1 Family and Child Psychology Research Centre, City University, Northampton Square, London EC1V 0HB, UK
2 To whom correspondence should be addressed. Email: s.e.golombok{at}city.ac.uk
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Abstract |
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Key words: child development/donor insemination/egg donation/parenting
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Introduction |
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There are, however, some exceptions to this pattern. In New Zealand, prevailing cultural attitudes favouring disclosure appear to have resulted in greater openness with children (Daniels and Lewis, 1996). In a study of a representative sample of 181 families, 30% of parents of children aged up to 8 years old had talked to them about the donor insemination, and 77% of the remaining parents intended to do so (Rumball and Adair, 1999
). In the USA, some clinics are recruiting sperm donors who are willing to have their identity released to adult offspring. A study of parents who chose such donors at the Sperm Bank of California found that almost all had informed their child about their donor conception (Scheib et al., 2003
). However, 40% of these families were headed by lesbian couples, 38% by single women and only 22% by heterosexual couples. Single heterosexual women and lesbian women who conceive through donor insemination are much more likely to be open with their children about their genetic origins than are women in traditional families because they have to explain the absence of a father to their child. In addition, they do not need to protect the father from the stigma of infertility. A similar pattern has been found in a study of donor insemination families headed by single heterosexual mothers in the UK, with 93% of mothers of 1-year-olds intending to tell their child about their conception by donor insemination (Murray and Golombok, 2004
). Of particular interest is an investigation of prospective parents entering a donor insemination programme in The Netherlands where there was a choice between identifiable and anonymous donors (Brewaeys et al., 2003
). Of the heterosexual couples, 47% opted for an identifiable donor, compared with 13% in 1996. All parents who chose an identifiable donor intended to inform their child.
In spite of the tendency towards secrecy of parents who have conceived through gamete donation, these families appear to be functioning well. Parentchild relationships in donor insemination and egg donation families with 4- to 8-year-old children in the European Study of Assisted Reproduction Families were just as positive as for the IVF families (Golombok et al., 1995, 1996, 1999
). When the families were followed-up at adolescence, the findings pointed to a high level of warmth between parents and their children accompanied by an appropriate level of discipline and control (Golombok et al., 2002
). With respect to psychological adjustment, the children did not appear to experience negative consequences arising from the circumstances of their birth (Golombok et al., 1995
, 1996, 1999
, 2002
).
These early studies of families created by gamete donation focused on children born in the mid-1980 s, a time when parents were not disclosing the donor conception to their child. The most recent information on the disclosure of donor conception in the UK comes from the first phase of the present study of 50 donor insemination families and 51 egg donation families with 1-year-old babies born between 1999 and 2001, of whom 46% of donor insemination parents and 56% of egg donation parents reported that they intended to be open with their child (Golombok et al., 2004). These figures suggest a marked rise in the proportion of parents who plan to tell their child about their donor conception. A study of these families is thus of particular interest as it will provide for the first time systematic information about the consequences of greater openness for parentchild relationships and the psychological well being of the child. The aim of the first phase of the investigation was to examine the quality of parentchild relationships in this recent cohort of gamete donation families with 1-year-old children. The differences that were identified between the gamete donation families and a matched comparison group of natural conception families indicated more positive parentchild relationships among the gamete donation parents accompanied by greater emotional involvement with the child. The focus of the present study was on the quality of parentchild relationships and the psychological development of the child at age 2 years. By age 2, attachment relationships with parents have been fully established (Ainsworth et al., 1978
; Bowlby, 1982
). In addition, age 2 is an important transitional period in relation to children's cognitive and emotional development (Edwards and Liu, 2002
; Carter et al., 2004
). The increase in resistant and angry behaviour in children of this age, often described as the terrible twos, has been associated with parenting difficulties (Belsky et al., 1996
; Carter et al., 2004
).
