7/28/2019 What makes a same-sex parented family?

1/3

Perspectives

MJA 198 (9) 20 May 2013

In 2011, we saw the Australian Census o Populationand Housing recognise same-sex marriages orthe frst time.1 However, we have also recently

witnessed the winding back o civil union legislation inQueensland, which had previously allowed or legallyrecognised unions between same-sex couples, and therehave been suggestions that same-sex couples shouldbe written out o surrogacy legislation in that state.It is in th is contradictory context that we are aimingto capture complete data on the physical, mental andsocial wellbeing o Australian children with at least onesame-sex attracted parent through a national researchproject, the Australian Study o Child Health in Same-Sex Families (ACHESS).2 In developing this study, weconsidered what makes a same-sex parented amily andhow many o these amilies there might be in Australia.Here, we bring a resh perspective to the concept osame-sex parented amilies in Australia by posing keyresearch questions and drawing rom the history osame-sex parenting and the present experience o theseamilies in Australia. In the process, we identifed thatthis group comprises a very diverse range o amily

types, with possible implications or health care delivery.

Questions or researchers

What is a same-sex parented amily?

There are many ways in which same-sex attracted peopleare creating amilies, through a mixture o dierentconception methods and adoption processes. Just someexamples o same-sex parented amilies are: a singlelesbian woman who has children rom a previousheterosexual relationship; a co-parenting arrangementbetween a lesbian couple and a gay male couple; a gay

male couple having children through surrogacy; anda bisexual man having children with a heterosexualwoman.

How many same-sex parented amilies are there in

Australia?

To date, there are no valid and accurate data availablethat describe the complete range o amily t ypes inAustralia that might be considered as same-sex parentedamilies. Data rom the 2011 Census indicated that therewere 33 714 same-sex couple households in Australia,and that there were 6120 children living in thesehouseholds.1 Although these data provide a starting

point, the fgures are a very conservative estimate asthey only capture amil ies in which two people sel-identifed as being in a same-sex de acto or marriage-like relationship. By comparison, or the purposes othe ACHESS, a same-sex parented amily is defned asany amily in which at least one parent sel-identifes asbeing same-sex attracted.2

Lessons rom history

In Australia, as in many other Western countries,

same-sex parented amilies became more visible inthe 1970s,3 as lesbian women with children romheterosexual relationships gradually started to comeout and establish new relationships with emalepartners. Although more gay men were also revealingtheir homosexual identities during this period, childrengenerally continued to reside with their mother whenissues o custody arose.

Over subsequent decades, lesbian women increasinglycreated their amilies within the context o their same-sex relationships, initially using home-based sel-insemination with known donors (oten gay men), andlater using assisted reproductive technologies (ART)with cl inic-recruited donors as an alternative, when thisoption became available.4 The availability o ART tolesbian women is a relatively new option in Australia,with states and territories only recently makinglegislative changes to enable it.

Gay men have also had children in the settingo previous heterosexual relationships and, liketheir lesbian counterparts, are now increasinglycreating amilies within the setting o their same-sexrelationships.5 Initially, this may have been through co-parenting arrangements with lesbian couples or singlewomen, by providing the donor sperm and playingvarying roles in the lives o the children. However, gaymen have now begun to use surrogacy as an option to

create their amilies.5 Early on, due to laws in Australiathat restricted surrogacy arrangements, this requiredoverseas travel, oten to the United States. This incurredconsiderable expense, limiting this option to relativelyew men. In the past ew years, surrogacy practices inIndia have become well established, with lower costs, sosurrogacy has become accessible to a younger and morediverse group o gay men. Some Australian states andterritories are also beginning to enact limited legislationenabling surrogacy or gay men, but many still appear tochoose the overseas surrogacy option.6

Fostering has oten been the only, and occasionallypreerred, choice or many same-sex attracted people

What makes a same-sex parented amily?

Recognising the diversity of same-sex parented families

could assist clinicians to provide optimal care

Simon R CrouchMB BS, MA, MPH,

PhD Candidate,1 and Public

Health Registrar2

Ruth P McNairMB BS, PhD, FRACGP,

Director o General Practiceand Primary Health Care,

Northwest Academic Centre3

Elizabeth B WatersMPH, DPhil,

Jack Brockho Chair o ChildPublic Health and Director,Jack Brockho Child Health

and Wellbeing Program4

Jennifer J PowerPhD, GradCert(Stat),

BA(Hons),

Research Fellow5

1 McCaughey VicHealth Centre

or Community Wellbeing,University o Melbourne,

Melbourne, VIC.

