social stigma. In fact, the feeling of having been ‘abandoned’ often motivated those who discovered their adopted status to search for the answer to the question ‘why did you abandon me’ [2]. After increasing pressure from both adoptees of adult status and currently adopting parents, this situation has changed, and most adopting couples are now given extensive information on the child’s birth parents and are counselled to tell the child in his/her early years that he/she is adopted. Research in adoption has indicated that this is a psychologically healthier situation for offspring, relinquishing parents and adopting parents [3]. As Sants has commented: “A principle in common use in family therapy is that conscious acceptance of the known facts, intolerable though they may appear to be, tends to improve rather than worsen relationships” (p. 140). There are some similarities between the AID and adoption situations which have been outlined elsewhere [4] and revolve around the deception element. There is also concern that AID offspring will become a pressure group demanding access to information about their donor fathers, and that if blocked, these adults may experience similar serious detrimental effects which many adoptees encountered. For AID adults the search would be even more frustrating because records of the donor fathers of many children have already been destroyed [5]. Currently we are also committing the same error which those in control of adoption previously committed. This is the infantalizing of the AID offspring. We always refer to them as children, thus allocating to ourselves the right to decide what is best for them. But like adoptees, AID offspring will eventually be adults like you and me, who will have definite opinions about their rights. The issue at stake here is the one at the base of the adoption model: does every
392
ROBYN ROWLAND
human adult have the right to know the origin of their conception. As with the question ‘does every adult have the right to take their own life’, we continue to avoid seeking discussion and consensus on such moral points. The differences between adoption and AID can also be clarified without invalidating the similarities. First, in AID one parent is the biological mother. In the studies I have been conducting, most women using AID prefer it to adoption for this reason: they want to experience pregnancy, bonding and ‘natural’ motherhood. However, because one parent is a birth parent in AID, the balance in the marriage dyad differs from that in adopting couples. There is an imbalance built into the relationship between mother, social father and AID child. This may or may not cause stress, though the psychological literature would indicate that for some couples this may come to represent a differential power dimension with potential for conflict. The position of the donor is also different to that of a biological father in the adoption situation. The donor has become involved, not through a relationship with the mother, but at the specific request of a hospital or physician to donate sperm to be available to an unknown woman. The definition of this responsibility can be debated, but he has donated on the understanding that his donation is the limit of this involvement in the procedure. With this background in mind I want now to discuss the secrecy issue as it relates to the three parties involved. THE
RECIPIENT
COUPLE’S
EXPERIENCE
AID couples have been an invisible group and therefore a silent group. Because of the secrecy element it has been impossible to research the impact of an AID child on the marital or family relationship.
The following material is the result of on-going research with AID couples in the Melbourne Family Medical Centre (MFMC) programme. The experiences of the recipient couple with a fertility problem begin long before they enter the programme and involves the discovery of the husband’s infertility and years of wearying medical testing which often reduces self-esteem, increases frustration and interferes with the sexual life of the couple. I have outlined these in a previous paper [7], and will limit discussion here to the issue of secrecy from the viewpoint of the couple. First, do couples want secrecy? One follow-up of 50 couples at Prince Henry’s Hospital by Clayton and Kovacs [6] indicated that 14% of couples will tell their child of his/her origins; 68% will not tell; and 18”; were unsure. In my current study of 93 couples to date, 9% intend to tell; 56”,/, intend not to tell; and 35% are unsure (see Table 1). I must point out however, that the two groups differ in that Clayton and Kovac’s group were AID parents with a child aged 12-36 months, and my group were just entering the AID programme. Furthermore, the Prince Henry’s group would have had some social work counselling, whereas the MFMC group had no counselling. In the MFMC group all couples were unsure about how and when a child could be told, and felt unsure about what information they would have available to them to disclose to the child. When asked what they would do if the child became suspicious and asked about his/her origin, 27% replied that they would tell the child the truth: 24% would give evasive answers; and 47% did not know what they would say. In a further question allowing open-ended responses, couples were asked to express their attitudes toward telling the child: 29% did not answer; 4O”/b said it would be best if the child did not know because they feared social stigma for the child or the child’s rejection of the social father; 7% felt the child had a
Table I. Responses of couples on questions relatmg to secrecy (in percentages)
Will the couple tell the child? Clqm and Kotacs [6] Will tell Will nor tell Not sure Rowlund [7] Will tell Will nor tell UllSUrc If child asks questmns. suspicious of AID origin. what would you do’! Tell the truth Give evasive answer Don’t know What are your attitudes to telling the child (open-ended)? -Best left alone because of fears of social stigma and fear of rejectmn by child of social father --Child has a right to know -Hope sltuatmn never arises but will tell if necessary -Depending on matunty of child. but probably would tell Have you told anyone of your involvement in AID’? Yes NO If Yes, how many people have you told? 7
14 68 18 9 56 35
27 24 47 40
IO I3 59 36 4 32 33 35
Consequences
of secrecy
