一项网络问卷调查：女同性恋者与双性恋者的妊娠丢失文档资料.ppt

background:,Although pregnancy loss is a distressing health event for many women,research typically equates womens experiences of pregnancy loss to married heterosexual womens experiences of pregnancy loss.The objective of this study was to explore lesbian and bisexual womens experiences of miscarriage,stillbirth and neonatal death.虽然妊娠丢失对于大多数妇女是让人痛苦的事件，这里却只是针对正常男女婚配的妇女来说的，而本文旨在针对研究女同性恋者与双性恋者妇女的妊娠丢失、死胎、新生儿死亡事件。,methods:,This study analysed predominantly qualitative online survey data from 60 non-heterosexual,mostly lesbian,women from theUK,USA,Canada and Australia.All but one of the pregnancies was planned.Most respondents had physically experienced one early miscarriage during their first pregnancy,although a third had experienced multiple losses.这份调查源于60位非异性恋者的网上调查数据，这些非异性恋者主要为女同性恋，囊括英、美、加、澳四地同性恋妇女。所有妊娠多为计划内妊娠，大多数受调查者的首次妊娠时就发生了早期流产，三分之一患者还经历多次妊娠丢失。,results:,The analysis highlights three themes:processes and practices for conception;amplification of loss;and health care and heterosexism.Of the respondents,84%conceived using donor sperm;most used various resources to plan conception and engaged in preconception health care.The experience of loss was amplified due to contextual factors and the investment respondents reported making in impending motherhood.Most felt that their loss(es)had made a significant/very significant impact on their lives.Many respondents experienced health care during their loss.Although the majority rated the overall standard of care as good/very good/outstanding,a minority reported experiencing heterosexism from health professionals.本研究强调三点：1怀孕过程与治疗2流产影响的扩大化3健康护理与受歧视带来的影响。84%受调查者使用精子库精子受孕，大多数利用各种资源准备妊娠并参加孕前健康护理。流产影响的扩大化除了与上文提到的三点有关，还与受调查者为受孕进行的多种投入有关。许多妇女认为妊娠丢失在她们的生活中会产生“重要”“非常重要”的影响。许多受调查者在妊娠丢失时正在接受健康护理等治疗。虽然大多数认为护理整体标准“不错”“很好”“特别好”，但仍有少数称在护理专业人员那里受到了歧视。,conclusions:,The main limitation was that the in flexibility of the methodology did not allow the specificities of womens experiences to be probed further.It is suggested that both coupled and single non-heterosexual women should be made more visible in reproductive health and pregnancy loss research.主要局限存在于调查方法的不灵活性，以至于无法适应于每位妇女的特殊性这一问题，故仍需远期的调查研究。这项调查反映出：在生殖健康研究和妊娠丢失研究中，无论非异性恋者的双方抑或单方妇女是都应该予以关注。,Introduction,Pregnancy loss is an important issue that affects family planning and childbearing,yet it is often overlooked in reproductive health research,and is shrouded in cultural silence(Layne,2003).Fetal mortality has also been described as a major.public health problem(MacDorman and Kirmeyer,2009a:1).Pregnancy loss,especially early miscarriage,extremely common and estimated to occur inbetween 12 and 31%of confirmed pregnancies,and up to as many as half of all pregnancies(Cramer and Wise,2000;Cosgrove,2004;Renner et al.,2000;Speroff et al.,1999).妊娠丢失影响着家庭计划与育儿的实施，常被生殖健康中心所忽视，并且掩盖了道德是非趋向。婴儿死亡率被认为是一个重要的社会健康问题，妊娠丢失特别是早期流产发生极普遍，发生率在经证实的妊娠中为12-31%，在整体妊娠中则升至50%。(Cramer and Wise,2000;Cosgrove,2004;Renner et al.,2000;Speroff et al.,1999）,Epidemiological evidencefrom the USA indicates that risk of pregnancy loss is increased for a number of groups of women,including non-white women teenagers,women aged 35 years and over,unmarried women and multiple deliveries(MacDorman and Kirmeyer,2009b:1).Within the unmarriedwomen category it not possible,however,to discern the sexuality of these women.Furthermore,in many Western jurisdictions marriage,or marriage-like legal frameworks,are now available to same-sex couples(Harding,2006;Peel and Harding,2008).流行病学证实美国妊娠丢失的风险在妇女在有逐年上升趋势，包括非白人的青少年团体，年龄大于等于35岁者、未婚者、多胞胎妊娠者。但是，在未婚妇女这个大范围中判断她们的性取向是不容易的，并且在许多西方国家的法律中是允许同性婚姻的。