Mukai ruling stirs debate / Highlights gaps between law, reality over surrogate births Atsuko Kobayashi / Yomiuri Shimbun Staff Writer
The Supreme Court's ruling Friday on twin sons born through surrogate birth did not address whether the medical practice should be allowed, but did strongly call for legislative action for reproductive assistance medicine.
The ruling said Aki Mukai's request to register the boys as her children by birth could not be accepted under the current law. The 3-year-old boys were born through an American surrogate mother using Mukai's eggs and her husband's sperm.
Yuki Sumi, head of the Japan Office of the Nevada Center for Reproductive Medicine in Tokyo, said, "Almost all babies born through surrogate birth overseas have been registered in Japan as the commissioning couples' children by birth."
The organization has brokered surrogate pregnancies in the United States for more than 15 years, helping 55 couples have 75 children.
Japanese law says that the woman who actually gives birth to a child is the mother, meaning registration of a child by a biological mother is not allowed if the baby was born through surrogate birth.
But in Nevada and some other U.S. states where surrogate births are allowed, couples that have used surrogate parents can obtain birth certificates for their babies stating they are their children by birth.
As the U.S. certificates do not mention the children as being born by surrogate birth, the couples can register their babies as children by birth in Japan, and such family registrations are often accepted unchecked.
Japan has no law to prohibit surrogate mothers. Yahiro Netsu, a doctor in Shimosuwamachi, Nagano Prefecture, has made public five cases in which he has overseen surrogate births using a women's kin, such as sister or mother, as a surrogate birth mother.
Netsu said the babies were once registered as children of the women who delivered them and then adopted as children of the couples.
===
Risks involved
The Japan Society of Obstetrics and Gynecology announced in April 2003 its guideline to ban surrogate births, and notified member doctors of the decision that the medical society does not allow any form of surrogate birth, regardless of whether it is done without charge.
The medical society cited four reasons:
-- Child welfare may be affected.
-- Surrogate mothers may be exposed to physical risk and psychological burden.
-- Family relationships may be come too complicated.
-- Surrogate births are not socially accepted.
A report compiled the same month by the Health, Labor and Welfare Ministry's panel on reproductive assistance medicine also proposed that surrogate births should be prohibited and punishable.
The report said, "The practice of surrogate birth treats humans like tools for reproduction and imposes serious danger on third persons."
Moves to ban surrogate births are based, in addition to ethical problems, on the view that pregnancy and delivery carry too many risks.
Even though medical technology has progressed, about six women out of every 100,000 births in the country die during delivery. There was a report of an overseas case in which a surrogate mother died after having a miscarriage.
Netsu's work with surrogate births, especially one case in which a woman in her 50s became a surrogate mother for her daughter, have been questioned for the dangers involved.
In the United States, it is common to pay about 3 million yen to a surrogate mother and another 3 million yen fee to a broker. If travel and other expenses are included, a commercial surrogate birth can cost tens of millions of yen before the baby is even born.
There is a deep-rooted perception that wealthy people exploit economically disadvantaged women as tools for having babies.
===
Changing opinions
The Supreme Court ruling pointed out that "surrogate birth is something that had previously been inconceivable under the Civil Code, and we strongly hope that legislative steps will be taken immediately to cope with the situation."
Today, an estimated 300,000 people in Japan are receiving some form of fertility treatment, and public perception of reproductive assistance medicine is changing.
Surrogate births are divided into two kinds. One is the host mother method, in which a fertilized egg produced from the couple's sperm and egg is implanted in another woman, who later gives birth to the child. The other method uses the husband's sperm and an egg cell of a woman other than the wife, with a third person used as the surrogate mother.
The Osaka High Court in May 2005 turned down a family's registration of a child born through the second method as theirs, saying the practice offended public order and morals.
The Supreme Court upheld the decision without deciding on whether the medical practice should be allowed.
Mukai's case used the first method. Because the boys are genetically no different than if they were born through a natural pregnancy, there is less public resistance to this method.
In a survey by the health ministry in 2003 of about 4,000 people, 44 percent said they could accept the first method, under certain conditions. Twenty-four percent said it should not be allowed.
After the Tokyo High Court's decision in September that allowed Mukai and her husband to register the children as their own by birth, the government decided in November to start preparations to regulate reproductive assistance medicine.
The government has asked the Science Council of Japan to discuss if surrogate births should be allowed, how to compile basic rules if they are implemented and how to define family relationships under the practice.
The council is expected to submit a report next year. Moves to create a new framework of surrogate birth have finally started.
