The Role Of Stigma in Adoption and ART

I’m about to go off for a one-day meeting about how stigma operates in various settings and so naturally enough I’ve been thinking about the topic of stigma generally.   That’s lead me to some thoughts that tie in here in some important ways.

Stigmatization can serve an important social function.   If conduct is stigmatized people ought to be less likely to do those things and sometimes that is exactly what we’d like.   For instance, it seems to me we want to stigmatize things like driving while drunk so that people will do that less.

But the picture can be a complicated one.   For instance, we’ve been talking about pregnant women who use drugs If you stigmatize that conduct you might drive it underground–which might turn out to be counter-productive.    One should always be alert to unintended consequences.

With this in mind I’ve been thinking about the role of stigma in adoption and ART.    It seems to me (but I am ready to be corrected) that adoption was once far more stigmatized than it is today.   This might offer us a chance to think about how behavior changes as stigma changes.

I’m  not sure that stigma was ever useful in this context–I mean, historically did we want to discourage adoption?   I think not.    So this reveals something important about stigma that I skipped over before.  While stigma can be socially useful (and can therefore be a tool of social ordering), it isn’t always.    Sometimes it arises out of shame and/or prejudice and has no social utility at all.   In this sort of a situation (and I’m thinking adoption was one), stigma can only cause harm.

Adoptive parents sought to protect their children from the stigma an adopted child might face (or the stigma that the parents thought the child might face)  by concealing the fact of adoption.   I am not condoning this conduct, but I think it might have been understandable in the face of stigmatization of adoption.

As I said, I think that over time the stigmatization of adoption has diminished.  Another way to say this might be that adoption has been normalized—which is to say that it seems more normal and ordinary.   Normalization of adoption has, I think, played a critical role in the move towards greater openness about adoption.   This move is a good thing.

I’m happy to discuss this more–and I know that many of you know more about/have thought more about adoption than I have–but I want to round out my initial picture here by moving along to ART.

Perhaps it isn’t so much that ART has been stigmatized as that infertility has been.   I think many people experience infertility as a shameful failing.  (And here I do mean the kind of infertility heterosexual couples experience–to the extent single parents or same-sex couples need assistance to have kids, it’s really a different story.)   I think stigmatization/shame has something of the same effect you saw (I hope, rather than “see”) in adoption–by which I mean it breeds secrecy and tension.   I would count this as a cost of stigmatization.

But there is a question I’m obliged to raise here with regard to ART that I brushed aside with regard to adoption:   Is the stigma also useful?   It might be  useful if you think  if you think 1) that the underlying conduct should be deterred; 2) that stigma has a deterrent function here: and  3) if you consider the unintended consequences problem.

I know that some people–perhaps many people–do not like the use of third-party gametes.   I won’t focus on that (question 1) for now.   I’m also going to defer discussing the second question.

Which takes me to the third question:  what about the unintended consequences.   And here I think I might hark back to the discussion of adoption/donor conception from a little while back.   What I’d suggest is that whatever deterrent effects it might have, stigmatizing use of third-party gametes will have collateral consequences parallel to those we saw in adoption.

People will continue to use third-party gametes (which is to say I’m skeptical about deterrence here), but their actions will be shaped by shame and fear–including fear that their donor-conceived children will be stigmatized.  Thus they will not be honest and they will be threatened by the prospect that the gamete provider might have a role to play in a child’s life or in the life of the adult the child becomes.

By contrast, if the use of third-party gametes is normalized–as adoption has been normalized–I think you’d find people more open to all sorts of possible constructions of family and relationships.   I think counselling that it is important that children be told the truth from the earliest moments would fall on  much more willing ears.

I know, of course, that many will disagree with me.  But I’m wondering what the core points of disagreement come down to.   Is it my assertion that people will use third-party gametes even if they are stigmatized for doing so?   Or something else?


