共同困境:穆斯林、移民、女同性恋、男同性恋、单身与高龄人群获取辅助生殖技术的经历
Shared struggles: Muslim, migrant, lesbian, gay, single and older experiences of accessing assisted reproductive technology
摘要
该定性研究于2020—2023年在新西兰开展,对73人进行52次深度访谈,并组织4场焦点小组(共40人),合计n=113;受访者覆盖异性恋、男同性恋、女同性恋、高龄、单身、已婚、穆斯林、移民、毛利及太平洋岛民等群体。研究采用反思性主题分析与跨群体结构化比较,识别出六类障碍:排斥性的临床设计、异性恋核心家庭的优先地位、亲属关系与生殖合规性的文化宗教张力、情感劳动与“为人父母资格”、配子与代孕的稀缺及治理、经济障碍。研究认为,不同社会位置的群体在制度障碍上存在共性,但作用机制各异;因此政策应对应针对具体机制。
原文摘要
BACKGROUND: Access to assisted reproductive technology (ART) is shaped by intersecting medical, legal, cultural and financial factors. While biological infertility is well studied, social infertility (where societal conditions constrain reproductive possibilities) remains comparatively underexplored. Existing research identifies distinct barriers affecting LGBTQ+ people, migrants, religious communities, people of colour, rural populations, and those with limited financial resources. Although group-specific research reveals important forms of exclusion, a siloed approach can obscure shared institutional barriers. Comparative analysis is therefore needed to examine where barriers converge, where they operate differently, and how these differences shape access to ART. METHODS: We conducted a qualitative study in Aotearoa New Zealand between 2020 and 2023, comprising 52 in-depth interviews with 73 individuals and four focus groups with 40 participants (total n = 113). Participants included heterosexual, gay, lesbian, older, single, coupled, Muslim, migrant, Māori and Pacific individuals. Recruitment occurred through fertility clinics, community organisations, and social networks. Data were analysed using reflexive thematic analysis, followed by structured comparison of where barriers converged, differed in form, were especially pronounced, or were not clearly evidenced across participant groups. RESULTS: Six recurring barriers were identified: exclusionary clinical design; privileging of the heterosexual nuclear family; cultural and religious tensions around kinship and permissible reproduction; emotional labour and parental deservingness; scarcity and governance of gametes and surrogacy; and economic barriers. These barriers did not occur uniformly. For example, donor scarcity affected single women and lesbian participants through waitlists and donor availability, Muslim participants through restrictions on third-party gametes, and gay men through dependence on both egg donation and surrogacy. Funding rules were especially consequential where age, residency, BMI and pathway-specific costs intersected with migration trajectories, singlehood, sexuality, and later-life family formation. CONCLUSIONS: The findings identify cross-group convergence in institutional barriers without suggesting that different social locations are interchangeable. Reproductive inequity is produced through distinct mechanisms, including formal funding rules, clinic and administrative design, donor-market conditions, legal regulation and informal cultural exclusion. Policy responses should therefore be mechanism-specific: equitable eligibility and funding, inclusive administrative and clinical design, culturally and religiously responsive care, clearer information pathways, and reforms that address donor and surrogacy scarcity.
推荐理由:该研究以较大的定性样本做跨群体比较,把“社会性不孕”从单一群体研究中抽象为可比较的制度机制,对理解ART可及性与公平政策有参考价值;但不涉及实验室或临床结局,对胚胎学与临床操作层面的直接指导有限。
文献解读
尚未生成。