Gamete donation, information sharing and the best interests of the child: an overview of the psychosocial evidence.

This paper overviews key empirical findings from social science research regarding the impact of gamete donation on child wellbeing. In particular, the paper addresses current regulatory debates concerning information sharing and the best interests of the child by considering psychosocial aspects of telling--or not telling--children about their donor conception and the identity of their donor. The paper identifies three core sets of empirical, ethical and policy concerns underpinning these debates relating to (i) the psychosocial impact of gamete donation per se on child wellbeing, (ii) the psychosocial impact of parental disclosure decisions on child wellbeing, and (iii) the psychosocial implications of donor identification for donor-conceived offspring. The paper illustrates how these concerns are framed by ideas about the significance-or not-of 'genetic relatedness'; ideas which have come to the fore in contemporary discussions about the potential consequences of donor-conceived individuals gaining access to their donor's identity. By drawing together research findings that may be pertinent to the regulation of gamete donation and information sharing, a further aim of this paper is to explore the potential use and misuse of empirical 'evidence' in ethical and policy debates. Whilst this paper starts from the premise that psychosocial data has a vital role in grounding normative discussions, it seeks to contribute to this dialogue by highlighting both the value and limitations of social science research. In particular, the paper argues for a cautious approach to applying psychosocial evidence to ethical issues that is sensitive to the caveats and nuances of research findings and the changing cultural and regulatory context.The empirical research presented in this paper is largely based on studies conducted at the Centre for Family Research, University of Cambridge, UK, and funded by grants awarded to Susan Golombok by the Wellcome Trust and the Nuffield Foundation.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s40592-015-0018-

Psychoanalytic Concepts of Fatherhood: Patriarchal Paradoxes and the Presence of an Absent Authority

This essay presents a critical examination of the patriarchal assumptions that have shaped psychoanalytic concepts of fatherhood since the inception of this discipline. Patriarchy is founded upon the symbolic power of the father and yet there has been a long-standing cultural silence shrouding men's parental roles and relationships in experiential terms. The subsequent tension between the symbolic presence and substantive absence of fathers is built into the heart of orthodox psychoanalytic theory, being enshrined in Freud's foundational concept of the Oedipus complex. In particular, the Oedipus complex is premised upon the father's absence from the pre-oedipal sphere, perpetuating an image of paternal authority legitimated by men's distance from, and difference to, the naturalized domain of mother-child relations. The simultaneous exaltation of paternal power and marginalization of fathers from the fabric of family life is reproduced across the central schools of psychoanalytic thought, as exemplified by the work of Klein and Lacan. At the core of this discussion is a critical analysis of key sites of silence and contradiction in Freud's account of the Oedipus complex that are attributed to the negation of paternal intimacy in early infant relationships. Most notably, the oedipal resolution is seen to lie at the source of deep psychological tensions within male and female gender identities that conform to patriarchal definitions of “normal” adult heterosexuality. In recent years, paternal absence has been problematized in theoretical, empirical, and political terms, with a weight of therapeutic observation, feminist critique, and cultural commentary beckoning a fundamental reassessment of psychoanalytic concepts of fatherhood. I argue that the corresponding turn toward more positive representations of father-child relationships signifies a radical critique of the paradoxes of patriarchy that has yet to be incorporated into psychoanalytic theory. By confronting the conceptual limits of the authority of the absent father, this discussion illuminates a theoretical vacuum within mainstream psychoanalytic thought in which to usher in more realistic conceptions of the fathering experience

'What Does Donor Mean to a Four-Year-Old?': Initial Insights into Young Children's Perspectives in Solo Mother Families.

This study reports on the questions, thoughts and feelings of children aged 4-9 conceived by donor insemination to single mothers. Fifty-one mothers and 47 children from the same families were each administered a semi-structured interview. Mothers generally reported that while children either lack understanding, or have not yet been told, about their donor conception, they may be thinking and talking about the absence of a father. Most children did not mention either donor conception or father absence and reported positive feelings about their families and friendships. Possible explanations for the discrepancy between mothers' and children's reports are discussed.Wellcome Trust (Grant ID: 097857/Z/11/Z)This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1111/chso.1218

Disclosure of sperm donation: a comparison between solo mother and two-parent families with identifiable donors.