A further advantage of the present study was the use of the Parent Development Interview (Aber et al., 1985; Slade et al., 1999
), an interview technique designed to tap beneath the surface to assess the nature of the emotional bond between the parent and the child. The Parent Development Interview examines parents' thoughts and feelings regarding their relationship with their child, and produces variables that specifically relate to the emotional experience of the parent such as joy and anger. Due to the absence of a genetic link between a parent and the child in gamete donation families, it was predicted that parents of children conceived by donor insemination or egg donation would show higher levels of negative emotions and lower levels of positive emotions in their relationship with their child than parents of naturally conceived children. Although this hypothesis was not supported in the earlier studies, the Parent Development Interview provides a method for assessing emotional aspects of the parentchild relationship more thoroughly. Moreover, the view that assisted reproduction parents may be overinvested in their children (Burns, 1990
), may have unrealistic expectations of them (McMahon, 1995; van Balen, 1998
) and may feel more protective towards them due to a greater sense of their vulnerability (Hahn and DiPietro, 2001
; Colpin, 2002
) suggested that gamete donation parents would obtain higher scores on the specific variables of level of child focus, disappointment with the child and overprotectiveness, respectively. A further question of interest was whether differences in the quality of parentchild relationships existed between donor insemination families where the father lacked a genetic link with the child and egg donation families where the mother lacked a genetic link. It may be expected that less positive motherchild relationships may be found in egg donation families than in donor insemination families, whereas less positive fatherchild relationships may be found in donor insemination families than in egg donation families due to the different pattern of genetic relatedness between parents and children in these two family types. In addition, as secrecy about genetic origins has been postulated to produce disturbances in parentchild relationships (Clamar, 1989
; Baran and Pannor, 1993
; Daniels and Taylor, 1993
), higher levels of negative emotions and lower levels of positive emotions regarding the child were predicted for gamete donation parents who did not intend to tell their child about the donor conception. To the extent that difficulties in parentchild relationships are a feature of gamete donation families, psychological problems may be expected for the child. Whereas the studies of children born in the mid-1980s examined children who ranged in age, the present study focused on children of the same age (2 years old) using measures specifically designed to assess psychological adjustment and cognitive development at that age.
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Subjects and methods |
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As shown in Table I, there were similar proportions of boys and girls in each family type, and the age of the children did not differ between groups. There was a significant group difference in the age of the mothers [F(2,159)=24.94, P<0.0]1. The egg donation mothers were the oldest with a mean age of 42 years, and the donor insemination and natural conception mothers were aged 37 and 36 years, respectively. There was a significant difference in social class (2=19.43, P<0.01), as assessed by the occupation of the parent with the highest ranking position according to a modified version of the Registrar General's Classification (OPCS and Employment Department Group, 1991) ranging from 1 (professional/managerial) to 4 (manual/unskilled). This resulted from a higher proportion of donor insemination families in less skilled occupations. The number of siblings in the family also differed between family types (
2=35.41, P<0.001), reflecting a higher number of children with siblings in the natural conception families. As significant differences between groups were found for mother's age, social class and number of siblings in the family, these variables were entered into the statistical analyses as covariates.
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Parental functioning
The short form of the Parenting Stress Index (PSI/SF) (Abidin, 1990), a standardized assessment of stress associated with parenting, was administered to mothers and fathers separately to produce a total score for each parent, with higher scores reflecting greater parenting stress. Testretest reliability for the total score was reported to be 0.96 over a 13 month interval and 0.65 over 1 year. Concurrent and predictive validity have been demonstrated for the full-length questionnaire, and the short form has been reported to correlate very highly with the full-length version. In addition, the Vulnerable Child Scale (Perrin et al., 1989) was administered to mothers only to provide an assessment of anxiety regarding the child's susceptibility to medical problems, with a lower score representing a greater sense of vulnerability. Testretest reliability was reported to be 0.95 over a 4 week period, and the scale was found to discriminate between parents of formerly sick premature infants and parents of healthy full-term infants when the child was 3 years old. The Trait Anxiety Inventory (Spielberger, 1983
) and the Edinburgh Depression Scale (Thorpe, 1993
) were completed by both mothers and fathers to assess anxiety and depression, respectively. Both of these instruments, for which higher scores represent greater difficulties, have been shown to have good reliability and to discriminate well between clinical and non-clinical groups. Mothers and fathers also completed the Golombok Rust Inventory of Marital State (GRIMS) (Rust et al., 1990
), a questionnaire assessment of the quality of the marital relationship with higher scores indicating poorer marital quality. Split-half reliability is 0.91 for men and 0.87 for women, and the GRIMS has been shown to discriminate significantly between couples who are about to separate and those who are not.
