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On the medical side, the right questions have not been consistently asked. In some of their annual statistics, the HFEA offer ‘No Partner’ as a cause for infertility’, but would-be mothers might list themselves under other headings if they also had a medical reason. In some years, there is no way to identify the number of women who are seeking treatment and do not have a partner. A large number of would-be mothers are also included as ‘patient unexplained’, some of whom may be single women who fear their status might prejudice their access to help, or clinics concerned about the risk of publicity.
On the part of academic research, samples have been too small to sustain rigorous study, as many single women wish to avoid publicity to protect their privacy, and their children’s. Once a single woman has a child, she is also likely to have more demands on her time than a woman with a partner, and less time to contribute to research. Finally, I was also told (informally) that because most of the studies have shown little of note, it has become more difficult to obtain research funding.
In my role coordinating the DCN’s service to single women, I had access to the 650+ women members, so from December 2015 to February 2016, I carried out a survey to investigate some of the stereotypes popular in the media and to establish some insight into who we are. Two hundred and twenty five women completed the survey. I designed it without any specialist advice, but the responses are interesting and useful, if not strictly conclusive.
Another factor for which I must apologise is failing to include any question about ethnic origins. My impression is that this group of women is predominantly white, though a significant number have origins abroad. The white European, American and Australasian women have often come to live in Britain as adults, while the Asian, African and African Caribbean women are more often from settled second or further generation families. There will be differences in the degree of community and family support, and in the individual personality traits associated with making such a decision, which are an important area for further study. It would be useful to know about the specific support needs of women from minority or marginalised communities.
The survey was completed by 225 respondents. The results show wide diversity: the stereotypes are not always true and there are always contrasting exceptions. It is these exceptions that are often more interesting – it is hard to generalise. The important fact of the impact on our children is omitted in this survey.
The women who responded expressed a great deal of satisfaction with their treatement, although there were also reports of difficulties and complaints.
We are generally well educated and trained and earning average or higher incomes, but many of us also reduce our work commitments once our children arrive, and our earnings reflect this. We mostly have stable housing, though many of us need to move in order to provide a more suitable home for a child. The stereotype of the ‘must have it all’ ‘high-flying professional’ does not apply to most of us, though some of us may have lived this life before we made the decision to have a family. Decisiveness and resilience might be common features that help us to make the choice and survive the challenges of achieving success.
Three in ten of us report having deliberated for over two years before making the decision, and five in ten spent more than a year considering it. This suggests that it is a well-considered choice for which we evaluate and plan carefully. In other words, we mostly recognise it is an onerous long-term commitment that will change our lives.
The common suggestion that it is a selfish choice is inconsistent with the fact that most of us are giving up valued resources such as time, income and freedom by taking this step. I am not sure I understand which reasons for having a baby might be more virtuous or altruistic anyway. Certainly, most of us will agree that having a baby to cement a relationship, or to please our elders, or to meet traditional expectations, or to escape from the world of paid employment, are not great reasons to bring a child into the world. Having a baby to nurture and love and to raise to become a happy person, should be a universal reason, whatever our status.
Thoughtful deliberation, decisiveness and resilience might be common features, allowing us to make the choice and achieve our goals despite all the pressures and conventions we face.
I will look at the outcomes of the survey next. Then I will identify where further research might be useful, to fill the gaps and answer questions, as well as to track changes in the rapidly changing world both of assisted conception and of social support structure and culture.
1/ What is your current fertility treatment
2/ What fertility treatment did you have?
3/ Were you offered NHS treatment?
4/ What year was your treatment?
5/ & 6/ Waiting times
7/ How many fertility counselling sessions
did you have?
8/ Did being single affect the service
you were offered?
9/ For people who went abroad,
what did you use?
10/ How do you feel about about the
treatment you received abroad?
11/ Would you recommend the treatment you
had to anyone else in the same position?
12/ Did you, or would you have used identity
release gametes if available?
13/ How old were you when you first
considered having a family alone?
14/ How long did it take from the initial idea to
taking the first step?
15/ How old were you when your first donor
conceived child was born?
16/ What is you annual income?
17/ What are your financial concerns?
18/ Do you have additional family
responsibilities other than your
19/ What is your housing situation?
20/ What is your highest academic
The conclusions I can draw from this is that we are after all a diverse group of women with a few things in common.
- We are on average older and better educated than the typical first time mother, though not always well-off. This may because we have already achieved our professional ambitions and are willing to compromise on material things, in other words a lifestyle choice.
- General knowledge about age and fertility needs to be better disseminated, to reduce the incidence of women not considering their options until they are running out.
- Housing and the care of ageing parents are often a worry.
- Counselling needs to be more consistently encouraged, and greater choice offered so that women can find someone who ‘fits’ and avoid negative experiences.
- Nearly all the women who had treatment abroad believed that identity release donors were preferable, although this might reflect the fact they were all DCN members. The DCN strongly advocates for openness about donors and against anonymity, so those who do not feel comfortable with either of these may not join, or leave when they feel they don’t fit in.
- The inequity of NHS provisions needs to be addressed. It affects all those who need fertility treatment, but single women are especially disadvantaged as CCG’s have the discretion to set upper age limits and other barriers which exclude single women disproportionately.
- Women from BAME communities: how do their experiences differ? Do they receive as much support from their family / communities? It would be interesting to look at cultures where there is a strong matrilineal support system.
- How many women change career as part of the process of becoming mothers?What is the long term impact of this?
- Are there personality traits (resilience, decisiveness?) common to women who make this choice?
- Treatment abroad: are UK clinics referring single women to sister-clinics abroad? Is that because it’s simpler than recruiting donors locally? How does that affect the cost / fees?
- Women who give up: understandably, women who give up trying to have a family are not keen on participating in any research. The loss of hope is deeply distressing, all the more so because the services tend to be so positive and encouraging, and many women never consider the possibility of failure until they have experienced it repeatedly. It would be useful to know how long / how many options they tried, and how often it’s because of:
- Finances running out
- Giving up hope of success
- Doubts about whether it’s the right thing for them
It would be interesting to repeat this research every few years to track how the situation changes, as treatment options and the social context we live in are changing all the time.
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