,The normative Western narrative of pregnancy is continually reproduced across medical,literary and mass-media resources.It involves a missed period,a positive home pregnancy test and a medically managed pregnancy that entails visits to view the developing baby via ultrasound(Davis-Floyd and Dumit,1998;Harpel,2008).According to Layne(2003:27),pregnancy loss at any gestational stage does not conform to the norm of joyful pregnancy。It also fails to conform to medical norms of correct reproductive embodiment,since it disrupts the myth of continuous,linear biomedical progress implicit in dominant Western technobirthing discourses that make pregnancy and child rearing the object of rationalizing medical management(Davis-Floyd,1998).西方国家的妊娠标准总是经常更新，跨越了从医学、道德伦理到大众传媒几个方面，它包括受孕期、自测妊娠试验阳性及医学上妊娠明确（利用超声可见活胎来明确）。莱恩称任何阶段的流产是不能顺应妊娠、分娩这一自然流程的结果，同样也是不能适应医学角度生殖遗传标准的结果，因为流产中断了生物进展的延续性。这意味着主导西方国家的人工受孕技术使得怀孕和产后婴儿的医学诊疗方法变得合理必要化。,Pregnancy loss is a physically and psychologically distressing event for many womena form of(often socially unrecognized)bereavement,trauma,significant loss and grief(Renner et al.,2000;Swanson,2000;Frost et al.,2007;Brier,2008).Furthermore,when non-normative relational contexts,such as lesbian couples,are considered,the phenomenon becomes even more complex.The narrative of normal pregnancy begins with natural conception,in the context of a heterosexual relationship,usually marriage.Lesbian motherhood is less common than heterosexual motherhood,and lesbian routes to conception are,by definition,non-(hetero)normative and prone to classification as artificial(Mamo,2007)even when medical assistance to conceive is not sought(Ferrara et al.,2000).流产不论从身体还是心理方面都是一件让人痛苦的事，进一步讲，非正常关系诸如同性恋夫妻使得流产变得更为复杂。正常怀孕始于“自然”受孕，比如从异性恋爱关系发展到结婚、生育。而同性恋关系不同与异性恋，所以她们的受孕不能称之为“自然受孕”而是“人造受孕”，而且没有足够的医学辅助措施。,Nevertheless,estimates suggest that there are between 1 and5 million lesbian mothers in the USA(Patterson and Redding,1996),and that about a third of British lesbians are mothers(Golombok et al.,2003).Sixteen percent of married and co-habiting lesbiancouples in Canada have children living with them(Statistics Canada,2009),and according to the 2001 Australian census 19%of femalesame-sex couples have children(Australian Bureau of Statistics,2005).As Bos et al.(2003:2216)acknowledge in most Western industrialized countries the total number of lesbians who have given birth to a child within a lesbian relationship amounts to several thousands;however,this is an estimate.Despite these significant numbersof lesbian women(and other women in same-sex relationships)becoming parents,very little is known about the incidence or psychosocial repercussions of pregnancy loss for non-heterosexual women.虽然如此 美国仍然有大约1百万至5百万女同性恋妇女成为母亲；而英国则有三分之一的女同性恋成为母亲；在加拿大，已婚女同性恋同居者中有16%的女同性恋和孩子们同住；而在澳大利亚2001年的人口调查中显示19%的女同性恋育有孩子。正如Bos et al.所称：在大多数西方工业国家中，正处于同性恋关系并决定怀孕的妇女们的数量可能数以万计，但这是一个推测的数据。尽管如此之多的同性恋妇女成为父母，但她们因妊娠丢失产生的心理反应及流产的概率是不为人所研究的。,Research suggests that around one quarter of lesbian-mother families,in the UK at least,are created through assisted conception services(Golombok et al.,2003:31).Many non-heterosexual women also utilize assisted reproduction technologies and services in creating their families(Mamo,2007).The regulation of,and access to,fertility clinics for non-heterosexual couples and single women,however,varies widely across different countries and jurisdictions(Gunning and Szoke,2003).A comparative study of intrauterine insemination(IUI)with frozen donor sperm(based on 122 single heterosexual women and 35 lesbian couples attending a fertility clinic in London)found that in 63 pregnancies the miscarriage rate was 15%for lesbians and 35%for single heterosexual women(Ferrara et al.,2000).The authors suggest that the difference in miscarriage rates between the two groups may be due to the heterosexual single women in their study being older and having failed to conceive for some time prior to clinic referral.