Hum. Reprod. Advance Access originally published online on June 22, 2007
Human Reproduction 2007 22(9):2566-2571; doi:10.1093/humrep/dem174
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Topic avoidance and family functioning in families conceived with donor insemination
School of Social Work, Adelphi University, 1 South Avenue, Garden City, NY 11530, USA
1 Correspondence address. Tel: +1-516-877-4365; Fax: +1-516-877-4392; E-mail: berger{at}adelphi.edu
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Abstract |
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BACKGROUND: While a move away from non-disclosure and secrecy toward more openness is demonstrated in the changing practices of donor insemination worldwide, scholars and practitioners continue to debate the effects of disclosure versus secrecy. This study examines if an association exists between adult donor offspring's perceptions of their parents' use of topic avoidance to maintain secrecy, and their perceptions of their family's functioning.
METHODS: Using a cross-sectional design, a convenience sample of 69 young adult donor offspring completed a demographic questionnaire, a topic avoidance scale relative to each of their rearing parents, and the Beavers Self Report Family Instrument.
RESULTS: There was a moderate significant inverse correlation between family functioning and topic avoidance in general, as well as for donor insemination-related topics, for both mothers (r = –0.55, r = –0.40, respectively, P 
0.01) and fathers (r = –0.53, r = –0.50, respectively, P 0.01), even after controlling for demographic variables. Disclosure by both parents jointly was associated with higher family functioning than disclosure under other circumstances.
CONCULSIONS: While this study is limited by the convenience sampling, the correlational design and measuring offspring's subjective perceptions, findings suggest that the information about donor conception should not be held secret from offspring and that the parents should disclose jointly.
Key words: family secrets/topic avoidance/donor insemination/family functioning/disclosure
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Introduction |
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The development of novel reproductive technologies presents ethical and professional challenges to infertility scholars and practitioners. Specifically, a debate was raised regarding the issue of disclosure of the circumstances of conception to offspring conceived by the practice of donor insemination. This strategy originated in the mid-twentieth century to circumvent male infertility by using semen from an anonymous sperm donor with similar physical attributes to a husband to inseminate the wife. The current debate includes cultural, political and social issues. Proponents of disclosure cite legal and ethical rights of children for information about their biological origins, changing social norms toward more openness in general, and protection from accidental disclosure. Proponents of non-disclosure express concerns regarding exposing the child to social and psychological turmoil following disclosure which may be disruptive to their development, as well as parental privacy issues [The Ethics Committee of the American Society for Reproductive Medicine (ASRM), 2004].
Historically, support for non-disclosure prevailed, as reflected by the 1993 recommendation of the ASRM (The Ethics Committee of the ASRM, 2004). According to this approach, couples were often encouraged to have intercourse immediately following insemination, resulting in ambiguity about the child's biological heritage, and supporting secrecy regarding the whole process (Klock and Maier, 1991
; Daniels, 2005).
With the growing societal tendency toward openness to sharing personal information in general (evidenced by the abundance of personal blogs), and relative to reproduction in particular (e.g. growing candidness in the field of adoption), as well as the increasing number of pregnancies created with the help of donor sperm and donor oocyte, and recognition of children's rights to knowledge about their genealogy, support for disclosure has increased. Furthermore, while use of donor insemination has often been considered a privacy issue for recipient parents, once a conception occurs, another individual (the child) becomes involved and thus, what was once considered the private information of the parents, i.e. the donor insemination, if not disclosed to the child, may become a family secret (Karpel, 1980).