The quality of the marital relationship was also assessed by interview using a standardized procedure for which predictive validity with marital breakdown has been demonstrated (Quinton et al., 1976; Quinton and Rutter, 1988
). The following ratings were made for mothers and fathers separately; relationship quality was rated on a 4-point scale from 1 (a great deal) to 4 (none) and was based on the enjoyment both partners experience in shared activities; confiding was rated on a 5-point scale from 1 (all important matters discussed adequately) to 5 (no communication about matters of importance) and took account of the ease of discussing important issues together; and arguments was rated on a 4-point scale from 0 (none or occasional) to 3 (>1 per month) and measured the frequency of conflicts involving shouting and/or violence, and/or denigration of each other or of each other's families, and/or not speaking after a difference for >1 h. The interview with mothers also obtained data on demographic characteristics of the family. In addition, data were obtained on the mother's perception of the father's contribution to parenting as follows: father's help in childcare assessed the extent to which the mother viewed the father as a help or a hindrance in parenting and was rated from 0 passive/unhelpful to 5 takes major responsibility, and father's load taking assessed the extent to which the father took care of the child to allow the mother time for other activities or to rest and was rated from 0 none to 4 takes major load. Pearson productmoment inter-rater reliability coefficients for relationship quality, confiding, arguments, father's help in childcare and father's load taking as rated by the same research team in the first phase of this investigation were 0.58, 0.64, 0.73, 0.83 and 0.53, respectively (Golombok et al., 2004
). The interview with fathers obtained frequency data on the number of weekday hours and the number of weekend hours the father spent at home while the child was awake.
Parentchild relationships
The mothers and fathers were interviewed separately using the Parent Development Interview (Aber et al., 1985; Slade et al., 1999
), an interview technique designed to assess the nature of the emotional bond between the parent and the child, using the coding scheme developed by Steele et al. (2000)
. This interview is derived from attachment theory and is based on the view that parents' thoughts and feelings about their child influence parenting behaviour. Parents are asked not simply to describe their child but instead to describe their own and their child's experience in moments of interaction and relatedness. For example, the parent is asked to describe the child's reactions to normal separations, routine upsets and parental unavailability, followed by questioning that addresses the parent's behavioural and emotional responses to these situations. In this way, the parents' experiences and representations of the dynamics of the relationship between themselves and their child may be evaluated. Data are scored according to well-defined coding criteria, taking account of the parent's affective tone and coherence in addition to the content of his or her response.
The variables used in the present study were degree of anger measuring the extent of parents' feelings of anger when faced with challenging behaviour (rated from 1 none/minimal anger to 4 considerable anger), acknowledgement of support needed assessing parents' acknowledgement of need for support/time for themselves (for mothers only, rated from 1 minimal feelings of needing support to 4 very strong feelings of needing support), satisfaction with support assessing satisfaction with the level of support that is available to them (for mothers only, rated from 1 very dissatisfied to 4 highly satisfied), guilt measuring the extent to which parental guilt is an issue in the relationship with the child (rated from 1 none/minimal guilt to 4 considerable guilt), joy/pleasure assessing the level of joy the parent experiences in the relationship with the child (rated from 1 minimal acknowledgement of joy or pleasure to 4 high/significant acknowledgement of joy or pleasure), competence measuring how well the parent is coping with the child (rated from 1 low competence to 4 high competence), level of child focus assessing the extent to which the parent is focused on the needs of the child as compared with their own emotional needs (rated from 1 low level of child focus to 4 high level of child focus), disappointment with child measuring the extent to which the parent expresses disappointment with the child due to expectations prior to the child's arrival (rated from 1 none/minimal disappointment to 4 high disappointment), parental hostility measuring parental hostile feelings towards the child (rated from 1 none/minimal hostility to 4 high hostility), overprotectiveness assessing the level of anxiety the parent experiences when separated from the child (rated from 1 none/minimal overprotectiveness to 4 high overprotectiveness), disciplinary overindulgence assessing the extent to which the child gets his or her own way (rated from 1 average to 4 indulgent) and clingy behaviour measuring the extent to which the child is upset by separations from the parent (rated from 1 none/minimal clinging to 4 high clinging). In order to calculate inter-rater reliabilities, a second interviewer coded 39 randomly selected interviews. Percentage agreement within one scale point for degree of anger, acknowledgement of support needed, satisfaction with support available, guilt, joy/pleasure, competence, level of child focus, disappointment with child, parental hostility, overprotectiveness, disciplinary overindulgence and clingy behaviour ranged from 92 to 100%.
Children's psychological development
Children's psychological adjustment was assessed using the Brief Infant Toddler Social and Emotional Assessment (BITSEA) (Briggs-Gowan and Carter, 2002; Briggs-Gowan et al., 2004
), a questionnaire measure of socialemotional problems and competencies in 1- to 3-year-olds adapted from the Infant Toddler Social and Emotional Assessment (ITSEA) (Briggs-Gowan and Carter, 1998
; Carter et al., 2001
). The questionnaire was completed by the child's mother. The BITSEA produces two scores, a Problem Scale score and a Competence Scale score, with higher scores representing greater problems and greater competence, respectively. Good testretest reliability has been demonstrated, with intra-class correlations of 0.82 and for the Problem Scale and 0.72 for the Competence Scale. The BITSEA has been validated against the ratings of independent assessors and the Child Behavior Checklist (Achenbach and Rescoria, 2000
), and has also been shown to correlate with parents' reports of parental worry, stress and interference in family life.