Wednesday, April 11, 2007
Relatives of Russian adoptees
from USA Today, 04/09/07
By Wendy Koch<http://www.usatoday .com/community/ tags/reporter. aspx?id=643> , USATODAY Ruslan Pettyjohn lives in a home with a pool, plays on a soccer team,goes bike-riding with friends and has two doting parents. He seems tohave everything a 13-year-old American boy would want. Except he doesn't have his big sister, Olga.When Ruslan was adopted from Russia nearly four years ago, she was leftbehind in their village, sweeping floors and living in a condemnedbuilding with broken windows and no running water. She looked after himfor years in the orphanage after their birth mother died. To give him abetter life, she signed off on his adoption.As international adoptions have soared, American parents are dealingwith an unintended consequence: siblings torn apart. More parents aresearching for their children's biological relatives, hoping to help themreconnect with their roots. Some want to adopt the kin; others just wantto visit.Now families are working together to seek a U.S. immigration fix, suchas a visitor program, that would allow brothers and sisters to see eachother. They're getting help from Empire Bay Group, a Washingtonconsulting firm, in approaching members of Congress. FIND MORE STORIES IN: Russia Family Ronald Federici Federici "We're committed to creating a path" for relatives to come to the USA,says Joan Knipe, Ruslan's adoptive mother. She and her husband, StevePettyjohn, of Scottsdale, Ariz., didn't know about Olga Lukinova untilRuslan's adoption was nearly complete. He didn't speak English, so hecouldn't tell them.They have tried to adopt her, but so far, she has been denied visas. Shelacks the formal schooling to qualify for a student visa and thefinancial assets for a tourist visa. Now they are seeking specialpermission because they're running out of time. For her to be adopted,Arizona state law requires her to enter the USA by her 22nd birthday,May 25."She doesn't know how to ride a bike. I could teach her," says blue-eyedRuslan, who clings to pictures of Olga when his mother reads HarryPotter to him at bedtime.To help other families in a similar plight, Knipe last year founded SaveOrphaned Siblings, a non-profit group that has attracted about 50families with children adopted from Russia. "We're just a group of moms who want to get some laws changed," saysJohanna Babcock, a kindergarten teacher who adopted two boys fromRussia. "We want to get these kids here."Her younger son, Sergei, 8, adopted at 2, has two teenage sisters inRussia. She found out about them when she got his final adoption papersand tracked them down. "I felt when I met these girls, they are themissing piece," says Babcock, of Locust Valley, N.Y. "My boys don'tunderstand why they're not here."Obstacles abound The families face obstacles. Many say they can't get visas for relativesto visit the USA because the relatives often don't have enough assets toassure authorities they would return to Russia. "Congress didn't create any special category" for adopters' relatives,says Tony Edson, deputy assistant secretary for visa services at theState Department. An application to adopt an orphan from another countrymust be filed by the time the child is 16 unless a younger sibling hasalready been adopted, in which case the age limit is 18. Once in theUSA, foreigners may be adopted as adults, depending on each state's law.Another obstacle is a new Russian process for accrediting adoptionagencies that has left most American agencies waiting for approval to beable to send orphans to the USA, says Thomas Atwood, president of theNational Council for Adoption. He says the Russian government has beenrestricting international adoption, prompted partly by the few buthorrific cases of Russian kids adopted by Americans who later abusedthem. The number of U.S. adoptions from Russia rose dramatically between 1992and 2004 but has since fallen markedly. Legal obstacles have left the Pettyjohns desperate. They're requesting aspecial kind of visa, known as "humanitarian parole," that theDepartment of Homeland Security grants in rare cases for what it calls a"very compelling emergency," such as medical treatment. Their firstapplication was rejected, but they're filing a second one. "I do believe this is life or death," says Knipe, a director atCaremark, a pharmaceutical firm. She says Olga has been sick twice thisyear with respiratory infections and is so thin that size 0 pants arebaggy.When Knipe mails Olga clothes or English-language tapes, they're stolen,Knipe says. She is careful not to send much money because she doesn'twant Olga to be a target of thieves. She wants to educate Olga and giveher a family. Olga's mother died at 33, and Knipe doesn't know whathappened to the father. Two other brothers were adopted by a relativeand stayed together.Russian orphans are exposed to "shocking levels of cruelty and neglect"and carry a lifelong stigma that results in many ending up homeless,according to a Human Rights Watch report in 1998. The report says 95% ofchildren in orphanages have a living parent, but many families are toopoor or abusive to take care of their kids.Jane Aronson, a pediatrician who has visited orphanages in manycountries and runs the non-profit Worldwide Orphans Foundation, saysre-establishing sibling ties makes "a huge difference" for adopted kids,who often struggle with questions about their birth parents."The more adoptees are connected to their roots, the better they are,"says Aronson, who adopted a boy from Ethiopia and another from Vietnam."Every parent who adopts feels guilty about a child left behind." Shesays she's 55, but she would adopt her sons' siblings "in a heartbeat,"if she could.People adopted as kids from Korea, which sent more orphans to the USAthan any other country in the early 1990s, are now going back as adultsto find relatives.In the USA, there has been a growing sensitivity in the past 25 years tokeeping siblings together in foster care or adoption, says BarbaraHolton, project manager of Adopt US Kids, a federally financed programthat promotes domestic adoption."Brothers and sisters who've lost everything don't need to lose eachother as well," says Holton, who adopted two children from Korea and onefrom Vietnam in the 1970s, when there was less push to adopt U.S. kids. Holton says her family recently returned from Vietnam, where she lookedfor the orphanage her 32-year-old son came from. It was gone, along withall records. She says it was a sad moment when they realized he'd neverfind his relatives.'Fraught with potential pitfalls' Still, re-establishing such ties is not for "the faint of heart," Holtonsays. "It's fraught with potential pitfalls," she says, including thepossibility that the adoptive parents could get scammed.Ronald Federici, a neuropsychologist and author of Help for the HopelessChild, says he has seen too many naive American parents being extortedfor money by the relatives of their adopted children. "The majority ofthe cases I've dealt with have been disasters," he says. In some cases,he says, the adoptees are traumatized again when they find out theirsiblings are living on the street or their birth mother doesn't want tosee them.He says one client, a stockbroker, sent $5,000 a month to a Romanianorphanage to help the siblings of his adopted children but later foundout that the orphanage director was pocketing the money.Federici says reunions can be valuable for children like Ruslan who wereadopted when they were older and had clear attachments to a sibling. Buthe questions the value for kids adopted so young they don't remembertheir original families. "It's not always the healing, holistic factor some would think," saysFederici, who knows where all the siblings are of the seven children headopted from Eastern Europe. He says his kids, now 18 to 25, have "nodesire" to