Members of The Arts Effect All-Girl Theater Company have developed a play,  Slut: The Play , in which they address the damaging impact of slut-shaming and slut culture. [ 52 ] [ 53 ]  The creators state that their play "is a call to action – a reminder" that slut-shaming is happening every day, almost everywhere. [ 53 ]   Slut  is inspired by real-life experiences of 14- to 17-year-old girls from New York, New Jersey, Connecticut, and Pennsylvania. [ 53 ]  The play was shown at the 2013 New York Fringe Festival. [ 53 ] [ 54 ]


In her statement on the production, and of slut-shaming in general, author of  Slut! Growing Up Female with a Bad Reputation ,  Leora Tanenbaum  writes:


A teenage girl today is caught in an impossible situation. She has to project a sexy image and embrace, to some extent, a 'slutty' identity. Otherwise, she risks being mocked as an irrelevant prude. But if her peers decide she has crossed an invisible, constantly shifting boundary and has become too 'slutty,' she loses all credibility. Even if she was coerced into sex, her identity and reputation are taken from her. Indeed, the power to tell her own story is wrested from her. The Arts Effect's SLUT written by  Katie Cappiello  vividly represents this irrational, harmful, terrible circumstance...This play is the most powerful and authentic representation of the sexual double standard I have ever seen. [ 53 ]


After experiencing slut-shaming firsthand, Olivia Melville, Paloma Brierly Newton and approximately a dozen other Australian women founded the organization, Sexual Violence Won't Be Silenced, on August 25, 2015. The association seeks to raise awareness of cyber-bullying and online sexual violence. The founders also launched a petition to the Australian government, requesting that they better train and educate law enforcement officers on how to prevent and punish violent harassment on social media. [ 55 ]


Gay and bisexual men are also victimized through slut-shaming because of their sexual activity. There has been research supporting that  LGBT  students were more likely to be bullied and called sluts than heterosexual students. Researchers discussed how these negative experiences of victimization by peers, friends and strangers can lead to physical harm, social shaming, and loss of friendships. [ citation needed ]  Unlike heterosexual people, LGBT people are more likely to learn about  safe sex  practices from friends. [ citation needed ]  Gay and bisexual men are at highest risk of HIV. [ 56 ]  Slut-shaming has been cited as an obstacle to men who have sex with men accessing ways to prevent infection by HIV, such as  PrEP . [ 57 ] [ 58 ]  Most of the education that young gay and bisexual men receive about safe sex practices is learned from friends, the Internet, hearsay or trial and error. [ 59 ] [ failed verification ]


Criticism of  non-heterosexual  men's sexual activity can either be said in a humorous context or not. Judgementalism happens when someone mentions gay men's sexual risk behavior or that they have  multiple sex partners . This implies that their behavior is "slutty" and dirty. [ 60 ]


Street harassment includes  cat-calling ,  victim blaming , and slut-shaming. Judgmentalism is not a pejorative word compared to women, and slut-shaming may have a positive connotation with men depending on context and relationship. [ 61 ] [ 62 ]


Though slut-shaming affects women from different racial, cultural, and economic backgrounds, black women are disproportionately affected by the act of slut-shaming. This can be attributed to both  misogynoir  and historical myths, which have worked together in dictating much of the public perception of black women. [ 63 ]  Due to these biases, black women must stand against more prejudice based on an often false perception of their sexual activity. [ 64 ] [ 63 ]  Furthermore, it is also true that women from low-income backgrounds are at greater risk of being slut-shamed. Black women experience financial disenfranchisement in comparison to their white peers which in turn adds to the unbalanced nature of the slut-shaming they experience. [ 65 ] [ 66 ] [ 63 ]


Myths about black women were established and cultivated during the time of slavery and onward to further oppress black women and justify committing acts of rape and sexual assault against them. One of the myths popularized was the myth of the hyper-sexual black woman or the  Jezebel . This myth, also known as, the myth of promiscuity, popularized the idea that black women were inherently more sexually charged and deviant than their white counterparts. Black women were determined by the Western world to have a wild, promiscuous nature and immoral, loose, and impure practices and values. This myth was then used as a justification for violating black women with no consequence. [ 64 ]


Furthermore, black women were forced into sexualized positions regularly, for instance during slave actions they were forcefully stripped of all clothes, and required to be paraded around for the masses, nude. [ 64 ]  These same involuntary actions would then be spun and used by white society in order to shame black women and reinforce the ideas created by the myth of promiscuity. This forceful sexualization of black women only furthered the ideologies prescribed to them by white society in a process of dehumanization and shaming that would be continued throughout history in new, inventive ways. [ 64 ]