To assess cognitive development, the children were tested on the Mental Scale of the Bayley Scales of Infant Development Second Edition (BSID II) (Bayley, 1993) at the time of their second birthday. The Mental Scale includes items that assess memory, habituation, problem solving, early number concepts, generalization, classification, vocalizations, language and social skills. The raw score for each child is transformed to produce an age-standardized Mental Development Index, and developmental delay was defined as a Mental Development Index of <85. Inter-rater reliability for the Mental Development Index was reported to be 0.96, and testretest reliability at age 2 years was 0.91. The BSID II has been demonstrated to have high content, construct, predictive and discriminant validity.
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Results |
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Family characteristics
All of the children were living with both parents, with the exception of one child in the donor insemination group whose father had died and one child in the natural conception group whose parents had separated. There was no group difference in the number of mothers who were employed outside the home, with between 10 and 13% of mothers in each family type in full-time employment. The variables father's help in childcare and father's load taking were entered into a MANCOVA, and Wilks's was not significant. However, when the number of weekday hours and the number of weekend hours the father spent at home while the child was awake were entered into a MANCOVA, Wilks's
was significant [F(4,180)=3.36, P<0.05]. One-way ANCOVAs showed a significant difference between family types for number of weekday hours [F(2,91)=4.36, P<0.05], reflecting a greater number of waking weekday hours spent at home by the gamete donation than the natural conception fathers (GD versus NC, P<0.05).
Psychological state: mothers
The total scores on the PSI, the Vulnerable Child Scale, the Trait Anxiety Inventory, the Edinburgh Depression Scale and the GRIMS were entered into a MANCOVA. Wilks's was significant [F(10,228)=2.25, P<0.05]. One-way ANCOVAs showed a significant difference between family types for the Vulnerable Child Scale [F(2,118)=5.03, P<0.01], reflecting greater perceptions of child vulnerability among the gamete donation than the natural conception mothers (GD versus NC, P<0.01) (see Table II).
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Psychological state: fathers
The total scores on the PSI, the Trait Anxiety Inventory, the Edinburgh Depression Scale and the GRIMS were entered into a MANCOVA. Wilks's was not significant. The interview variables relating to the marriage, relationship quality, confiding and arguments were also entered into a MANCOVA. Wilks's
was not significant.
Parent Development Interview: mothers
The variables degree of anger, acknowledgement of support needed, satisfaction with support, guilt, joy/pleasure, competence, level of child focus, disappointment with child, parental hostility, overprotectiveness, disciplinary overindulgence and clingy behaviour were entered into a MANCOVA. Wilks's showed a non-significant trend [F(24,284)=1.43, P<0.10]. As shown in Table III, one-way ANCOVAs found a significant difference between family types for joy/pleasure [F(2,153)=3.66, P<0.05], reflecting higher levels of joy/pleasure among the gamete donation mothers than the natural conception mothers (GD versus NC, P<0.05) and higher levels of joy/pleasure among the egg donation mothers than the donor insemination mothers (DI versus ED, P<0.05). There was also a significant difference between family types for overprotectiveness [F(2,153)=3.71, P<0.05], reflecting higher levels of overprotectiveness among donor insemination than egg donation mothers (DI versus ED, P<0.05).
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Children's socio-emotional and cognitive development
The total score of the BITSEA Problem Scale and the total score of the BITSEA Competence Scale were entered into a MANCOVA. Wilks's was not significant. In addition, there was no difference according to family type in the proportion of children who obtained scores above cut-off for the Problem Scale, or in the proportion of children who obtained scores below cut-off for the Competence Scale. Scores above cut-off for the Problem Scale represented scores above the 75th percentile, and scores below cut-off for the Competence Scale represented scores below the 25th percentile, in a representative community sample. Regarding the Bayley Scale, a one-way ANCOVA found no difference in the Mental Development Index between family types for either boys or girls. The proportion of children obtaining a Mental Development Index of <85, representing developmental delay, was 12, 9 and 10% for the donor insemination, egg donation and natural conception families, respectively.