right to know; 13% said that depending on the maturity of the child, they probably would end up telling him/her; and 10% hope the situation never arises, but will tell if necessary. We can see that there is considerable confusion and uncertainty in these responses. Also, there emerges a distinction in the minds of couples between volunteering the knowledge of origin to the child and waiting until the child asks questions. Overall, roughly half the group are adamantly against telling the child under any conditions and roughly half are unsure but see a possible time when they feel they will have to disclose. A clear 9% intend to disclose the information. We could assume that if people intend never to tell the child, they will in fact have told no-one else of their involvement in AID. Couples were asked to list those who know of their involvement: 59% had told someone; 367, recorded they had told no-one; and 4% did not reply. Of those who had discussed their involvement: 32% had told 1 or 2 people; 33% had told 3-6 people; and 357; had told over 7 people. These involved both sides of the family and close friends. Couples were replying to individual questionnaires and interviews separately, and 14 couples differed in their responses: one partner indicating they had discussed it with one or two people, and the other told no-one and assumed no-one knew. There is potential conflict between partners in this situation. When asked if they were worried that one of their confidants might disclose the secret to the child, all couples expressed complete trust in the confidants. Yet the adoption experience indicates that in the secrecy situation of the past, it was often the confidant who disclosed information; and this often came after the death of a parent, leaving the offspring no means of discussing it with the parent and receiving their explanation. Furthermore, spouses place great trust in each other which can also be misplaced. The most likely times of disclosure of a secret such as this are those periods in the family life-cycle which are called transition periods. such as adolescence, a marriage of offspring or birth of grandchildren. It is particularly the adolescent period in which identity becomes an issue for the first time, when tension peaks between parents and offspring. In a heated argument, one parent may disclose the AID origin, which would be one of the worst scenarios [8]. The second question is, why wouldparents want to maintain secrecy? One answer relates to the husband’s infertility and the desire on the part of most couples to hide it. Our society has unfortunately equated virility with fertility in men, with the concomitant assumption that infertility is somehow more devasting for men than for women. No evidence supports this assumption, yet many of the women are prepared to let people think infertility is their problem in order to protect their husband’s feelings. Most counselling of AID couples should begin at this point. helping the man to find a new definition of self based on his worth as a person and not only as a generative being. The issue is unlikely to be resolved ia that it will be a recurring grief at times throughout the life-span. Both parents and childfree people have been found to experience periods of regret over their
in AID programmes
393
decisions at transition points in their lives, and the infertile person is likely to have similar periods of regret [9], but if the couple understand that acceptance of infertility is a process and not a static state, they will be unafraid to discuss it and cope with the reappearing feelings. Secrecy for this reason then becomes less urgent. Part of the desire for secrecy is related also to the issue of ‘ownership’ of children and the line of inheritance, particularly when the AID couples’ own parents are concerned. They often fear the grandparents’ rejection of the child. Our society needs to create a new caring-oriented definition of parenthood: a parent is the one who rears and cares for a child. Couples also want to protect the child from social disapproval as the current MFMC study indicates. This concern indicates that AID couples themselves feel there is something ‘not quite right’ about using AID. We are currently uncertain about society’s attitudes to AID, and as the Wailer Committee Report [lo] points out, a large-scale education programme is needed in this direction. But the continued secrecy about AID will only serve to reinforce any taboos or negative attitudes towards it, in much the same way as sexuality was once taboo. We have learned that if a behaviour needs to be kept secret and hidden, there must be something wrong or unclean about it. Couples are also concerned that the child may respond negatively to knowledge of their origin and may blame the parents or reject their social father. Again, the father is really the centre of this intended protection. However, it is clear from the adoption literature that this reaction is more likely to come from an adolsescent who ‘discovers’ their origin, rather than from the young child who grows up with this knowledge, and with the experience of a loving social father. The stress experienced by couples who try to maintain this secrecy can only be suggested at this point because there are no follow-up studies which assess the impact of an AID child on a marriage. In the study of their 50 couples, Clayton and Kovacs [6] commented that no emotional problems were apparent, though no adequate assessment was conducted. They do, however, note that “all wives were anxious about their husband’s reaction to the child, but only four admitted having any problems. Two of the wives felt that the husband was overprotective. one husband felt the child was a constant reminder of his infertility. One wife telephoned after the interview to say that she thought her husband had not accepted the child” (p. 338).
They concluded that some interpersonal problems in the family unit had been encountered. Until we have further follow-up studies with the active co-operation of couples, this area will continue to be one of speculation and concern. A major reason why many parents are unsure about telling the child is the fact that we have no scripts for this disclosure: no way of explaining AID to them. Most parents find explanations of sexuality difficult enough. Furthermore, if the child is told. she/he may want to know some information about their donor parent, and this will not be possible for those whose donor records have been destroyed, and
394
ROBKN ROWLAND Table 2. Biographical information
on the 67 AID donors 01 0
Age range: 19-49 years Median age: 31 years Marital status Married Separated;divorced Singlvcohabiting Single/alone Socio-economic group by occupation Upper class Middle class Student Other Religion
34 8 24 34 7 58 30 5
Nil Protestant Catholic Other Educational level reached Lower high school
58 16 15 9
Higher school certificate University degree Diploma Post-graduate work Donors who are fathers
29 37 9 13 35
6
for all future children unless the laws are clarified with respect to donor registration. THE DONOR’S
EXPERIENCE