Today the myth of promiscuity or the “Jezebel” still permeates the black female experience in a myriad of ways. For instance, hip hop's portrayal of black women is hypersexualized and deeply stereotypes them both in character and in physicality. [ 63 ]  The industry not only perpetuated the already existing ideas of the myth of promiscuity but additionally, it directly correlates the physical characteristics often found in black women such as a large behind which is often addressed in hip hop music, with having a sexually promiscuous nature. Although these ideas were not created by the hip hop/rap industry and have been around since the time of enslavement, they are popularized and reinforced by the overwhelming sexualization of specifically black women within the music being created today. [ 63 ]  Hip hop contributes to the overexposure to slut-shaming experienced by black women, manifest both verbally through lyrics used and visually through imagery in music videos and album covers. The imagery that accompanies overtly sexual lyrics is often of the stereotypical normative black female body often adorned in minimal clothing. This imagery of black femininity is then streamlined into the media to be absorbed by the public, therein altering the public's perception of both the standard black female body and the behaviors of black women in general. The effect of this reinforces the public perception that black women are inherently hypersexual beings. [ 63 ]


Yet another contributor to the high rates at which black women encounter slut-shaming is because of income inequality. slut-shaming does not permeate high-status circles of women at nearly as high a rate as it does within communities of women that are low-income. As those individuals coming from the powerful position within the already existing ruling class have the ability to dictate what activities, attire, and body standards are deemed respectable they can remove themselves from experiencing slut-shaming much more readily than their marginalized, low-income, BIPOC counterparts. [ 66 ]  On the flip side, black women are more likely to face poverty because they are statistically more likely to experience unemployment, have lesser pay when employed, and often less of a chance to rise in position in comparison to their white female counterparts, let alone their white male counterparts. So therein, these systems of  misogynoir  place black women into a financially disadvantaged state, and those who are from lesser incomes are more likely to experience slut-shaming, thus black women are further placed in the position to experience slut-shaming at a greater rate. [ 65 ]  Furthermore, white and upper-class women are often participators in the shaming of fellow women, especially black women, as this practice allows them to maintain the existing hierarchical dynamics wherein white, high-class women are a symbol of ideals of “true womanhood” and purity and black women are ascribing the characteristics of as deviance and sexually immorality. [ 64 ] [ 66 ]


Although the myth of promiscuity was constructed by white society and spread through all social orders including, political, economic, and educational, today those same ideals can be seen distinctly within the interior social structures of the black community. Black women, in order to gain any social standing, had to do everything in their power to remove themselves from the idea of being promiscuous. For black women distancing themselves from all forms of perceived sensuality allowed them to a rise in social positioning. In turn, they forced themselves into a strict modesty culture in order to assimilate and rise in standing within white social structures. Those same women who conformed to the modesty standards set by white society, and did so in order to shirk their preconceived sexual nature that was also ascribed to them by white society seem to have little to no sympathy for black women within the community that chose not to assimilate into this system of forced modesty. Therein the process of slut-shaming is even perpetuated internally from black female individuals to one another. [ 64 ]


Along with gay and bisexual men,  lesbian  and  bisexual  women are also key victims of slut-shaming and bullying. Bisexual women are mainly bullied by other women due to their “open option” choice of preference for both genders. [ 67 ]  However on the other hand, bisexual and lesbian women are  fetishised  due to the porn industry, and from this fetishisation a group of people would only see them as a “porn category”. Lesbian porn is one of the most searched for categories in the porn industry. [ 68 ]  Lesbian women have struggled with the concept of straight men trying to convert them into a different sexuality [ 69 ]  as they are viewed by that group of men as a porn category or a “sexual object”, this is due how some groups only understand the concept of lesbianism only what they see on media. Women in the porn industry are putting on a show to entertain, so they’re shown as feminine  seductress  figure that’s very  promiscuous , [ 68 ]  which of course is false to reality. Linking to that issue, lesbianism is considered to exist outside of the  male gaze , therefore there’s this frustration for some men that they are unable to pursue women in these groups. However, there’s also groups of individuals that view any members of the  LGBTQ+ community  as predatory. Especially some women towards lesbians, how they assume members of that community will actively pursue them due to their preference and stereotype them as predatory. For bisexual and lesbian women, both genders vent their frustration based on  homophobia , false media and their indifference to “societal stereotypes”. However, this does not only apply to lesbian women, but gay men are also stereotyped to be predatory by some groups of heterosexual/straight males. [ 67 ]


" Supertoys Last All Summer Long " is a  science fiction   short story  by  Brian Aldiss , first published in the UK edition of  Harper's Bazaar , in its December 1969 issue. [ 1 ]  The story deals with humanity in an age of intelligent machines and of the aching  loneliness  endemic in an  overpopulated future  where child creation is controlled.