meet them, although one visits her birth mother in Belarus.Some adoptees push their parents for answers about their pasts. OnMother's Day 2000, then-first-grader Tatiana Kirkpatrick tearfully askedwhat her birth mother looks like. Mary Kirkpatrick, who had adopted thegirl from a Siberian orphanage when she was 18 months old, says she felthurt at first by the request but later understood. She hired a freelancereporter for his investigative skills and spent $2,400 to track down thewoman, whom Tatiana has since met.In 2003, Kirkpatrick launched Russian Family Search, a non-profit effortto help others locate relatives. She now has three full-timereporter/photograph ers and three part-timers in Russia who do the work.Kirkpatrick charges families only what the reporters charge her,typically $500 to $600 per search if several are done at the same time.She's working on 50 requests now and expects to receive 200 this year.They take four to six weeks.She has helped find dozens of people, including Olga. Since Kirkpatrickand Knipe both live in the Phoenix area, they frequently meet tocoordinate efforts, hoping to assist families adopting from othercountries, too.Knipe and her husband, who have no other children, originally planned toadopt a child from foster care in this country, which has about 114,000kids waiting for adoption. A friend suggested they give parenting abrief try first. They agreed to host a Russian child visiting their areain a three-week cultural-exchange program.Three days after Ruslan landed on their doorstep, Knipe says, herhusband came to her in tears, saying, "We have to adopt him." Ruslanreturned to Russia, and nine months later they followed. They went backlast year to visit Olga."I knew when we were all together for two weeks, we were a completefamily," Knipe says. They arrange to call Olga, who has no phone, at theorphanage every other week. Knipe has promised her that regardless ofwhether they can adopt her, "I'll always be your mother."They've called, written and met with members of Congress, requestinghelp to rescue Olga. And they wait, with a bedroom in their housepainted in light blue and white, Olga's favorite colors.Knipe says Olga and Ruslan need each other: "These two will seek eachother out for the rest of their lives."[Non-text portions of this message have been removed]
By Wendy Koch<http://www.usatoday .com/community/ tags/reporter. aspx?id=643> , USATODAY Ruslan Pettyjohn lives in a home with a pool, plays on a soccer team,goes bike-riding with friends and has two doting parents. He seems tohave everything a 13-year-old American boy would want. Except he doesn't have his big sister, Olga.When Ruslan was adopted from Russia nearly four years ago, she was leftbehind in their village, sweeping floors and living in a condemnedbuilding with broken windows and no running water. She looked after himfor years in the orphanage after their birth mother died. To give him abetter life, she signed off on his adoption.As international adoptions have soared, American parents are dealingwith an unintended consequence: siblings torn apart. More parents aresearching for their children's biological relatives, hoping to help themreconnect with their roots. Some want to adopt the kin; others just wantto visit.Now families are working together to seek a U.S. immigration fix, suchas a visitor program, that would allow brothers and sisters to see eachother. They're getting help from Empire Bay Group, a Washingtonconsulting firm, in approaching members of Congress. FIND MORE STORIES IN: Russia Family Ronald Federici Federici "We're committed to creating a path" for relatives to come to the USA,says Joan Knipe, Ruslan's adoptive mother. She and her husband, StevePettyjohn, of Scottsdale, Ariz., didn't know about Olga Lukinova untilRuslan's adoption was nearly complete. He didn't speak English, so hecouldn't tell them.They have tried to adopt her, but so far, she has been denied visas. Shelacks the formal schooling to qualify for a student visa and thefinancial assets for a tourist visa. Now they are seeking specialpermission because they're running out of time. For her to be adopted,Arizona state law requires her to enter the USA by her 22nd birthday,May 25."She doesn't know how to ride a bike. I could teach her," says blue-eyedRuslan, who clings to pictures of Olga when his mother reads HarryPotter to him at bedtime.To help other families in a similar plight, Knipe last year founded SaveOrphaned Siblings, a non-profit group that has attracted about 50families with children adopted from Russia. "We're just a group of moms who want to get some laws changed," saysJohanna Babcock, a kindergarten teacher who adopted two boys fromRussia. "We want to get these kids here."Her younger son, Sergei, 8, adopted at 2, has two teenage sisters inRussia. She found out about them when she got his final adoption papersand tracked them down. "I felt when I met these girls, they are themissing piece," says Babcock, of Locust Valley, N.Y. "My boys don'tunderstand why they're not here."Obstacles abound The families face obstacles. Many say they can't get visas for relativesto visit the USA because the relatives often don't have enough assets toassure authorities they would return to Russia. "Congress didn't create any special category" for adopters' relatives,says Tony Edson, deputy assistant secretary for visa services at theState Department. An application to adopt an orphan from another countrymust be filed by the time the child is 16 unless a younger sibling hasalready been adopted, in which case the age limit is 18. Once in theUSA, foreigners may be adopted as adults, depending on each state's law.Another obstacle is a new Russian process for accrediting adoptionagencies that has left most American agencies waiting for approval to beable to send orphans to the USA, says Thomas Atwood, president of theNational Council for Adoption. He says the Russian government has beenrestricting international adoption, prompted partly by the few buthorrific cases of Russian kids adopted by Americans who later abusedthem. The number of U.S. adoptions from Russia rose dramatically between 1992and 2004 but has since fallen markedly. Legal obstacles have left the Pettyjohns desperate. They're requesting aspecial kind of visa, known as "humanitarian parole," that theDepartment of Homeland Security grants in rare cases for what it calls a"very compelling emergency," such as medical treatment. Their firstapplication was rejected, but they're filing a second one. "I do believe this is life or death," says Knipe, a director atCaremark, a pharmaceutical firm. She says Olga has been sick twice thisyear with respiratory infections and is so thin that size 0 pants arebaggy.When Knipe mails Olga clothes or English-language tapes, they're stolen,Knipe says. She is careful not to send much money because she doesn'twant Olga to be a target of thieves. She wants to educate Olga and giveher a family. Olga's mother died at 33, and Knipe doesn't know whathappened to the father. Two other brothers were adopted by a relativeand stayed together.Russian orphans are exposed to "shocking levels of cruelty and neglect"and carry a lifelong stigma that results in many ending up homeless,according to a Human Rights Watch report in 1998. The report says 95% ofchildren in orphanages have a living parent, but many families are toopoor or abusive to take care of their kids.Jane Aronson, a pediatrician who has visited orphanages in manycountries and runs the non-profit Worldwide Orphans Foundation, saysre-establishing sibling ties makes "a huge difference" for adopted kids,who often struggle with questions about their birth parents."The more adoptees are connected to their roots, the better they are,"says Aronson, who adopted a boy from Ethiopia and another from Vietnam."Every parent who adopts feels guilty about a child left behind." Shesays she's 55, but she would adopt her sons' siblings "in a heartbeat,"if she could.People adopted as kids from Korea, which sent more orphans to the USAthan any other country in the early 1990s, are now going back as adultsto find relatives.In the USA, there has been a growing sensitivity in the past 25 years tokeeping siblings together in foster care or adoption, says BarbaraHolton, project manager of Adopt US Kids, a federally financed programthat promotes domestic adoption."Brothers and sisters who've lost everything don't need to lose eachother as well," says Holton, who adopted two children from Korea and onefrom Vietnam in the 1970s, when there was less push to adopt U.S. kids. Holton says her family recently returned from Vietnam, where she lookedfor the orphanage her 32-year-old son came from. It was gone, along withall records. She says it was a sad moment when they realized he'd neverfind his relatives.'Fraught with potential pitfalls' Still, re-establishing such ties is not for "the faint of heart," Holtonsays. "It's fraught with potential pitfalls," she says, including thepossibility that the adoptive parents could get scammed.Ronald Federici, a neuropsychologist and author of Help for the HopelessChild, says he has seen too many naive American parents being extortedfor money by the relatives of their adopted children. "The majority ofthe cases I've dealt with have been disasters," he says. In some cases,he says, the adoptees are traumatized again when they find out theirsiblings are living on the street or their birth mother doesn't want tosee them.He says one client, a stockbroker, sent $5,000 a month to a Romanianorphanage to help the siblings of his adopted children but later foundout that the orphanage director was pocketing the money.Federici says reunions can be valuable for children like Ruslan who wereadopted when they were older and had clear attachments to a sibling. Buthe questions the value for kids adopted so young they don't remembertheir original families. "It's not always the healing, holistic factor some would think," saysFederici, who knows where all the siblings are of the seven children headopted from Eastern Europe. He says his kids, now 18 to 25, have "nodesire" to meet them, although one visits her birth mother in Belarus.Some adoptees push their parents for answers about their pasts. OnMother's Day 2000, then-first-grader Tatiana Kirkpatrick tearfully askedwhat her birth mother looks like. Mary Kirkpatrick, who had adopted thegirl from a Siberian orphanage when she was 18 months old, says she felthurt at first by the request but later understood. She hired a freelancereporter for his investigative skills and spent $2,400 to track down thewoman, whom Tatiana has since met.In 2003, Kirkpatrick launched Russian Family Search, a non-profit effortto help others locate relatives. She now has three full-timereporter/photograph ers and three part-timers in Russia who do the work.Kirkpatrick charges families only what the reporters charge her,typically $500 to $600 per search if several are done at the same time.She's working on 50 requests now and expects to receive 200 this year.They take four to six weeks.She has helped find dozens of people, including Olga. Since Kirkpatrickand Knipe both live in the Phoenix area, they frequently meet tocoordinate efforts, hoping to assist families adopting from othercountries, too.Knipe and her husband, who have no other children, originally planned toadopt a child from foster care in this country, which has about 114,000kids waiting for adoption. A friend suggested they give parenting abrief try first. They agreed to host a Russian child visiting their areain a three-week cultural-exchange program.Three days after Ruslan landed on their doorstep, Knipe says, herhusband came to her in tears, saying, "We have to adopt him." Ruslanreturned to Russia, and nine months later they followed. They went backlast year to visit Olga."I knew when we were all together for two weeks, we were a completefamily," Knipe says. They arrange to call Olga, who has no phone, at theorphanage every other week. Knipe has promised her that regardless ofwhether they can adopt her, "I'll always be your mother."They've called, written and met with members of Congress, requestinghelp to rescue Olga. And they wait, with a bedroom in their housepainted in light blue and white, Olga's favorite colors.Knipe says Olga and Ruslan need each other: "These two will seek eachother out for the rest of their lives."[Non-text portions of this message have been removed]
Monday, April 9, 2007
Update on Guatemala
March 16, 2007- Alexandria, Virginia – Legislation intended to reform the current international adoption system will be introduced in Guatemala early next week. The legislation puts into place much needed oversight and is in line with the Hague Convention on Protection of Children and Cooperation in Respect of Intercountry Adoption, an international convention signed or ratified by over 60 countries.“This legislation gives children the legal protections they need and also the continued opportunity to find love and safety through adoption” said Thomas DiFilipo, President of the Joint Council on International Children’s Services (Joint Council). International adoption in Guatemala has been criticized by numerous groups for unethical practices and a lack of governmental oversight. Such criticism has called into question whether intercountry adoption will continue in Guatemala. “Legislative reform is the key to continuing intercountry adoption in Guatemala” said DiFilipo. DiFilipo’s statement seems to echo that of many members of the Guatemalan Congress who met in early December and throughout the winter to address a range of issues related to international adoption and are now prepared to present their recommendations to Congress. The Hague Convention on International Adoption will be ratified by the United States later this year. Since more Guatemalan orphans find loving families in the United States than in any other country, passage of this legislation in Guatemala appears vital to the protection of children’s right. The United States Department of State has clearly stated that adoptions with Guatemala will not be permissible under law unless such legislation is passed. According to DiFilipo “It is clear the Guatemalan Congress intends on passing the respective legislation this Spring. The best interest of each child is at the center of their efforts.” Joint Council on International Children’s Services117 South Saint Asaph StreetAlexandria, VA 22314703-535-8045www.jcics.orginfo@jcics.org
Saturday, April 7, 2007
Fertility clinic websites and advertising
Internet sites operated by the majority of fertility clinics do not adhere to their own association's advertising guidelines, says a study published in the journal Fertility and Sterility. The study also revealed that services offered at private clinics and academic clinics were similar, but private clinics were more likely to publish success rates, use comparative marketing, and offer financial incentives.
Because many consumers rely on the Internet to gather health information; "the concern is that vulnerable patients may be misled by information that does not give the whole picture," said Dr. Tarun Jain, senior author of the study from the University of Illinois at Chicago.
Advertising guidelines that clinics should be adhering to require clinics to provide specific information about how in vitro fertilization outcome statistics are reported, mandate that clinics follow Federal Trade Commission guidelines, and warn against the comparison of success rates between clinics. But the researchers found that approximately half of the websites published success rates, and of those, the percentage adhering to the advertising guidelines was low in all categories evaluated.
"Despite an attempt to clarify assisted reproduction information on the Internet, there is a great deal of disparity among how clinics publish success rates on their Web sites," said Jain. "Patients need to carefully evaluate the information presented on Web sites, and they need to know what questions to ask when they meet face-to-face with a physician."
The researchers also evaluated clinic websites for advertising specific services, including donor egg program, embryo and egg cyropreservation, pre-implantation genetic diagnosis, sex selection, shared-risk financing and 100 percent money-back guarantees. Private clinic Web sites were significantly more likely than academic clinics to offer financial incentives, including shared risk financing, and to use the catchphrase "100 percent Money Back Guarantee."
Jain recommends that infertility patients not rely solely on success rates published on fertility clinic websites. "Patients should meet with a prospective physician and have their questions answered in person," he said. "Success rates will vary depending on the patient's diagnosis, age and other factors, but unfortunately, many patients choose a practice based on information obtained on the Internet."
Source: University of Illinois at Chicago
Because many consumers rely on the Internet to gather health information; "the concern is that vulnerable patients may be misled by information that does not give the whole picture," said Dr. Tarun Jain, senior author of the study from the University of Illinois at Chicago.
Advertising guidelines that clinics should be adhering to require clinics to provide specific information about how in vitro fertilization outcome statistics are reported, mandate that clinics follow Federal Trade Commission guidelines, and warn against the comparison of success rates between clinics. But the researchers found that approximately half of the websites published success rates, and of those, the percentage adhering to the advertising guidelines was low in all categories evaluated.
"Despite an attempt to clarify assisted reproduction information on the Internet, there is a great deal of disparity among how clinics publish success rates on their Web sites," said Jain. "Patients need to carefully evaluate the information presented on Web sites, and they need to know what questions to ask when they meet face-to-face with a physician."
The researchers also evaluated clinic websites for advertising specific services, including donor egg program, embryo and egg cyropreservation, pre-implantation genetic diagnosis, sex selection, shared-risk financing and 100 percent money-back guarantees. Private clinic Web sites were significantly more likely than academic clinics to offer financial incentives, including shared risk financing, and to use the catchphrase "100 percent Money Back Guarantee."
Jain recommends that infertility patients not rely solely on success rates published on fertility clinic websites. "Patients should meet with a prospective physician and have their questions answered in person," he said. "Success rates will vary depending on the patient's diagnosis, age and other factors, but unfortunately, many patients choose a practice based on information obtained on the Internet."
Source: University of Illinois at Chicago
Thursday, April 5, 2007
Motivations of Surrogate Mothers
MOTIVATIONS OF SURROGATE MOTHERS:
PARENTHOOD, ALTRUISM AND SELF-ACTUALIZATION (a three year study)
Author: Dr. Betsy P. Aigen
Because surrogacy questions cherished cultural beliefs and ideals regarding the mother-infant relationship, it inenvitably stimulates intense anxiety and discomfort. Women who choose to bear children voluntarily for someone else reap disdain, and are seen as cold, heartless, and mercenary, because they seem to so easily “give away their babies". Even in the absence of the issue of fee payment, there is a clear moralistic underpinning to the arguments against surrogacy, which is rarely stated overtly, that choosing to have a baby for someone else is reprehensible because it represents a “rejection" of the infant by its biological mother. These women, who are seen as being prompted by materialistic motives, are correspondingly seen as coming from a financial and/or social “underclass". This is perceived as making them vulnerable to being exploited by reproductively “prostituting" themselves. Finally, they are assumed to suffer a serious traumatic experience because of the perceived “loss" they suffer in surrendering the infant to the couple.
Although critics have been vocal and strident, there is little actual data to substantiate these claims. This study was a preliminary effort to assess the reality of the assumptions behind this stereotype, to clarify their motives.
METHODInterviews
Two hundred potential surrogates applying to The Surrogate Mother Program of New York were screened using a series of three semi-structured interviews, 90 minutes each, to assess their motivation, feelings about surrendering the baby, and a number of related attitudes. General demographic data, medical history, as well as information regarding their current and past life situation, were asked for as well, including childhood relationships. Questions also pertained to their state of emotional health, and corresponded to a traditional clinical interview. The following is a very brief summary of the results of this three year study.
SUBJECTSThe Rejected Group
Individuals were rejected for "emotional" reasons such as:
1. Individuals too ambivalent about becoming surrogates. Serious expressions of conflict over either the responsibility or the commitment of time, energy, and resources required; or uncertainty over whether they would feel comfortable carrying a child that was not "theirs"; or being very anxious about the possibility of social criticism.
2. Individuals overly motivated by the fee.
3.Indivials potentially experiencing too much difficulty in surrendering the baby.
4. Indiviuals likely to suffer severe loss reaction afterwards.
5. Indiviuals in the middle of a "life crisis". Crisis refers to such events as being, at the time of application, in the process of divorce, still recuperating from a divorce, mourning the recent death of a family member or spouse, or being in the midst of an identity crisis, i.e. not knowing what to do with one’s life.
6. Indiviuals trying to use the role of surrogate as a way to deal with a traumatic situation. Efforts to "relive" abandonments suffered in childhood through "identifying" with the infant whom they see as being abandoned by themselves or given away; or unconscious conflict over another child themselves. Being a surrogate would allow the applicant to bear the child yet not keep it. The possibility exists of her changing her mind and keeping the child.
7. Individuals in poor emotional condition,depressed, immature, or unstable.
8. Judged to be dishonest and untrustworthy.
The Accepted Group
The accepted group includes those applicants who did not fall into any category of the rejection categories. They were (at most) minimally ambivalent about becoming surrogates not primarily motivated by the fee, and judged as having little potential difficulty in surrendering the baby. They were emotionally adequate, with no serious outstanding pathology. They were frequently judged to be honest and trustworthy.