本实验说明：在英国，至少有大约四分之一的女同性恋家庭经历过妊娠辅助的服务措施。许多非异性恋妇女同样利用辅助生殖技术和服务来创立她们的家庭。法律规定生殖诊所可向非异性恋夫妻或者单身母亲提供服务，这在多个国家与立法中都有体现。一项比较性研究表明宫腔内人工授精术施用于女同性恋者和正常异性恋妇女后，在妊娠的63例中，流产率分别为15%和35%，（此实验基于英国生殖中心35对女同性恋夫妻和122对正常夫妻）作者表示两组反应的不同流产率可能与异性恋单身妇女的年龄较大以及曾经有过流产有关。（女同性恋的流产数反而少）,Lesbian and bisexual women are all but invisible in the generic literatures on pregnancy and pregnancy loss(Peel and Cain,2008).The heterosexist monopoly of reproductionis invidiously pervasive(Trettin et al.,2006;Wojnar and Swanson,2006:5).The only empirical study,to date,that has specifically focused on lesbiansexperiences is a small-scale qualitative study based on interviews with 10 white USA lesbian couples(Wojnar,2007).The participants had all experienced miscarriage as a couple within the previous 2 years;five couples had used identified sperm donors and fivehad used anonymously donated sperm.Gestational age at miscarriage ranged from 1 to 20 weeks and conception had taken from 1 to 5 years.多数文献著作几乎不涉及女同性恋者与双性恋者的妊娠与流产的相关问题。“异性恋关系生殖的垄断性”具有不公平的普遍性(Trettin et al.,2006;Wojnar and Swanson,2006:5)。距今为止，仅有一项女同性恋者的研究，样本为美国的10对女同性恋夫妇。参与者都曾经流产过，其中，1对夫妇的流产发生于近两年，5对夫妇选用熟人捐献的精子，5对选用精子库匿名捐献的精子，流产月份从120周不等，怀孕从15年不等。,A central theme of we are not in control was identified in these womens accounts,alongside we work so hard to get a baby and it hurts so bad:the sorrow of miscarriage.”Wojnar found that birth(biological)mothers typically grieved their loss openly whereas social(non-biological)mothers kept their sadness more private and felt that they needed to be strong for their partners.In order to develop the limited literature in this area,the current study aimed to:(i)find out how birth mothers and social mothers experience pregnancy loss;and(ii)gain lesbians and bisexual womens views about health care provision,attitudes and behaviour of health professionals and support provided by health professionals.这些流产妇女的留言中主要话题为：“我们不能自已”。旁边附带写着“我们辛苦工作为了要个baby”和“流产的悲伤-生命不能承受之痛”。Wojnar 认为生物学母亲可以公开的宣泄自己的失子之痛，而社会学（非生物学）母亲更愿意将痛苦隐藏，她们认为作为父母应该坚强。为了扩展此领域的伦理学的局限性，此项研究旨在：1弄清楚生物学母亲与社会学母亲如何经历失子之痛2探求有关女同性恋者和双性恋者关于健康护理、健康专业人士的行为以及健康护理方式的态度。,Materials and Methods,Study design：An online survey methodology was chosen in order to maximize the geographical spread of respondents,speed of data collection and anonymity of participants(Harding and Peel,2007;Peel,2009)and because online methods are well utilized with lesbian,gay,bisexual and trans(LGBT)populations(Ellis et al.,2003).The survey was designed using SurveyM and contained six sections:demographic information;conceptionand pregnancy;experience of pregnancy loss;health professionals;sourcesof support and;after your loss(es).The questions were developed basedon key issues in the academic and lay literatures and experiential knowledge.Questions included:How did you conceive?,During your/yourpartners pregnancy,how did you feel?,What,if any,preparations did you make for the baby?,How did you first realize that you were likely to lose your baby/fetus/embryo?and Please tell the story of how you lost your baby(ies)/fetus(es)/embryo(s)?Write as much or as little as you wish.For example,you could include how,where and when the loss(es)happened;how you felt at the time and afterwards;what health professionals said and did;how/when you told others of your loss(es)选用网络调查问卷的优点：地域广泛化、数据收集快速、参与者匿名性，更为重要的是男、女同性恋者、双性恋者、变性者可以分享自己的经历。此调查问卷由SurveyMonkey设计制作。问卷包含6部分：人口统计学信息、受孕与妊娠、妊娠丢失、健康专业人士、辅助资源、流产后。这些问题隐含着学术要点及道德、试验知识。问题有：你是怎样受孕的？在你伴侣怀孕的时候，你是如何感觉到的？你为baby的到来有何准备？你如何感觉到可能失去baby、婴儿、胚胎？请描述你是怎样流产的？写多写少如你所好。举个例子，答案可以包括流产如何、何地、何时发生的，流产发生前后你有何感觉，护理人员如何说的做的，何时你将此事怎样告知他人的？等等。