In the next century it will become increasingly unusual to grow up in a conventional family, with two parents biologically related to the children they bring up. The nuclear family has already been fractured by divorce and single parenthood, but the family will change even further because of infertility and new reproductive technologies.
In Britain, as in other western countries, about one in seven couples now seek help for fertility problems. The reasons for infertility range from disease to environmental factors, but there is a consensus among experts on the main reason why more women are having difficulty conceiving. Women's fertility is at its peak in their 20s and declines gradually thereafter. The decline gathers pace after 30, and after 35 fertility drops sharply. In Britain, the average age for having a first child was almost 27 in 1997, up from 25 in 1987 and 24 in 1967. This average masks a huge range between the many teenage pregnancies (Britain has the highest rate in the western world) and the many women who delay having children until they are well into their 30s.
Consultant Paul Serhal, an infertility expert at University College Hospital, London, says the problem is that "women believe that because they have a normal cycle they will be fertile and then they come to us after the age of 35 and think we can perform miracles." But the pressures to delay starting a family are strong: many of Serhal's patients tell him that they put off having children for economic reasons. Child care in Britain is haphazard, and women can expect to lose 50 per cent of what they would have earned had they not had children.
Male fertility problems are also on the rise. In 1997, two American studies, by the National Academy of Sciences and the National Institutes of Health, confirmed that sperm counts have almost halved in the last 50 years. This may be due to environmental factors such as oestrogens in the water supply. Last year, the British government launched a programme to find out more about these so-called "endocrine disruptors." We are also exposed to about 3,000 man-made chemicals, in household products, packaging and food; the British Medical Association states that only 7 per cent of these have undergone full toxicity testing.
The rise and fall of adoption
In the past it was relatively easy for couples with fertility problems to create a family. In Britain, adoption was legalised in 1926 and took off in the 1960s, when childless couples were encouraged to adopt. It reached a peak in 1968, when almost 25,000 children were adopted. In Britain, just under 1m children have been brought up as adoptees-almost one in 50 of the current population.
A Darwinian view of the family suggests that the love felt for one's own genetic stock is stronger than the altruistic love felt for an adopted child. But the experiences of adopted children challenged that deterministic view of the family. None the less, some of the time the relationships did fail children, and the policy was called into question because of the controversy surrounding trans-racial adoption.
In the 1970s, social workers lobbied successfully against the placement of racially mixed children in white families, to the extent that it remains outlawed in many local authorities to this day. Add to this the distress of some birth mothers who felt that they had been coerced into giving up their children in the 1950s and 1960s, and adoption was gradually pushed on to the defensive. Although at any one time there are some 40,000 children in the care system, only about 6,000 of these are adopted each year, half of them by step-parents. Relinquishment work, in which a social worker works through the adoption process with the birth mother, has lost almost all its funding. Although there is something of a fightback by parents to be able to adopt, which the government tried to encourage by issuing new, more flexible guidelines on adoption last summer, local authority culture is still hostile to adoption.
In the early 1990s, a new form of adoption, inter-country adoption, became popular. In 1991 about 500 children were adopted by this method. But many local authorities remain hostile; in this case the hostility is shared by civil servants. All inter-country adoptions pass over the desk of one civil servant at the Department of Health who has the power to delay each adoption. Although British, Scandinavian and American research on inter-country adoption shows that it is often very successful, numbers have decreased sharply to only 258 last year. This contrasts with the US, where more than 10,000 children were adopted inter-country and France where more than 3,500 children were adopted in this way. Liberal Democrat MP Mark Oaten has sponsored a Private Member's Bill to improve the regulation of inter-country adoption, but the involvement of this same civil servant in drafting the Bill means that it will probably end up becoming more difficult, not less.
Although adoption has become more difficult, there are now technological alternatives. Fertility technology is expensive in Britain: only one third of couples seeking help with infertility get it on the NHS, while others have to pay for it at an average cost of ?10,000 for a successful outcome. (In France, all couples with fertility problems receive help through their public health system.)
New ways to make babies
The least problematic treatment for fertility problems in psychological terms (although there are questions about ovarian cancer) is in-vitro fertilisation (IVF). IVF, where the egg is fertilised by the sperm outside the woman's body in a "glass dish" and then placed in the womb, allows couples to have their own genetic child. In 1997, a total of 726,000 children were born in England and Wales, of whom 7,292 were born by IVF-more than one in 100 and the trend is up. In a primary school of, say, 500 children, an average of five will have been conceived by IVF. But not all couples can conceive even by this method.
Many men have difficulties producing sperm. Artificial insemination of the woman with "donor" sperm began in the 1950s. In Britain, some 30,000 children have been conceived in this way and the figures now run at about 1,500 to 2,000 a year. In 1997, 1,482 children were born by donor insemination-about one in 500. This figure doesn't include IVF with donor sperm, which pushes the figures up by 430. The figures were higher still before 1992, when scientists discovered a treatment for infertile men which allowed them to have their own children. An intra-cytoplasmic sperm injection allows men with a low sperm count to have their own children through a procedure where a single sperm can be injected into an egg. None the less, the figures for donor insemination are still high and may be much higher than the data suggests because of informal arrangements between family and friends, particularly among gays and lesbians.
