From Stonewall to Surrogacy: The LGBTQ+ Community and Family Planning

Jul 22

Visibility is something the LGBTQ+ community has worked hard to achieve since the Stonewall uprising in 1969. Before that time, the LGBTQ+ community was forced to be in the shadows due to the legality of their existence and widespread persecution. However, in the last fifty years — sadly only in some but not all countries around the world — the LGBTQ+ community has gained increasing acceptance and legal protections, but statistics and data regarding queer people and families has been lacking. Queer people have always had their ‘chosen family’ of queer friends and allies who accept and support them for who they are, but now they are increasingly embarking on the creation of their own ‘rainbow families.’

This article aims to discuss several topics as it relates to the LGBTQ+ community and their evolving family planning:

The LGBTQ+ community is finally being included in government censuses, so more will be known in the future regarding queer demographics.
More queer people are starting or planning on starting rainbow families.
How queer people have children is evolving, with a growing preference for surrogacy.
It’s important to make sure surrogacy remains an option for queer families by engaging with policy makers to ensure its adequate regulation.

In terms of demographic trends, one of the most fundamental methodologies is the national census. These are important tools for governments to understand their constituencies and how best to fund and address the diverse needs of a society. Despite the importance of accurate information on demographics, major governments such as the United States (1) and the United Kingdom (2) have only added questions on sexual orientation and gender identity in 2021. Europe has included questions specific for the LGBTQ+ community for several years, with the following data on LGBTQ+ families (referred to as LGBTI) in the European Union Agency for Fundamental Rights report from 2012 (3):

Overall, 14% of all LGBTI respondents with a partner say that they are raising a child. This includes 29% of bisexual males, 19% of trans persons, 17% of bisexual women and 15% of lesbian women with a partner.
However, there are considerable country differences. The highest proportion of LGBTI respondents raising children with a partner are found in Denmark (21%), Ireland (20%), the Netherlands (19%) and Sweden (19%).

These census data are still new and increasing in countries outside of the European Union, and it is great as they will continue to play a bigger role in representation and influencing policy in these countries.

Because of this gap in government data on LGBTQ+ family planning, an incredible organization has taken the lead on gathering and researching this topic in the United States. Family Equality (4) is the leading national nonprofit dedicated to supporting LGBTQ+ families and those who wish to form them. They conducted a national Family Building Survey, and compiled the results in a 2019 report (5). The survey was conducted with the following sample:

500 adults who identify as LGBTQ+, comprising 237 men, 253 women, and 10 other.
1,004 adults who identify as non-LGBTQ+, comprising 488 men and 516 women.

The results showed dramatic changes in LGBTQ+ family planning methodologies and interest by generation, as well as almost parity with the family planning intentions of non-LGBTQ+ identified people. Some of the key findings include:

63% of LGBTQ+ millennials (aged 18 to 35) are considering expanding their families, either becoming parents for the first time, or by having more children.
48% of LGBTQ+ millennials are actively planning to grow their families, compared to 55% of non-LGBTQ+ millennials, a gap of 7% that has narrowed significantly in comparison to older generations.
63% of LGBTQ+ people planning families expect to use assisted reproductive technology, foster care, or adoption to become parents, a significant shift away from older generations of LGBTQ+ parents for whom the majority of children were conceived through intercourse.

A Gallup poll conducted in May 2018 (6) indicated that 4.5% of American adults identify as LGBTQ+. This is a total of about 15.9 million LGBTQ+ Americans. That percentage increases to 8.1% for millennials, resulting in over 6.1 million LGBTQ+-identified 18 to 35 year-olds. This means that as many as 3.8 million LGBTQ+ millennials are considering expanding their families in the coming years, and 2.9 million are actively planning to do so. These are indeed large and growing numbers of rainbow families in the United States.

Personally, I have friends who have gone through several types of the more ‘historical’ rainbow family building processes. I know men who, prior to coming out, married women and had children with them. I also know a gay man who donated sperm to a single, straight woman, and who has continued to enjoy a long-distance co-parenting relationship with her. Lastly, I know several gay men who donated sperm to lesbian couples, each with varying degrees of involvement in the upbringing of the child. All these and many other pathways to LGBTQ+ family building are great options, depending on what each of the individuals is looking for in terms of the relationships and parentage. However, in recent years there has been an increasing trend for queer male couples to use surrogacy for their family building. In 2016, an informal survey of fertility clinics in more than ten cities across the United States was conducted. The survey found that 10% to 20% of donor eggs were going to gay men having babies via surrogacy, and in a lot of places the numbers were up 50% from five years ago (7).

