Caroline E. Richburg, B.S.(a), Molly B. Moravek, M.D., M.P.H. (b)
(a) University of Michigan Medical School
(b)University of Michigan Department of Obstetrics and Gynecology
The following is an accounting of one woman’s path to lesbian motherhood. The informant, who we call Joan, was interviewed as a part of an IRB-approved thesis project in anthropology.
Do you want to hear the story of when you were born? Once upon a time, there was a girl named Joan[*] who wanted to be a mom more than anything in the world. When she was old enough, she asked God if she could be a mom. To have a baby in your tummy, you need girl parts and boy parts, so Joan asked for God’s help. Then, with the help of Angel Grandma and the Angels on Earth, Joan did get a baby in her tummy. That baby was you.
Joan is a 57-year-old, white, middle-class woman. She lives in a conservative, evangelical Christian, midwestern town. By age ten, she knew she was gay and wanted children “more than anything else in the world,” but had “no possible ideas” how to do both. She married a man for “the sole purpose of wanting to be a mother,” but subsequently divorced and no children came from that marriage. She then met Grace, who would become her partner of twelve years. They explored adoption, but international adoption was too expensive, and a nearby agency would not adopt to lesbian women. Joan underwent three rounds of donor insemination and four cycles of in vitro fertilization (IVF) without success. Grace had a genetic condition rendering her eggs unusable.
The finances of fertility treatment were crushing. Joan and Grace took out a second mortgage to cover expenses as they felt Joan’s biological clock ticking. Following Joan’s last IVF cycle, a coworker mentioned that a local couple was considering donating their embryos through the “Snowflakes Embryo Adoption Program.”1 Through IVF, Lisa and Chase had given birth to twins and then quadruplets. The quadruplets ruptured Lisa’s uterus, and since gestational surrogacy was legally unenforceable in Michigan and the couple was uncomfortable discarding embryos, they chose to donate their excess embryos to another couple.
Organizations have taken up the issue of excess embryos by pioneering “embryo adoption agencies” which match embryos with recipient parents. Nightlight Christian Adoptions started the first program in 1997, the Snowflakes Embryo Adoption Program.2 “Just as each snowflake is frozen, unique, and a gift from heaven,” the webpage states, “so are each of our Snowflake Babies.”1 Nightlight came into the national spotlight when George W. Bush hosted snowflake children and their parents at the White House, stating “there is no such thing as a spare embryo. Every embryo is unique and genetically complete, like every other human being.”3 Through this discourse, a particular kind of individual is conceived — namely, a living entity, frozen in time in a resource-rich area via high-tech, high-expense medical equipment, meant to be adopted by parents with financial and social means to successfully navigate an embryo adoption agency.
The matching process is extensive. Would-be adoptive parents must have the socioeconomic capital to take on $15,000+ fees and pass a “home study/family evaluation” by Nightlight.4 Match criteria include religious faith, financial stability, education, and length of marriage5, which would have implicitly excluded many same-sex couples before gay marriage was legalized nationally in 2015. This is in stark contrast to a statement by the Ethics Committee of the American Society for Reproductive Medicine (ASRM). While the committee has long established the ethical appropriateness of embryo donation for both family building and research, they state that embryos should not be afforded the same legal or moral status as people. They state:
“Equating an embryo with an existing child and applying the procedural requirements of adoption designed to protect existing children to embryos is not ethically justifiable and has the potential for harm. […] Home visits, legal fees, and judicial review are all standard elements of adoption but are appropriately absent in the context of assisted conception through medical means. […] Requiring infertile patients who need donor gametes to suffer the imposition of unnecessary administrative and legal trappings of adoption and the costs that accompany them is not ethically justifiable.”6
In addition, adoptive couples must have access to facilities which can ship frozen embryos and perform the necessary medical procedures. Importantly for Joan and other same-sex couples, the founder of Snowflakes also founded Focus on the Family1, a conservative Christian ministry highly vocal in anti-gay discourse. The organization states that homosexual behavior “violates God’s intentional design for gender and sexuality.”7 Through Snowflakes’ extensive matching criteria, Snowflakes babies are incubated into a particular kind of family — one that is white, heterosexual, affluent, pro-life, and Christian.
Joan’s coworker connected Joan and Grace with Lisa and Chase, and the couple agreed to meet to discuss the possibility of donating embryos outside of the Snowflakes Program. Joan and Grace drove just 1.2 miles up the road to their home.
“My partner and I were nervous... My partner is a whole different ballgame, but I know she was incredibly nervous, and she's a little bit pretentious, so she didn't want them to think we were just some .... I'm going to use a term that I would never use, but that she would use... some 'white trash dykes'... I would never say that, but she grew up in a house that, that's how they talked. And she wanted for us to look as tip-top shape as possible, to look like we had all the money to take care of what could've been three babies, or even two, and one was a struggle enough, so I know she was incredibly nervous, and she was also not very positive about it. When we left there, she was like, 'they're never going to say yes to us, we're lesbians, we're gay, nobody's going to adopt to us.’”
