People form families in many ways—through natural conception, through adoption and, more recently, through assisted reproductive technology (ART). Since the first birth of a child conceived by means of technology in the late 1970s, nearly 200,000 babies have been born, and 100 million procedures have been performed, according to an estimate by the International Committee for Monitoring ART. Many children have been born with the help of sperm or egg donation. The use of donor sperm as a treatment for male infertility in the United States was first reported in 1884, while the use of donor eggs was made possible in the United States more recently, in 1984.
Psychology, however, has been lagging behind technology. Guidance for parents and follow-up of children born by means of a donor egg or sperm is just beginning. There's lots of expert opinion on how, what and when to tell most children about where they come from, but expert opinion on conveying this information to children born as a result of egg or sperm donation is hard to find.
AOK spoke about this issue with Margot Weinshel, LCSW, RN, Clinical Instructor of Child and Adolescent Psychiatry at the NYU Child Study Center and Membership Chair for the Mental Health Professional Group of the American Society for Reproductive Medicine. The interview was conducted by Anita Gurian, Ph.D., for AboutOurKids.org.
Q: To tell or not to tell is a choice that must be made by heterosexual parents of children born by means of a donor egg or sperm. How can parents decide?
A: Both psychological and medical experts advise parents to tell the child. There are several reasons for this opinion. First, every child has the right to know his/her genetic background, particularly since there have been many medical advances in identifying and curing genetically transmitted diseases. Second, keeping secrets represents a denial of reality and is likely to cause problems in family relationships. In addition, children's trust in their parents may be shaken, as they wonder if other secrets have also been kept from them.
Q: Isn't keeping it a secret better for the child? Why look for problems? This is the only family she has ever known, and no one else has to know the details of how she was born. Why tell if the child doesn't ask?
A: In the long run, not telling leads to more problems than telling. Telling early avoids the betrayal children may experience if they find out when they're older. The current opinion that the child has a right to know represents a shift from 20 years ago when people were advised not to tell.
Q: What led to this change?
A: At that time, the medical profession felt that since the mother became pregnant and gave birth to the baby, it was not necessary to tell. The current view advocates an open and honest attitude.
Many adults who were born as a result of sperm donation have stated that they wished that they had been told the truth earlier, that the love and respect they have for their parents would not have been lessened. Some felt they had been betrayed because their parents had not been truthful and might have withheld other important information. Since egg donation is a relatively recent procedure, children born as a result of egg donation are still young and have not yet expressed their views on this issue.
Q: When do you tell a child? What's the best time?
A: Child development experts recommend that the child be told as early as possible. Even at the age of three the idea can be planted, for example, by reading a story book. (One example: Mommy was your tummy big? http://www.lulu.com/content/365108). In this way, the story becomes part of the child's reality from an early age, and she won't be able to recall a time when she didn't know this aspect of her history.
Q: Isn't the concept hard for young children to understand?
A: Not if it's presented in simple language and is not too detailed. By age four or five, most children will ask questions about how babies are born, so parents can take advantage of their natural curiosity. Don't tell young children more than they can absorb or more than they're asking. Telling doesn't happen in just one session, so remain open for ongoing conversations as questions will keep changing. Young children usually don't regard the topic as a big deal and quickly move on to something else.
Q: How do you tell? How much information is appropriate?
A: Keep the child's developmental stage in mind. The specific information should be tailored to the age of the child in language he can understand. For young children, it's okay to use terms that may be somewhat inaccurate but familiar: for example, you might say tummy for uterus, or egg for ovum, and then correct it later on. Whenever possible both parents should tell the child together. Don't tell too much; just answer the child's questions. Keep the communication honest, open and age-appropriate. The underlying message should reflect the fact that the parent or parents needed help and some very nice person helped. It is recommended that the word donor be used to describe this person. Referring to the donor as the real or biological parent erroneously implies that the donor has a parental role in the family.
Q: What about telling an older child?
At the age of eight or nine a child is expanding his ability to tune in to the feelings of others and can understand why parents might need help to have a child. At this age children can understand about genetic connections, sex, and egg or sperm donation. Make sure the child knows there was no sex between the parent and the donor. It's important to focus on the child's needs and feelings, not the parents'. Talk about the various ways that people form families, and that this is the way you chose, stressing the warm and loving feelings, not the technical process. Allow time for questions; it takes a while for the information to sink in. Then check in a few weeks, and talk again. Ongoing talks of this nature normalize the process and usually make the family feel closer.