27 responses to “The Role Of Stigma in Adoption and ART

  1. For better or worse the ART industry failed to look at the effect secrecy would play in stigmatizing those party to it. It also appears that counselling regarding infertility may have been haphazard at best, perhaps in hopes that ART would be enough of a cure for infertility. They also failed to factor in is that secrets eat away at you – whether you acknowledge them or not. What they should have learned from adoption they didn’t. That open honest dialogue is the most productive to acknowledging difference and to assist in best practices. If the ART industry refuses to acknowledge they were wrong the situation will not resolve itself and will become a multi-generational wrong. To me they appear entrenched that they did nothing wrong.

    What it will take is some strong folk (the parents) to stand up and talk about it, share the deep remorse they feel for keeping secrets. It will require the ART industry to humble itself and not silence the voices (the parents and the donor conceived) – that will be the harder of the two to get done. if you compare them with how the adoption industries have reacted. (I do not believe the adoption industry became open to openness for the greater good – only to keep the industry alive.)

    I am not sure societal shame works in very many circumstances, except to make it not something you admit to doing because you don’t want to be shamed too. I think people who have come to have deep remorse over their actions taking a public stand on what they did wrong, so that others may do right. goes further and touches more individuals.

    Not sure where I am going except to say society needs to accept something was wrong and more forward in a better choice. We need to teach young people how to reason cause and effect for all actions not just stopping teaching kids when they know the basics rules, but to weigh out choices based on reality – at least until evolution ensures the front temporal lobe maturity happens before puberty anyway.

    • Certainly conventional wisdom within the ART industry has, in the past, been that secrecy was for the best. Early on even women who were being inseminated with third-party sperm didn’t know it wasn’t their husband’s. But I think there really has been something of a sea change here. Certainly there is a substantial chorus (if not a majority) that counsels disclosure–from the beginning. I think the popularity of identifiable providers speaks to this.

      I don’t mean to say it’s all better. Only that progress is being made. There are some steps in the right direction. And there could be a bit of a snowball effect. What I mean is that as more people are (courageously) out about using third party sperm, it might become easier for other people to be out about it. And of course, the way might be paved by those people who have no choice but to be out (as it were)–single mothers and lesbian couples.

      You mean you’re not sure shame works as a deterrent, I think? Perhaps not here–because perhaps the desire for children is too strong for shame to dissaude people. Perhaps it works better in other areas of life–posting tax cheats, maybe? But if you think you are in an area where people are going to do the thing anyway (like have kids) then maybe we’d be better off accepting that and moving on to how to help people make the best choices for themselves and their kids.

  2. Bill Cordray

    Adopted children were often insulted by their peers as bastards for a long time. Bullying is even much worse now and adopted people are often still victims of it during their teens.

    In DI, there was the specific stigma that DI meant that the father was infertile, not so much with adoption where it was assumed, incorrectly, that the woman was infertile, or just the couple. Male shame about infertility can be intense. In DI, there was also the danger that revealing the conception to others outside the family was dangerous in that it was legally considered adultery in many jurisdictions. For example the Archbishoip of Canterbury condemned as such, leading to very limited public exposure and the damage of decades of deception.

    I don’t agree that stigma is absent in adoption, now. It exists in a different form. There is a tendency for adoption to be presented as a totally wonderful way to build a family. From the point of view of adopted people, this leaves them stigmatized against expressing any justifiable anger at how it has affected them. As I listened to male adoptees this past weekend at a conference for the American Adoption Congress, for instance, I often heard variations of “we are not supposed to be affected by the denial of our roots.” As a poster on several Infertility web sites, I often get stigmatized for any sort of legitimate criticism of the DI profession, as well as for the choice of terms I use. We are expected to be “grateful” but DI parents are upset when we say we are not. Instead of receiving some empathy, we are accused of being disloyal or mentally disturbed.

    Bill Cordray

    • You’ve made me realize that when people adopt a child we may suspect infertility, but we don’t know and we certainly don’t know whether it is the man or the woman. (Unless they tell us, of course.) But if you tell people you’ve used third-party sperm the cat is pretty well out of the bag. And I totally agree with what you say about male infertility. Male shame around this can be intense and as far as I can tell there’s nothing good about that shame. I mean, it has no useful social function. It’s like being ashamed of any other physical trait or short coming–it’s often just the hand you are dealt. Moving away from that cannot be easy, but one could hope to try, or at least to find agreement that it would be the right direction to move.