Disclosure of donor conception to children was compared between solo mother and two-parent families with children aged 4-8 years conceived since the removal of donor anonymity in the UK. Semi-structured interviews were conducted with 31 heterosexual solo mothers and 47 heterosexual mothers with partners to investigate their decisions and experiences about identifiable donation and disclosure to their children. No significant difference was found in the proportion of mothers in each family type who had told their children about their donor conception (solo mothers 54.8%; partnered mothers 36.2%). Of those who had not told, a significantly higher proportion of solo mothers than partnered mothers intended to disclose (P < 0.05). Partnered mothers were more likely than solo mothers to feel neutral, ambivalent or negative about having used an identifiable donor (P < 0.05), and were less likely to consider children's knowledge of their genetic origins as extremely important (P < 0.05). These findings are relevant to provision of counselling services as it cannot be assumed that parents will tell their children about their origins or their entitlement to request the identity of their donor at the age of 18 years. Further qualitative research would increase understanding of solo mothers' attitudes towards disclosure.Wellcome Trust (Grant ID: 097857/Z/11/Z

Single Mothers by Choice: Mother–Child Relationships and Children’s Psychological Adjustment

Fifty-one solo mother families were compared with 52 two-parent families all with a 4 –9-year-old child conceived by donor insemination. Standardized interview, observational and questionnaire measures of maternal wellbeing, mother– child relationships and child adjustment were administered to mothers, children and teachers. There were no differences in parenting quality between family types apart from lower mother– child conflict in solo mother families. Neither were there differences in child adjustment. Perceived financial difficulties, child’s gender, and parenting stress were associated with children’s adjustment problems in both family types. The findings suggest that solo motherhood, in itself, does not result in psychological problems for children.This project was supported by a Wellcome Trust Senior Investigator Award

Single mothers by choice: Parenting and child adjustment in middle childhood.

Findings are presented of the second phase of a longitudinal study of families created by single mothers by choice. Forty-four single heterosexual mothers were compared with 37 partnered heterosexual mothers, all with a donor-conceived child aged around 8-10 years. Standardized interview, observational, and questionnaire measures of maternal wellbeing, mother-child relationships and child adjustment were administered to mothers, children, and teachers. There were no differences in maternal mental health, the quality of mother-child relationships or children's emotional and behavioral problems between family types. However, higher levels of parenting stress and higher levels of children's prior adjustment difficulties were each associated with children's adjustment difficulties in middle childhood irrespective of family type. The findings suggest that the presence of two parents-or of a male parent-is not essential for children to flourish, and add to the growing body of evidence that family structure is less influential in children's adjustment than the quality of family relationships. (PsycInfo Database Record (c) 2021 APA, all rights reserved).The Wellcome Trus

Integrating donor conception into identity development: adolescents in fatherless families.

OBJECTIVE: To study the processes by which donor-conceived children incorporate donor conception into their subjective sense of identity. DESIGN: Cross-sectional. SETTING: Family homes. PATIENT(S): Nineteen donor-conceived adolescents. INTERVENTION(S): Administration of an interview and questionnaire. MAIN OUTCOME MEASURE(S): The mother-child relationship was assessed through the Friends and Family Interview, a semistructured interview designed to assess adolescents' security of attachment in terms of secure-autonomous, insecure-dismissive, insecure-preoccupied, and insecure-disorganized attachment patterns. The Donor Conception Identity Questionnaire assessed adolescents' thoughts and feelings about donor conception, yielding two factors: [1] curiosity about donor conception and [2] avoidance of donor conception. RESULT(S): Statistically significant associations were found between the Curiosity scale and the secure-autonomous and insecure-dismissing attachment ratings. Adolescents with secure-autonomous attachment patterns were more interested in exploring donor conception whereas those with insecure-dismissing patterns were less likely to express curiosity. Insecure-disorganized attachment ratings were statistically significantly correlated with the Avoidance scale, indicating higher levels of negative feelings about donor conception. CONCLUSION(S): The results of this study of the influence of parent-child relationships on thoughts and feelings about donor conception in adolescence suggest that the valence of the parent-child relationship influences adolescents' appraisal of their donor conception within the context of their growing sense of identity.This research was supported by a Wellcome Trust Senior Investigator Award [097857/Z/11/Z].This is the final version of the article. It first appeared from Elsevier via https://doi.org/ 10.1016/j.fertnstert.2016.02.03

Experiences of UK identity-release egg donors

The objective of this study was to examine the motivations, experiences and future expectations of identity-release egg donors in the UK following the removal of donor anonymity and the increase in financial compensation for egg donation. This exploratory, in-depth qualitative study comprised semi-structured interviews with 11 women who had attended an egg donation screening appointment at a UK clinic during a four-month period in 2014. Interviews were conducted two to six weeks after the woman had donated or had withdrawn/been rejected from the donation process. Participants' primary motivation for donating was to help infertile women have their 'own child', and the recent increase in financial compensation did not seem to play a significant role in their decision. All were happy to be identifiable and contacted by children born as a result of their donation. However, some were hesitant about providing non-identifying information about themselves for these offspring and wished for further information about the recipient(s) of their eggs and the outcome of their donation. Whilst this study was limited due to the small sample size, it is the first study of UK egg donors following the rise in donor compensation and suggests that other strategies may be more effective in increasing donor numbers.The study was funded by a research grant from the London Women’s Clinic.This is the author accepted manuscript. It is currently embargoed pending publication

Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: A systematic review

Background The role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people. Methods A systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies. Results Of 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none. Conclusions More research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence