Disclosure and donor-conceived children

Sir,

In the March 2017 issue of Human Reproduction, Guido Pennings published an opinion piece arguing that there is little empirical evidence in support of the disclosure of donor conception to children (Pennings, 2017). He claimed that researchers tend to ignore their own findings in recommending openness to children regarding their biological origins. As I am one of the researchers concerned, and have been conducting empirical studies on the psychological well-being of donor-conceived children since the 1980s, the article caused me to reflect on what the evidence actually tells us. The question Pennings has raised is a perfectly reasonable one but I do not believe that his conclusion is correct.

My thoughts on this issue are based on the findings of two longitudinal studies carried out by my research team, the European Study of Assisted Reproduction Families and the UK Longitudinal Study of Assisted Reproduction Families, as well as our cross-sectional studies of children and adults who are aware of their donor conception. Although there are other informative studies mentioned in the Pennings article, I am focusing largely on my own research (see Golombok, 2015, 2017 for reviews) not only because I know it best but also because my interpretation of the results of my studies does not align with that of Pennings. Also, I believe that it is important to view the findings within the context of the wider field of developmental psychology, in particular, the highly relevant research literature on the development and well-being of adopted children.

The European Study of Assisted Reproduction Families, a longitudinal study of children born by donor insemination at ages 6, 12 and 18 years, conducted in Spain, Italy, the Netherlands and the UK, found the children to show high levels of psychological adjustment, comparable to that of a comparison group of naturally conceived children. As Pennings points out, the findings suggest that children who are not told about their donor conception are not psychologically harmed by non-disclosure.

However, this initial study did not directly address the more specific question of how donor-conceived children who are aware of their genetic origins differ from those who are not. Do children who are told show higher levels of psychological problems because they are distressed by the knowledge that they lack a genetic connection to a parent? Are they accepting of this information? Or do their responses depend on factors such as how and when their parents disclose? The aim of the UK Longitudinal Study of Assisted Reproduction Families was to address these questions by comparing families who had been open about their children's biological origins with those who had not. There are a number of important advantages to this study. Firstly, the families were recruited before the children were old enough to be informed of the circumstances of their birth thus minimizing selection bias. Secondly, the research is longitudinal. So far, the families have been assessed six times from infancy to adolescence. In the field of developmental psychology, longitudinal research is the optimal, although not definitive, approach to understanding causation; it enables the impact of experiences in early childhood (such as disclosure of donor conception) on later development (such as children's adjustment in adolescence) to be examined. Thirdly, data were obtained not only from parents but also from the children themselves. We found that families who had disclosed donor conception to their children in the preschool years generally showed more positive outcomes when the children reached middle childhood (with the exception of those whose mothers were experiencing mental health problems), and more positive mother–child relationships at adolescence as reported by mothers and the adolescents themselves (Ilioi et al., 2017). Had we simply conducted a cross-sectional study at adolescence, it would not have been possible to examine the cause of any differences identified between family types.

So far, this is the only study of its kind as in-depth, longitudinal, multi-informant, controlled studies are extremely time-consuming and expensive, and thus the findings have yet to be replicated. It is important to emphasize, as Pennings also pointed out, that the less positive findings for non-disclosing families did not represent clinical problems but instead fell within the normal range. Nevertheless, different methodological approaches to the study of donor-conceived children and adults who are aware of their genetic origins, by ourselves and other research teams, have similarly concluded that the earlier children are told, the better the outcomes, and that discovering one's donor conception later in life may cause psychological harm. Although different in important ways, the overwhelming evidence that adopted children benefit from openness about their origins in terms of their psychological well-being and identity development, is also relevant here. Moreover, research on members of the Donor Sibling Registry, an internet site designed to facilitate the search for donors and families who share the same donor, has highlighted the importance of information about their donor and donor relatives for large numbers of donor offspring. Thus, taken together, the evidence points to the benefits of openness about donor conception when children are young. It is noteworthy that parents who disclose donor conception to preschool children do not appear to regret their decision. Although many feel anxious about the prospect of telling, it appears that their fears are unfounded as their children tend to respond with curiosity or indifference, rather than distress.

As the research that exists so far suggests neutral or positive psychological consequences from disclosure, and possible psychological harm from non-disclosure, this leads to the conclusion—based on empirical evidence rather than an implicit moral judgement—that it is generally better to tell. Put more simply, if the empirical evidence does not indicate greater psychological problems for children whose parents disclose their origins at an early age, and there are psychological risks associated with non-disclosure, it seems to me that openness is usually in the best interests of the child.

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