This discussion arises from a study of 67 donors at Queen Victoria Hospital. Table 2 indicates the biographical picture of the group, 27 of which had donated in the last 12 months, while the remaining 40 were current donors. I will restrict discussion of the results to the issue of secrecy. Again, the question is, do donors want secrecy? All donors entered the AID programme on the written understanding that their anonymity would be protected. The medical profession has always been concerned that should anonymity not be provided, men would no longer donate. Since the current discussions have been underway, a number of past donors have become anxious that their anonymity will not in fact be protected, and are concerned that as the law now stands, they are the legal father of their AID offspring. Table 3 shows the responses of donors to the questions in this study concerning secrecy. A majority felt that their names should not be given automatically to recipient couples, but 42% of them would still donate if their names were available. Over threequarters of the group had told friends and family that they are donors. Eighty-two per cent would not object if non-identifying information such as OCcupation, education and hobbies, were given to the couple, but about three-quarters of the group had no desire to meet either the mother or father in the couple. (This feeling is reciprocated by the couples who have no desire to meet donors.) When asked about records being kept, half of the donors indicated they would like non-identifying information kept and half specified they would not like records destroyed. In interviews I conducted following the questionnaire, donors were not adverse to the idea of a national register where non-identifying, and possibly identifying information could be kept. Many donors
felt that the issue had not been adequately discussed with them, and that they had no real opportunity to develop a view on many of the important issues. Their attitudes were split over their own desire to know of their origins should they be an AID adult: 549; said they would want to know; 34”, said no; and 129, were unsure. Most would like to know if a child were conceived using their sperm. Furthermore. in spite of the fact that donors are specifically selected by technicians only if they show 110 interest in the potential offspring, 480; said they would or did feel a connection with their offspring. It is perhaps this sense of social responsibility in donors which we should be encouraging, not discouraging. Perhaps the most astonishing finding was that 60”, of donors would not mind if their AID offspring contacted them after the age of 18, in order to discuss family background and so on. (However. the 40”” who did not support this should not be ignored.) In general, these results tell us that although concerned and wary, donors are not as desperate about having absolutely no contact with the child and about having no information about them relayed to the family as was previously thought. However, it is also clear that there are in fact three groups of donors whose attitudes may differ, and who may need to be considered separately if the Waller Committee’s suggestion of a central registry is established. Past donors entered AID programmes under different conditions to those of current donors, and certainly to those of future donors. Some hospitals are disposing of records now, and are ready to dispose of all past donor records before legislation is introduced requiring them to maintain such records. Their reasons for this are clearly that the records of past donors should be treated as standard medical records, with confidentiality. However, some past donors may have no objection to non-identifying information being collected now and kept for their offspring. Future donors should be clearly informed that this will in all probability be standard procedure, and that their names may also be kept in a central registry. If counselled adequately, donors can then make an educated decision about donating, which is the healthiest situation. It is, in fact, possible to satisfy the needs and anxieties of all parties if we are careful and specific in the legal context. The primary concern of donors for secrecy revolves around two main issues. First, they do not want to be legally liable for their AID children, nor do they want these children to be able to claim inheritance rights. This is currently the case. but soon will be legally rectified, so that the social father is the legal father. Second, some are concerned about possible disruption to their normal’ families, should a number of their AID offspring have direct access to them. A number of donors suggested that this could be protected by the central registry where access can only be granted by mutual consent. Notable also was the fact that if donors had not told their wives of their involvement. they were concerned about repercussions within their marriage if their wives found out. From discussions with both donors and couples it is clear that neither have a desire for contact with the other party. However. donors and about half the couples seem to realize that the offspring may have
Consequences Table
395
of secrecy in AID programmes
3. Responses ol- donors to qnesuons
relating to secrecy tflgures are percentages)
couples receive the name of the donor? Yes N” Unsure Would you still donate if your name were available to parents‘! Yes NO U”S”K Have you told anyone of your donation? Yes. these were: Personal friends Parents Frtends at work Others Would you mind if details of your occupation, education and hobbies (hut nor your name) were given to the couple receiving your sperm? Yes NO Would you like to meet the AID mother? Yes NO U”S”K Would you like to meet the AID father? Yes NO Unsure Would you like the records of donors destroyed except for non-identifying information? Not destroyed Non-identifying only kept U”S”K If you had been conceived by AID would you want to know about the donor? Yes NO Unsure Would you like to know if a child is born using your sperm? Yes NO Would you feel any connection with that child? Should
Yes NO Would
42 52 6 77 40 I5 IO 12
18 82 22 70 8 I5 77 8
46 46 8
54 34 I2 81 I9 48 48
you mind if your AID child contacted you after the age of 18. e.g. to find out about your family tree? Yes No
differing opinions, and many are unsure but would like to leave options available. As one donor commented: “I made a contract with the couple that we should never meet. but the child made no such contract” [ 1I]. THE OFFSPRING
I5 75 IO
EXPERIENCE
We currently have little knowledge of the possible attitudes and opionions of AID ol?spring. In Austraha the first hospital generation of these children is only 5- to 8-years old. In America, some adults are discovering their parentage under the worst conditions: in their mature years with one parent deceased. Their frustration and anger has an .obvious source. The most well-publicized of these adults is Suzanne Rubin [12] who has written: “Artificial insemination sounds wonderful in the textbooks, but what it can do to human lives is something else. By encouraging verl young. very immature and very shortstghted males to become sperm donors. you are creating countless triads of husband and wife and donor. Unfortunately the missing component is the child. No one considers how the child feels when she finds that her natural father was a 95 cup of sperm. The fantasies revolve around
40 60
