SUE MIDFORD Psychologist in private practice Member of the Western Australian Reproductive Technology Council

TELLING:

WHAT? HOW? WHEN? WHY?

WHY TELL? their biological heritage, we are restricting the information they have about themselves. Why tell? Why not tell? If we are going to tell, The child’s life course is the outcome of a donor what do we need to know about the various stages of conception, whether eggs, sperm or embryo. The development in the life of a child? What do parents child would not exist unless conceived in this way. It need to know about their situation? Finally, how can is very easy to overlook the child and to trivialise the we put together the whole developmental framework significance of donor conception because the child with the realities of the world? What are some isn’t around when the treatment takes place. We practical ideas about how to actually tell? must however attend to the needs of the parents A lot of people have been saying “Don’t tell” for a AND the child. long time. Now we are saying “Tell”. Why should we Secrecy versus openness is an important issue. tell? In my clinical work, it has become obvious to me that Firstly, I believe there is a profound risk to secrets in families are often a source of significant the parent-child relationship and to the child in problems - something like a cancer. Secrecy is about not telling. The risk is in the context of the ‘haves’ and the ‘have nots’ in terms of information. Secrets create power struggles in information about that child which may be families. Certainly much has been written about the revealed from sources other than the parents. harm that secrets can do. I think parents need to be Lack of origin information has significant aware of this threat when they are making the implications for the development of identity decision to tell or not to tell about DI origins. and maturation for the child. We have our I am aware of the difficulties which parents children by a variety of means. Some choice is face when considering telling their children. It is a always involved, whether the child is conceived very difficult decision and an even more demanding unexpectedly or after a long and deeply action to implement. Secrets, on the other hand, are considered process. . The child however never very difficult to guarantee because some of the people who have the knowledge may choose, for chooses to exist. I have yet to meet a donor reasons that have very little to do with reasoning offspring who doesn’t want to exist. We behind the original secret, to reveal it, and perhaps parents have responsibilities because we choose not in the way that other parties to the secret would to create our children. The developing child is want it to be revealed. dependent on his nurturing parents for We must also look at donation in the normal information and explanations about his creation. context of children growing up. It is not unusual for Society is increasingly open about many things, children to ask their parents “Am I adopted?” I not only reproductive technology. We have accepted remember thinking that I must be adopted when I responsibility in many areas concerning rights and was a teenager because I concluded my parents the provision of information. People have access to seemed so horrible there was no way I could be material about them that is held in government and related to them! I can remember hunting through other institutional files and this right is discussed drawers, trying to find the document which would and exercised widely. We can thus think about this prove I was right. When an adopted son or daughter matter of telling in civil law and human rights says to their adoptive parents “You’re not my real contexts. If we are not telling our children about parents, I’m adopted and I don’t like you!”, it’s the