2 Australasian Faculty oPublic Health Medicine,

Sydney, NSW.

3 Department oGeneral Practice,

University o Melbourne,Melbourne, VIC.

4 School o Population

and Global Health,

University o Melbourne,Melbourne, VIC.

5 The Bouverie Centre,

La Trobe University,Melbourne, VIC.

s.crouch3@student.unimelb.edu.au

doi: 10.5694/mja12.11234

Online first 22/04/13

7/28/2019 What makes a same-sex parented family?

2/3

Perspectives

2 MJA 198 (9) 20 May 2013

who wish to raise chi ldren. While this has not alwaysbeen a positive experience, with recorded incidents odiscrimination against same-sex attracted prospectiveparents within the oster care system,7 some oster careagencies have recently targeted same-sex attractedpeople in recruitment campaigns, due to a shortage ooster carers and an awareness o interest in osteringamong the gay and lesbian community.8 Conversely,adoption is limited or not available to same-sex couplesand single parents in many states and territories oAustralia.

Glimpses o the present

Research conducted in 2008 to explore variation in same-sex parented amilies provided an initial idea o theproportion o amilies created using di erent methods.9The study used an online survey to collect data rom434 same-sex attracted parents (85% women and 14%men) in Australia and New Zealand. It ound that mostsame-sex attracted male parents had children throughheterosexual relationships (57% had at least one childby this method), but 23% had acted as a known spermdonor or a single woman or lesbian couple, and 18%

had engaged in surrogacy arrangements. Female parentshad most commonly used a orm o insemination (59%or home-based sel-insemination and ART combined),although a signifcant proportion (42%) had had at leastone child through heterosexual sex. Building on thisinitial work, we have expanded the concept o same-sexparented amilies to summarise the complex array oamily creation methods and relationships in Box 1.

To provide a truer picture o the Australian contextand the complexity o the issues, it is essential to collectaccurate data on same-sex parented amilies romrepresentative samples. However, we already knowthat same-sex attracted parents and their amil ies otenencounter stigmatisation, which is known to aecttheir health and wellbeing. Experiences o stigma, asdescribed by same-sex attracted parents, have beenshown to be associated with lower scores on measureso psychological wellbeing or their children.2 Therelationship between stigma and child health in same-sex parented amilies will be explored urther in theACHESS.

Possible implications or clinicians

There is a general lack o recognition among healthservice providers that same-sex parented amilies exist,and non-biological parents are oten not acknowledgedas parents. Australian research has shown that lesbianparents perceive barriers when accessing healthservices.10 This can lead to a sense o vulnerability,when the health care system should be a sae place orlesbians [and gay men] to authentically talk about theirrelationships with lovers, riends and amily.11

The current population o same-sex parented amilieshas evolved through a changing social context. For theseamilies, social parenting (ie, parenting o non-birth ornon-biological children) plays an important role, andthe defnition o amily relationships is requently notrestricted to biological ties. Clinicians need to be awareo the diversity in amily ormation methods representedby these amilies, and the social context in which theylive. This needs to be openly acknowledged with amilieswithin consultations, along with recognition o dierent

1 A summative model o gay, lesbian, bisexual andtransgender parented amily construction

Parental orientation and current relationship

Male couple gay or bisexual

Female couple lesbian or bisexual

Single man gay or bisexual

Single woman lesbian or bisexual

Bisexual man or woman with heterosexual partner

Bisexual man and bisexual woman

Transgender person (male-to-emale or emale-to-male) withheterosexual or homosexual partner (identity o partner might

be based on persons gender beore or ater transition)

Single transgender person

More than two parents (combinations o gay, lesbian andheterosexual men and women)

Methods o amily ormation

Home-based sel-insemination

Clinic-based insemination or in-vitro ertilisation (known orunknown donor)

Heterosexual sex

Provided sperm as known donor

Provided egg as known donor

Co-parenting arrangement

Surrogacy

traditional: using the surrogates egg

gestational: using a donor egg

Adoption

Fostering

Blended amilies

Parental relationship status at time o amily ormation

Current same-sex relationship

Intentional single parent

Previous heterosexual relationship

Previous homosexual relationship

2 Examples o health care issues that could afect same-sex parented amilies

Conception planning for women: advice on known donor screening or clinic-recruited donor

selection, ovulation monitoring, preconception care, acquisition o legal advice regarding

involvement o known donor, and reerral or assisted reproductive technologies

Conception planning for men: advice on options or surrogacy in Australia with knownsurrogates, or overseas alternatives