Recent studies indicate a growing trend toward disclosure in families formed with donor insemination as well as donor oocyte (Golombok et al., 2004; Lycett et al., 2005; Nachtigall, 2005), with parents' plans to disclose to their children ranging from 46 to 75%, up significantly from percentages as low as 9% cited in previous studies (Daniels, 1988; Daniels et al., 1995; Klock and Maier, 1991). In the USA, the identity-release programs (e.g. at The Sperm Bank of California) that developed in the 1980's largely in response to requests from recipients who were single women and lesbian couples are now used by heterosexual couples as well, and dual track insemination programs offer the option of using known or anonymous donors for all recipients (DeJonge and Barratt, 2006; Scheib, 2004). Yet, studies of the relationship between using identity-release donors and disclosure in heterosexual couples remain inconclusive. For example, Greenfield and Klock (2004) found no difference in plans to disclose to the child based on use of a known or anonymous donor, Brewaeys et al. (2005) found a positive significant relationship between using identity-release donors and plans to disclose in Norwegian heterosexual and lesbian couples, and although Scheib et al. (2003) found a lower correlation between using identity-release donors and disclosure in heterosexual couples than in lesbian couples and single women, 70% of the heterosexual couples in this study had disclosed. Other studies reveal that level of disclosure in donor insemination and donor oocyte families remain low compared with IVF families (Murray et al., 2006). Therefore, although the tendency toward disclosure in donor insemination families may be increasing for some, it still appears to be relatively low for others, and lower than disclosure about other types of assisted reproduction, and results from studies are not necessarily generalizeable. Still the ASRM recently changed its policy to endorse disclosure (The Ethics Committee of the ASRM, 2004), and internationally there is now legislation abolishing anonymity for gamete donors and making provision for their identity release to the recipient offspring in Sweden, Austria, Switzerland, UK, Norway, The Netherlands, New Zealand and the states of Western Australian and Victoria in Australia (Daniels, 2007).
In spite of theoretically and practice-based concerns by mental health professionals regarding negative effects of secrets on family functioning, specifically relative to issues of trust and communication (Karpel, 1980; Imber-Black, 1998; Caughlin and Afifi, 2004), empirical knowledge about the effects on individuals and families of secrecy versus disclosure of donor insemination-related information has been scarce. Secrecy in families has been studied mostly in the context of adoption (Berry et al., 1998; Grotevant and McRoy, 1998;) and has been found to have negative effects on relational satisfaction (Baran and Pannor, 1990), whereas disclosure has been associated with parental satisfaction (Cushman et al., 1997), active parental-child communication (Wrobel et al., 1998), and satisfaction among pre-adolescent adoptees (Wrobel et al., 1996).
Maintaining secrets by topic avoidance, i.e. withdrawal from and omission of discussion of certain issues from conversation, e.g. by changing topics, looking away or becoming silent, was documented in relation to marital conflict (Sillars et al., 1983; Christensen and Heavey, 1993) and has been found to be inversely associated with individuals' relational satisfaction for a wide range of family situations (e.g. stepfamilies), topics (e.g. dating and sexual experiences, drugs, money, religion) and ages (Vangelisti, 1994; Golish, 2000). Personal satisfaction was negatively associated both with respondents' own reports of topic avoidance and with the extent to which they perceived that their relational counterparts avoided topics (Caughlin and Golish, 2002).
Very few recent studies have examined secrecy in the context of donor insemination, and have yielded inconclusive results. One group of researchers (Golombok et al., 2002; Lycett, et al., 2004) found disclosing parents to report less severe and frequent disputes with their children and more relational satisfaction than non-disclosing parents and Scheib et al., (2003,2005) found positive and non-defensive family communication style between parents and adolescents when parents have disclosed to children at a young age. Another study, however, found no relationship between disclosure and parenting, parental strictness, involvement with the child, marital satisfaction, or marital intimacy (Nachtigall et al., 1997). A European study that followed a single family over time documented the reduction of anxiety symptoms in the child and the parents as well as improved family communication following parental disclosure (Bonney, 2002). Qualitative studies and testimonials of adolescent, young adult and adult donor offspring have suggested an association between later life and accidental disclosures and strained relationships and/or mistrust within rearing families (Turner and Coyle, 2000; Hewitt, 2002).
While the studies tend to suggest the relative benefits of disclosure, they lack representation of families through the life cycle, often fail to distinguish between plans to disclose and actual disclosure, and often conceptualize disclosure as a one-time event rather than as a process occurring over time. This study sought to add to the slim body of available knowledge by exploring the relationship between families' avoidance of the topic of using donor insemination for conception and family functioning in families conceived with donor insemination as perceived by young adult offspring.