what the donor was thinking of while he was filling the cup. There is no passion, no human contact in such a union; just cold calculation and manipulation of another person’s life. And for those of you who feel that a healthy family relationship can be built around a foundation of deliberate lies, I would wonder what fantasy land you have been living in”. Clamar [13] on the other hand, cites an adult who knew of her origins from childhood on, and writes: “Knowing about my AID origin did nothing to alter my feelings for my family. Instead I felt grateful for the trouble they had taken to give me life. And they had given me such a strong set of roots, a rich and colourful heritage, a sense of being loved. With their adventure in biology, my parents ‘had opened up the fairly rigid culture they had brought with them to this country. The secret knowledge of my ‘differentness’ and my sister’s may have helped our parents accept.. the few deviations from their norms that we argued for”. CONCLUDING
COMMENTS
Discussion of ‘protection’ and ‘rights’ is not I think a useful approach, and perhaps a better one is to consider how best we can improve a currently stressful situation for all parties concerned. We can begin
396
ROBYN
this process by listening and discussing the issues with those most intimately concerned. In fact we need urgently the active co-operation of recipient couples in research in this area. Clarity is also of paramount importance in these discussions. For example, the Waller Committee has supported the July 1980 Standing Committee of Commonwealth and State Attorneys-General’s recommendations that the social father will be deemed the father of AID offspring. But how will this be enacted. Hopefully, it does not mean that the social father’s name will be placed on the birth certificate as is currently the case, thus falsifying the document and building deception into the law. The Committee also rightly emphasizes the need for counselling for all people involved in AID, but again hog: can we ensure that this is carried out: what mechanisms are to be created? AID does in fact effect UN parents and children in our community now. The issue of having access to information on the origins of our conception is relevant to all children born of this generation onwards. If birth certificates continue to be falsified, it intrudes on the lives of all children and thus adults, because all children will be open to doubt about their parentage. No parent will be able to prove parentage of their child via birth certificates, as these are fraudulent in the cases of donor sperm and donor ova. Distrust will be built into the relationship between all parents and children unless the legal tracing of the origin of conception is possible. In the future, many ways of creating a family will be possible: adoption, IVF, AID, donor ova and donor embryos will be used. We should be changing our lessons on sexuality for children to include the fact that not all adults will be fertile and there are options available now for creating families in other ways. Although I am sympathetic with some concerns expressed in the Dissenting Statement by Dr Harman from the Wailer Committee, I object strongly to the term ‘synthetic child’ which is continuously used there [14]. The means may be synthetic: but the child is not, nor will the adult be. This kind of statement leads only to a sense of guilt which the child is asked to carry. AID is here to stay, and it is best that we construct programmes which serve the needs of infertile
ROWLAND
couples. AID-conceived people. donors and the rest of the community. in a caring way. while eliminating the secrecy. guilt and therefore aura of indecency and taboo which surround it. Ackno~rle~gemenrs-This research was funded by the Deakin Foundation and Deakin University. It was carried out with the kind co-operation of Professor John Lerton. Melbourne Family Medical Centre. and with the research assistance of Angela Coughlan
REFERENCES
1. Sants H. Genealogical bewilderment in children with substitute parents. Br. J. med. PsychoI. 37, 133-141.
1964. Berger D. Reply on anonymity and donor insemination.
6. 7.
8. 9.
IO.
Am. J. Psychiar. 138, 262. 1981. McWinnie A. Adopted Children. HON They Grow 19. Routledge & Kegan Paul. London. 1967. Brandon J. and Warner J. AID & adoption: some comparisons. Br. J. sot. Wk 7 (3). 1977. Saunders D. Assessment of the infertile couple for AID. In Artificial Insemination by Donor (Edited by Wood C.. Leeton J. and Kovacs G.). Monash University Press. Melbourne, 198 1. Clayton C. and Kovacs G. AID offspring. Initial follow-up study of 50 couples. Med. J. Aust. 338-339. 1982. Rowland R. The complexity of psychological issues involved in artificial insemination by donor. Under editorial review, 1983. Brandon J. Telling the AID child. Adoptn Fosrering 95, 13-14, 1979. Rowland R. The childfree experience in the aging context: an investigation of the pro-natahst bias of life-span developmental literature. Ausf. Psycho/. 17. 141-150, 1982; Childfree Parents. Res. In progress. Wailer L. (Chairman) Report of Committee to Consider the Social, Ethical and Legal Issues Arising from In Vitro Fertilization, Melbourne, 1983.
Il. Rowland R. Attitudes and opinions of donors on an Artificial Insemination by Donor (AID) Programme. Clin. Reprod. Fertility 2, 1983. S. Letter to the Editor, School Paper, CSU. Northbridge, Calif., 1983. 13. Clamar A. Psychological implications of donor insemination. Am. J. Psychoanalysis 40, 1980. 14. Harman F. Dissenting Statement on the employment of donor gametes by Rev. Dr Francis Harman. Appendix A, Wailer Committee Report, see Ref. [IO].
12. Rubin
0277-9536/85 S3.00 + 0.00 Pergamon Press Ltd
1985
THE SOCIAL AND PSYCHOLOGICAL CONSEQUENCES OF SECRECY IN ARTIFICIAL INSEMINATION BY DONOR (AID) PROGRAMMES ROBYN ROWLAND* School
of Humanities,
Deakin
University,
Victoria
3217, Australia
Abstract-The assumption that secrecy is of paramount importance in AID programmes has arisen in order to protect the three parties involved: donor, recipient couple and offspring. Due to the uncertain legal position. the medical profession has also been concerned to protect itself against possible litigation. Recent calls for an abolition of all secrecy have been motivated by the knowledge and experience of workers in the field of adoption. The similarities and differences between adoption and AID as ways of creating a family are discussed, with the resulting conclusion that, although the two have much in common they do present different experiences and problems for parents and offspring. The experiences of donors and recipient couples are then discussed based on data gathered to date from 67 donors and 93 couples in an AID programme at the Melbourne Family Medical Centre. It is stressed that many statements in the past regarding secrecy have not been informed by the opinions and intentions of participants themselves. and further information is needed in this area. Furthermore, it is clear that all members of a society are affected by the codes of secrecy currently operating an.d the ‘rights’ of all members of that society need to be considered.
