P–508 The relational self in fertility decision-making: Chinese lesbians exploring donor conception and biological ties
Authors: Lo I P Y 
Published: August 2021

Abstract

Study question
How does the cultural importance attached to biological family ties shape Chinese lesbians’ decision-making processes regarding whether and how to have children?

Summary answer
The cultural significance of biological ties shapes Chinese lesbians’ fertility decisions, including those regarding conception methods, who will get pregnant, and whose sperm to use.

What is known already
Previous research has shown that normative expectations towards opposite-sex marriage and biological parenthood impose significant psychological burden on lesbians in China, where same-sex couples are not entitled to the rights to partnership/marriage, assisted reproductive technology (ART), and parenthood. Despite the legal barriers, online discussions on same-sex parenthood and commercial consultation services targeted at same-sex couples who want to travel overseas to use ART have emerged in recent years. While more lesbians have become parents of donor conceived children in Western developed countries, little is known about Chinese lesbians’ reproductive experiences in the context of increasing reproductive transactions that transgress borders.

Study design, size, duration
In-depth, semi-structured interviews were conducted with 35 Chinese lesbians between July 2017 and June 2018 in Beijing, China. To better understand the context and social and clinical implications of global ART services for Chinese society, I also carried out participant observation by attending informal gatherings organised by the local lesbian community and public events targeted at (same-sex) individuals and couples who want to travel overseas to use ART and producing fieldnotes after the events.

Participants/materials, setting, methods
Participants were aged between 25 to 45. The majority were in their thirties. Each interview took around 2 hours and was audio-recorded and transcribed. The interview guide covered questions about their family beliefs, views on and/or experiences of donor conception, and perceived and actual difficulties in pursuing motherhood. With the assistance of NVivo (a qualitative data analysis software), I carried out thematic analysis of the interviews and fieldnotes to identify common patterns across the dataset.

Main results and the role of chance
Participants shared a belief that being biologically connected with their (prospective) children was, to varying extents, important to their families. They were at different stages of fertility decision-making, ranging from achieved motherhood (8 participants), actively planning to pursue motherhood (9), hesitation in taking action (11), and a lack of interest in or hope of becoming a mother (7). Almost all participants expressed that they did not prefer adoption and that they were reluctant to involve known sperm donors, who were considered a threat to their parental status. Rather, they were inclined to seek ART overseas in order to create their desired biological ties in a clinical setting. Issues including donor screening, desire for family resemblances, the status of biological and social mothers, and plans to purchase sperms from the same donor to conceive “siblings” were discussed in the interviews. It is evident that when deciding on whether to have a child and how to involve any third parties, participants tended to embrace the relational self and carefully balance individuals desires with familial and social expectations. The felt need to legitimise their relationships with donor conceived children imposes psychological burden on lesbian intended parents and discourages many from pursuing motherhood.

Limitations, reasons for caution
The findings of this qualitative study are not intended to be generalised to the whole lesbian population in China. Given the hidden nature of this population, my research, despite its small sample size, represents a significant step forward and calls for more quantitative and qualitative studies on lesbians’ fertility health.
Wider implications of the findings: This study shows that lesbians’ journeys to donor conception require not only medical and legal support but also psychosocial care that attends to one’s perceived importance of biological ties and family beliefs. It sensitises healthcare professionals to the specific fertility-related psychosocial needs and concerns among lesbians in a family-centred context.

Trial registration number
Not applicable