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Materials and Methods |
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Sample
A non-representative (convenience) sample of 69 young adults, aged 21–34 years, conceived with donor insemination, was recruited by advertisements placed on relevant discussion boards, with sperm banks and the media as well as snowballing. Eligibility criteria included ability to speak, read and write English and absence of current or recent-past crises (e.g. death, serious psychological or mental illness in family). Participants were mostly in their mid-twenties (M = 25.88, SD = 4.1), educated single Caucasian (97.1%), females (85%), born into two-parent families (78%), of which half were currently divorced, reflecting current US consensus statistics (Raley and Bumpass, 2003
). Most participants (71%) learned of their donor conception from their mothers at age sixteen or older (56%). A relatively small group were informed of their donor conception by both of their rearing parents (20%), some of whom claim they were told at or before age five (18%).
Measures
Three instruments were administered to participants. A 22 item seven-point Likert-type scale was used to assess perceived degree of parents' topic avoidance in participants' families of origin. The scale included the original 16 item topic avoidance scale (Guerrero and Afifi, 1995; Caughlin and Afifi, 2004) which measures topic avoidance associated with friends, sex, dating/marriage, negative events/failures, relationship issues and other miscellaneous topics, and six additional items designed to specifically measure donor insemination-related topic avoidance, including the existence of a donor parent, the donor conception process, resemblances, traits, genealogy and medical history. Participants were instructed to complete the scale relative to their mother and relative to their other rearing parent. Since 82% of participants reported their other rearing parent to be their social father, i.e. the man who was married to their mother at the time of their conception and birth, reference to ‘other rearing parent’ in the results section will be ‘father’. Fourteen participants completed the questionnaire only relative to their mother because the other rearing parent was absent (due to divorce, death or single-parent family configuration). Chronbach's alpha reliability for the topic avoidance scale relative to mother was 0.95, and relative to other rearing parent was 0.97.
The widely used 36 item five-point Likert-type ‘Beavers Self-Report Family Instrument (SFI) Version II’ was used to measure participants' perception of five domains of their family of origin functioning including health/competence, conflict, cohesion, leadership and emotional expressiveness. SFI has high internal consistency and test-retest reliability (Chronbach's alpha 0.84–0.93; and 0.85, respectively) as well as good concurrent validity with other self-report family scales and discriminant validity demonstrated by its capacity to discriminate groups of psychiatric patients with differing diagnoses (Hampson et al., 1989; Beavers and Hampson, 1990, 2000). Chronbach's alpha reliability for the SFI was 0.96.
In addition to the two aforementioned questionnaires, participants provided information about their personal and family background including age, gender, marital status, education, occupation, ethnicity, family of origin configuration, parents' current marital status, age at time of disclosure and discloser.
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Results |
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Participants in this study reported that in their family of origin secrecy was maintained by the strategy of topic avoidance, to some degree regarding general issues and to a higher degree in relation to donor insemination, and by fathers more than by mothers.
Mothers' topic avoidance in general was perceived as low-moderate whereas fathers' was moderate (M = 39.26; SD = 20.15; M = 56.56, SD = 27.44, respectively, of a possible range of 16–112), and mothers' donor insemination-related topic avoidance was moderate whereas fathers' was high (M = 20.63, SD = 13.51; M = 30.33, SD = 13.39, respectively, of a possible range 6–42). For both mothers and fathers, topic avoidance in general and donor insemination-related topic avoidance in particular were significantly different (t = –9.48, t = –8.40, respectively, P 0.001) and moderately correlated (r = 0.60, P 0.001, r = 0.61, P 0.001, respectively). This indicates that albeit refraining from discussing the circumstances of conception differs from avoidance as a characteristic of family communication in general, families that use the strategy of avoiding topics as a measure to maintain secrecy tend to do so in relation to all topics. However, because donor insemination-related topic avoidance was significantly higher than general topic avoidance, it appears that the same mechanism is used more for sensitive themes such as reproduction.