The assumption that secrecy is of paramount importance in AID programmes has arisen in order to protect the three parties involved: recipient couple, donor and offspring. This secrecy has been supported by the medical profession because of its own fears concerning possible legal liability and because of what it considers to be binding agreements of anonymity with both donors and couples. The current discussion of secrecy often uses the adoption system as a model. In the past, adopted babies were secretly acquired by parents who often never revealed to the offspring any information regarding their adoptee status or their origins. In most cases. adopting couples knew nothing of the child’s birth parents. This secrecy in adoption resulted in some adult adoptees undertaking a painful and frustrating search for their birth parents. They experienced what Sants [I] called ‘adoption stress’, a factor of which is ‘genealogical bewilderment’. Sants described the genealogically bewildered child as one who either has no knowledge of or only uncertain knowledge of his ‘her birth parents. The confusion and uncertainty which this creates in the child can fundamentally undermine his/her security of self and mental health. For some it may become an obsessional search. The resulting possible disappointment if the birth parent fails to ‘measure up’ and the frustration and despair experienced if the search is impeded or unsuccessful, can prove undermining for the individual. The reasons adoptees were not told of their origins revolved around social taboos of the time. Children were often ‘illegitimate’. Young girls were forced by social pressure and lack of social supports to relinquish babies conceived out of wedlock; and were often financially pressured to relinquish within wed*Currently:
Visiting Research Fellow. Institute
lation Studies. University De\on. England.
of Exeter.
Exeter
of PopuEX4 6DT.
391
lock. Secrecy was intended to protect the child from the dark knowledge of her/his origins, and so avoid social stigma. In fact, the feeling of having been ‘abandoned’ often motivated those who discovered their adopted status to search for the answer to the question ‘why did you abandon me’ [2]. After increasing pressure from both adoptees of adult status and currently adopting parents, this situation has changed, and most adopting couples are now given extensive information on the child’s birth parents and are counselled to tell the child in his/her early years that he/she is adopted. Research in adoption has indicated that this is a psychologically healthier situation for offspring, relinquishing parents and adopting parents [3]. As Sants has commented: “A principle in common use in family therapy is that conscious acceptance of the known facts, intolerable though they may appear to be, tends to improve rather than worsen relationships” (p. 140). There are some similarities between the AID and adoption situations which have been outlined elsewhere [4] and revolve around the deception element. There is also concern that AID offspring will become a pressure group demanding access to information about their donor fathers, and that if blocked, these adults may experience similar serious detrimental effects which many adoptees encountered. For AID adults the search would be even more frustrating because records of the donor fathers of many children have already been destroyed [5]. Currently we are also committing the same error which those in control of adoption previously committed. This is the infantalizing of the AID offspring. We always refer to them as children, thus allocating to ourselves the right to decide what is best for them. But like adoptees, AID offspring will eventually be adults like you and me, who will have definite opinions about their rights. The issue at stake here is the one at the base of the adoption model: does every
392
ROBYN ROWLAND
human adult have the right to know the origin of their conception. As with the question ‘does every adult have the right to take their own life’, we continue to avoid seeking discussion and consensus on such moral points. The differences between adoption and AID can also be clarified without invalidating the similarities. First, in AID one parent is the biological mother. In the studies I have been conducting, most women using AID prefer it to adoption for this reason: they want to experience pregnancy, bonding and ‘natural’ motherhood. However, because one parent is a birth parent in AID, the balance in the marriage dyad differs from that in adopting couples. There is an imbalance built into the relationship between mother, social father and AID child. This may or may not cause stress, though the psychological literature would indicate that for some couples this may come to represent a differential power dimension with potential for conflict. The position of the donor is also different to that of a biological father in the adoption situation. The donor has become involved, not through a relationship with the mother, but at the specific request of a hospital or physician to donate sperm to be available to an unknown woman. The definition of this responsibility can be debated, but he has donated on the understanding that his donation is the limit of this involvement in the procedure. With this background in mind I want now to discuss the secrecy issue as it relates to the three parties involved. THE
RECIPIENT
COUPLE’S
EXPERIENCE
AID couples have been an invisible group and therefore a silent group. Because of the secrecy element it has been impossible to research the impact of an AID child on the marital or family relationship.