In addition, they passed the following criteria:
1. Individuals for whom this would be a positive emotional experience, who feel they would gain by it.
2. High frustration tolerance and “ego strength". People with determination to follow through and the capacity to endure the physical and emotional demands and realities of the process.
3. A history of positive and enjoyable preganancies, both physically and emotionally.
4. Positive relationships with their children, to ensure that they have the necessary concern, understanding, and closeness to deal adequately with their children’s questions and feelings about the choice of surrogacy.
5. The presence of a supportive home environment, i.e. spouse or significant others, to ensure an adequate environment during pregnacy.
Demographic Characteritics and Attitudes Related to Surrogacy
The mean age of the entire group was 26. Fifty percent were married, and 26% were single. Seventy-five percent were mothers. Forty percent had a history of one or more abortions. Sixteen percent had some relation to adoption (they or a significant family member were adopted, or they surrendered a child for adoption). As a group, they were predominantly white and either Catholic or Protestant. Almost three-fourths came from large families (three or more siblings). The average educational level was 13.3 years. Fifty percent had one or more years of college. Approximately 71% were employed (at least part-time), and 20% were either teachers or nurses. Their mean income level was above $24,000 per year. Twenty-five percent had combined family incomes above $35,000 per year. [This includes women judged to be “financially desperate.] On average, applicants had been interested in being a surrogate for 1 1/2 years. Seventy-five percent wished to meet the couple.
The "average" surrogate emerges as a white mother with a fair amount of education and income. As a group, they cannot be described as destitute or living in poverty, and do not need the fee being paid them for basic survival. On average, they do not report being under serious financial pressure. Further data reflecting this is presented later on. Most of them are parents who know what the experience of bearing a child is about. There is nothing to indicate that they are naive, passive dupes who are desperate and susceptible to exploitation.
Conclusion
Although money is an important motive to many surrogates, it is not their primary motive. Almost all report a variety of emotional reasons for undertaking surrogacy, and many of these can be grouped together under the heading of wishes to enable parenthood, to feel self-actualized, and to enhance their identity. It is, for these women, a particularly female experience, related to the experiences and meaning of biological functioning and motherhood. The love of their children, the gratification their children offer them, and the wish to share these experiences, were often mentioned by these women. These feelings, influenced a number of the motive categories, including empathy with the infertile wife and the drive to generate parenthood for others.
An indirect implications of all this is that these women are as "normal" as anyone else. Previous research assessing surrogates has also found them to be unremarkable and their personalities to be average. Although psychological needs may sometimes, or perhaps even often, be found underlying a number of the motives reported (e.g., guilt), we do not see that this, in an of itself, invalidates the surrogates’ choice. Such conflicts and needs, in part, fuel most "normal" choices and activities of human beings, such as marriage and career. What are "healthy" motives? We do not ban people from becoming CIA agents or test pilots because they are prompted by unresolved wishes.
This does not mean that there are no unhealthy motives for becoming a surrogate and that no discrimination is necessary. On the contrary, the fact that over 40% of our 200 applicants were rejected for emotionally-based reasons, having to do either with poor motives, general life situation, or general emotional makeup, suggests that great discrimination and caution are necessary in accepting individuals for this process. The reasons for rejection listed earlier, as well as the criteria for acceptance, can provide a useful start in the process of providing needed criteria for evaluating surrogate applicants effectively. Additionally, differences in the composition of accepted and rejected groups reflect the importance of assessing motivation and character. Those individuals and parents who are less detached, more connected to the couple, the baby, and probably to their own children and partners, seem to be the ones favored by our selection criteria. The results may also suggest that, in general, parents are better suited to be surrogates than non-parents, in terms of significant traits, motivation, and more adaptive reactions to surrendering the child.
Being a surrogate is a life experience that allows some women real success in altering their emotional state in a direction they desire and fulfilling ideal images of themselves. A very significant aspect of that image is that of being a mother and, by extension, enabling others to enjoy the pleasures of parenthood that they themselves have had. Because surrogacy involves an act of giving that is personally meaningful to the surrogate, and because what is being given is of unique value, being a surrogate mother has the potential to be a "mutative" event, an experience capable of altering and transforming identity, self-image, and existing psychic structure.
It is exactly the fact that these otherwise individuals, through their biological ability to bear children, feel that they can achieve some measure of greatness that would otherwise be beyond them, that makes being a surrogate so psychologically extraordinary. They feel this moment of greatness as a permanent possession. The memory of this action is a permanent psychological reserve against negative emotional states and events. The motives for becoming a surrogate mother cannot be glibly dismissed as mere "acting out".
In contrast to the stereotype of a heartless, misguided, impoverished woman primarily motivated by money, surrogates emerge here as average mothers, often trying to further the goals of their children and families.
PARENTHOOD, ALTRUISM AND SELF-ACTUALIZATION (a three year study)
Author: Dr. Betsy P. Aigen
Because surrogacy questions cherished cultural beliefs and ideals regarding the mother-infant relationship, it inenvitably stimulates intense anxiety and discomfort. Women who choose to bear children voluntarily for someone else reap disdain, and are seen as cold, heartless, and mercenary, because they seem to so easily “give away their babies". Even in the absence of the issue of fee payment, there is a clear moralistic underpinning to the arguments against surrogacy, which is rarely stated overtly, that choosing to have a baby for someone else is reprehensible because it represents a “rejection" of the infant by its biological mother. These women, who are seen as being prompted by materialistic motives, are correspondingly seen as coming from a financial and/or social “underclass". This is perceived as making them vulnerable to being exploited by reproductively “prostituting" themselves. Finally, they are assumed to suffer a serious traumatic experience because of the perceived “loss" they suffer in surrendering the infant to the couple.
Although critics have been vocal and strident, there is little actual data to substantiate these claims. This study was a preliminary effort to assess the reality of the assumptions behind this stereotype, to clarify their motives.
METHODInterviews
Two hundred potential surrogates applying to The Surrogate Mother Program of New York were screened using a series of three semi-structured interviews, 90 minutes each, to assess their motivation, feelings about surrendering the baby, and a number of related attitudes. General demographic data, medical history, as well as information regarding their current and past life situation, were asked for as well, including childhood relationships. Questions also pertained to their state of emotional health, and corresponded to a traditional clinical interview. The following is a very brief summary of the results of this three year study.