Mothers' and fathers' topic avoidance was perceived as significantly different. Fathers were perceived as avoiding more than mothers both in general and with respect to donor insemination-related topics (t = –4.89, t = –6.09, respectively, P 0.001). Although there was a moderate significant correlation between mothers' and fathers' general and donor insemination-related topic avoidance (r = 44, r = .57, respectively, P 0.001), using a mean parents' topic avoidance score would be contraindicated because it would mute the individual gender-based differences between parents (Ransom et al., 1990). No significant difference was found in perceived mothers' mean topic avoidance between offspring raised in single-parent configuration (n = 14) compared with those raised in two-parent configuration (n = 55).
Since the SFI scale is coded such that a low-score represents high family functioning and a high-score represents low family functioning, the scale was reverse coded to ease interpretation of results. While family functioning was perceived by participants as moderately-high (M = 117.02, SD = 31.47 of possible range 36–180), its level varied in relation to topic avoidance, i.e. in families where parents were perceived as avoiding topics more, functioning was perceived to be lower than in families who avoided topics less. There was a moderate significant inverse correlation between family functioning and topic avoidance in general as well as donor insemination-related topic avoidance for both mothers (r = –0.55, r = –0.40, respectively, P 0.01) and fathers (r = –0.53, r = –0.50, respectively, P 0.01).
Regression analysis using a general linear model with family functioning as the dependent variable and background variables (gender, parents' current marital status, age at disclosure, identity of discloser) as well as each parent's degree of donor insemination-related topic avoidance as independent variables (see Table 1, models 1 and 2) indicated that an increase in either mothers' or fathers' donor insemination-related topic avoidance significantly predicted a decrease in family functioning (R2 = 0.372, F(6,51) = 5.04, P = 0.0004; R2 = 0.38, F(6,40) = 4.11, P = 0.003, respectively).
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A third regression model using family functioning as the dependent variable and background variables (excluding parents' topic avoidance) as the independent indicated that mothers' donor insemination-related topic avoidance explained 7% and fathers' donor insemination-related topic avoidance explained 8% of the variance in family functioning. This model also determined additional variables predictive of family functioning and included parents not being divorced (17.15 point increase in family functioning score) and parents' disclosing together (48 point increase in family functioning score). Offspring's gender, age at disclosure and mother as discloser were not significant predictors of family functioning.
Regression analysis with donor insemination-related topic avoidance as the dependent variable and the aforementioned background variables as the independent indicated that age at time of disclosure and joint disclosure by both parents predicted mothers' (R2 = 0.295, F(6,61) = 4.26, P 0.001) but not fathers' topic avoidance score.
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Discussion |
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The main result of this study, i.e. the inverse relationship between topic avoidance and family functioning, supports the theoretically and clinically-based idea that secrecy in families compromises functioning, lends credence to previous findings related to negative effects on families of topic avoidance as a way to maintain secrecy (Vangelisti, 1994
; Golish, 2000; Caughlin and Golish, 2002) and expands them to reproduction-related issues.
Various explanations were offered for the connection between family secrets and dysfunction. Karpel (1980) viewed family dysfunction as a product of a process that creates barriers between secret holders and other family members leading to psychological distances. Imber-Black (1998) emphasized the lack of trust implied by secrets as generating self-doubt, distance and suspicion as well as fueling fear and anxiety in those family members who are excluded from the knowledge circle and eventually leading to family dysfunction.
The finding that offspring perceived their parents' donor insemination-related topic avoidance as significantly higher than general topic avoidance, may be explained by the combination of intra-familial and external factors. The defensive avoidance reaction as a way to address the pain of the psychological loss created by the experience of infertility, reinforced by physician support for non-disclosure and donor anonymity, may have led to the increased use of avoidance with regard to donor insemination compared with other family topics that may be less painful, and meet more societal acceptance.
The finding that participants in this study perceived their fathers as more avoidant than their mothers both in general and with respect to donor insemination agrees with previous studies which found in men with infertility a tendency to feel guilty and use avoidance and denial to obscure feelings of loss (Mahlstedt, 1985; Snowden, 1990; Abbey et al., 1991; Myers et al., 1995a,1995b; Webb and Daniluk, 1999). Furthermore, men's tendency to use avoidance may be increased by couples' decisions to use insemination before men have an opportunity to complete the infertility-related grieving process (Daniels et al., 1995).
