The Imagined Child: Ambiguity and Agency in Australian Intercountry Adoption

The adoption by Australian couples of children from ‘overseas’ involves claborate processes of bureaucratic assessment, approval and ‘parent education’. This paper explores adults' notions of ‘child’(ren) from ‘overseas’, which help shape and constitute such social processes, not only with couples seeking to adopt, but also with those cultural brokers who assess, regulate and ‘educate’ couples pursuing adoption, such as social workers and psychologists. The ways in which the adoptive ‘child’ is imagined and anticipated by counsellors and would‐be parents alike are explored through ethnographic data from South Australia. However, the proclivities of prospective adoptive parents to imagine their child‐to‐be are attenuated by certain social knowledge in relation to countries of origin. This leads to an exploration of ambiguities and tensions between the intercountry adoptive child as a tabula rasa and as a culturally and historically constituted person. The significance of ambiguities and contradictions for the child's agency and identities is highlighted, within the context of certain social policies around adoption. The chronological age of the child at the time of ‘allocation’ to its adoptive parents is considered as constituting a cultural fulcrum, upon which the identity and situational significance of the ‘origins’ of the child are deemed to subsequently turn.     

Transracial adoption: white American adoptive mothers’ constructions of social capital in raising their adopted children

In the field of adoption and child welfare, there is ongoing debate and discussion about how white adoptive parents in transracial families construct personal and social relationships and networks to promote cultural belonging and identity development in their children. In spite of this however, there is, to date, no research study that has sought to apply the notion of social capital to understand transracial adoptive families. With its exploration of how white American adoptive mothers construct social capital in raising their transracially adopted children, this paper seeks to contribute to the literature on social capital and families in general, and social capital and transracial families in particular. By drawing upon a qualitative study involving white adoptive mothers’ discursive practices, and multiplex constructions of intersectionality, the paper seeks to offer rich theoretical and empirical insights into social capital and transracial adoption to contribute to the literature in this area.     

CLONING, PARENTHOOD, AND GENETIC RELATEDNESS

In this paper I examine what I take to be the best case for reproductive human cloning, as a medical procedure designed to overcome infertility, and argue that it founders on an irresolvable tension in the attitude towards the importance of being ‘genetically related’ to our children implied in the desire to clone. Except in the case where couples are cloning a child they have previously conceived naturally, cloning is unable to establish the right sort of genetic relation to make couples the parents of their cloned child. If anybody is the genetic parent of a cloned child it is the natural parent(s) of the DNA donor. Paradoxically, in order to resist the claims of the parents of the donor to the cloned child, the argument for human reproductive cloning must place more weight on the intention to parent a child, than we do in cases of ordinary reproduction. It must insist that the parental relation is established by the intentions of the couple who bring a clone into the world and not by their genetic relation to the child. The emphasis placed on intention as establishing the parental relationship works to undermine the justification for cloning in the first place. For cloning to play a useful role as a reproductive technology, it must allow couples to become parents who could do so no other way. However, to the extent that intention is sufficient to establish parenthood, adoption or surrogacy, which are existing alternatives to cloning, will serve equally well to allow couples to become parents.     

Intra-Family Gamete Donation: A Solution to Concerns Regarding Gamete Donation in China?

Gamete donation from third parties is controversial in China as it severs blood ties, which are considered of utmost importance in Confucian tradition. In recent years, infertile couples are increasingly demonstrating a preference for the use of gametes donated by family members to conceive children—known as “intra-family gamete donation.” The main advantage of intra-family gamete donation is that it maintains blood ties between children and both parents. To date there is no practice of intra-family gamete donation in China. In this paper, we investigate intra-family adoption in China in order to illustrate that intra-family gamete donation is consistent with Confucian tradition regarding the importance of maintaining blood ties within the family. There are several specific ethical issues raised by intra-family gamete donation. It may, for example, result in consanguinity and the semblance of incest, lead to confused family relationships, and raise concerns about possible coercion of familial donors. Confucian tradition provides a new approach to understand and deal with these ethical issues in a way that Western tradition does not. As a result, we suggest intra-family gamete donation could be an acceptable solution to the problem of infertility in China. However, further discussion and open debates on the ethical issues raised by intra-family gamete donation are needed in China.     