With adolescents, keep several issues in mind: adolescents are focused on themselves, and issues of trust and identity are prominent. They're dealing with pubertal changes in their brains and in their hormonal systems. The immediate reaction of an adolescent can range from apathy to shock and anger. They may question why they haven't been told before. As adolescents struggle to establish their identity and their independence, new knowledge about their genetic inheritance requires considerable adjustment on their part.
Q: What about telling the children of single parents and gay and lesbian couples?
A: It's clear that a single parent cannot have a child without a partner and that two same-sex partners cannot create a biological child with each other, so the child must be told that a donor was involved. The time when a child asks about her mommy or daddy presents a natural opportunity. A number of books for children are available on this issue.
Q: What if the parents have other kids, either naturally or by adoption or by other forms of ART?
A: Parents should share the information with their children about how they chose to make a family at a time when they're all together or shortly thereafter. If there are differences, they should be explained. In this way, the facts are out in the open. Since cultural values have become more inclusive and accepting of the many ways that families are made, children are less likely to feel different than their peers.
Q: Is it ever a good idea not to tell?
A: Under certain circumstances it's not advisable to tell: a) if a child is not capable of understanding because of mental retardation or other condition, b) if parents are in a state of conflict, such as divorce, when telling might occur in a moment of anger, c) if the child is going through a particularly stressful time, and d) if the family is part of a culture in which assisted reproduction is a taboo and the child would be ostracized.
Q: Should other people be told?
A: Some people must be told. Physicians, for example, need to know a child's genetic background. It may also be advisable to tell teachers if the topic is likely to come up in class. It's usually advisable to inform family members and friends. The child may wish to talk with them at some point, and family members and friends often create a support network.
Some children may participate in the decision of who to tell. Around the age of eight a child can understand the difference between privacy (which is the individual's right not to divulge information) and secrecy (which is shameful). By this age a child can decide who to tell or to keep the information to herself if she prefers.
Q: How do parents' experiences in the process of infertility and in considering the help of a sperm or egg donor or other form of ART affect their decision to tell and the way they tell?
A: Anxiety and reluctance about telling are to be expected. Telling may reawaken earlier feelings of shame, blame, guilt and the emotional ups and downs regarding infertility. Parents have had to make hard choices and have had failures and disappointments in the processes involved. They have had to grieve for the fully genetic child they cannot have with each other and to adjust to the change in the future they imagined together. Despite the pain of re-experiencing these feelings, many parents report that they feel relieved after telling their child and that the family is stronger.
Q: Research thus far reports that children born as a result of sperm donation are doing well psychologically. When should people consult a mental health professional for guidance in making decisions about telling children, family, friends and others?
A: If parents are unsure or in conflict about deciding to disclose, need help with the specifics of how and when to tell their children, or tensions among family members are causing distress, consultation with a mental health professional with experience in this field can be helpful.
Further information and bibliography for parents and children are available on the following sites:
The website of the Donor Conception Network, www.dcnetwork.org, presents information about telling and talking to children as well as other donor issues.
American Society for Reproductive Medicine (ASRM) www.asrm.org presents multidisciplinary information in regard to education, advocacy and standards in the field of reproductive medicine. The ASRM Mental Health Professional Group deals with psychological issues in reproductive medicine.
About the Author
Margot Weinshel, LCSW, RN, is a clinical instructor in the Department of Child and Adolescent Psychiatry, NYU School of Medicine, on the teaching faculty of the Ackerman Institute for the Family; and in private practice in Manhattan. She is Membership Chair for the Mental Health Professional Group of the American Society for Reproductive Medicine. Ms. Weinshel is the co-founder of the Ackerman Institute's Infertility Project, co-author of Couple Therapy for Infertility (Guilford, 1999) and author of Surviving an Eating Disorder: Strategies for Families and Friends (Harper Collins, 1988, 1997). She has also co-authored chapters about infertility in Couples on the Fault Line, edited by Peggy Papp (Guilford, 2000) and Handbook of Primary Care Psychology, edited by Leonard J. Haas (Oxford University Press, 2004). Ms. Weinshel has published numerous articles and presents nationally and internationally.