There are a number of factors that I believe have contributed to the rise of surrogacy usage among gay men, but it is important to realize that this is a hugely under-researched and emerging area. For example, research only started being published in 2008 with papers from India, the United States, and Australia providing the first indications of clinical outcomes and experiences of men accessing surrogacy to become parents (8). I believe the increase of surrogacy in the last decade has been due to the groundwork laid by legalization of same sex marriage and increased accessibility of IVF (in vitro fertilization) and surrogacy agencies. Same sex marriage was first legalized in 2001 in the Netherlands, with subsequent approvals in other European countries (the United Kingdom in 2013) followed by the United States in 2015. The most recent legalization occurred in Andorra in 2023 (9). I believe this legalization has helped queer men believe that they have the societal support to be more open in their desire to have children. IVF has gone from the first live birth of a “test tube baby,” Louise Brown, in 1978 to today, where IVF accounts for millions of births worldwide and 1% to 3% of all births every year in the United States and Europe (10). Interestingly, a study in 2018 examined 547 websites for IVF clinics and surrogacy agencies in the United States to see how welcome gay men were in this market (11). The results showed the majority of IVF clinics (62%) and 42% of surrogacy agencies did not directly advertise or appear to be welcoming to gay men. However, a minority of gay-friendly clinics and agencies actively recruited gay men, creating a limited but niche market. Data on how much this ‘niche market’ has grown since this study in 2018 is not available, but the trend with gay celebrities such as Andy Cohen and his groundbreaking gestational surrogacy in the state of New York (12) suggests it continues on an upward trend.

In addition to the factors of social and legal acceptance for same sex relationships as well as the increases in IVF clinics and agencies, surrogacy has emerged as the preferential option for LGBTQ+ family building for other reasons. Personally, and anecdotally through friends, adoption was a pathway that was initially considered for family building. However, the regulations, timings, and expenses — much of which is put up at risk and then lost with last minute changes — make the process of adoption emotional and financially risky. Don’t get me wrong, adoption should be extremely scrutinized, and birth parents should have every right to change their minds at any point. However, if there is another option that provides more security in terms of having a child, then it makes sense that gay men would pursue it. A study published in 2017 found similar results to what I and others have experienced. This study (13) used a cross-sectional design and semi-structured interviews with 74 gay fathers (35 genetic fathers, 32 non-genetic fathers and 7 fathers who did not know or did not disclose who the genetic father was). The most common reason given for pursuing surrogacy, given by approximately two-thirds of fathers (N = 50, 68%), was that adoption was a less desirable and/or achievable path to parenthood than surrogacy. This is shared in a representative quote from one of the fathers:

‘We liked surrogacy really because what we had read about adoption, it seemed like quite a random process, and you weren’t in control. Even after the child was born, there were all sorts of stipulations and criteria by which you, for no reason of your own, lose your child. And we just thought let’s keep it simple, it’s complicated enough being a parent.’

The second most common response as to why fathers chose surrogacy was that they wanted to have a genetic connection with their child as this was important to them either as an individual, or as a couple (N = 38, 51%). However, the genetic-relatedness, often pointed to as the primary reason for gay men to pursue surrogacy, was not as significant as the more straightforward or controllable process of surrogacy compared to adoption. Also of note, the study did not detect differences between genetic and non-genetic fathers’ motivations for surrogacy, which also supports the argument that the genetic link is not always the priority for gay men having children.

The study also followed up after the surrogacy process to gather how the process went for the fathers. Results showed genetic and non-genetic fathers did not differ in how they felt about having conceived a child through surrogacy. Most fathers (N = 55, 74%) were satisfied with the surrogacy journey. Five fathers (7%) had neutral feelings about surrogacy. Five fathers (7%) were mostly dissatisfied. Fathers who were dissatisfied described the surrogacy process as a huge undertaking, which could produce feelings of anxiety and concern.

The field of rainbow family planning for LGBTQ+ is an exciting and rapidly developing area. It’s great that governments have started to count us as a representative group in the population. Much more research is needed to better understand the history, trends, and motivations as we continue to evolve as a community across the globe. With the increasing role that surrogacy is playing in LGBTQ+ family planning, it’s critical that we continue to support policy around the world that allows for well-regulated altruistic and commercial surrogacy as an option for everyone.

References:

Rainbow FamiliesAdoptionSurrogacyLGBTQ Trends

Bryan McColgan, MD

From Stonewall to Surrogacy: The LGBTQ+ Community and Family Planning

Gay Celebrities and Surrogacy

Netflix’s ‘The Surrogacy:’ A Terrible Portrayal of Surrogacy That Comes at a Bad Time

BABYMOON FAMILY