The use of donor eggs has also been made possible through IVF. In Britain in 1997, 279 babies were born by donor egg. But there is a donor egg shortage. No one knows how many women are waiting, but clinicians put the figure at about 2,000. Now it is even possible to have a fertilised embryo implanted in the womb and carry it to term. In 1997, some 30 children were born by this method. The embryo is not genetically related to either parent and this has some similarities to adoption, although the mother carries the baby and gives birth to it. Putting all these figures together, in Britain there are more than 2,000 two-year-olds who are unrelated to either one or both parents through donor conception.
Over the past ten years surrogacy has become more acceptable. Although commercial surrogacy is outlawed, it is possible to pay living costs (about ?12,000) to a surrogate mother. Some 100 children a year are born this way, but there may be many more informal arrangements. Surrogacy is becoming more acceptable because it is cheaper than conventional IVF treatment and some NHS clinics now use surrogacy as a treatment method. Kim Cotton's organisation, Childlessness Overcome Through Surrogacy (Cots), says that the number of straight surrogates, where a woman carries her own genetic child (with the sperm of the father of the couple) is in decline. Most people prefer host surrogacy, where the genetic child of the commissioning couple is carried in the womb of the surrogate.
Although it is recommend
What should the children know?
The difficult questions raised by new ways to make babies was recognised by the appointment of the Warnock Committee which led to the formation of the Human Fertilisation and Embryology Authority (HFEA) in 1991. But social policy has not yet caught up with the technology. With adoption, there is a very real understanding of the problems, but the issues surrounding the alternatives are only now being discussed. For example, little attention has been paid to the potential psychological effects of being a child conceived by sperm or egg donation (or indeed by straight surrogacy) and having a genetic link to only one parent. The children of donors (like surrogates) have no legal right to be told about their origins nor the legal right to trace a genetic parent, which adoptees now have. Susan Golombok at City University has started the first big comparative study of such children. Her study looks at 400 children growing up in four European countries: 100 are naturally conceived; 100 are adopted; 100 are born by IVF; and 100 by sperm donation. Her initial findings seem to confound the Darwinian understanding of the importance of the genetic link. "The lack of a genetic relationship on the part of one parent didn't seem to make any difference," she says.
However, although all of the adopted children were told about their history, none of her children born of sperm donors were told. So there is still little data on how the children respond once they know. Alexina McWhinnie at the University of Dundee, who has studied older donor children and adults, says that they are often very angry that they were not told because they had always suspected they were different because of how they looked.
The Donor Insemination Network (DIN), a group formed to support parents who do want to tell their children, estimates that less than 10 per cent of parents tell their children. The DIN has drawn on research into the psychological effects of adoption and believes that children have a right to know as much as their parents do. Olivia Montuschi speaks for the DIN and has a family created by donor insemination: "When parents do not tell, the information often comes to light when the situation is already bad-when families are breaking up for instance. Secrecy is not helpful for families, we learnt that from the world of adoption."
On the other hand, some families don't see the point of telling their children because the donor remains anonymous. At the moment, there is a section on the HFEA files where the donor can supply a pen-profile of their life, but many donors do not fill it in and some clinics do not encourage it. The Department of Health is looking into donor anonymity-an internal paper is being drafted, but it is unlikely that it will be lifted. Proponents of anonymity point to Sweden, where donor anonymity was removed in the late 1980s and where the numbers of donors fell dramati-cally. But some clinics in Sweden now report that donors are returning.
Christine Whipp, who was born by donor insemination in the 1950s, feels that her donor father is her father and feels robbed of her history. "I am just as much his daughter as the children he brought up. I have half his DNA. What makes me so angry is that everyone in this, my father, my mother, the clinic, deliberately set out to create me, but that they thought it was right to withhold information that every other child has the right to have. I feel like I am nobody." Whipp also asks a tricky question: if someone falls in love with a person sharing the same "donor father or mother," how can they find out? There is a system whereby those who know they were born by donor insemination can check whether they are genetically related to someone they have a relationship with, but in practice this is of little use if only 10 per cent of them are told. There are also unanswered questions about the effects of donor insemination on parents. Parents have to face the issue of parity, because one parent is usually genetically related but the other is not.
Bring back adoption?
No response to infertility is without its problems. We should, of course, make it easier for women to have children earlier without financial penalties. But the fact is that many women will still choose to delay motherhood. Infertility will not go away, and the number of children who are not genetically related to at least one of their parents will continue to grow. We have to decide how to balance the rights of the future child against the rights of the parent, a balancing act which has tipped the scales against adoptive parents in the past, but now favours couples who try other alternatives, perhaps, in some cases, at the expense of the child's psychological well-being.
Technology will offer us more options, some of which will strengthen the genetic link, such as cloning. But each "fix" will carry its own pitfalls. Egg freezing technology, for example, will offer women the chance to have their own children later, but we have no idea how children will react to being brought up by significantly older mothers.
At least we can apply the lessons we have learnt about the psychology of adoption to the new generation of children without (or with only partial) genetic links to their parents. But McWhinnie and others believe that given the problems of the new technologies, we should reconsider our hostile attitude to adoption itself. After all, if we share 99.9 per cent of our genetic makeup with our parents, but 99.5 per cent with everyone else, how much does genetics really matter to parenting?