The short story was later used as the basis for the first act of the feature film  A.I. Artificial Intelligence  directed by  Steven Spielberg  in 2001. In the same year, the short story was republished in the eponymous Aldiss short-story collection  Supertoys Last All Summer Long and Other Stories of Future Time , along with the tie-in stories  Supertoys When Winter Comes  and  Supertoys in Other Seasons . Parts of two other Supertoys stories are also reflected in the film. The collection also contained a number of stories not tied to the Supertoys theme. [ 2 ]


In a dystopian future where only a quarter of the world's oversized human population is fed and living comfortably, families must request permission to bear children. Monica Swinton lives with her husband, Henry, and her young son, David, with whom she struggles to bond. She seeks help from Teddy, a robot toy companion of sorts, to try to understand why she feels unable to communicate with David, let alone feel compassion for him. David also questions Teddy about whether his mother truly loves him and wonders whether he is truly real. He attempts to write letters of his own to explain how he feels about his mother and the inner conflict he faces but all of his letters remain unfinished.


Meanwhile, the story jumps to Henry, who is in a meeting with a company he is associated with known as Synthank. They are discussing  artificial life forms  and bio-electronic beings for future developments. Henry tells them he believes that the new AI under production will finally solve humanity's problems with experiencing personal isolation and loneliness.


Monica discovers David's unfinished letters which express both love and a jealous contempt for Teddy, whom Monica always seemed to connect with more than David himself. Monica is horrified by the letters but overjoyed when Henry arrives home and she is able to share with him that the family has been chosen to give birth to a child by the Ministry of Population. It is then revealed that David is an artificial human, used as a replacement for a real child (of that he is himself unaware, he becomes aware in the second story, "Supertoys When Winter Comes"). Monica tells Henry that David is having verbal "malfunctioning" problems and must be sent back to the factory again. The story ends with David thinking of the love and warmth of his mother.


Those three short stories were used as the basis for the feature film  A.I. Artificial Intelligence  (2001).  Stanley Kubrick  originally obtained the rights in the 1970s to produce a film adaptation. However, the project was bogged down in " development hell " and was repeatedly postponed. A few years before Kubrick's death in 1999, he suggested to  Steven Spielberg  that it might be a project better suited for Spielberg to direct. After Kubrick's death, Spielberg ultimately did direct the film, which was released in 2001. Monica Swinton was portrayed by  Frances O'Connor , Henry Swinton by  Sam Robards , and David Swinton by  Haley Joel Osment . The film portrays Teddy as a robotic teddy bear, voiced by  Jack Angel .


Unintended pregnancies  are  pregnancies  that are mistimed or unwanted at the time of  conception , [ 1 ]  also known as unplanned pregnancies. [ 2 ] [ 3 ]


Sexual  activity without the use of effective  contraception  through choice or coercion is the predominant cause of unintended pregnancy. Worldwide, the unintended pregnancy rate is approximately 45% of all pregnancies (for a total of 120 million unintended pregnancies annually), but rates vary in different geographic areas and among different sociodemographic groups. [ 4 ] [ 5 ]  Unintended pregnancies may be  unwanted pregnancies  or  mistimed pregnancies . [ 6 ]   While unintended pregnancies are the main reason for induced  abortions , [ 6 ]  unintended pregnancies may also result in other outcomes, such as live births or miscarriages.


Unintended pregnancy has been linked to numerous poor maternal and child health outcomes, regardless of the outcome of the pregnancy. [ 6 ]  Efforts to decrease rates of unintended pregnancy have focused on improving access to effective contraception through improved counseling and removing barriers to contraception access.


Research on unintended pregnancy rates is challenging, as categorizing a pregnancy as "intended" or "unintended" does not capture the many complex considerations that go into a person's or couple's feelings towards the pregnancy itself or their reproductive plans in general. [ 7 ]  However, for data collection purposes, an "unintended pregnancy" is defined as a pregnancy that occurs either when a woman wanted to become pregnant in the future but not at the time she became pregnant, or one that occurred when she did not want to become pregnant then or at any time in the future. [ 7 ]


Conversely, an "intended pregnancy" is one that is consciously desired at the time of conception or sooner. [ 6 ] [ 7 ]  For research purposes, all pregnancies not explicitly categorized as "unintended" are combined, including those pregnancies where the pregnant woman feels ambivalent or unsure about the pregnancy. [ 7 ]  Most sources consider only the intentions of the woman when defining whether a pregnancy is unintended, but some sources also consider the intentions of the male partner. [ 6 ] [ 7 ]


Terming a pregnancy "unintended" does not indicate whether or not a pregnancy is welcomed, or what the outcome of the pregnancy is; unintended pregnancies may end in abortion, miscarriage, or birth. [ 7 ]


The global rate of unintended pregnancy was estimated at 44% of all pregnancies between 2010 and 2014, corresponding to approximately 62 unintended pregnancies per 1000 women between the ages of 15–44 years old. [ 4 ]  While unintended pregnancy rates have been slowly declining in most areas of the world, [ 4 ]  different geographic regions have different estimated unintended pregnancy rates. [ 4 ] [ 8 ]  Rates tend to be higher in low-income regions in Latin America and Africa, estimated at 96 and 89 unintended pregnancies per 1000 women, respectively, and lower in higher-income regions such as North America and Europe, estimated at 47 and 41 unintended pregnancies per 1000 women, respectively. [ 4 ]  Unwanted pregnancies continues to be a major public health issue worldwide, especially in low- and middle-income countries. The annual number of unwanted pregnancies in Asia is estimated to be 53.8 million. It is estimated that between 2010 and 2014, around 5.4% of Asian women ages 15 to 44 had unintended pregnancies. [ 9 ]


The  United Nations Population Fund , the  United Nations  sexual and reproductive health agency, explains that nearly half of all pregnancies, totalling 121 million each year throughout the world, are unintended. [ 5 ]


From 1990–1994 to 2010–2014, European rates of unintended pregnancy decreased from approximately 66 such pregnancies per 1000 women ages 15–44 years old to 41. [ 4 ]  These rates vary between different European countries.


According to a 2013 study approximately 16% of British pregnancies are unplanned, 29% are ambivalent, and 55% are planned. [ 10 ]


In France, 33% of pregnancies are unintended. Of women at risk for unintended pregnancy, only 3% do not use contraception, and 20% use  intrauterine devices  (IUDs). [ 11 ]


One study from Sweden (2008–2010) showed that the prevalence of unintended pregnancies was 23.2%. [ 12 ]  One study conducted in Uppsala (2012–2013) found that 12% of pregnancies were fairly or very unplanned. [ 13 ]


According to a 2004 study, current pregnancies were termed "desired and timely" by 58% of respondents, while 23% described them as "desired, but untimely", and 19% said they were "undesired". [ 14 ]


From 2010–2014, approximately 5.4% of women aged 15–44 years old got pregnant unintentionally, and the number of unintended pregnancies is 53.8 million each year in Asia. [ 9 ]


India, the number of unintended pregnancies has not changed much or been measured in a specific way in the last ten years. [ as of? ] [ 9 ]  In each of the three rounds of the  National Family Health Surveys  (NFHS), about a quarter of the women in India had unintended pregnancies. [ 9 ]  Every year, there are about 121 million or 12.1 crore unintended pregnancies around the world. One of every seven of these happens in India, according to a report from the  United Nations Population Fund . [ 15 ]  India's most populous state,  Uttar Pradesh , with a population of about 200 million, has twice as many unwanted births as India as a whole (1.65 vs. 0.80). [ 16 ]  The level of unmet need for contraception among women in India is consistent with the incidence of unintended pregnancies and the incidence of abortions. These facts highlight the necessity for additional investment to meet the contraceptive needs of women and couples and to ensure access to safe abortion services. [ 17 ]


A quarter of unintended pregnancy happens in Africa and the average unintended pregnancy rate in Sub-Saharan Africa is 33.9%. [ 18 ]


From 1990–1994 to 2010–2014, North American rates of unintended pregnancy decreased from approximately 50 such pregnancies per 1000 women ages 15–44 years old to 47. [ 4 ]


According to the  Guttmacher Institute , 45% of U.S. pregnancies in 2011 were unintended, approximately 2.8 million pregnancies per year. [ 7 ]  In 2006, most states' rates were between 40 and 65 unintended pregnancies per 1,000 women. The state with the highest rate of unintended pregnancies was Mississippi, with 69 per 1,000 women, followed by  California ,  Delaware , the District of Columbia, Hawaii and Nevada (66 to 67 per 1,000). New Hampshire had the lowest rate, 36 per 1,000 women, followed by Maine, North Dakota, Vermont and West Virginia (37 to 39 per 1,000 women). [ 19 ] [ 20 ]


Over 92% of abortions are the result of unintended pregnancy, [ 21 ]  and unintended pregnancies result in about 1.3 million abortions per year. [ 22 ]  In 2001, 44% of unintended pregnancies resulted in births, 42% resulted in induced abortion, and the rest in  miscarriage . [ 23 ]  It is estimated that more than half of US women have had an unintended pregnancy by age 45. [ 24 ]  One 2012 study found over one-third of living people in the US under 31 years of age (born since 1982) were the result of unintended pregnancies, a rate virtually unchanged from 2002. [ 25 ] [ 26 ]


Unintended pregnancy typically occurs after sexual activity without the use of  contraception , or not using it correctly. Such pregnancies may still occur despite using contraception correctly, but are uncommon. For example, in the  United States , of all the unintended pregnancies that occurred in 2008, women who used modern contraception consistently accounted for only 5% of the unintended pregnancies, while women who use contraception inconsistently or not at all accounted for 41% and 54% of all unintended pregnancies, respectively. [ 29 ]


There are many factors that may influence a person or couple's consistent use of contraception; a woman may not understand her risk of unintended pregnancy, and/or may not be able to access effective  birth control  to prevent pregnancy. Similarly, she may also not be able to control when/how she engages in sexual activity. Thus, many factors have been associated with higher likelihood of having an unintended pregnancy, as follows.


Studies across the globe consistently find that younger age (adolescence or young adulthood) increases the likelihood of a pregnancy being unintended or unplanned. [ 30 ] [ 31 ] [ 10 ] [ 18 ] [ 32 ] [ 12 ]


In the US, younger women who are sexually active are less likely to use contraception than other age groups, and thus are more likely to have unintended pregnancies. Approximately 18% of young women aged 15–19 years old at risk of unintended pregnancy do not use contraception, compared with 13% of women aged 20–24 and 10% of women aged 25–44. [ 33 ]


Of the estimated 574,000  teen pregnancies  (to young women aged 15–19) in the US in 2011, 75% were unintended. [ 34 ]  In 2011, the unintended pregnancy rate was 41 per 1,000 women aged 15–19. [ 34 ]  Because many teens are not sexually active, these estimates understate the risk of unintended pregnancy among teens who are having sex. Calculations that account for sexual activity find that unintended pregnancy rates are highest among sexually active women aged 15–19 years old compared to other age groups. [ 35 ]  About one-third of unintended teen pregnancies end in abortion. [ 34 ]


The unintended pregnancy rate among teens has been declining in the US. Between 2008 and 2011, the unintended pregnancy rate declined 44% among women aged 15–17 years old and 20% among women aged 18–19 years old. [ 34 ]  This decline is attributed to improved contraceptive use among sexually active teens, rather than changes in sexual activity. [ 36 ]


Relationship status has a strong correlation with unintended pregnancy, but measures for relationship status vary by study.  Some studies find that being  single  increases the likelihood of experiencing an unintended pregnancy, [ 18 ] [ 37 ] [ 38 ]  some find that  not living with a partner  increases the likelihood, [ 12 ] [ 37 ]  and others find  cohabitation  with a partner to increase the risk of unintended pregnancy. [ 39 ]


In the US, women who are unmarried but live with their partners ( cohabiting ) have a higher rate of unintended pregnancy compared with both unmarried noncohabiting women (141 vs. 36–54 per 1,000) and married women (29 per 1,000). [ 7 ]


Poverty, lower income, and/or economic hardship increases a woman's risk of unintended pregnancy across the globe. [ 31 ] [ 18 ] [ 32 ] [ 12 ]


Poverty and lower income increases a woman's risk of unintended pregnancy. Unintended pregnancy rates among women with incomes less than 100% of the poverty line was 112 per 1,000 in 2011, more than five times higher than the rate among women with incomes of at least or greater than 200% of poverty (20 per 1,000 women). [ 7 ]


Women living in countries where they belong to a racial or ethnic  minority group  frequently have higher unintended pregnancy rates compared to women of the regional majority. [ 30 ] [ 31 ] [ 12 ]


In the US, women who identify as racial minorities are at increased risk of unintended pregnancy. In 2011, the unintended pregnancy rate for non-Hispanic black women was more than double that of non-Hispanic white women (79 versus 33 per 1,000). [ 7 ]


Studies across the globe consistently find that women with relatively lower educational attainment are far more likely to experience an unplanned pregnancy than women who are more educated; the level of  education  education that makes the difference is relative, varying by region and country, as demonstrated by multiple studies. [ 31 ] [ 10 ] [ 18 ] [ 32 ] [ 12 ] [ 37 ] [ 39 ] [ 40 ]


Women without a high school degree had the highest unintended pregnancy rate among any educational level in 2011, at 73 per 1,000, accounting for 45% of all pregnancies in this group. Unintended pregnancy rates decreased with each level of educational attainment. [ 7 ] [ 34 ]


Sexual coercion,  rape , or even  forced pregnancy  may be associated with unintended pregnancy, all of which sometimes happens in the context of  domestic violence . Studies in various countries have linked intimate partner violence or current abuse, [ 12 ] [ 37 ] [ 38 ] [ 41 ]  as well as prior abuse [ 12 ]  (incl. during childhood), [ 42 ]  to a higher risk of experiencing unintended pregnancy.


