"To whom is childbearing important?": The association between perceived childbearing importance, attitudes towards assisted reproductive technologies and psychological well-being among Chinese lesbians

Abstract

STUDY QUESTION: What is the impact of perceived importance of childbearing and attitudes towards assisted reproductive technologies (ART) on the psychological well-being of Chinese lesbians? Summary answer: Chinese lesbians who perceived childbearing as important to their parents or their partners but did not want to seek ART reported higher anxiety level. WHAT IS KNOWN ALREADY: Existing research in the West shows that lesbians tend to express less childbearing desire and are less likely to become parents compared with heterosexual counterparts. For involuntarily childless couples in general, fertility treatment has implications on psychological well-being and marital relationship, as it is considered a deviation from traditional family formation. For lesbians in particular, anxiety is associated with contextual factors, namely legal recognition of parental status and neighbourhood climate. Little is known about lesbians’ perceived childbearing importance, attitudes towards ART, and psychological well-being in Asia, where heteronormativity remains dominant and access to ART is restricted to heterosexual couples. STUDY DESIGN, SIZE, DURATION: An online cross-sectional survey of Chinese lesbians in Hong Kong was conducted from December 2014 to March 2015. A total of 438 self-identified lesbians participated in the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 438 Chinese lesbians in Hong Kong were recruited by bulk e-mail invitations through local lesbian, gay, bisexual, and transgender organizations and a university in Hong Kong. They completed the online questionnaire which consisted of the Childbearing Importance Index, the Hospital Anxiety and Depression Scale, and other measures and questions related to their attitudes towards ART. MAIN RESULTS AND THE ROLE OF CHANCE: Compared to heterosexual childless women, Chinese lesbians in our study thought childbearing was significantly less important (3.30 versus 6.00 on a 1–10 scale, t = 14.6). Perceived childbearing importance was also negatively associated with age (r = −0.23), relationship length (r = −0.18) and full-time employment (F = 4.29). Vast majority of participants (92%) supported legalizing same-sex couple’s access to ART, although less than half (41%) wanted to use it themselves to have children. Among those who thought childbearing was important to their parents or their partners, not wanting ART was associated with higher anxiety level. These results were significant at p < 0.05. LIMITATIONS, REASONS FOR CAUTION: As the lesbian community remains a hidden population in Hong Kong, snowball sampling method and anonymous online questionnaire were used, rendering it difficult to ascertain the response rate and warranting caution when generalizing the results. The cross-sectional design also limited the ability to make causal arguments regarding the observed relationships. WIDER IMPLICATIONS OF THE FINDINGS: This is the first quantitative study of reproductive preferences among lesbians in Asia. The findings are helpful for healthcare professionals to address the psychological burden of Asian lesbians in relation to reproductive issues, particularly those pertaining to their perceived expectations from parents and partners concerning childbearing.