The following material is the result of on-going research with AID couples in the Melbourne Family Medical Centre (MFMC) programme. The experiences of the recipient couple with a fertility problem begin long before they enter the programme and involves the discovery of the husband’s infertility and years of wearying medical testing which often reduces self-esteem, increases frustration and interferes with the sexual life of the couple. I have outlined these in a previous paper [7], and will limit discussion here to the issue of secrecy from the viewpoint of the couple. First, do couples want secrecy? One follow-up of 50 couples at Prince Henry’s Hospital by Clayton and Kovacs [6] indicated that 14% of couples will tell their child of his/her origins; 68% will not tell; and 18”; were unsure. In my current study of 93 couples to date, 9% intend to tell; 56”,/, intend not to tell; and 35% are unsure (see Table 1). I must point out however, that the two groups differ in that Clayton and Kovac’s group were AID parents with a child aged 12-36 months, and my group were just entering the AID programme. Furthermore, the Prince Henry’s group would have had some social work counselling, whereas the MFMC group had no counselling. In the MFMC group all couples were unsure about how and when a child could be told, and felt unsure about what information they would have available to them to disclose to the child. When asked what they would do if the child became suspicious and asked about his/her origin, 27% replied that they would tell the child the truth: 24% would give evasive answers; and 47% did not know what they would say. In a further question allowing open-ended responses, couples were asked to express their attitudes toward telling the child: 29% did not answer; 4O”/b said it would be best if the child did not know because they feared social stigma for the child or the child’s rejection of the social father; 7% felt the child had a
Table I. Responses of couples on questions relatmg to secrecy (in percentages)
Will the couple tell the child? Clqm and Kotacs [6] Will tell Will nor tell Not sure Rowlund [7] Will tell Will nor tell UllSUrc If child asks questmns. suspicious of AID origin. what would you do’! Tell the truth Give evasive answer Don’t know What are your attitudes to telling the child (open-ended)? -Best left alone because of fears of social stigma and fear of rejectmn by child of social father --Child has a right to know -Hope sltuatmn never arises but will tell if necessary -Depending on matunty of child. but probably would tell Have you told anyone of your involvement in AID’? Yes NO If Yes, how many people have you told? 7
14 68 18 9 56 35
27 24 47 40
IO I3 59 36 4 32 33 35
Consequences
of secrecy
right to know; 13% said that depending on the maturity of the child, they probably would end up telling him/her; and 10% hope the situation never arises, but will tell if necessary. We can see that there is considerable confusion and uncertainty in these responses. Also, there emerges a distinction in the minds of couples between volunteering the knowledge of origin to the child and waiting until the child asks questions. Overall, roughly half the group are adamantly against telling the child under any conditions and roughly half are unsure but see a possible time when they feel they will have to disclose. A clear 9% intend to disclose the information. We could assume that if people intend never to tell the child, they will in fact have told no-one else of their involvement in AID. Couples were asked to list those who know of their involvement: 59% had told someone; 367, recorded they had told no-one; and 4% did not reply. Of those who had discussed their involvement: 32% had told 1 or 2 people; 33% had told 3-6 people; and 357; had told over 7 people. These involved both sides of the family and close friends. Couples were replying to individual questionnaires and interviews separately, and 14 couples differed in their responses: one partner indicating they had discussed it with one or two people, and the other told no-one and assumed no-one knew. There is potential conflict between partners in this situation. When asked if they were worried that one of their confidants might disclose the secret to the child, all couples expressed complete trust in the confidants. Yet the adoption experience indicates that in the secrecy situation of the past, it was often the confidant who disclosed information; and this often came after the death of a parent, leaving the offspring no means of discussing it with the parent and receiving their explanation. Furthermore, spouses place great trust in each other which can also be misplaced. The most likely times of disclosure of a secret such as this are those periods in the family life-cycle which are called transition periods. such as adolescence, a marriage of offspring or birth of grandchildren. It is particularly the adolescent period in which identity becomes an issue for the first time, when tension peaks between parents and offspring. In a heated argument, one parent may disclose the AID origin, which would be one of the worst scenarios [8]. The second question is, why wouldparents want to maintain secrecy? One answer relates to the husband’s infertility and the desire on the part of most couples to hide it. Our society has unfortunately equated virility with fertility in men, with the concomitant assumption that infertility is somehow more devasting for men than for women. No evidence supports this assumption, yet many of the women are prepared to let people think infertility is their problem in order to protect their husband’s feelings. Most counselling of AID couples should begin at this point. helping the man to find a new definition of self based on his worth as a person and not only as a generative being. The issue is unlikely to be resolved ia that it will be a recurring grief at times throughout the life-span. Both parents and childfree people have been found to experience periods of regret over their
in AID programmes
393
decisions at transition points in their lives, and the infertile person is likely to have similar periods of regret [9], but if the couple understand that acceptance of infertility is a process and not a static state, they will be unafraid to discuss it and cope with the reappearing feelings. Secrecy for this reason then becomes less urgent. Part of the desire for secrecy is related also to the issue of ‘ownership’ of children and the line of inheritance, particularly when the AID couples’ own parents are concerned. They often fear the grandparents’ rejection of the child. Our society needs to create a new caring-oriented definition of parenthood: a parent is the one who rears and cares for a child. Couples also want to protect the child from social disapproval as the current MFMC study indicates. This concern indicates that AID couples themselves feel there is something ‘not quite right’ about using AID. We are currently uncertain about society’s attitudes to AID, and as the Wailer Committee Report [lo] points out, a large-scale education programme is needed in this direction. But the continued secrecy about AID will only serve to reinforce any taboos or negative attitudes towards it, in much the same way as sexuality was once taboo. We have learned that if a behaviour needs to be kept secret and hidden, there must be something wrong or unclean about it. Couples are also concerned that the child may respond negatively to knowledge of their origin and may blame the parents or reject their social father. Again, the father is really the centre of this intended protection. However, it is clear from the adoption literature that this reaction is more likely to come from an adolsescent who ‘discovers’ their origin, rather than from the young child who grows up with this knowledge, and with the experience of a loving social father. The stress experienced by couples who try to maintain this secrecy can only be suggested at this point because there are no follow-up studies which assess the impact of an AID child on a marriage. In the study of their 50 couples, Clayton and Kovacs [6] commented that no emotional problems were apparent, though no adequate assessment was conducted. They do, however, note that “all wives were anxious about their husband’s reaction to the child, but only four admitted having any problems. Two of the wives felt that the husband was overprotective. one husband felt the child was a constant reminder of his infertility. One wife telephoned after the interview to say that she thought her husband had not accepted the child” (p. 338).