DONOR FAMILIES – Raising the issues 1 flip side of what I said to my parents: “You’re so There are differences. DI offspring usually revolting, I must be adopted”. The reality is that have one genetic parent and the parents have to deal there are more children born these days from donor with that reality. As someone remarked from the insemination than from adoption. Children in the floor, children in the DI family are brought up with future aren’t going to say “Am I adopted?”, they will two parents who really want to have a child in a say “Am I from donor insemination?” supportive environment and it is an oversimplification The last point in this incomplete list of reasons to only emphasise the sensational medical factors. to tell is that the fear that the child will reject the There are parallels with adoption but we must remain parents is overwhelmingly groundless. There may be thoughtful about the impact of the differences. So an initial adjustment necessary after being told, but in relation to how to tell DI children about their the child will not reject the parents. I base this on a family creation we do not know very much at all. We range of evidence. I’ve worked in adoptions, with have some information from DI offspring, DI step parents and with donor insemination families. I parents and others and can use some information have yet to see a situation in which the child rejects from related areas such as adoption, step-parent the parent for telling. There may be some settling in families etc. problems, but rejection does not occur because of There are now more children born each year now telling. If rejection happens there are other factors from donor insemination than are in Australia placed in the relationship which have caused it. for adoption. An estimate made in the late 1980’s was that there were as many as a quarter of a TELLING: RESEARCH AND OTHER SOURCES OF million children per annum created internationally INFORMAITON through donor insemination. The reality is that most of those children and the adults they have become What do we know about telling DI offspring of do not know about the donation. In Australia there their origins? Formal population research studies would have been at least 100,000 people born in the following up donor families who have told their twentieth century from DI. children in a planned manner, or whose children have There is a self help group in the United States heard inadvertently, do not exist to date. There is called Donor Offspring. They have a newsletter and however anecdotal information and some small have been in operation since the late 1980’s. What research studies. strikes you as you read their newsletter is their Donor insemination has been occurring since the confusion and despair. There is no anger that they late nineteenth century. There are thus DI exist, just an incredible need for information. They offspring of all ages including many who have died are not rejecting their parents. They are bewildered never knowing they were born from donor about why they have been shut off from their insemination. This is because it was always kept genetic information, and why they have fewer rights secret. This creates a major problem in conducting than others. research projects because the people you want to I was involved in conducting a national phone-in a contact do not know they are donor offspring and couple of years ago. We had national media coverage their families want to keep it a secret. So the trying to encourage donor-offspring, donors and research cannot proceed. recipient parents to participate. We had excellent One area for research could be on the parallels response from recipient parents and donors but had between adoption and donor conception. I have very few responses from donor offspring. I believe worked in the area of adoption for a long time and the small response from donor offspring wasn’t there are many parallels. Some reject those because they were disinterested but rather that similarities saying that donation and adoption are there were very few in the teenager plus age group just not the same. But in my work I have found that who knew of their donor status. We heard from just the way donor offspring speak about their emotions, five DI offspring, all teenagers. They were all very issues of identity and their relationships with their consistent in what they said. They strongly family and extended family are often very similar to recommended that offspring be told and they were what adopted people have said about these matters all glad that they knew. They had all been told by in their lives. their mother alone or by their parents together. The age at which they were told ranged from 7 to 12

DONOR FAMILIES – Raising the issues 2 years, with a mean of 8 and a half years. They were the child. It is easier for children to accommodate all happy to provide information to the donor and both the differences and the similarities of their that ranged from identifying to non-identifying family situation later on if this information has an information. They all wanted non-identifying established basis. information for themselves and all felt that they For this age group there is an issue of should have the right to full identifying information permanency. The foundations of family building and about the donor and possible contract with the donor family identification occur at this time. The child is after they turned 18. They didn’t all want to use working out to whom and where they belong. They these rights immediately but all said they should need to know they are accepted, what their role in have them. the family is, and where they fit in the family. They From clinical evidence, I can say that I have not need an awareness of their family and their found any DI offspring who hate their parents for extended family. This is also a time of preparation using DI to create them. They are glad to exist even for the parents who are thinking about telling. It is a when things have been tough. They are annoyed with time for discussing with each other ideas about how their parents for keeping it a secret. They want to go about telling. things to be more open and to be treated as adults with the right to adult information about themselves. 2. From Five to Nine Years When denied information, they can experience great frustration. Evidence from the adoption and step- This is a latency period when children become parent literature supports this clinical experience. involved outside the family at school, and in other activities in the outside world. They need to feel WHEN TO TELL: The Developmental Context secure in their place in the family and this has hopefully been established in the earlier phase. 1. Birth to Pre-school It is most important to be aware that children under 6 years do not understand how babies are Children in this group have a limited made. You can tell them and they can repeat back understanding of complex relationships. They do not what you say but they do not really understand it. I understand biological relationships. They are very have heard some amazing distortions from children in concrete in their thinking. I recall the story of a this age group. They accept without question that child who was told by his parents that he was put up they came from their mother’s tummy but have no for adoption. He was very puzzled. “Why was I put real idea of how it all began. It is simply a fact. up?”, he said to his mother and she went into the long I recall one of my children talking about being explanation of how the birth mother had given him with us before she had been born. She said she was up. Then she realised that in their family things you in my tummy at the time. She had to exist and this weren’t supposed to have were put up on the shelf. was her way of making sense of it. One little boy He was very confused. The child thought this meant told me that he had a window in his Mummy’s tummy that the birth mother had put him on the shelf, so he could see out when his mother was talking because he was one of the things she was not allowed about a family trip to Sydney which occurred several to have. This is an example of the concrete nature years before his birth. He existed. He could not of thinking in this age group. conceptualise not existing. Between 6 and 8 years This is the time for children to be introduced to children are ready to understand the reality of the the diversity of family groups. A time to set the biology of themselves and the potential difference scene. It’s not the time to say “You were born from between biological and non-biological parents. This is donor sperm”, because the child does not have the the time to introduce telling specifics. cognitive framework to comprehend this. There are This is also the time when family romance many different family configurations in our society. fantasies begin. These can intensify strains and We are not all nuclear families. There are single threats in family identification which is also parent families, couple families, adoptive families, occurring during this period. Parents need to step families, blended families and families that have understand that it is normal for children to have used donation. The broad range of families needs to these fantasies. Be indulgent of the fantasy while be introduced in a normal context as it comes up fro reinforcing the reality and stability of the family