A longitudinal study in 1996 of over 4000 women in the United States followed for three years found that the  rape-related pregnancy  rate was 5.0% among survivors aged 12–45 years. Applying that rate to rapes committed in the United States would indicate that there are over 32,000 pregnancies in the United States as a result of rape each year. [ 43 ]


Birth control sabotage  is abuse in the form of tampering with contraception or interfering with the use of contraception in order to undermine efforts to prevent pregnancy. [ 44 ]


Women who already have children are more likely to report a pregnancy as unintended. The number of children that makes the difference is relative, varying by region and country, as demonstrated by different studies. [ 31 ] [ 18 ] [ 32 ] [ 37 ]


In the United States in 2011, 42% of all unintended pregnancies ended in abortion, and 58% ended in birth (not including miscarriages). [ 7 ]  Regardless of the outcome of the pregnancy, unintended pregnancies have significant negative impacts on individual and public health.


Pregnancy, whether intended or unintended, has risks and  potential complications . On average, unintended pregnancies that are carried to term result in poorer outcomes for the pregnant woman and for the child than do intended pregnancies.


Unintended pregnancy usually precludes  pre-conception counseling  and pre-conception care. [ 45 ]  Patients with unintended pregnancies with preexisting medical comorbidities such as  diabetes  or  autoimmune disease  may not be able to optimize control of these conditions before becoming pregnant, which is often associated with poorer outcomes during the resulting pregnancy. Patients taking known  teratogenic  drugs, such as some of those used for  epilepsy  or  hypertension , may not have the opportunity to change to a non-teratogenic drug regimen before an unintended conception. Unintended pregnancies preclude chance to resolve  sexually transmitted infections  (STIs) before pregnancy; untreated STIs may be associated with premature delivery or later infection of the newborn. [ 6 ]


Patients with unintended pregnancies enter prenatal care later. [ 46 ] [ 6 ]   Unwanted pregnancies have more delay than mistimed. [ 6 ]  Patients who present late to prenatal care may also miss the opportunities for genetic testing of the fetus in the second trimester, which can identify abnormal fetuses and may be used in the decision to continue or terminate the pregnancy.


Women with an unintended pregnancy are more likely to develop  depression during or after pregnancy . [ 47 ] [ 48 ] [ 49 ]


Women with unintended pregnancy are at increased risk of physical violence during pregnancy [ 47 ] [ 49 ]  and report feeling greater relationship instability. [ 50 ]


Women with unintended pregnancies are more likely to  smoke tobacco , [ 45 ]  drink alcohol during pregnancy, [ 6 ] , [ 51 ]  and binge drink during pregnancy, [ 45 ]  which results in poorer health outcomes. [ 6 ]   (See also:  fetal alcohol spectrum disorder )


Unintended pregnancies are more likely to delivery prematurely, [ 6 ] [ 45 ] [ 49 ]  and have a greater likelihood of low birth weight, [ 49 ] [ 52 ]  particularly for unwanted pregnancies. [ 6 ] [ 51 ]


Unintended pregnancies have been associated with lower mother–child relationship quality. [ 47 ] [ 50 ]  (See also  maternal bond .)


Women who deliver unintended pregnancies are less likely to  breastfeed , [ 47 ] [ 51 ]  which in itself has been associated with a number of improved health outcomes for both mothers and infants.


Children born of unintended pregnancies have higher risk of  child abuse  and  neglect . [ 6 ] [ 53 ]


Children born of unintended pregnancies are less likely to succeed in school, [ 21 ]  with significantly lower test scores, [ 50 ]  more likely to  live in poverty  and need  public assistance , [ 21 ]  and more likely to have  delinquent  and criminal behavior. [ 21 ]


Unintended pregnancies may result in an adoption of the infant, where the biological parents (or birth parents) transfer their privileges and responsibilities to the adoptive parents. Birth parents choose adoption when they do not wish to parent the current pregnancy and they prefer to carry the pregnancy to term rather than ending the pregnancy through an abortion. [ 54 ]   In the United States alone, 135,000 children are adopted each year [ 55 ]   which represents about 3% of all live births.  According to the 2010 census, there were 1,527,020 adopted children in the United States, representing 2.5 percent of all U.S. children. [ 56 ]  There are two forms of adoption: open adoptions and closed adoptions.  Open adoption allows birth parents to know and have contact with the adoptive parents and the adopted child. [ 57 ]   In a closed adoption, there is no contact between the birth parents and adoptive parents, and information identifying the adoptive parents and the birth parents is not shared. However, non-identifying information (i.e. background and medical information) about the birth parents will be shared with the adoptive parents. [ 57 ]