Understanding the Social Meaning of Infertility and Childbearing: A Qualitative Study of the Perception of Childbearing and Childlessness in Northern Ghana

Background

Infertility is a major medical condition that affects many married couples in sub-Saharan African and as such associated with several social meanings. This study therefore explored community''s perception of childbearing and childlessness in Northern Ghana using the Upper West Region as a case study.

Methods

The study was exploratory and qualitative using in-depth and key informant interviews and focus group discussions. Fifteen marriage unions with infertility (childless), forty-five couples with children, and eight key informants were purposively sampled and interviewed using a semi-structured interview guides. Three focus group discussions were also carried out, one for childless women, one for women with children and one with men with children. The data collected were transcribed, coded, arranged, and analyzed for categories and themes and finally triangulated.

Results

The study revealed that infertility was caused by both social and biological factors. Socially couples could become infertile through supernatural causes such as bewitchment, and disobediences of social norms. Abortion, masturbation and use of contraceptives were also identified as causes of infertility. Most childless couples seek treatment from spiritualist, traditional healers and hospital. These sources of treatment are used simultaneously.

Conclusion

Childbearing is highly valued in the community and Childlessness is highly engendered, and stigmatised in this community with manifold social consequences. In such a community therefore, the concept of reproductive choice must encompass policies that make it possible for couples to aspire to have the number of children they wish.     

THE LIMITS OF INTIMATE CITIZENSHIP: REPRODUCTION OF DIFFERENCE IN FLEMISH‐ETHIOPIAN ‘ADOPTION CULTURES’

The concept of ‘intimate citizenship’ stresses the right of people to choose how they organize their personal lives and claim identities. Support and interest groups are seen as playing an important role in the pursuit of recognition for these intimate choices, by elaborating visible and positive cultures that invade broader public spheres. Most studies on intimate citizenship take into consideration the exclusions these groups encounter when negotiating their differences with society at large. However, much less attention is paid to the ways in which these groups internalize the surrounding ideologies, identity categories and hierarchies that pervade society and constrain their recognition as full citizens. In contrast, this paper aims to emphasize the reproduction of otherness within alternative spheres of life, and to reveal the ambiguities and complexities involved in their dialectic relationship with society at large. To address this issue, the paper focuses on the role that ‘adoption cultures’ of Flemish adoptive parents with children from Ethiopia play in the pursuit of being recognized as ‘proper’ families and full citizens. The ethnographic research among adoptive parents and adoption professionals shows a defensive discourse and action that aims at empowering against potential problems, as well as a tendency to other the adoptive child by pathologizing its non‐normativity. By showing the strong embeddedness of adoptive families' practices of familial and cultural construction in larger cultural frames of selfing and othering, characterized by biologism and nativism, one begins to understand the limits of their capacity to realize full citizenship.     

Mothers,Fathers, Families,and Circumstances: Factors Affecting Children's Adjustment

The burgeoning empirical literature exploring the factors accounting for individual differences in psychological adjustment is reviewed. Many studies have shown that adjustment is largely affected by differences in the quality of parenting and parent–child relationships, the quality of the relationships between the parents, and the richness of the economic and social resources available to the family; more recent research signals the importance of congenital differences as well. Dimensions of family structure—including such factors as divorce, single parenthood, and the parents' sexual orientation—and biological relatedness between parents and children are of little or no predictive importance once the process variables are taken into account, because the same factors explain child adjustment regardless of family structure. These findings have important social and legal implications, especially in relation to decisions regarding foster care and adoption, as well as those concerning children's well-being following family dissolution.     

