Decline in ethical concerns about reproductive technologies among a representative sample of US women

Abstract

Public awareness and utilization of assisted reproductive technology has been increasing, but little is known about changes in ethical concerns over time. The National Survey of Fertility Barriers, a national, probability-based sample of US women, asked 2031 women the same set of questions about ethical concerns regarding six reproductive technologies on two separate occasions approximately 3 years apart. At Wave 1 (2004)(2005)(2006)(2007), women had more concerns about treatments entailing the involvement of a third party than about treatments that did not. Ethical concerns declined between Wave 1 and Wave 2, but they declined faster for treatments entailing the involvement of a third party. Ethical concerns declined faster for women with greater levels of concern at Wave 1. Initial ethical concerns were higher, and there was less of a decline in ethical concerns for women with higher initial levels of religiosity.

Sociocultural determinants of US women's ethical views on various fertility treatments

“…While increased public discourse is necessary, education alone may not be sufficient to overcome ethical concerns among some segments of the population. For instance, women whose ethical concerns are borne out of religion have been shown to have less change in their views of fertility treatments over time when compared with women who are not religious (Greil et al, 2016). While one approach may be to ignore this segment of the infertile population, the findings of the current study show that specific treatments may be acceptable to religious women while others are not.…”

“…Multivariate logistic regression models were constructed to identify significant sociocultural factors which predict the level of ethical concern with the six fertility treatments described above. Each model included the following covariates based upon known sociocultural determinants of general ethical concern over fertility treatments: race/ ethnicity (Greil et al, 2011), age, marital status, family income, level of education (Shreffler et al, 2010), religious service attendance (Greil et al, 2010) and religious affiliation (Greil et al, 2016). Additionally, each model included the following covariates, based upon our a priori hypothesis of plausible impact: nulligravidity, nulliparity, geographic region of residence and metropolitan versus non-metropolitan residence.…”

“…As increased ethical concern over fertility treatments in general has been shown to result in decreased medical help-seeking (Greil et al, 2010), it is essential that fertility healthcare providers and their colleagues continue to educate the public about fertility treatments and engage in public discourse regarding the ethical concerns that such treatments bring. Overall trends towards increased acceptance of reproductive technologies have been attributed to increased public awareness (Greil et al, 2016;Kovacs et al, 2012). As access to care is reliant upon overcoming both financial and social barriers (Ethics Committee of the American Society for Reproductive Medicine, 2015a), assuaging ethical concerns is essential in order to increase the desirability of existing treatment options for a broader segment of the infertile population.…”

“…A survey of women throughout the Midwest found greater ethical concern among older women with lower income and less education (Shreffler et al, 2010). Religion is also significantly associated with general ethical concern over fertility treatments (Missmer et al, 2011), mediated both by attendance at religious services (Greil et al, 2010) and by religious affiliation (Greil et al, 2016).…”

Responding to Infertility: Lessons from a Growing Body of Research and Suggested Guidelines for Practice

“…Some delay or avoid treatment by their own choice because they perceive infertility to be a stigmatized condition (Bunting & Boivin, 2007) or because they have ethical concerns about infertility treatments-for example, they are opposed to selective reduction of multiple-embryo pregnancies to reduce risk to the mother or to treatments that result in a child who is not biologically related to either parent (Shreffler, Johnson, & Scheuble, 2010). However, ethical concerns about ART are declining over time, and they are declining fastest for women, who initially had the greatest concerns (Greil et al, 2017).…”