F. van Balen

Minority stress, experience of parenthood and child adjustment in lesbian families

The aim of this study was to explore the relationship of minority stress with experiences of parenthood (e.g. parental stress and parental justification) and child adjustment in lesbian mother families. Three components of minority stress were examined, namely, experiences of rejection as a result of the non‐traditional family situation, perceived stigma, and internalized homophobia. A total of 100 planned lesbian families (100 biological mothers and 100 social mothers) were involved in this study. Data were collected by means of a written questionnaire. The lesbian mothers in this sample generally described low levels of rejection, they perceived little stigmatization, and they also manifested low levels of internalized homophobia. However, minority stress was significantly related to experiences of parenthood. Lesbian mothers with more experiences of rejection experienced more parental stress, and appeared to defend their position as mother more strongly (e.g. parental justification). Furthermore, mothers with higher levels of perceived stigma and internalized homophobia felt significantly more often that they had to defend their position as mother. Finally, mothers who reported more experience of rejection were also more likely to report behaviour problems in their children. Our findings emphasize the importance of the effect of minority stress on the lives of lesbian mothers and their children.

Involuntarily Childless Couples: Their Desire to have Children and Their Motives

Long-term infertile couples often reflect seriously on their desire for a child. By investigating involuntarily childless couples we might get a better understanding of the intensity of the desire for the first child, the motives behind this desire and the difference between men and women in these respects. In this study among 108 couples with a mean infertility period of 8.6 years, the desire for children was still very strong especially among the women. Also, there were differences between men and women as to their motives for having a child. The most frequent motives for wanting a child are part of the categories happiness and well-being. Motives within the categories social control and continuity were seldom mentioned. Among women with the most intense desire for a child, motives within the categories motherhood and identity-development were very important.

Factors influencing the well-being of long-term infertile couples.

The aim of the study was to investigate factors that may influence the well-being of long-term infertile couples. One hundred and eight childless couples with a long-term infertility completed a structured questionnaire. Three groups of independent variables were discerned: sociodemographic factors, factors associated with infertility and the desire to have a child, and personality characteristics. The effect of these variables upon seven dimensions of (negative) well-being: depression, anxiety, hostility, health complaints, guilt/blame, self-esteem and sexuality was investigated. Strong negative feelings concerning infertility and a high degree of femininity were associated with a low level of well-being (among women as well as among men). To a lesser extent, secrecy with regard to infertility and being the infertile partner (among men) and still pursuing medical treatment (among women) were related to a lower sense of well-being. Recognition of these relations may help in the counselling of infertile couples.

Infertility, culture, and psychology in worldwide perspective

For most people, having children is an essential part of life. All societies value the birth of children and attach great importance to the upbringing: if this were not the case, there would of course not be any societies. However, the meaning and importance of children differs from society to society and from era to era. It has been debated whether parents in early capitalist Europe really loved their children, or whether they simply considered the economical and societal advantages of having children. Proof of this supposition was the 18th–19th century French custom of handing over newborn babies to wet-nurses who usually lived far away from the parents. In similar vein, it has been argued that in resource-poor countries people have children for economical reasons (to help the family to earn an income) and/or for cultural/religious reasons (to bring offerings to their parents and ancestors, such as among Confucians in China). In our era, scientists have put forward various theories to explain why people choose to have children. Examples are theories about inborn drives and subconscious feelings (psycho-dynamics), and rational choice theories. Theories about subconscious motives are impossible to prove empirically. Economical cost–benefit models have shown that over the life course, children in the West cost more than they deliver to their parents. It appears that in modern individualistic societies, children are desired mainly for individual reasons, namely, for the happiness, well-being and life fulfilment that children bring to their parents. There are no strong constraints and social pressures on women to have children. In Western society, many women choose to be childfree. In the Netherlands, for example, 50% of childless women in the 37to 46-year-old age group declared to be childless by choice. However, in many traditional and transitional societies, children are important for social and economical reasons, and it is not acceptable to decide not to have children. With few exceptions, all childless women in these societies are involuntarily childless. These women suffer not only because they cannot be mothers, but also because they are isolated and excluded from social life, are subjected to scorn and slurs, lose their rights, and suffer from poverty and lack of support. In this issue we shift the focus of the study of infertility and childlessness from the rich Western world to a global perspective. In the Western world, the subject of