Somatic chromosomal abnormalities in infertile men and women

Infertility--the inability to achieve conception or sustain a pregnancy through to live birth--is very common and affects about 15% of couples. While chromosomal or genetic abnormalities associated with azoospermia, severe oligozoospermia or primary ovarian failure were of no importance for reproduction prior to the era of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), advances in assisted reproductive techniques (ART) now enable many infertile couples to have children. These developments have raised the question of the genetic consequences of ICSI: concerns of the potential harm of the invasive procedure and concerns about the genetic risk. The infertile male and female definitely have an increased risk to carry a chromosomal abnormality. Detection of such an abnormality is of fundamental importance for the diagnosis of infertility, the following treatment, the evaluation of the risk for the future child and the appropriate management of the pregnancy to be obtained. Therefore, cytogenetic screening of both partners is mandatory prior to any type of ART. The present review is based on several surveys on male and female infertility and analyzes the types and frequencies of the different reported chromosome abnormalities according to the type of impairment of spermatogenesis and the type of treatment planned or performed. With regard to assisted reproductive techniques (especially ICSI) the main types of chromosomal abnormalities are discussed and their potential risks for ICSI. If available, reported cases of performed ICSI and its outcome are presented. The detection of an abnormal karyotype should lead to comprehensive genetic counselling, which should include all well-known information about the individual type of anomaly, its clinical relevance, its possible inheritance, the genetic risk of unbalanced offspring, and the possibilities of prenatal diagnosis. Only this proceeding allows at-risk couples to make an informed decision regarding whether or not to proceed with ART. These decisions can be made only when both partners have clearly understood the genetic risks and possible consequences when ART is used.     

The Experience of Chinese Couples Undergoing In Vitro Fertilization Treatment: Perception of the Treatment Process and Partner Support

Background

Couples undergoing In Vitro Fertilization (IVF) Treatment suffer as dyads from the stressful experience of the painful treatment and the fear that the IVF cycle will fail. They are likely to report that their marital relationship has become unstable due to the prolonged period of treatment.

Methods

This is a qualitative study that was conducted to explore the experiences that Chinese couples have had with IVF treatment, especially their perceptions of the process and the support between couples.

Results

The interviews revealed that couples suffered from the process, experiencing physical and emotional pain, struggling with the urgency and inflexibility of bearing a child, and experiencing disturbances in their daily routines and work. The participants described how they endured the hardships as a couple and how it affected their relationship. The couples felt that sharing feelings and supporting each other contribute to psychological well-being and improves the marital relationship. They also identified some unfavorable aspects in their partner relationship. They were ambivalent about receiving social support from friends and family members.

Conclusions

With the couples indicating that the support that they received from each other affected their experience during the treatment process, it is suggested that a supportive intervention that focuses on enhancing the partnership of the couples and dealing with their inflexibility on the issue of bearing a child might result in improvements in the psychological status and marital relationship of infertile couples undergoing IVF treatment.     

Sperm centriole assessment identifies male factor infertility in couples with unexplained infertility – a pilot study

Unexplained infertility affects about one-third of infertile couples and is defined as the failure to identify the cause of infertility despite extensive evaluation of the male and female partners. Therefore, there is a need for a multiparametric approach to study sperm function. Recently, we developed a Fluorescence-Based Ratiometric Analysis of Sperm Centrioles (FRAC) assay to determine sperm centriole quality. Here, we perform a pilot study of sperm from 10 fertile men and 10 men in couples with unexplained infertility, using three centriolar biomarkers measured at three sperm locations from two sperm fractions, representing high and low sperm quality. We found that FRAC can identify men from couples with unexplained infertility as the likely source of infertility. Higher quality fractions from 10 fertile individuals were the reference population. All 180 studied FRAC values in the 10 fertile individuals fell within the reference population range. Eleven of the 180 studied FRAC values in the 10 infertile patients were outliers beyond the 95% confidence intervals (P = 0.0008). Three men with unexplained infertility had outlier FRAC values in their higher quality sperm fraction, while four had outlier FRAC values in their lower quality sperm fraction (3/10 and 4/10, P = 0.060 and P = 0.025, respectively), suggesting that these four individuals are infertile due, in part, to centriolar defects. We propose that a larger scale study should be performed to determine the ability of FRAC to identify male factor infertility and its potential contribution to sperm multiparametric analysis.     