      That’s a good point about the way adopted people are treated now. Hadn’t thought about it in quite that way. It may not quite be stigma–or at least not the sort of stigma I meant to refer to. Perhaps I’d say that adopted people are expected to conform to a stereotype and to behave in certain ways and that those expectations can make the honest expression of feeling unacceptable, which can lead to a silencing. Or something like that. Or maybe I’d say that the stigma has shifted–it’s not being adopted per se that is stigmatized, it’s being angry, say, at being adopted that is stigmatized? I do not mean to offend–I’m just trying to think it through here. It’s an important point.

      • Julie said: “Or maybe I’d say that the stigma has shifted–it’s not being adopted per se that is stigmatized, it’s being angry, say, at being adopted that is stigmatized? I do not mean to offend–I’m just trying to think it through here. It’s an important point.”

        Just a couple of quick points before I go away from the Internet for the next two weeks to visit my incredible new grandson.

        I think the stigma gets dumped onto adopted people by society and parents, when we (I considered myself adopted through DI):
        1. are critical of the professionals and their policies,
        2. express feelings that go against how our parents want us to feel
        3. express sadness for the losses we experience
        4. are angry over the denial of what we consider essential information about our original families
        5. are frustrated in trying to build an authentic identity, to be our genuine selves, within a family that doesn’t accept part of our essential differences from them
        6. are frustrated in our attempts to fit within our artificially created family
        7. feel like a stranger within these families
        8. can’t understand why we are supposed to be grateful for all these losses
        9. and, for many other reasons, we are unhappy with the whole idea.

        For traditional adopted people, a common source of anger, sadness, grief, etc. is the social emphasis on providing help for infertile people that entails taking helpless children away from their famillies, often through deceptive practices, shaming pregnant women, offering money, etc. We need to recognize that the system uses children to make infertile people happy by causing immense pain to original parents. Birth mothers do not think of relinquishment as as altruistic gift but as a surrender to overwhelming social forces. Of course, we are moving slowly away to a better form and maybe people like me ought to focus on some ideal future where no one gets hurt and rights are recognized. However, we are a long way from that so our generation of adoptees and DI adults are not going to stop being critical.

        • I’m not suggesting that people should stop being critical. And I don’t think many people will endorse “deceptive practices.” But I’m not comfortable with statements like “birth mothers do not think of reliquishment as…..” First off, I’m not sure the either/or you’ve captured here really expresses the range of how people might think of it. I would expect that there are women who become pregnant, do not want to have an abortion and do not want to raise a child at that time of their lives. They may not think of what they are doing as altruistic, but they may conclude that it is the best option they have. And if they are allowed to retain some track of the child then they may not think of it as “surrender to overwhelming social forces” either.

          I’m also rarely happy with blanket statements and this seems to be one. I don’t claim that all women have the experience I just described. I think the experiences vary a lot.

  3. Julie said: “But if you think you are in an area where people are going to do the thing anyway (like have kids) then maybe we’d be better off accepting that and moving on to how to help people make the best choices for themselves and their kids.”

    Exactly – when people are in the desperation mindset infertility can cause “of got to have kids now” – very few have the werewithal or desire to think past that. Not all but being in a mode of desperation changes people. (I am not trying to be meanspirited – just realistic).

    There is a darn good reason there are laws and requirements for adoption…not that it works perfectly and definitely needs an updated overhaul, but there are checks and balances. You have none now in ART so to speak other than the man profiting.

    • I wonder whether the desperation people experience is something that is externally reinforced. I mean, having chidren is so much created as the norm that not having children seems a pale second. I know some will say that there is an intrinsic desire to have children but since I’m generally suspicious of reliance on the idea of intrinsic impulses I should probably be suspicious here. Certainly our culture reinforces ideas that children and the necessary completion of a family, don’t you think? And that makes not having children rather a big deal.

