Last year, at the Hay Festival of Literature and the Arts, feminist icon Germaine Greer scolded gay parents Sir Elton John and David Furnish for naming Furnish as the mother of their two sons on the children's respective birth certificates, each born to the same surrogate mother (Buckley, 2015). Greer said: ‘Sometimes I think that really the problem is the concept of motherhood, which we can't give any real structure to.’
Some might argue that the concept is further challenged by lesbian couples who wish to share biological motherhood, essentially creating a two-mother child—but with an anonymous father—through in vitro fertilisation (IVF) involving reception of oocytes from a partner (ROPA). In this procedure, one partner achieves genetic motherhood by providing her oocytes, which have been fertilised by donor sperm—so are, therefore, embryos—and the other partner achieves gestational motherhood when the embryos are transferred to her uterus; she becomes pregnant and gives birth.
The term ROPA was coined by Marina et al (2010) when they described their work at the CEFER Institute of Reproduction in Spain, where the ROPA technique was used to treat 14 lesbian couples between 2007 and 2009. The Institute is a private organisation and the couples paid for their treatment. Marina et al (2010: 938), who feel that ‘the ROPA process is a perfectly valid and ethical assisted reproduction technique’, reported that six pregnancies were achieved from 13 embryo transfers; there were two miscarriages ‘and there are three ongoing pregnancies, one of them twins. One healthy female baby was born.’
Before considering ethical aspects of ROPA, a legal point arises: who is the legal mother of a two-mother child if the genetic mother and gestational mother separate? For example, the England and Wales Court of Appeal (2014) addressed a ROPA case from Portsmouth County where the couple had separated, and the genetic mother had sought parental responsibility, but the gestational mother who had given birth to twins was declared the legal mother. During the case judgment, the point was made that under certain provisions in the Human Fertilisation and Embryology Act 2008:
‘Where a woman is treated by virtue of section 42 or 43 as a parent of the child, section 45 of the 2008 Act provides that no man is to be treated as the father of the child, thus denying the biological father the status of a parent.’
The case of a child with two maternal parents plus a biological father whose parental status is denied suggests the question of the purpose of assisted reproduction may be more subtle than at first glance. Is it to enable people who are infertile or childless to have a child, or to enable couples to have children together?
Pennings (2015: 2) notes that one major argument against ROPA ‘is the fact that the egg donation, and the IVF cycle that is needed for that, is completely medically unnecessary’. The assumption is that the gestational mother who receives the fertilised oocytes from her partner has healthy eggs of her own, so there is an extra risk—and extra cost—involved for what some might argue is, in the context of non-maleficence, no good reason.
However, Zeiler and Malmquist (2014) point out that although IVF with ROPA is illegal in Sweden, egg-donor IVF for heterosexual couples is permitted, as is sperm-donor IVF for lesbians and even live uterus transplantation (albeit as a research undertaking). They consider this an ethically weak position, reflecting ‘a heteronormative bias in the legislation on assisted reproduction, in the sense that the law takes the heterosexual couple's situation as its point of departure’ (Zeiler and Malmquist, 2014: 354).
My request to the Human Fertilisation and Embryology Authority for a comment on the legal status of ROPA in the UK elicited the following response:
‘We don't have anything to say on this, other than to say that donation in that context in this country is lawful. I know this isn't a very helpful response for you, but I can't offer you anything else.’
A literature review entitled ‘How do midwives treat childbearing lesbians?’ (Association of Radical Midwives, 2013: 8) considered five relevant peer-reviewed studies, finding that although positive experiences were recalled by lesbian mothers—‘largely related to acknowledgement, acceptance, sensitivity and open-mindedness’—participants in four of the five studies ‘reported incidents of either covert or overt discrimination from their attending midwives.’
It is clear that the reproductive landscape is changing, along with society's evolving view of what constitutes a family—something of which I suspect midwives are increasingly aware.