DONOR FAMILIES – Raising the issues 3 group. A child of 7 or 8 years may fantasise that and their loyalty to their parents. They do not want their biological donor was a prince. That’s a common to hurt their parents. fantasy. The parents need to gently reinforce the In late adolescence and early adulthood a truth that the child belongs in this family and has a different process starts to take place. We could place in it, perhaps talking about the process that describe it as reconstructing around the whole issue occurred for them to be born. Acknowledge the of family. The child comes to accept him/herself as fantasy but bring them back to their reality and an adult and develops an adult-adult relationship with their stability. the parents. This happens in all families and is a There may be much curiosity about the bits normal part of family life. which don’t belong to the biological parent. “Where does my nose come from?” “Why am I so tall when HOW AND WHAT TO TELL? everyone else is short?” A trait needs to be accepted even if it’s not a nice trait. “Well that’s Taking into account these developmental stages, just part of you and we love all of you. Everybody’s how do we go about it? different”. Birth to 4 years is preparation time for parents and child. Parents need to come to terms with many 3. Adolescence strong emotional issues they have been grappling with for a long time: There are two major processes which occur in  The loss of the child they originally wanted to adolescence: identity formation and puberty. It can have, the child who was the product of their own be a hard time for lots of kids and it will be hard for gametes and their love for each other: some donor offspring too. It doesn’t have to be hard  The replacement of that first choice with this specifically because of the donation. very precious child created through donation. The major task of adolescence is to increase the  They need to think about what telling means not flexibility of family boundaries. Adolescents have to just for the child but also for themselves. It’s achieve autonomy and that process can sometimes be not a time for pushing things away. read by parents as rejection or abandonment. Non- Donation doesn’t have to be mentioned at this biological parents may be particularly vulnerable to stage but the child should gain some essential this interpretation of adolescent independence. information which are the beginnings of telling Sometimes this is expressed as “I hate you”. I have including: a 15 and a 13 year old at home at present and they  My parents love me and wanted me to be born. regularly tell me that I am the worst mother in the  They need to feel they have permission to ask world. I don’t think I am but I realise that these questions about their pregnancy and birth, and comments are part of them working out who they to gain a sense of how they came into the world. are. I don’t like it but I know it is a normal process.  They can also begin to get information that their Sorting out what is normal for the development of parents needed some special help to have the child and what is specifically different about the them. .You may be able to say that you had to donor family circumstances is an important task for see lots of doctors and get help from a parents in this age bracket. It is especially particular clinic. You could say “Mummy and important during adolescence for the young person Daddy really wanted to have a baby but we had and his parents to accept the particular character of some problems. So we saw a doctor who helped their family group and to recognise it as legitimate us and we were really glad when we had you”. A as any other family group. In most DI families’ one child up to 4 years will accept this without parent has the biological, genetic bond while both question. have the psychological bond. The significance of the It’s also helpful for children to be allowed to a psychological bond is as great or greater than the talk aobut reproduction in other contexts such as biological one. I know this from personal and clinical growing plants, and looking after animals. They need experience. There are exceptions but these occur in a general knowledge of birth, growing, reproduction, biological families as well. DI offspring may struggle pregnancy. The information given needs to be kept with their wish to meet their donor. There may be a simple but convey to the child that it is okay to talk conflict for them between their wish for information about these things, We have all heard the joke