      Also, I cannot help but wonder about why, if there are darn good reasons for screening adoptive parents and if, as you suggest, they should be extended to ART parents, we shouldn’t (at least in theory) extend the same screeing for all parents. Surely the mere fact that you can reproduce on your own is not any guarantee that you’ll be a good parent? I realize there are concerns about both practicality and privacy, but shouldn’t the question be whether these facors outweigh the need for screening? Shouldn’t the need for screening be the same?

  4. My mother had to take the blame for 12 years of infertility. If my narcissistic social father had been legally forced to be open about the DI, I’m pretty certain they wouldn’t have taken that route. No amount of desperation for a child would have overcome that particular shame in him. But this does not apply to most other men, I would hope.

    Perhaps paradoxically, forced openness might help reduce shame and stigma, because if things are out in the open enough and attached to people like us we know and possibly like, we get used to them, for better or worse.

    And live the reality of DC authentically, openly, unashamedly. Why the need to have it always repeated “but I’m the real father, the only real father, have no fathers but me”? Can’t the infertile man muster the strength to say “you have a biological father/progenitor, and I’m your legal father/custodian. But you can call me just Dad, if you wish”?

    • That’s really interesting. It might actually be easier to not have a child because not having a child would be less remarkable–look less like a failure. Thus, if you weren’t comfortable using third-party gametes, you would more readily choose not to have a child and if you were, you might go ahead and you’d be better at it.

      I’m not sure how you force openness. Anything akin to forcing the child to wear a badge is going to reinforce the shame/stigma side, isn’t it? And I really do think that children vary enough so that saying exactly what you have to tell each child at each age is not likely to work. Is it enough to ensure that a child will know when they turn 18? WOuld that certainty inspire people to tell. (ANd then, of cousre, how do we do that?)

      Again I think about how adoption is managed now. Prospective parents are told about why they need to be honest. There are resources for them–everything from picture books to movies and I’m sure there are support groups. They know their kids will have access to their original birth certificates. Most tell now, but not all, right? It will never be all. What to do?

      One last thought–about what kids call their parents. When you raise kids from infancy you get to tell them what you want to be called and for most people I know, you actually train them. “Where’s mommy” you ask when you play hide and seek or whatever. I know children may choose their own names later. But at least in my admittedly limited experience, the first choice goes to those raising the child. Choosing later to reject that name is sometimes fraught–though many kids do so for many reasons. I would think if you reintroduce, over and over, the idea that there’s a sperm provider out there you would also give the child a name for that person–you’d describe them. Another topic.

      • I didn’t mean we’d force openness from the start and in the general public – no, just that the child would have access to factual biological information independently from the legal parents at a certain age.

        It is a good motivation to tell – and you have, say, 18 years to do so. And if concealing this is more important than having the child, you wouldn’t have the child.

        • I think I generally agree here and I’d work hard to set things up to encourage the telling and retelling. (Telling once won’t suffice–kids need to hear things more than once in different ways at different ages.)

          Interestingly, I am spending some time with lawyers who do a lot of ART work and several of them take exactly the stance your last paragraph suggests: If prospective parents won’t agree to tell, then the lawyers won’t work with them. I think it’s important to give credit here because many comments suggest that lawyers are part of the problem (and of course, sometimes they are). But they can also be part of the solution.

  5. while openness relieves stigma, to a certain extent there will always remain a stigma of being somewhat other than normal; whatever normal happens to be

    • I think I disagree, at least to some degree. We create normal in many contexts. Maybe wearing glasses was once stigmatized and abnormal, I think it’s now pretty much normal. We just don’t see it as a very meaningful difference even though it is a difference. I don’t drive. In many places, that is distinctly not normal. But of course once it was normal and in NYC (where I happen to be now) it’s actually normal, too.

      This can work the other way, too. I worry, for example, that looking old (which used to be normal) is becoming less normal as more and more people elect plastic surgery.

      In other words, normal is what we think it is. I do not think stigma is inevitable. Difference might be, but the meaning we give difference is changable.

      • I agree that normal changes. there was a time when divorce was abnormal, and children whose parents divorced had that stigma to deal with on top of all the other issues that go along with divorce. But I don’t think that lecturing about the stigma of divorce or advising against secrecy lessened the stigma. The only reason that happened is because divorce itself became commonplace and normal. if half the class is donor conceived than the kid wouldn’t feel stigmatized. but I don’t think we will be getting there soon- sex isn’t going out of style just yet.