They concluded that some interpersonal problems in the family unit had been encountered. Until we have further follow-up studies with the active co-operation of couples, this area will continue to be one of speculation and concern. A major reason why many parents are unsure about telling the child is the fact that we have no scripts for this disclosure: no way of explaining AID to them. Most parents find explanations of sexuality difficult enough. Furthermore, if the child is told. she/he may want to know some information about their donor parent, and this will not be possible for those whose donor records have been destroyed, and
394
ROBKN ROWLAND Table 2. Biographical information
on the 67 AID donors 01 0
Age range: 19-49 years Median age: 31 years Marital status Married Separated;divorced Singlvcohabiting Single/alone Socio-economic group by occupation Upper class Middle class Student Other Religion
34 8 24 34 7 58 30 5
Nil Protestant Catholic Other Educational level reached Lower high school
58 16 15 9
Higher school certificate University degree Diploma Post-graduate work Donors who are fathers
29 37 9 13 35
6
for all future children unless the laws are clarified with respect to donor registration. THE DONOR’S
EXPERIENCE
This discussion arises from a study of 67 donors at Queen Victoria Hospital. Table 2 indicates the biographical picture of the group, 27 of which had donated in the last 12 months, while the remaining 40 were current donors. I will restrict discussion of the results to the issue of secrecy. Again, the question is, do donors want secrecy? All donors entered the AID programme on the written understanding that their anonymity would be protected. The medical profession has always been concerned that should anonymity not be provided, men would no longer donate. Since the current discussions have been underway, a number of past donors have become anxious that their anonymity will not in fact be protected, and are concerned that as the law now stands, they are the legal father of their AID offspring. Table 3 shows the responses of donors to the questions in this study concerning secrecy. A majority felt that their names should not be given automatically to recipient couples, but 42% of them would still donate if their names were available. Over threequarters of the group had told friends and family that they are donors. Eighty-two per cent would not object if non-identifying information such as OCcupation, education and hobbies, were given to the couple, but about three-quarters of the group had no desire to meet either the mother or father in the couple. (This feeling is reciprocated by the couples who have no desire to meet donors.) When asked about records being kept, half of the donors indicated they would like non-identifying information kept and half specified they would not like records destroyed. In interviews I conducted following the questionnaire, donors were not adverse to the idea of a national register where non-identifying, and possibly identifying information could be kept. Many donors
felt that the issue had not been adequately discussed with them, and that they had no real opportunity to develop a view on many of the important issues. Their attitudes were split over their own desire to know of their origins should they be an AID adult: 549; said they would want to know; 34”, said no; and 129, were unsure. Most would like to know if a child were conceived using their sperm. Furthermore. in spite of the fact that donors are specifically selected by technicians only if they show 110 interest in the potential offspring, 480; said they would or did feel a connection with their offspring. It is perhaps this sense of social responsibility in donors which we should be encouraging, not discouraging. Perhaps the most astonishing finding was that 60”, of donors would not mind if their AID offspring contacted them after the age of 18, in order to discuss family background and so on. (However. the 40”” who did not support this should not be ignored.) In general, these results tell us that although concerned and wary, donors are not as desperate about having absolutely no contact with the child and about having no information about them relayed to the family as was previously thought. However, it is also clear that there are in fact three groups of donors whose attitudes may differ, and who may need to be considered separately if the Waller Committee’s suggestion of a central registry is established. Past donors entered AID programmes under different conditions to those of current donors, and certainly to those of future donors. Some hospitals are disposing of records now, and are ready to dispose of all past donor records before legislation is introduced requiring them to maintain such records. Their reasons for this are clearly that the records of past donors should be treated as standard medical records, with confidentiality. However, some past donors may have no objection to non-identifying information being collected now and kept for their offspring. Future donors should be clearly informed that this will in all probability be standard procedure, and that their names may also be kept in a central registry. If counselled adequately, donors can then make an educated decision about donating, which is the healthiest situation. It is, in fact, possible to satisfy the needs and anxieties of all parties if we are careful and specific in the legal context. The primary concern of donors for secrecy revolves around two main issues. First, they do not want to be legally liable for their AID children, nor do they want these children to be able to claim inheritance rights. This is currently the case. but soon will be legally rectified, so that the social father is the legal father. Second, some are concerned about possible disruption to their normal’ families, should a number of their AID offspring have direct access to them. A number of donors suggested that this could be protected by the central registry where access can only be granted by mutual consent. Notable also was the fact that if donors had not told their wives of their involvement. they were concerned about repercussions within their marriage if their wives found out. From discussions with both donors and couples it is clear that neither have a desire for contact with the other party. However. donors and about half the couples seem to realize that the offspring may have
Consequences Table
395
of secrecy in AID programmes
3. Responses ol- donors to qnesuons
relating to secrecy tflgures are percentages)
couples receive the name of the donor? Yes N” Unsure Would you still donate if your name were available to parents‘! Yes NO U”S”K Have you told anyone of your donation? Yes. these were: Personal friends Parents Frtends at work Others Would you mind if details of your occupation, education and hobbies (hut nor your name) were given to the couple receiving your sperm? Yes NO Would you like to meet the AID mother? Yes NO U”S”K Would you like to meet the AID father? Yes NO Unsure Would you like the records of donors destroyed except for non-identifying information? Not destroyed Non-identifying only kept U”S”K If you had been conceived by AID would you want to know about the donor? Yes NO Unsure Would you like to know if a child is born using your sperm? Yes NO Would you feel any connection with that child? Should
