Adoption Policy and the Construction of Infertility as a Treatable Problem

During and after the Second World War, at the same time as infertility began to be constructed as a medical problem, and therefore open to treatment, psychoanalytical theories of infertility were gaining ascendancy. Doctors influenced by Freudian theory began to argue for infertility as a psychosomatic condition, and hence amenable to psychological interventions. Freudian theorists identified infertility as a failure to reproduce, which they explained as the result of an unconscious desire or will.39 Such theories provided a scientific gloss to beliefs, dating from Victorian times, that motherhood was woman’s destiny and infertility occurred when that destiny was denied by women who focused on the development of their intellectual rather than their bodily functions.40 Doctors who accepted this theory tried to use the language of biochemistry to link female physiology to the psyche.41 Psychoanalysts, however, explained the connection in terms of unconscious urges, and validated their claims with case examples of women whose infertility was cured by psychoanalysis.42

Medicalization rendered infertility a treatable condition. Women who sought help for their childlessness were now encouraged to consult a doctor who could diagnose its causes.43 However, as part of this diagnosis, a doctor who had kept up with the literature would systematically go through the questions that Freudian analyst Helene Deutsch (1884-1982) had articulated to identify psychosomatic infertility:

Has her fear of the reproductive function proved stronger than her wish to be a mother? Is she still so much a child that she cannot emotionally and consciously decide to assume the responsible role of mother? Is she so much absorbed emotionally in other life tasks that she fears motherhood? [... ] Does a deeply unconscious curse of heredity burden all her motherly wish fantasies? And, above all, has the sterile woman overcome the narcissistic mortification of her inferiority as a woman to such an extent that she is willing to give the child, as object, full maternal love?44

By the 1950s this theory had permeated even the problem pages of women’s magazines. One reader, anxious that her past moral faults might be the cause of her infertility, was reassured but then advised that she should seek medical help with the suggestion that ‘it may be your mental attitude that is the root of your trouble, not any physical inability’.45

Crucially, it was in the gap which occurred between the recognition of infertility as a treatable condition and the increase in the ability of medicine to guarantee a ‘cure’ that adoption came to be understood as a possible solution. Although infertility had long provided an important motivation to adopt, from the 1930s US doctors started to report cases in which adoption seemed to act as a cure for infertility, an observation which fitted well with the increasingly influential Freudian theories of psychosomatic causation.46 As a 1937 US article observed: ‘Certain sterile types have apparently become fruitful by “induction” when they adopt a child [... ]. The probabilities are that chronic anxiety of tensions of neurotic conflict origin rather than specific anxieties for children operate to affect the organism’.47

This connection entered into folk wisdom despite the repeated failure of statistical research to provide any validation. It was sustained, US adoption historian Ellen Herman observes, ‘by anecdote, desperation, eugenics, and popular belief in the psychological forces at play in human fertility’.48 The 1950 study by obstetrician-gynaecologists Frederick M. Hanson (1921-2008) and John Rock (1890-1984), which concluded that the rate of conception after adoption was less than the normal rate of spontaneous cure, did little to dent the spread of the belief.49 Although subsequent studies were less conclusive, the best they could offer was that the rate of pregnancy after adoption neither disproved nor supported the psychogenic hypothesis, with pregnancy more likely to be explained by the age of the mother or by prior evidence of fertility than by the act of adoption.50 Despite such findings, the theory of psychogenic infertility and adoption as cure continued to prove attractive, working together to support the claims to expertise amongst professionals specializing in treating sterility. If, they argued, ‘adoption facilitates an emotional reconciliation to the fact of sterility which somehow puts a stop to certain pathological influences upon the ovaries and thus makes pregnancy possible’, they could claim to have a cure for those stubborn cases which resisted the techniques they had available.51 Even if the research failed to support this connection, they claimed, it seemed logical that adoption, by releasing the tension inherent in the process of treatment for infertility, could create an environment in which pregnancy could occur.52