        • in fact I think that parental secrecy is a result of the stigma, not the other way around. but perhaps that is a chicken-egg question.

  6. Julie said: “Perhaps I’d say that adopted people are expected to conform to a stereotype and to behave in certain ways and that those expectations can make the honest expression of feeling unacceptable, which can lead to a silencing. Or something like that. Or maybe I’d say that the stigma has shifted–it’s not being adopted per se that is stigmatized, it’s being angry, say, at being adopted that is stigmatized? I do not mean to offend–I’m just trying to think it through here. It’s an important point.”

    Julie – some / most (?) people don’t have the ability to separate “their personal adoption story” from “practices of the adoption industry that are harmful if not illegal”. In part it can be understood because JQPublic is ignorant but in reality the longer the bad practices continue the more harm is done. There is also the irrational fear factor of not being enough or good enough that the child (now adult) had to seek out their family of birth. It is also coupled by the inability to see that an adult adoptee can have had the best life and also see the impact of adoption, that we feel a solidarity to other adoptees in wanting better for them than many fellow adoptees had (even if had the best). To many AP’s if you aren’t “pro-adoption” and every adoption is better than not being adopted – then you are automatically deemed “anti-adoption”. I am one who would be tagged as the “anti” although I am not – I am pro-reform, pro-family preservation explored first, pro-ethical adoption when the process and rights are all in sync. People see either/or and not all the different shades of grey. I also get very tired of being asked what my parents did wrong – what to raise an individual to see deeper than media sound bites? To do your own research and form your own opinions? To speak up when something is wrong? Bad parenting I guess…ugggh…

    • Perhaps it’s only human to prefer a simple good/bad picture at the same time that is also human to have a life that is full of far more complexity. We like generalizations but we don’t live lives that can readily be generalized.

  7. Julie – you said to Pronoia “They know their kids will have access to their original birth certificates.”

    That is incorrect in the vast majority of states in the US. Some have changed on a go forward basis, but have provided a veto clause for the mother and other exceptions. If not for the Adoptee Rights Activists even that would not have happened. Retroactively it is even more dismal, even Washington legislature this last session failed at the senate level to open retroactively where it didn’t even get to a vote – despite having the house on board.

    Have you ever read the requirements to get a passport post 9/11 if your (amended) birth certificate is dated more than a year after birth? Try applying the test to prove citizenship with no genetic connection to your parents, exlude the doctors who delivered you because you are somebody else now, you are left with early documentation and see how much you have at your age now, that you could present that qualifies. And no, you have no adoption paperwork because that too is sealed away.

    • Thanks for catching this error. I suppose I tend to overestimate the bright side and it is important not to mistate things.

      I also was sloppy about going forward vs. retroactivity. I assume that it is correct that there will be greater access going forward than retroactively, but that doesn’t say that there will be adequate access in either case. I think it is at least the case that the trend is in the right direction? But I take your point.

      I have not read the requirements for passport. I want to make sure I understand what you’re saying here. For a child, isn’t it enough that the bc says you were born in the US and that they reflect your legal parents? I’m travelling so I cannot go and look but my kids have birth certificates that are likely dated more than a year after their birth (which is to say, they reflect changes in legal parentage that I know occured more than a year after birth.) But they show the kids were born here in the US. And I got them passports. I have this feeling I’m missing something, though. Is this a greater problem for older people? Will it continue to be a problem going forward?

      I don’t mean to impose on you but if you cared to elaborate a little I’d be interested. If not, that’s fine, too.

  8. Julie said: (snips to shorten) “I wonder whether the desperation people experience is something that is externally reinforced…haning chidren is so much created as the norm… I know some will say that there is an intrinsic desire to have children but since I’m generally suspicious of reliance on the idea of intrinsic impulses…our culture reinforces ideas that children and the necessary completion of a family…

    Yes, we are reinforced starting very young with dolls, nuclear family themes, want to be grandparents pressure, friends having kids, etc. I do think that is a large part. I also think we are internally triggered as a species to reproduce to ensure the survival of a species.