Yes NO Would
42 52 6 77 40 I5 IO 12
18 82 22 70 8 I5 77 8
46 46 8
54 34 I2 81 I9 48 48
you mind if your AID child contacted you after the age of 18. e.g. to find out about your family tree? Yes No
differing opinions, and many are unsure but would like to leave options available. As one donor commented: “I made a contract with the couple that we should never meet. but the child made no such contract” [ 1I]. THE OFFSPRING
I5 75 IO
EXPERIENCE
We currently have little knowledge of the possible attitudes and opionions of AID ol?spring. In Austraha the first hospital generation of these children is only 5- to 8-years old. In America, some adults are discovering their parentage under the worst conditions: in their mature years with one parent deceased. Their frustration and anger has an .obvious source. The most well-publicized of these adults is Suzanne Rubin [12] who has written: “Artificial insemination sounds wonderful in the textbooks, but what it can do to human lives is something else. By encouraging verl young. very immature and very shortstghted males to become sperm donors. you are creating countless triads of husband and wife and donor. Unfortunately the missing component is the child. No one considers how the child feels when she finds that her natural father was a 95 cup of sperm. The fantasies revolve around
40 60
what the donor was thinking of while he was filling the cup. There is no passion, no human contact in such a union; just cold calculation and manipulation of another person’s life. And for those of you who feel that a healthy family relationship can be built around a foundation of deliberate lies, I would wonder what fantasy land you have been living in”. Clamar [13] on the other hand, cites an adult who knew of her origins from childhood on, and writes: “Knowing about my AID origin did nothing to alter my feelings for my family. Instead I felt grateful for the trouble they had taken to give me life. And they had given me such a strong set of roots, a rich and colourful heritage, a sense of being loved. With their adventure in biology, my parents ‘had opened up the fairly rigid culture they had brought with them to this country. The secret knowledge of my ‘differentness’ and my sister’s may have helped our parents accept.. the few deviations from their norms that we argued for”. CONCLUDING
COMMENTS
Discussion of ‘protection’ and ‘rights’ is not I think a useful approach, and perhaps a better one is to consider how best we can improve a currently stressful situation for all parties concerned. We can begin
396
ROBYN
this process by listening and discussing the issues with those most intimately concerned. In fact we need urgently the active co-operation of recipient couples in research in this area. Clarity is also of paramount importance in these discussions. For example, the Waller Committee has supported the July 1980 Standing Committee of Commonwealth and State Attorneys-General’s recommendations that the social father will be deemed the father of AID offspring. But how will this be enacted. Hopefully, it does not mean that the social father’s name will be placed on the birth certificate as is currently the case, thus falsifying the document and building deception into the law. The Committee also rightly emphasizes the need for counselling for all people involved in AID, but again hog: can we ensure that this is carried out: what mechanisms are to be created? AID does in fact effect UN parents and children in our community now. The issue of having access to information on the origins of our conception is relevant to all children born of this generation onwards. If birth certificates continue to be falsified, it intrudes on the lives of all children and thus adults, because all children will be open to doubt about their parentage. No parent will be able to prove parentage of their child via birth certificates, as these are fraudulent in the cases of donor sperm and donor ova. Distrust will be built into the relationship between all parents and children unless the legal tracing of the origin of conception is possible. In the future, many ways of creating a family will be possible: adoption, IVF, AID, donor ova and donor embryos will be used. We should be changing our lessons on sexuality for children to include the fact that not all adults will be fertile and there are options available now for creating families in other ways. Although I am sympathetic with some concerns expressed in the Dissenting Statement by Dr Harman from the Wailer Committee, I object strongly to the term ‘synthetic child’ which is continuously used there [14]. The means may be synthetic: but the child is not, nor will the adult be. This kind of statement leads only to a sense of guilt which the child is asked to carry. AID is here to stay, and it is best that we construct programmes which serve the needs of infertile
ROWLAND
couples. AID-conceived people. donors and the rest of the community. in a caring way. while eliminating the secrecy. guilt and therefore aura of indecency and taboo which surround it. Ackno~rle~gemenrs-This research was funded by the Deakin Foundation and Deakin University. It was carried out with the kind co-operation of Professor John Lerton. Melbourne Family Medical Centre. and with the research assistance of Angela Coughlan
REFERENCES
1. Sants H. Genealogical bewilderment in children with substitute parents. Br. J. med. PsychoI. 37, 133-141.
1964. Berger D. Reply on anonymity and donor insemination.
6. 7.
8. 9.
IO.
Am. J. Psychiar. 138, 262. 1981. McWinnie A. Adopted Children. HON They Grow 19. Routledge & Kegan Paul. London. 1967. Brandon J. and Warner J. AID & adoption: some comparisons. Br. J. sot. Wk 7 (3). 1977. Saunders D. Assessment of the infertile couple for AID. In Artificial Insemination by Donor (Edited by Wood C.. Leeton J. and Kovacs G.). Monash University Press. Melbourne, 198 1. Clayton C. and Kovacs G. AID offspring. Initial follow-up study of 50 couples. Med. J. Aust. 338-339. 1982. Rowland R. The complexity of psychological issues involved in artificial insemination by donor. Under editorial review, 1983. Brandon J. Telling the AID child. Adoptn Fosrering 95, 13-14, 1979. Rowland R. The childfree experience in the aging context: an investigation of the pro-natahst bias of life-span developmental literature. Ausf. Psycho/. 17. 141-150, 1982; Childfree Parents. Res. In progress. Wailer L. (Chairman) Report of Committee to Consider the Social, Ethical and Legal Issues Arising from In Vitro Fertilization, Melbourne, 1983.
Il. Rowland R. Attitudes and opinions of donors on an Artificial Insemination by Donor (AID) Programme. Clin. Reprod. Fertility 2, 1983. S. Letter to the Editor, School Paper, CSU. Northbridge, Calif., 1983. 13. Clamar A. Psychological implications of donor insemination. Am. J. Psychoanalysis 40, 1980. 14. Harman F. Dissenting Statement on the employment of donor gametes by Rev. Dr Francis Harman. Appendix A, Wailer Committee Report, see Ref. [IO].
12. Rubin