Identity of the discloser was found to be a significant correlate of family functioning such that joint parental disclosing was perceived by participants as being associated with higher family functioning than disclosure under other circumstances. Joint disclosure may be a manifestation of the strength and quality of the parental dyad and the existence of a respectful co-leadership within a family, which is key to optimal family functioning (Beavers and Hampson, 1990).
Surprisingly, this study failed to find an association between age at time of disclosure and family functioning, challenging theoretical and clinical beliefs that early disclosure is beneficial to family functioning. The relationship between age at disclosure and mothers' but not fathers' donor insemination-related topic avoidance, such that the older the offspring at the time of disclosure the higher the participants rated their mothers' donor insemination-related topic avoidance, may suggest that the less comfortable mothers felt relative to the circumstances of conception, the more they tended to avoid it and to delay revealing it to the child. However, because findings indicated that mothers' donor insemination-related topic avoidance is associated with age at disclosure on one hand and with family functioning on the other hand, the question remains whether there is an indirect relationship between age at disclosure and family functioning moderated by mothers' donor insemination-related topic avoidance. This question should be examined in future research. Furthermore, this pattern was not seen in fathers, which may be reflective of differences in communication patterns between mothers and daughters and/or biological connectedness.
Since there is no way to gather information from offspring where there has been no disclosure of donor insemination, it remains impossible to make a strong statement on the relative benefits of disclosure. However, the implications of these findings for practitioners support encouraging disclosure jointly by both parents, as such a process is anticipated to prevent offspring's experience of a sense of suspicion associated with their parents' avoidant communication leading to distrust and disengagement.
While the findings offer practice strategies regarding disclosure, several limitations of the study must be kept in mind when considering its results. The self selected nature of the sample introduces possible cultural and gender bias. Participants were largely educated Caucasians, which on one hand limits generalizability of findings to other population groups but on the other hand is reflective of consumers of assisted reproduction (Nachtigall, 2006). Because typically women tend to respond to calls for study participation more than men do, a deliberate effort to recruit male participants in future studies is called for. A large portion of the participants were individuals affiliated with support organizations for people conceived with donor insemination. This recruitment strategy introduces a selection bias, which may affect outcome. However recruitment of a traditional representative sample is not feasible because of privacy policies regarding medical information. Consequently most studies thus far were limited to interviewing of parents and young offspring. Furthermore, because of the unique nature of variables in donor insemination studies, like in many similar research projects, no control group was used (Nachtigall, 1997; Scheib et al., 2003,2005; Lycett et al., 2004). These limitations need to be taken into consideration in interpreting the outcomes. This study focused on the perception of one family member—the young adult who is the product of a donor insemination pregnancy, reflecting participants' personality and subjective life experience. The importance of understanding such lived experience has been increasingly recognized in current social research (Padgett, 1998). The cross-sectional correlational nature of the design allows for conclusions regarding association rather than causation.
In summary, this study, which is the first to look empirically at the relationship between disclosure of donor insemination and family functioning in families with grown children, offers some guidance for practice as well as directions for future research, which should address male offspring, participants of various ages and from various non-traditional family configurations, and oocyte donor assisted pregnancies to enhance our understanding of the effects of donor assisted reproduction and family dynamics.
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Acknowledgements |
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The authors would like to thank Dr. Tamara Afifi for her assistance in adapting the topic avoidance scale for use in this study, and Wendy Kramer, Bill Cordray, Dianne Allen, Olivia Montuschi, Lori Carangelo and Drs. Joanna Scheib, Charles Debrovner, Judith McCoyd, Ken Daniels, Resolve of Long Island and the Mental Health Professional Group of the American Society for Reproductive Medicine for helping recruit participants.
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Submitted on February 23, 2007; resubmitted on May 11, 2007; accepted on May 18, 2007.
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