    And there are those who never desired to be parents.

    Julie said: (snips) “Also, I cannot help but wonder about why, if there are darn good reasons for screening adoptive parents and if, as you suggest, they should be extended to ART parents, we shouldn’t (at least in theory) extend the same screeing for all parents. Surely the mere fact that you can reproduce on your own is not any guarantee that you’ll be a good parent?…Shouldn’t the need for screening be the same?”

    Practically unless it was a country like China it can’t happen. I do think all parents should be screened, counselled, courses taken, but aside from offering solutions to not parent or get pregnant, you would have the consitution to change first.

    I do think though there are distinct reasons for adoption and art screenings (what type is the ?) and perhaps different standards.

    Adoption (voluntary) you are asking someone (a stranger) to give you their child and sign away their legal rights, and the state is accepting and approving that transfer. The responsiblity factor is identical to what any parent would require when choosing legal guardians for their child if something happened, and the state has legal obligations to a citizen of their state who is a minor compounded by their role in approving the transfer.

    Where ART and Adoption meet is in the intracacies (sp?) of what the difference is in raising a child with other parents out their somewhere. The emotional aspects are/can be different for the child. Your emotions if you dealt with infertility are going to be different and may impact how you parent, and your expectations of how that child will be, may based on what you would expect from your own bio kid (pressure to be someone you aren’t). (not everyone by any means, but the counselling, screenings etc are meant to discover and work through those challenges or any other concerns). There are differences and whether they are hurdles to overcome, then it is better to do it before rather than later. Some will never get past it and they are simply in adoption not approved – the checks and balances.

    • So very true. I don’t think it’s prudent to pretend that having to raise someone else’s biological offspring after having struggled with infertility (which is true for the majority of adoptive parents and couples who use third-party gametes) is just the same. Not everyone is ready for it. Not everyone is realizing what it entails. Not everyone can do it.

    • So much to respond to here.

      I think there are people who want to be childless (as there are people who want to be single) and that this is a hard choice to make sometimes. People have a hard time believing that not having children can actually be your preference and, if they do, they may think you selfish (as though having children was an act of generosity). I fear a number of people have children for the wrong reasons–because they do not have the strength to go with their inclination not to have children. And that is often not so good.

      I do see the practical problem with screening people who reproduce on their own. Same problem with people who do home insemination. So it’s really a theoretical question, I suppose. But I think the core question is nevertheless important: iS there any reason we’d expect the genetically related people to typically be better parents?

      I think the points you raise about screening adoptive/ART parents are insightful and really interesting. I need to think about them more. I’m still travelling so that’s hard to do right now. It seems like, having done all that groundwork on the ways in which adoption/ART are/are not alike, it would pay to follow through as you have done.

      One thought occurs to me: The screening process also presents and excellent opportunity for education. This is the time, for example, to teach people about the importance of transparency with their kids. If there isn’t going to be screening for those conceiving via sex, then you don’t have that chance. Which means people launch into parenthood often without a clue. And of course, no matter how you conceive there are things you need to know about raising children. (I see a potential post taking shape but must run.)

      I will be back to regular schedule before the end of the week and will I ever be glad! Home sweet home and all that.

  9. we are socialized to reproduce begins any culture that socialized its members not to reproduce, went out the Darwin why. example the essenes.

  10. actually reproduction has in most societies been the MOST IMPORTANT human activity, whether this is consciously acknowledged or not. Note that all of humanity is divided into separate categories- male and female- based on reproductive roles. not just some societies. all.

    • Is this really true? What about gathering food? Caring for already born young? (Or is that part of reproduction?) And while reproduction is important for a society not every member of the society needs to individually reproduce. Isn’t there stuff about how aunts/uncles (or the equivlant in the animal world) can assist in the raising of young and thereby promote the survival of their genetic line even though they themselves may not have offspring? (This was an early explanation for why being gay might be evolutionarily functional, I think, but I have no idea if it’s really true.)

  11. i therefore find it odd when people wonder why people feel incomplete.

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