A review of Islamic Middle Eastern migrants: traditional and religious cultural beliefs about procreation in the context of infertility treatment

In many societies cultural beliefs about procreation exist that differ from the Western biomedical model. In the Middle East monogenetic patriarchal preformation models and mixtures of these models with the biomedical model exist, alongside the Western biomedical model. This review gives an overview of these non‐biomedical beliefs in the Middle East and their connection with the biomedical model. The likelihood that non‐biomedical procreation beliefs exist among a number of Middle Eastern migrants is demonstrated and it is shown how these beliefs might influence the experience of infertility and attitudes towards infertility treatment. Several suggestions for improving healthcare are made.

Preimplantation genetic diagnosis as an alternative to amniocentesis and chorionic villus sampling: psychosocial and ethical aspects

Social and ethical considerations play an increasing role in decisions about the use of diagnostic technologies. In this article expert opinions of a medical-biological and a social-ethical panel on psychosocial, ethical and social aspects of preimplantation genetic diagnosis (PGD) are discussed. PGD is a new diagnostic technology for identifying chromosomal or single gene defects, which is now available as a medical treatment in several western countries. In contrast to traditional technologies like amniocentesis and chorionic villus sampling PGD offers the possibility for diagnosis before pregnancy. The panels expected PGD to be chosen only in serious situations. IVF was considered to be a barrier for PGD but less so in more serious situations. Destruction of pre-embryos was thought more acceptable than selective abortion, but only marginally. Finally a substantial decrease was expected in the acceptance of handicapped people in society as a consequence of the possibilities of technologies like PGD. Although PGD offers new possibilities for couples at risk of having a child with a genetic defect, it is important that couples are counseled in a way that emphasizes both the advantages and disadvantages of the technology. The general public should be informed about possibilities and impossibilities of preventive diagnosis and the right of future parents not to use genetic diagnosis.

Perspectives of reproductive health

This issue of Patient Education and Counseling is dedicated to reproductive health. The main focus is infertility as it is experienced in different of our world. In western societies, medical breakthroughs give couples with fertility problems a good chance to have a child. However, in many developing societies adequate medical treatment is only available for the upper classes, and many women keep going to traditional healers. In addition, the social consequences of childlessness are much greater than in western societies. Another focus of this issue is negative experiences regarding pregnancy. A very distressing experience is late pregnancy loss. Late pregnancy loss is different from infertility with respect to the tangibility of an object of grief, though it may also result in permanent childlessness. Other aspects of negative pregnancy experiences are exceptional physical reactions and recurrent induced abortions. Furthermore, two other elements of reproductive health are addressed in this issue: STD among female adolescents and gender aspects of gene technology. Finally, the ramifications of these various aspects of reproductive health on education and counseling are discussed.

Perspectives of new reproductive and diagnostic techniques among biologists and physicians, social scientists and ethicists

The introduction and acceptance of new techniques in the field of reproductive medicine and antenatal genetic diagnosis is a complicated process in which biomedical professionals, and also social scientists and ethicists, play an important role. In this study the attitudes, expectancies and opinions of a panel of biological and medical professionals working in the field of this new technology are compared with those of a panel of concerned social scientists, psychologists, ethicists and leading members of patient groups. Various aspects of the new techniques are investigated: the present and future feasibility, the potential importance, the ethical evaluation and the social acceptance. The social-ethical panel appears to be much more reluctant regarding the importance, ethical values and social acceptability of new techniques than the biomedical panel, in particular, for preimplantation genetic diagnosis and fetal cell sorting large differences exist.