SUBJECTSThe Rejected Group
Individuals were rejected for "emotional" reasons such as:
1. Individuals too ambivalent about becoming surrogates. Serious expressions of conflict over either the responsibility or the commitment of time, energy, and resources required; or uncertainty over whether they would feel comfortable carrying a child that was not "theirs"; or being very anxious about the possibility of social criticism.
2. Individuals overly motivated by the fee.
3.Indivials potentially experiencing too much difficulty in surrendering the baby.
4. Indiviuals likely to suffer severe loss reaction afterwards.
5. Indiviuals in the middle of a "life crisis". Crisis refers to such events as being, at the time of application, in the process of divorce, still recuperating from a divorce, mourning the recent death of a family member or spouse, or being in the midst of an identity crisis, i.e. not knowing what to do with one’s life.
6. Indiviuals trying to use the role of surrogate as a way to deal with a traumatic situation. Efforts to "relive" abandonments suffered in childhood through "identifying" with the infant whom they see as being abandoned by themselves or given away; or unconscious conflict over another child themselves. Being a surrogate would allow the applicant to bear the child yet not keep it. The possibility exists of her changing her mind and keeping the child.
7. Individuals in poor emotional condition,depressed, immature, or unstable.
8. Judged to be dishonest and untrustworthy.
The Accepted Group
The accepted group includes those applicants who did not fall into any category of the rejection categories. They were (at most) minimally ambivalent about becoming surrogates not primarily motivated by the fee, and judged as having little potential difficulty in surrendering the baby. They were emotionally adequate, with no serious outstanding pathology. They were frequently judged to be honest and trustworthy.
In addition, they passed the following criteria:
1. Individuals for whom this would be a positive emotional experience, who feel they would gain by it.
2. High frustration tolerance and “ego strength". People with determination to follow through and the capacity to endure the physical and emotional demands and realities of the process.
3. A history of positive and enjoyable preganancies, both physically and emotionally.
4. Positive relationships with their children, to ensure that they have the necessary concern, understanding, and closeness to deal adequately with their children’s questions and feelings about the choice of surrogacy.
5. The presence of a supportive home environment, i.e. spouse or significant others, to ensure an adequate environment during pregnacy.
Demographic Characteritics and Attitudes Related to Surrogacy
The mean age of the entire group was 26. Fifty percent were married, and 26% were single. Seventy-five percent were mothers. Forty percent had a history of one or more abortions. Sixteen percent had some relation to adoption (they or a significant family member were adopted, or they surrendered a child for adoption). As a group, they were predominantly white and either Catholic or Protestant. Almost three-fourths came from large families (three or more siblings). The average educational level was 13.3 years. Fifty percent had one or more years of college. Approximately 71% were employed (at least part-time), and 20% were either teachers or nurses. Their mean income level was above $24,000 per year. Twenty-five percent had combined family incomes above $35,000 per year. [This includes women judged to be “financially desperate.] On average, applicants had been interested in being a surrogate for 1 1/2 years. Seventy-five percent wished to meet the couple.
The "average" surrogate emerges as a white mother with a fair amount of education and income. As a group, they cannot be described as destitute or living in poverty, and do not need the fee being paid them for basic survival. On average, they do not report being under serious financial pressure. Further data reflecting this is presented later on. Most of them are parents who know what the experience of bearing a child is about. There is nothing to indicate that they are naive, passive dupes who are desperate and susceptible to exploitation.
Conclusion
Although money is an important motive to many surrogates, it is not their primary motive. Almost all report a variety of emotional reasons for undertaking surrogacy, and many of these can be grouped together under the heading of wishes to enable parenthood, to feel self-actualized, and to enhance their identity. It is, for these women, a particularly female experience, related to the experiences and meaning of biological functioning and motherhood. The love of their children, the gratification their children offer them, and the wish to share these experiences, were often mentioned by these women. These feelings, influenced a number of the motive categories, including empathy with the infertile wife and the drive to generate parenthood for others.
An indirect implications of all this is that these women are as "normal" as anyone else. Previous research assessing surrogates has also found them to be unremarkable and their personalities to be average. Although psychological needs may sometimes, or perhaps even often, be found underlying a number of the motives reported (e.g., guilt), we do not see that this, in an of itself, invalidates the surrogates’ choice. Such conflicts and needs, in part, fuel most "normal" choices and activities of human beings, such as marriage and career. What are "healthy" motives? We do not ban people from becoming CIA agents or test pilots because they are prompted by unresolved wishes.
This does not mean that there are no unhealthy motives for becoming a surrogate and that no discrimination is necessary. On the contrary, the fact that over 40% of our 200 applicants were rejected for emotionally-based reasons, having to do either with poor motives, general life situation, or general emotional makeup, suggests that great discrimination and caution are necessary in accepting individuals for this process. The reasons for rejection listed earlier, as well as the criteria for acceptance, can provide a useful start in the process of providing needed criteria for evaluating surrogate applicants effectively. Additionally, differences in the composition of accepted and rejected groups reflect the importance of assessing motivation and character. Those individuals and parents who are less detached, more connected to the couple, the baby, and probably to their own children and partners, seem to be the ones favored by our selection criteria. The results may also suggest that, in general, parents are better suited to be surrogates than non-parents, in terms of significant traits, motivation, and more adaptive reactions to surrendering the child.
Being a surrogate is a life experience that allows some women real success in altering their emotional state in a direction they desire and fulfilling ideal images of themselves. A very significant aspect of that image is that of being a mother and, by extension, enabling others to enjoy the pleasures of parenthood that they themselves have had. Because surrogacy involves an act of giving that is personally meaningful to the surrogate, and because what is being given is of unique value, being a surrogate mother has the potential to be a "mutative" event, an experience capable of altering and transforming identity, self-image, and existing psychic structure.