Their nerves stemmed from a hyperawareness of the fact that, as lesbian women, they were stretching the mold of the kind of parent “meant” for embryo adoption. In approaching a heterosexual couple with the power to give them embryos, Joan and Grace presented as the type of parents that Snowflakes might find not only palatable, but desirable: white, “put together,” and financially stable – albeit lesbian. “White trash dykes” are in diametric opposition to the smiling, affluent-appearing heterosexual couples depicted by the Snowflakes Embryo Adoption website. In a conscious way, Joan and Grace became “snowflakes-adoption-status” parents. The meeting lasted five hours. When Lisa and Chase called a few days later and offered Joan their embryos, she accepted enthusiastically.
Unfortunately, Joan’s challenges did not end with the acquisition of embryos. The only local specialist who would treat lesbian patients had retired, so she drove 90 minutes to see a willing provider, despite every needed medical service existing in her own town. For over 15 trips — more than 45 hours of driving — Joan traveled to her physician.
“I don’t know if you know what I’m talking about, the milking jug, but it’s really heavy and big and metal and filled with frozen ice or whatever. That’s what [my daughter] came in and I seat-belted her in the car and drove her all the way to [the hospital] in that thing.”
Fortunately, one of Joan’s frozen embryos – carefully acquired and buckled into a car seat within a “milking jug” – would result in a child, Erin.
While Joan faced the emotional, financial, and physical tumults typical of infertility, her pursuit of motherhood was riddled with additional barriers directly related to her sexual orientation. She was categorically excluded from fostering and adoption, forced to “prove herself” to embryo-donor parents, and faced discrimination among local medical providers, forcing her to travel for care. In the early 2000s when Erin was born, Grace and Joan could not marry and there was no legal mechanism for Grace to adopt her. Today, second-parent adoptions are legal in Michigan (though, not all states)8, but Grace and Joan have since separated. Legal adoption would have required Grace to pay child support, but Joan remains a single-parent both legally and financially — a lingering reminder of the discrimination and intolerance that marked her journey to motherhood.
During the time since Joan’s journey, legal rights for queer couples have grown alongside an advancing landscape of reproductive technologies, offering same-sex couples new opportunities to build families. In a 2008 case, a fertility clinic in San Diego refused to provide artificial insemination for a lesbian couple due to “religious objections.” The case went to the state Supreme Court of California, and justices ruled unanimously that physicians may not refuse service to lesbian couples on the basis of sexual orientation.9 Importantly, this was a decision of the state Supreme Court of California and therefore does not apply nationally. In the same year, the American College of Obstetrics and Gynecology expressed support for same-sex couples desiring assisted reproductive care, stating that discrimination would “reinforc[e] the scientifically unfounded idea that fitness to parent is based on sexual orientation.”10
The ASRM Ethics Committee also reviewed the issue of access to assisted reproduction by LGBT couples and single men and women, concluding that there is an ethical duty to treat same-sex couples equally to heterosexual married couples in determining which fertility services to provide.11 However, survey data show that a sizeable minority of infertility specialists and health care providers would still discourage or turn away same-sex couples.12,13 Notably, this Committee opinion was published before same-sex marriage was legalized nationally in 2015, when the Supreme Court ruled that same-sex couples have the right to marry in all fifty states in Obergefell v. Hodges.
Today, virtually every state has some iteration of religious refusal laws that allow providers to refuse to treat, but these laws vary dramatically by state. For example, Mississippi passed a near-exhaustive law in 2016 that allows providers to refuse “treatments, counseling, or surgeries related to sex reassignment or gender identity transition [and] psychological, counseling, or fertility services.”14 In May 2019, a new division of the US Department of Health and Human Services finalized a religious refusal rule modeled after laws like that in Mississippi, providing “additional conscience protections for providers who have objections to […] fertility treatments,” among other medical interventions.15,16,17 Though LGBT access to reproductive services has improved dramatically since Joan’s time, same-sex couples continue to face barriers secondary to sexual orientation and remain vulnerable to the political atmosphere of the day.
The minority stress theory describes the ways discrimination and intolerance secondary to social stigma are associated with negative health outcomes through both objective (ie. Joan’s rejection by medical providers) and subjective (ie. Joan’s fears around presenting as a “white trash dyke”) stressors. Amodeo et al drew on this framework to explore that internalized homophobia, unexpectedly, is positively associated with parenting desire in lesbians, perhaps a response to social pressure to conform to gendered expectations, such as affirming one’s identity as “female” through motherhood.18 Even after motherhood is attained, Bos et al show that minority stress implicates the experience of parenthood for lesbian women. Lesbian mothers experienced more parental stress than opposite-sex parents secondary to stigma, including feeling the need to defend their role as “mother.”19 These findings are particularly poignant for infertility specialists, who meet lesbian women after they have likely faced discrimination and intolerance on their journey to the office and before they venture out into the world with the new identity of “mother.” Particular attention should be paid to minority stress during clinical encounters to support and counsel lesbian mothers-to-be, like Joan, who bring battles-fought, intolerance-faced, and discrimination-to-come into clinic with them. As more same-sex couples seek out fertility services20 and infertility clinics aim to become more LGBT-friendly, stories like Joan’s remind us that infertility struggles do not start and end with a patient’s medical presentation. Rather, patients present with identities, adversities, victories, and losses that shape their experiences in clinic and in the world.