,It was stated in the introductory information that the studys focus excluded heterosexual women and fathers.It also stated that you will remain anonymous and any identifiable information you provide will be changed，Information you provide will be held on Survey Monkeys server,however,Survey Monkey guarantee that the data will be kept private and confidential.The researchers contact information was provided for respondents to ask any questions about the study before deciding whether to take part,and information about further sources of support and information were provided.Respondents were free to exit the survey at any point without giving reason and a response was not mandatory for most questions.British Psychology Society ethical guidelines were adhered to and Aston University Ethics Committee granted ethical approval.问卷有前言简介，故排除了正常的异性恋者父母参与进来，并告知受调查者匿名，Survey Monkey将授权保存受调查者的隐私资料。受调查者可在决定参与实验之前阅读相关信息并提出异议，而最终决定是否参与。本实验坚守英国心理社会道德方针并通过阿斯顿大学道德委员会批准。,Recruitment and data collection,Respondents were recruited using strategic opportunistic sampling.Twelve recruitment emails were sent to LGBT email lists,e-newsletters and personal contacts(e.g.Diva magazine,Pink Therapy newsletter,University and Colleges Union LGBT email list,Psychology of Women Section listserv,Lesbian and Gay Psychology listserv,British Sociological Association Human Reproduction Study Group,American Anthropological Association Council on the Anthropology of Reproduction).The study was also publicized through community organization websites in the UK,USA and Canada.Invitations to assist with recruitment were also sent to mainstream miscarriage,stillbirth and neonatal death organizations,but these organizations declined to publicize the study.Data were collected between November 2008 and March 2009,with the majority of responses(40)occurring within the first 2 weeks of the study being publicized.选取受试者运用了随机抽样的方法。12封招募函分别寄给从电子邮件目录、电子时事通讯录、个人电子邮箱等选取的受试者那里。（如：Diva杂志、Pink疗法通讯录、大学联盟变性者电邮录、妇女心理协会清单表、同性恋者心理协会清单表、英国社会联盟人类生殖生育研究部、美国人类学联盟人类生殖部）此研究通过英美加三国的网络机构公开于众。招募邀请函也一同发给那些帮助流产死胎新生儿死亡家庭的团体组织，但是这些组织拒绝公开研究。2008年11月至2009年3月收集数据，本研究公开初的前两周得到了多份问卷答案（40份）,Respondents,The 60 women who responded to the survey came from four countries:the UK(43.3%,26),the USA(28.3%,17),Canada(18.3%,11)and Australia(10.0%,6).Of the respondents,39(65%)fully completed the survey.All respondents are included in the analysis because answering most questions was optional,and valuable qualitative data were gained from incomplete surveys:numbers do not necessarily add to 60because some respondents did not answer all questions and some provided multiple responses(if,for example,they had experienced multiple losses or could chose a number of responses to a fixed choice question).60名受调查妇女来自于4个国家，英国占43.3%为26人，美国28.3%为17人，加拿大18.3%为11人，澳大利亚占10%为6人。这些妇女中，39名完整回答问卷，所有答题者皆在数据分析选用范围之内，因为答完大多数题即可被入选。许多有价值的数据来自于未完成答题的问卷，这些数据不必要重复再加到60里，因为一些答题者没有回答所有题目，而且有些题提供了多种答案（例如：如果她们之前有过多次流产，她们可能会选择多重答案）,The majority defined their sexuality as lesbian(76.6%,46);the remainder as bisexual(15.0%,9)or other(8.3%,5).The mean age of respondents was 35 years(range 2255 years).Most respondents identified as white(92%,55),middle class(78%,47)and as not having a disability(95%,57).Just over half the respondents had children(55%,33)whose mean age was 4.5 years(range 4 days17 years).The majority(82%,49)were in relationships with women 45%(22)of which were legally recognized8%(5)were single,5%(3)were in polyamorous relationships,3%(2)were married to men and one respondent was in a relationship with atrans man.Most were in the same relationship context when they experienced pregnancy loss(90%,54).大多数受调查者的性取向为女同性恋者占76.6%为46人，其余为双性恋占15%9人，其他性取向占8.3%5人，平均年龄为35岁（22-55岁之间）且多数为白人占92%55人，中等阶级占78%47人，无身体残疾占95%57人，孩子的平均年龄为4.5岁（4天-17岁之间）。调查者中82%（49人）的妇女有伴侣，8%（5人）的人为单身，5%（3人）的人为一妻多夫，3%（2人）的人与男性结婚，1个与变性为男性者结婚，她们曾经经历的流产事件，多数妇女的关系背景是无差别可比较的.,In terms o