Gamete donation families
In order to examine whether parental intentions regarding disclosure of the donor conception to the child influenced the quality of the parentchild relationship, comparisons were conducted according to whether or not the gamete donation parents intended to be open with their child. Fifty-four percent of gamete donation parents intended to tell their child about their donor conception, whereas 46% had decided against telling or were uncertain (Golombok et al., 2004). The mothers' variables and the fathers' variables from the Parent Development Interview were entered separately into a MANOVA. There were no significant differences between gamete donation families where the parents intended to tell their child about the donor conception and those who had decided against telling or were uncertain for either the mothers' or the fathers' relationship with their child. For the egg donation families only, the influence on motherchild relationship of whether the donor was known or unknown to the parents prior to the conception was also examined. Twenty-seven percent of egg donors were known, i.e. relatives or friends, and 73% were unknown. When the mothers' variables from the Parent Development Interview were entered into a MANOVA there were no significant differences between egg donation families with known and previously unknown donors.
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Discussion |
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Within the gamete donation families, the egg donation mothers appeared to be more comfortable about parenting than were the donor insemination mothers in that they tended towards higher levels of joy/pleasure whereas the donor insemination mothers tended towards higher levels of overprotectiveness towards the child. The differences between the egg donation mothers and the donor insemination mothers may stem from differences between the two procedures. Although the egg donation mothers lacked a genetic bond with their child, and thus were expected to show a less positive motherchild relationship than donor insemination mothers, pregnancy and motherhood may have compensated for this, particularly as many of these women had known for some time that they were unlikely to bear children. The experiences of the donor insemination mothers, on the other hand, may have been somewhat different due to the lack of a genetic relationship between their husband and the child. It is conceivable that in families where the mother, and not the father, has a genetic bond with the child, the mother feels particularly protective.
As with the earlier studies, few differences were found between fathers in gamete donation families and fathers whose child was naturally conceived (Golombok et al., 1995, 1999
, 2002
). The gamete donation fathers spent more of their child's weekday waking hours at home than did the natural conception fathers. However, no differences were identified between the gamete donation fathers and the natural conception fathers with respect to the quality of their relationship with the child or their involvement. For fathers, their role as parent may be less central to a secure sense of identity than it is for mothers, and it may be for this reason that the use of assisted reproduction does not appear to affect their relationship with their child (ESHRE Capri Workshop Group, 2001
). It is perhaps surprising that no differences were identified between the donor insemination fathers and the egg donation fathers, as a distant or hostile relationship has been predicted for fathers who lack a genetic bond with their child (Clamar, 1989
; Baran and Pannor, 1993
). However, the earlier studies similarly failed to find empirical evidence in support of this hypothesis. Thus the lack of a genetic relationship with their child may be less deleterious to fatherchild relationships than has been thought previously.
Regarding the children, those conceived by gamete donation were no more likely than their naturally conceived counterparts to show raised levels of psychological problems or cognitive impairment. This is to be expected given the general lack of difference in parentchild relationships between these different family types. Although it may be predicted that the gamete donation mothers' greater perception of child vulnerability would have resulted in raised levels of emotional problems in their children (Thomasgard and Metz, 1993), the gamete donation mothers' scores on this measure were not sufficiently different from those of the natural conception mothers to produce a marked effect on children's emotional well being.
It is important to point out that there were no significant differences between family types for many of the variables under study. Although this may reflect a true lack of difference between the families, it is conceivable that the sample sizes were such that there was insufficient statistical power to detect significant effects. However, power for the comparison between the gamete donation families and the natural conception families for a medium effect size was 0.87, showing that there was an 87% chance of identifying significant group differences were they to exist. Thus it appears that the lack of differences between families created by gamete donation and by natural conception represented a genuine finding.
The findings from this recent cohort of families are in line not only with previous studies that identified a greater involvement in parenting among mothers who conceived their child through gamete donation (Golombok et al., 1995, 1999
, 2002
) but also with the findings of the first phase of the present investigation using a different measure of parentchild relationships (Golombok et al., 2004
), and thus add further weight to the growing body of research showing that the absence of a genetic link between a parent and a child does not necessarily jeopardize the development of a positive relationship between them. Interestingly, there were no differences in parentchild relationships between gamete donation families where the parents intended to disclose the donor conception to the child and those where the parents favoured non-disclosure or were still undecided. Similarly, for the egg donation families, there were no differences according to whether the donor was previously known or unknown to the parents. However, the children were only 2 years old at the time of study. As they become old enough to understand the nature of their conception, parental attitudes towards disclosure and the involvement of a known donor may begin to impact upon their relationship with their child.
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Acknowledgements |
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Submitted on April 6, 2004; resubmitted on July 16, 2004; accepted on October 4, 2004.