DONOR FAMILIES – Raising the issues 4 about the boy who asked where he came from. After identified to the child from the beginning. The child his father had told him he said: “That’s really needs to be given permission to talk about it with interesting because Johnny comes from Queensland”. these people. The donor information can be labelled The child needs basic information the details will private information which is restricted but not come later on. secret. For this age group I strongly recommend a life I think the best scenario is to tell the child book. The best type is done in a photo album with an before they reach 10 years of age. Before this age a expansion capacity so you can add bits later on. It’s child accommodates these things more easily than an extension of a traditional baby book but can be later. After 10 they enter a period of identity added to by the child as he grows up. You could formation and incorporating new information begin with a story of how Mummy and Daddy wanted becomes more complicated. I am not suggesting that a baby, then a photo of the doctor or the clinic which a child should not be told later than 10 years if they helped with tests and treatments. Photos of the don’t already know. The literature suggests that 10 pregnancy at various stages with both parents is a significant age and it is simply preferable to tell present. Birth details, a photo after birth with both before that age if possible.. parents, together and apart. This life book provides We must, of course, be practical and sensitive to a structure for discussion. The child can see the the child’s capacities. There are problematic aspects parent’s acceptance of discussion of telling both in relation to the child and society. The book is important to the child because it is a I am not passing a moral judgement on those who book about “me”. The child can add to it and include are not able to tell at this age. In any case, the child things that are important: drawings, writing, pictures needs more than one opportunity to talk. You need etc. The life book communicates to the child that to convey that ongoing discussion of these matters is their story can be known and loved. All children love welcome. A life book makes going over the story ‘me’ books. much more accessible for both parents and child. When the child is 4 – 9 years, parents should Children are extremely sensitive to the moods continue to reinforce their great desire to have a and emotional reactions of their parents and they will child and the fact that they needed help from other pick up your anxiety. This is an important reason for people. Children will be at least 6 or 7 years old resolving your own problems about telling before you before they will understand the facts of start to talk to your child. You may find it helpful to reproduction. It is at this time that they can be see a counsellor or attend a self help group to work introduced to donor insemination. through the more difficult issues. Together you may Before telling, parents need to take note of who decide that one parent will do a better job of telling else knows or should know. There may be some than another. You can arrange this between you. Tell people who need to know who else knows. There may your child if you are upset. Tell the child how hard it be some people who need to be prepared to respond was wanting a child and thinking about that time to what the child may tell them. brings back those memories. Also tell the child how It is important that the secrecy and openness of much you love him/her. Children manage real the topic is discussed by the parents prior to the communications. Amazing assumptions are made actual telling. It’s normal for a 6 or 7 year old to about parents’ behaviour when it remains a mystery. want to tell their DI status for news. This may not In adolescence, offspring will be accommodating be something that the family wants to be told for what they have already been told about their family Year 1 or 2 news. If the parents believe that the links into their developing identity. It is an easier child cannot manage to be selective in his telling, I task to already know about the donation before this recommend that the child be told a little later, when process commences. When told in adolescence or 8 or 9 years of age. This is exciting information and later the person has to reconcile the information if there must be prohibitions on who can be told, the that they are not who they thought they were. If child needs to be able to understand these anybody receives information which requires revision restrictions. The role of society and its responses to of their identity, that person loses the identity they such information can be a very real problem for had already created and has to recreate a new one. many. If there are a limited number of people with Working out your identity makes adolescence a whom it can be discussed, they need to be clearly difficult time for us all. It is more complicated for

DONOR FAMILIES – Raising the issues 5 DI offspring. The complexity does not however mean that they are not going to manage it. It does mean that the family needs to take the process required into consideration. Finally, the task of telling is best done by parents. When the information slips out unexpectedly from other sources a situation of considerable damage can be created. The donor offspring needs to know why the parents kept the secret, to have their initial surprise and confusion accepted and they need to know who else knows. It is my experience that where parents are open and honest in telling and answer these and other questions the donor offspring manages well. For parents, there are no established paths. There are some books written for children and parents to read together but we need more. For some there are additional complications which would best be thought through with someone who can help such as a counsellor. Parents can learn from other parents: that the process is okay; that they will not be rejected; that their child will not be damaged. Offspring need a voice: to give help to other donor children and to permit them to become adult offspring. The community needs to be educated about donation and the families and offspring created. Donation needs to become just another normal way for a family to be created.

REFERENCES

Midford S, Baker L, Cinquina A, Esslemont S, Higgins P, Jackson R, Minchin K, Norman D, Samson H, and Unwin K. : The Donation and Use of Human Gamete: Psychological Implications for Donors, Recipients, and Offspring”. Paper Presented at The Fertility Society of Australia Conference, Sydney 2 – 6 November, 1993.

Paper presented at a workshop DONOR FAMILIES: Raising the Issues, in Melbourne on 9 February 1996,

DONOR FAMILIES – Raising the issues 6