1. Embryo Adoption | Snowflakes Embryo Adoption Program. Nightlight Christian Adoptions. https://nightlight.org/snowflakes-embryo-adoption-donation/embryo-adoption/. Accessed October 20, 2019.
2. Christian Adoption Agencies | Snowflakes Embryo Adoption Program. Nightlight Christian Adoptions. https://nightlight.org/snowflakes-embryo-adoption-donation/embryo-adoption/why-choose-snowflakes/. Accessed October 20, 2019.
3. Roberts E. God’s Laboratory: Assisted Reproduction in the Andes. University of California Press; 2012.
4. Nightlight Christian Adoptions. Embryo Adoption Cost | Snowflakes Embryo Adoption Program. Nightlight Christian Adoptions. https://www.nightlight.org/snowflakes-embryo-adoption-donation/embryo-adoption/funding/. Accessed April 8, 2019.
5. Nightlight Christian Adoptions. Guide for Embryo Placement: Snowflakes Embryo Adoption Program. https://www.nightlight.org/wp-content/uploads/Snowflakes-Placing-Parent-Information-Packet.pdf. Accessed April 8, 2019.
6. Daar J, Amato P, Benward J, et al. Defining embryo donation: an Ethics Committee opinion. Fertility and Sterility. 2016;106(1):56-58. Doi:10.1016/j.fertnstert.2016.03.017
7. Revisionist Gay Theology: Did God Really Say…? Focus on the Family. https://www.focusonthefamily.com/get-help/revisionist-gay-theology-did-god-really-say/. Published July 29, 2019. Accessed October 20, 2019.
8. National Center for Lesbian Rights. Legal Recognition of LGBT Families. 2019. http://www.nclrights.org/wp-content/uploads/2013/07/Legal_Recognition_of_LGBT_Families.pdf. Accessed December 29, 2019.
9. SCOCAL. North Coast Women’s Care Medical Group v. San Diego Superior Court – 44 Cal. 4th 1145, 189 P.3d 959, 81 Cal. Rptr. 3d 708. https://scocal.stanford.edu/opinion/north-coast-womens-care-medical-group-v-san-diego-superior-court-33046. Published 2008. Accessed April 10, 2019.
10. The Limits of Conscientious Refusal in Reproductive Medicine – ACOG. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/The-Limits-of-Conscientious-Refusal-in-Reproductive-Medicine?IsMobileSet=false. Accessed December 29, 2019.
11. Amato P, Brzyski R, Benward J, et al. Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion. Fertility and Sterility. 2013;100(6):1524-1527. Doi:10.1016/j.fertnstert.2013.08.042
12. Gurmankin AD, Caplan AL, Braverman AM. Screening practices and beliefs of assisted reproductive technology programs. Fertility and Sterility. 2005;83(1):61-67. doi:10.1016/j.fertnstert.2004.06.048
13. Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists’ beliefs about assisted reproductive technologies. Obstet Gynecol. 2010;116(1):127-135. doi:10.1097/AOG.0b013e3181e2f27d
14. Gunn P, Arnold W, Bounds C, et al. Protecting Freedom of Conscience from Government Discrimination Act.; 2016. http://billstatus.ls.state.ms.us/documents/2016/pdf/HB/1500-1599/HB1523SG.pdf. Accessed December 29, 2019.
15. US Department of Health & Human Services. Trump Administration Actions to Protect Life and Conscience. HHS.gov. https://www.hhs.gov/about/news/2019/01/18/trump-administration-actions-to-protect-life-and-conscience.html. Published January 18, 2019. Accessed April 10, 2019.
16. Institute TF. Trump Administration finalizes rule that will make it harder for LGBT people to access health care | Fenway Health: Health Care Is A Right, Not A Privilege. https://fenwayhealth.org/trump-administration-finalizes-rule-that-will-make-it-harder-for-lgbt-people-to-access-health-care/. Accessed December 29, 2019.
17. US Department of Health & Human Services. Protecting Statutory Conscience Rights in Health Care; Delegations of Authority. https://www.hhs.gov/sites/default/files/final-conscience-rule.pdf. Accessed December 29, 2019.
18. Amodeo AL, Esposito C, Bochicchio V, et al. Parenting Desire and Minority Stress in Lesbians and Gay Men: A Mediation Framework. Int J Environ Res Public Health. 2018;15(10). doi:10.3390/ijerph15102318
19. Bos HMW, van Balen F, van den Boom DC, Sandfort ThGM. Minority stress, experience of parenthood and child adjustment in lesbian families. Journal of Reproductive and Infant Psychology. 2004;22(4):291-304. doi:10.1080/02646830412331298350
20. Wu HY, Yin O, Monseur B, et al. Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites. Fertility and Sterility. 2017;108(1):183-191. doi:10.1016/j.fertnstert.2017.05.011
[*] All names have been changed to protect the privacy of the informants.