Abortion, the voluntary termination of pregnancy, is one of the primary consequences of unintended pregnancy. [ 6 ]   A large proportion of induced abortions worldwide are due to unwanted or mistimed pregnancies. [ 58 ] [ 59 ]  Unintended pregnancies result in about 42 million induced  abortions  per year worldwide. [ 22 ]   In the United States, approximately 42% of all unintended pregnancies ended in abortion. [ 7 ]  Over 92% of abortions are the result of unintended pregnancy. [ 21 ]  The U.S. states with the highest levels of abortions performed were Delaware, New York and New Jersey, with rates of 40, 38 and 31 per 1,000 women, respectively. High rates were also seen in the states of Maryland, California, Florida, Nevada and Connecticut with rates of 25 to 29 per 1,000 women. The state with the lowest abortion rate was Wyoming, which had less than 1 per 1,000 women, followed by Mississippi, Kentucky, South Dakota, Idaho and Missouri with rates of 5 to 6 abortions per 1,000 women. [ 60 ] [ 61 ]


Abortion carries few health risks when performed in accordance with modern medical techniques. [ 6 ] [ 62 ] [ 63 ]   In higher resource areas where abortion is legal, it has lower morbidity and mortality for the pregnant woman than childbirth. [ 6 ] [ 64 ] [ 65 ]   However, where safe abortions are not available, abortion can contribute significantly to maternal mortality [ 66 ]  and morbidity. [ 62 ]  While decisions about abortion may cause some individuals psychological distress, [ 67 ]  some find a reduction in distress after abortion. [ 6 ] [ 68 ]   There is no evidence of widespread psychological harm from abortion. [ 6 ] [ 69 ] [ 70 ]


Over the six years between 1995 and 2000 there were an estimated 338 million pregnancies that were unintended and unwanted worldwide (28% of the total 1.2 billion pregnancies during that period). [ 71 ]   These unwanted pregnancies resulted in nearly 700,000 maternal deaths (approximately one-fifth of maternal deaths during that period). More than one-third of the deaths were from problems associated with pregnancy or childbirth, but the majority (64%) were from complications from  unsafe or unsanitary abortion . [ 71 ]   Most of the deaths occurred in low resource regions of the world, where  family planning  and  reproductive health  services were less available. [ 71 ]  In certain countries with extreme prohibitions on abortions like  El Salvador ,  Honduras ,  Nicaragua ,  Haiti , the  Dominican Republic ,  Jamaica ,  Suriname ,  Egypt ,  Madagascar ,  Mauritania ,  Senegal ,  Sierra Leone , the  Republic of Congo ,  Laos , the  Philippines ,  Iraq  forced women which have unintended pregnancies to commit  suicide  and its also contributed to maternal deaths. [ 72 ]


The public cost of unintended pregnancy is estimated to be about 11 billion dollars per year in short-term medical costs. [ 21 ]   This includes costs of births, one year of infant medical care and costs of fetal loss. [ 21 ]   Preventing unintended pregnancy would save the public over 5 billion dollars per year in short-term medical costs. [ 21 ]   Savings in long-term costs and in other areas would be much larger. [ 21 ]
By another estimate, the direct medical costs of unintended pregnancies, not including infant medical care, was $5 billion in 2002. [ 73 ]
The Brookings Institution conducted research and their results show that taxpayers spend more than $12 billion each year on unintended pregnancies. They also find that, if all unintended pregnancies were prevented, the resulting savings on medical spending alone would equal more than three-quarters of the federal FY 2010 appropriation for the Head Start and Early Head Start programs and would be roughly equivalent to the amount that the federal government spends each year on the Child Care and Development Fund (CCDF). [ 74 ]  Contraceptive use saved an estimated $19 billion in direct medical costs from unintended pregnancies in 2002. [ 73 ]


Most unintended pregnancies result from not using contraception, or from using contraceptives inconsistently or incorrectly. [ 7 ]  Accordingly, prevention includes comprehensive  sexual education , availability of  family planning  services, and increased access to a range of effective  birth control  methods.