Embryo Donation in Iran: An Ethical Review

Iran is the only Muslim country that has legislation on embryo donation, adopted in 2003. With an estimated 10–15% of couples in the country that are infertile, there are not any legal or religious barriers that prohibit an infertile couple from taking advantage of Assisted Reproductive Technologies (ARTs). Although all forms of ARTs available in Iran have been legitimized by religious authorities, there is a lack of legislation in all ARTs except embryo donation. By highlighting ethical issues in embryo donation, the paper presents a critical review of the Act of Embryo Donation in Iran. The paper argues that the Act does not provide enough safeguards for the future child and assurance for the safety of the donated embryos. It also does not restrict embryo donation to surplus embryos from infertile couples and is silent about the number of embryos that could be donated by each couple as well as the number of recipients for donated embryos by a couple. The Act is also silent about the issues of genetic linkage (nasab) and heritage which are challenging issues, especially in a conservative Islamic society. As a result, the future child may not inherit from their birth parents, as it is not required by the Act, or from the genetically related parents under the anonymity policy. Finally there is no standard national protocol or guidelines to evaluate the safety of the donated embryos. The paper concludes that despite its benefits, the Act lacks clarity, and it is subject to misunderstanding and confusion.     

Bioethics in artificial reproduction in the Muslim world

In Islam infertility and its remedy with the unforbidden is allowed and encouraged. It is essential if it involves preservation of procreation and treatment of infertility in one partner of the married couples. This is applicable to artificial reproduction which is one line of treatment of infertility.... The prevention and treatment of infertility are of particular significance in the Muslim World. The social status of the Muslim woman, her dignity and self-esteem are closely related to her procreation potential in the family and in the society as a whole. Childbirth and rearing are regarded as family commitments and not just biological and social functions.     

Cultural Identity and Internationally Adopted Children: Qualitative Approach to Parental Representations

Approximately 30 000 children are adopted across national borders each year. A review of the literature on the cultural belonging of these internationally adopted children shows substantial differences between the literature from English-speaking countries and that from France and Europe in general. The objective of this study is to start from the discourse of French adoptive parents to explore their representations of their child''s cultural belonging and their positions (their thoughts and representations) concerning connections with the child''s country of birth and its culture. The study includes 51 French parents who adopted one or more children internationally. Each parent participated in a semi-structured interview, focused on the adoption procedure and their current associations with the child''s birth country. The interviews were analyzed according to a qualitative phenomenological method, Interpretative Phenomenological Analysis. The principal themes that emerged from our analysis of the interviews made it possible to classify the parents into three different groups. The first group maintained no association with the child''s country of birth and refused any multiplicity of cultural identities. The second group actively maintained regular associations with the child''s country of birth and culture and affirmed that their family was multicultural. Finally, the third group adapted their associations with the child''s birth country and its culture according to the child''s questions and interests. Exploring parental representations of the adopted child enables professionals involved in adoption to provide better support to these families and to do preventive work at the level of family interactions.     

Adoption and Kinship in Oceania

The frequency and form of adoption practices in Oceania recently have been cited as evidence that human behavior is inconsistent with predictions derived from sociobiological theory (Sahlins 1976). Ethnographic data reviewed here, however, suggest otherwise. In Oceania kinship is an important factor in the selection and treatment of adopted children as adoption occurs almost exclusively among close relatives. Natal children often ally against their adopted siblings over the division of their common parents' estate while adoptive parents themselves frequently apportion their land unequally among their natal and adopted children. These patterns and other data are consistent with predictions generated by a socio biological model of adoptive decisions. The model illustrates how kinship facilitates adoption as a means of modifying extreme family sizes, and how asymmetries in the degrees of relatedness between parents and their adopted and natal children provide the basis of differential treatment of them. Adoption in Oceania provides an example of a clearly cultural behavior which is consistent with socio biological predictions, and suggests that both culture and biology are relevant to an understanding of human behavior . [sociobiology, kinship, adoption, Oceania]     

Anonymity and informed consent in artificial procreation: a report from Denmark

The practice of informed consent in biomedicine is so widely spread that it must be considered the most important principle within bioethics, and the most universally appealed to within recent legislation. There seems to be a consensus as to its value in research on autonomous persons, but also a problem concerning its application when dealing with people having a serious mental, social or even physical disability.
Within the field of artificial procreation there are even more problems. Informed written consent is often demanded from anonymous donors of gametes in order to ensure their consent to the legal and moral consequences of their anonymity. The child resulting from the artificial procreation, on the contrary, cannot consent to, nor be informed before being conceived, of the secrecy laid on the identity of its genetic parents. Some countries resolve this problem by allowing the children, when they reach their majority, to obtain some information pertaining to the health or the identity of their genetic parents.
This presents ethical problems. It can be argued that the anonymity of the parents chiefly affects the children, so that an agreement on this point among parents, doctors and others must be regarded as invalid. The paper will argue that a law ensuring the complete anonymity of the parents is disregarding the informed consent and the interests of the children resulting from artificial procreation, and is thus doing more damage to society than good.     