Perinatal care for same-sex attracted women: selection o lesbian-sensitive services

Infant and early childhood care: supportive care or parents and children that recognises

varying amily structures

Family transitions: recognising the dif culties associated with transition rom heterosexual to

same-sex relationships and the stresses this may place on parents and children

Disclosure: understanding and respecting decisions around disclosure o parents same-sex

relationships within health care services, including permission to record this in reerral letters

and medical records

Non-biological parents: clariying, acknowledging and accepting the role o non-biological

parents

Stigma: willingness to ask about experiences o stigma and subsequent impacts on health o

parents and children

same-sexattracted

parents and

their amilies

oten encounter

stigmatisation,

which is known

to aect their

health and

wellbeing

7/28/2019 What makes a same-sex parented family?

3/3

3MJA 198 (9) 20 May 2013

Perspectives

amily structures and roles not just mother andather.

Some o the specifc health care issues that couldaect same-sex parented amilies are summarised inBox 2. More detailed guidelines or health care providersworking with same-sex parented amil ies are availablerom the Bouverie Centre at La Trobe University (http://www.bouverie.org.au).

We believe health care proessionals should be awareo the historical, legislative and social contexts inwhich same-sex parented amilies exist. The ACHESSwil l use high-quality epidemiological methods andinternationally validated measurement tools to providea more complete contemporary picture o the health andwellbeing o Australian children with same-sex attractedparents. It will include an analysis o the relative impacto the social environment and attitudes and examinehow this might aect child health and wellbeing. In themeantime, we believe health care proessionals need toput aside any preconceptions about these amilies andremain open to the rich social experiences in whichchildren with same-sex attracted parents live and,hopeully, thrive.

Acknowledgements: This research is unded by a National Health and MedicalResearch Council Postgraduate Scholarship, the John and Allan Gilmour Research Award,and the Jack Brockhof Foundation.

Competing interests: No relevant disclosures.

Provenance: Not commissioned; externally peer reviewed.

1 Australian Bureau o Statistics. Same-sex couple amilies. In: Reflecting anation: stories rom the 2011 Census, 20122013. Canberra: ABS, 2012. (ABSCat. No. 2071.0.) http://abs.gov.au/ausstats/abs@.ns/Lookup/2071.0main+eatures852012-2013 (accessed Jul 2012).

2 Crouch SR, Waters E, McNair R, et al. ACHESS The Australian Study oChild Health in Same-Sex Families: background research, design andmethodology. BMC Public Health 2012; 12: 646.

3 Short E, Riggs DW, Perlesz A, et al. Lesbian, gay, bisexual and transgender(LGBT) parented amilies: a literature review prepared or the AustralianPsychological Society. Melbourne: Australian Psychological Society, 2007.

4 Gartrell N, Hamilton J, Banks A, et al. The National Lesbian Family Study:1. Interviews with prospective mothers.Am J Orthopsychiatry1996; 66:272-281.

5 Bergman K, Rubio RJ, Green RJ, Padron E. Gay men who become athers viasurrogacy: the transition to parenthood.J GLBT Fam Stud2010; 6: 111-141.

6 Gay Dads Australia. Chapter 1. Surrogacy an introduction. http://www.gaydadsaustralia.com/surrogacy (accessed Apr 2013).

7 Hicks S. Queer genealogies: tales o conormity and rebellion amongstlesbian and gay oster carers and adopters. Qual Soc Work 2005; 4: 293-308.

8 Foster Care Association o Victoria. Inormation sheet: support or gayand lesbian oster carers. Melbourne: Foster Care Association o Victoria,2013. http://www.cav.org.au/images/documents/Inormation_Sheets/CISS_15_-_Support_or_gay__lesbian_carers_V2_As_at_21_Jan2013pd.pd(accessed Apr 2013).

9 Power J, Perlesz A, Brown R, et al. Diversity, tradition and amily: Australian

same-sex attracted parents and their amilies. Gay Lesbian Issues PsycholRev2010; 6: 66-81.10 McNair R, Brown R, Perlesz A, et al. Lesbian parents negotiating the health

care system in Australia. Health Care Women Int 2008; 29: 91-114.11 McDonald C, Anderson B. The view rom somewhere: locating lesbian

experience in womens health. Health Care Women Int 2003; 24: 697-711.