In popular discourse science was replaced by an appeal to anecdote, with stories of pregnancy following adoption told and retold, often enriched by the validation of a doctor who claimed to be relating an experience from his or her practice.53 Popular advice columns regularly recycled the advice that childless couples should proceed to adopt, ‘and if Providence should then send along a baby as their own (as has happened more than once), then they are richer by another child and two little souls have found a happy home’.54 Shorn of its harsher woman-blaming implications, the notion that the psyche could interfere with fertility became a commonplace. In 1965 a popular women’s magazine concluded an article about pregnancy after adoption with the claim that ‘any major change in one’s life, even moving to another house, will often result in a woman conceiving’.55 Such populist information infiltrated the literature directed at professional social workers, with a 1967 article published in their national journal informing readers that ‘in some cases the fear of childbirth may have been the basis of a functional sterility, and this condition may or may not resolve itself [... ] after the adoption of a child’.56 Randi Epstein has suggested that belief in the psychogenic causes of infertility survived for so long because it helped ‘sterility specialists [... ] to minimize their “unknown etiology” statistics, and please patients yearning for reasons for their abysmal state’.57 However, and crucially for the purposes of this chapter, the critical role which ‘adoption as cure’ played in proving this connection also created a demand for babies to adopt. As Isobel Strahan, chief medical social worker at Melbourne’s major maternity hospital, warned, ‘far too often adoption is regarded as a therapeutic measure’, creating a situation in which the needs of the prospective adoptive parents had the potential to override the best interests of the child.58

Belief in ‘adoption as cure’ was implicit in Australian sterility clinics from their earliest days. Even the most optimistic reports of the success of infertility treatment had to admit to what were commonly called the ‘hopeless cases’, couples for whom, despite the best that treatment had to offer, conception proved impossible, but in these cases an immediate solution was at hand.59 Sterility clinics were located within hospitals which provided public maternity facilities for the majority of single mothers, and the clinics could therefore refer infertile couples to the social work department which, it was promised, would be able to provide a child. Specialists operating outside the public sector used their connections with private hospitals to provide a similar service. In a smooth transition, couples at the Melbourne clinic were told to ‘attend the Women’s Hospital’, where they would be ‘given regular advice over a period of two years’. If they had ‘no children in that time’, theywere ‘advised to adopt a child’.60 This ‘solution’ was acclaimed as ‘one of the great successes from a community viewpoint’ because ‘the children were adopted while the foster parents were young and active’.61

Through this process, infertility replaced benevolence as the key motivation stated for adopting.62 Indeed, as demand began to exceed supply, proof of infertility was required of all applicants, with the specialist who made the diagnosis facilitating the adoption arrangements.63 Expert opinion was unanimous: ‘When once medical opinion has decided that they are not likely to have children, then the sooner they commence their “adopted” family the better’.64 At Melbourne’s Women’s Hospital, adoption became a service facilitated by social workers to provide babies for infertile patients for whom specialists had been unable to provide a ‘cure’. Although social workers fought for the right to evaluate the fitness of such patients to adopt, arguing from the principle of the best interests of the child, hierarchies within the hospital were such that their voices were far less likely to prevail.65 It was not surprising, then, that on her admission to the hospital Dianne Gray felt the presence of ‘a huge mass of people, wealthy people, that couldn’t have children [... ] people with some power and all this pool of women with no power, that [... ] were like a labour force of people to donate their children to all the wealthier people’. 66

The national Inquiry found evidence of concern amongst child welfare workers about the quality of the screening of prospective adoptive parents by the early 1960s.67 In subsequent legislative reform, designed primarily to institute consistent adoption laws across the country, the right to arrange adoptions was increasingly focused on social work professionals, but in the context of the large maternity hospitals this did little to change practice standards, given the status which specialist doctors occupied within such hierarchical systems. Although the goal of those who devised the model legislation was to concentrate the power to arrange adoptions within a single non-medical organization, there was only one state, Queensland, in which this goal was met. While, in all the other states, the model legislation did severely curtail the ability of non-social work professionals to arrange private adoptions, the rights of existing adoption agencies, including the major maternity hospitals, were left undisturbed.68 The notion that such organizations might have a conflict of interest was never entertained.

 
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