Anonymity and Informed Consent in Artificial Procreation

The practice of informed consent in biomedicine is so widely spread that it must be considered the most important principle within bioethics, and the most universally appealed to within recent legislation. There seems to be a consensus as to its value in research on autonomous persons, but also a problem concerning its application when dealing with people having a serious mental, social or even physical disability.
Within the field of artificial procreation there are even more problems. Informed written consent is often demanded from anonymous donors of gametes in order to ensure their consent to the legal and moral consequences of their anonymity. The child resulting from the artificial procreation, on the contrary, cannot consent to, nor be informed before being conceived, of the secrecy laid on the identity of its genetic parents. Some countries resolve this problem by allowing the children, when they reach their majority, to obtain some information pertaining to the health or the identity of their genetic parents.
This presents ethical problems. It can be argued that the anonymity of the parents chiefly affects the children, so that an agreement on this point among parents, doctors and others must be regarded as invalid. The paper will argue that a law ensuring the complete anonymity of the parents is disregarding the informed consent and the interests of the children resulting from artificial procreation, and is thus doing more damage to society than good.     

Accepting Adoption’s Uncertainty: The Limited Ethics of Pre-Adoption Genetic Testing

An increasing number of children are adopted in the United States from countries where both medical care and environmental conditions are extremely poor. In response to worries about the accuracy of medical histories, prospective adoptive parents increasingly request genetic testing of children prior to adoption. Though a general consensus on the ethics of pre-adoption genetic testing (PAGT) argues against permitting genetic testing on children available for adoption that is not also permitted for children in general, a view gaining traction argues for expanding the tests permitted. The reasoning behind this view is that the State has a duty to provide a child with parents who are the best “match,” and thus all information that advances this end should be obtained. While the matching argument aims to promote the best interests of children, I show how it rests on the claim that what is in the best interests of children available for adoption is for prospective adoptive parents to have their genetic preferences satisfied such that the “genetics” of the children they end up adopting accurately reflects those preferences. Instead of protecting a vulnerable population, I conclude, PAGT contributes to the risks of harm such children face as it encourages people with strong genetic preferences to adopt children whose genetic backgrounds will always be uncertain.     

Management of the infertile couple: an evidence-based protocol

Background

Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility.

Objectives

The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload.

Methods

A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib) by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), and Royal College of Obstetricians and Gynaecologists (RCOG).

Results

A simple guide for the clinicians to manage the infertile couples.

Conclusions

The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.

     

'The good of the child'

Warnock, chair of Britain's Committee of Inquiry into Human Fertilisation and Embryology, discusses the implications of the "artificial family" for children born through the use of reproductive technologies. She considers both treatment of infertility and the possible use of assisted reproduction to enable persons other than infertile couples, such as single persons and homosexuals, to have children. Warnock has found that emphasis has been placed on the wants and well-being of the adult(s) involved, and that the "good of the child" is a "wide and vague concept, widely invoked, not always plausibly." She is particularly concerned about children born as a result of the delayed implantation of frozen embryos, AID children who are deceived about their origins, and children born of surrogate pregnancies. She recommends that a detailed study of existing "artificial family" children be conducted to aid public policy decisions on assisted reproduction.     

Génétique et infertilité masculine: données actuelles

Intracytoplasmic sperm injection (ICSI) and testicular biopsies (TESE) have revolutionized the treatment of male infertility, introducing a risk of an increased frequency of genetic defects in the offspring. These risks and their consequences must therefore be evaluated when proposing ICSI to an infertile man. Karyotype and molecular analysis should be performed to detect any genetic defects responsible for male infertility. Y microdeletion screening is important, not only to define the aetiology of spermatogenic failure, but also to provide information allowing a more appropriate management of both the infertile male and his future male child. Genetic counselling is then advised before deciding to attempt ICSI.