It is exactly the fact that these otherwise individuals, through their biological ability to bear children, feel that they can achieve some measure of greatness that would otherwise be beyond them, that makes being a surrogate so psychologically extraordinary. They feel this moment of greatness as a permanent possession. The memory of this action is a permanent psychological reserve against negative emotional states and events. The motives for becoming a surrogate mother cannot be glibly dismissed as mere "acting out".
In contrast to the stereotype of a heartless, misguided, impoverished woman primarily motivated by money, surrogates emerge here as average mothers, often trying to further the goals of their children and families.
Wednesday, April 4, 2007
Adoption Tax Credit
This information comes directly from - http://www.irs.gov/taxtopics/tc607.html
Topic 607 - Adoption Credit
You may be able to take a tax credit for qualifying expenses paid to adopt an eligible child (including a child with special needs). The adoption credit is an amount subtracted from your tax liability. Although the credit generally is allowed for the year following the year in which the expenses are paid, a taxpayer who paid qualifying expenses in the current year for an adoption which became final in the current year, may be eligible to claim the credit on the current year return. The adoption credit is not available for any reimbursed expense. In addition to the credit, certain amounts reimbursed by your employer for qualifying adoption expenses may be excludable from your gross income.
For both the credit or the exclusion, qualifying expenses include reasonable and necessary adoption fees, court costs, attorney fees, traveling expenses (including amounts spent for meals and lodging while away from home), and other expenses directly related to and for which the principal purpose is the legal adoption of an eligible child. An eligible child must be under 18 years old, or be physically or mentally incapable of caring for himself or herself. The adoption credit or exclusion cannot be taken for a child who is not a United States citizen or resident unless the adoption becomes final. An eligible child is also a child with special needs if he or she is a United States citizen or resident and a state determines that the child cannot or should not be returned to his or her parent's home and probably will not be adopted unless assistance is provided. Under certain circumstances, the amount of your qualified adoption expenses may be increased if you adopted an eligible child with special needs.
The credit and exclusion for qualifying adoption expenses are each subject to a dollar limit and an income limit.
Under the dollar limit the amount of your adoption credit or exclusion is limited to the dollar limit for that year for each effort to adopt an eligible child. If you can take both a credit and an exclusion, this dollar amount applies separately to each. For example, if we assume the dollar limit for the year is $10,000 and you paid $9,000 in qualifying adoption expenses for a final adoption, while your employer paid $4,000 of additional qualifying adoption expenses, you may be able to claim a credit of up to $9,000 and also exclude up to $4,000.
The dollar limit for a particular year must be reduced by the amount of qualifying expenses taken into account in previous years for the same adoption effort.
The income limit on the adoption credit or exclusion is based on your modified adjusted gross income (modified AGI). If your modified AGI is below the beginning phase out amount for the year, the income limit will not affect your credit or exclusion. If your modified AGI is more than the beginning phase out amount for the year, your credit or exclusion will be reduced. If your modified AGI is above the maximum phase out amount for the year, your credit or exclusion will be eliminated.
Generally, if you are married, you must file a joint return to take the adoption credit or exclusion. If your filing status is married filing separately, you can take the credit or exclusion only if you meet special requirements.
To take the credit or exclusion, complete
Topic 607 - Adoption Credit
You may be able to take a tax credit for qualifying expenses paid to adopt an eligible child (including a child with special needs). The adoption credit is an amount subtracted from your tax liability. Although the credit generally is allowed for the year following the year in which the expenses are paid, a taxpayer who paid qualifying expenses in the current year for an adoption which became final in the current year, may be eligible to claim the credit on the current year return. The adoption credit is not available for any reimbursed expense. In addition to the credit, certain amounts reimbursed by your employer for qualifying adoption expenses may be excludable from your gross income.
For both the credit or the exclusion, qualifying expenses include reasonable and necessary adoption fees, court costs, attorney fees, traveling expenses (including amounts spent for meals and lodging while away from home), and other expenses directly related to and for which the principal purpose is the legal adoption of an eligible child. An eligible child must be under 18 years old, or be physically or mentally incapable of caring for himself or herself. The adoption credit or exclusion cannot be taken for a child who is not a United States citizen or resident unless the adoption becomes final. An eligible child is also a child with special needs if he or she is a United States citizen or resident and a state determines that the child cannot or should not be returned to his or her parent's home and probably will not be adopted unless assistance is provided. Under certain circumstances, the amount of your qualified adoption expenses may be increased if you adopted an eligible child with special needs.
The credit and exclusion for qualifying adoption expenses are each subject to a dollar limit and an income limit.
Under the dollar limit the amount of your adoption credit or exclusion is limited to the dollar limit for that year for each effort to adopt an eligible child. If you can take both a credit and an exclusion, this dollar amount applies separately to each. For example, if we assume the dollar limit for the year is $10,000 and you paid $9,000 in qualifying adoption expenses for a final adoption, while your employer paid $4,000 of additional qualifying adoption expenses, you may be able to claim a credit of up to $9,000 and also exclude up to $4,000.
The dollar limit for a particular year must be reduced by the amount of qualifying expenses taken into account in previous years for the same adoption effort.
The income limit on the adoption credit or exclusion is based on your modified adjusted gross income (modified AGI). If your modified AGI is below the beginning phase out amount for the year, the income limit will not affect your credit or exclusion. If your modified AGI is more than the beginning phase out amount for the year, your credit or exclusion will be reduced. If your modified AGI is above the maximum phase out amount for the year, your credit or exclusion will be eliminated.
Generally, if you are married, you must file a joint return to take the adoption credit or exclusion. If your filing status is married filing separately, you can take the credit or exclusion only if you meet special requirements.
To take the credit or exclusion, complete
Sunday, April 1, 2007
Adoption Consent and Revocation
One of the major issues that adoptive families are concerned about is if the birth parents will consent to the adoption and if so, how long they have to revoke that consent. The below link gives a great description of when parental consent is needed, how it needs to be executed, and the revocation of consent.
http://www.abcadoptions.com/consent4.htm
http://www.abcadoptions.com/consent4.htm
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