In the US it is estimated that 52% of unintended pregnancies result from couples not using  contraception  in the month the woman got pregnant, and 43% result from inconsistent or incorrect contraceptive use; only 5% result from contraceptive failure, according to a report from the  Guttmacher Institute . [ 22 ]


Increasing the use of  long-acting reversible contraceptives  (LARCs) (such as IUD and contraceptive implants) decreases the chance of unintended pregnancy by decreasing the chance of incorrect use. [ 75 ]  Method failure is relatively rare with modern, highly effective contraceptives, and is much more of an issue when such methods are unavailable or not used. In the period from 2001 to 2008, there were notable increases in the use of long-acting methods among younger women. [ 28 ]  (See  comparison of contraceptive methods ). Available contraception methods include use of  birth control pills , a  condom ,  intrauterine device  (IUD, IUC, IUS),  contraceptive implant  (Implanon or  Nexplanon ), hormonal  patch , hormonal  ring ,  cervical caps ,  diaphragms ,  spermicides , or  sterilization. [ 76 ]  People choose to use a contraceptive method based on method efficacy, medical considerations, side effects, convenience, availability, friends' or family members' experience, religious views, and many other factors. [ 77 ]  Some cultures limit or discourage access to birth control because they consider it to be morally or politically undesirable. [ 78 ]


While not yet available commercially, the future introduction of effective LARCs for men could have a positive effect on unintended pregnancies. [ 79 ]


The CDC encourages men and women to formulate a  reproductive life plan  to help them avoid unintended pregnancies, improve the health of women, and reduce adverse pregnancy outcomes. [ 80 ]


Providing contraceptives and family planning services at low or no cost to the user helps prevent unintended pregnancies.  Many of those at risk of unintended pregnancy have little income, so even though contraceptives are highly cost-effective, [ 81 ]  up-front cost can be a barrier.  Subsidized family planning services improve the health of the population and saves money for governments and health insurers by reducing medical, [ 47 ]  education, and other costs to society.


In 2006, publicly funded family planning services (Title X, Medicaid, and state funds) helped women avoid 1.94 million unintended pregnancies, thus preventing about 860,000 unintended births and 810,000 abortions. [ 82 ]  Without publicly funded family planning services, the number of unintended pregnancies and abortions in the United States would be nearly two-thirds higher among women overall and among teens, and the number of unintended pregnancies among lower-class women would nearly double. [ 82 ]  The services provided at publicly funded clinics saved the federal and state governments an estimated $5.1 billion in 2008 in short term medical costs. [ 82 ]  Nationally, every $1.00 invested in helping women avoid unintended pregnancy saved $3.74 in Medicaid expenditures that otherwise would have been needed. [ 82 ]


In the United States, women who have an unintended pregnancy are more likely to have subsequent unplanned pregnancies. [ 48 ]  Providing family planning and contraceptive services as part of prenatal, postpartum and  post abortion care  can help reduce recurrence of unintended pregnancy.


Outside of the United States, providing modern contraceptives to the 201 million women at risk of unintended pregnancy in low income countries who do not have access to effective contraception would cost an estimated US$3.9 billion per year. [ 83 ]   This expenditure would prevent an estimated 52 million unintended pregnancies annually, preventing 1.5 million  maternal  and child deaths annually, and reduce induced abortions by 64% (25 million per year). [ 83 ]   Reduced illness related to pregnancy would preserve 27 million  healthy life years , at a cost of $144 per year of healthy life. [ 83 ]


Early ways of preventing unintended pregnancy included  withdrawal  and various alternatives to intercourse; they are difficult to use correctly and, while better than no method, have high failure rates compared to modern methods. [ 84 ] [ 85 ]   Various devices and medications thought to have  spermicidal , contraceptive, abortifacient or similar properties were also used.


Abortions have been induced to prevent unwanted births since antiquity, [ 6 ]  and abortion methods are described in some of the earliest medical texts. [ 85 ]   The degree of safety of early methods relative to the risks of childbirth is unclear. [ 85 ]


Where modern contraceptives are not available, abortion has sometimes been used as a major way of preventing birth.  For instance, in much of Eastern Europe and the former Soviet republics in the 1980s, desired family size was small, but modern contraceptive methods were not readily available, so many couples relied on abortion, which was legal, safe, and readily accessible, to regulate births. [ 84 ]   In many cases, as contraceptives became more available, the rate of unintended pregnancy and abortion dropped rapidly during the 1990s. [ 84 ]


Infanticide  ('customary  neonaticide ') or  abandonment  (sometimes in the form of exposure) are other traditional ways of dealing with infants that were not wanted or that a family could not support. [ 85 ]   Opinions on the morality or desirability of these practices have changed throughout history.


In the 19th and 20th centuries, the desired number of pregnancies declined as reductions in infant and childhood mortality rates increased the probability that children would reach adulthood.  Other factors, such as the level of education and economic opportunities for women, have also led to reductions in the desired number of children. [ 84 ]   As the desired number of children decreases, couples spend more of their reproductive lives trying to avoid unintended pregnancies. [ 84 ]


US birth rates declined in the 1970s.  Factors that are likely to have led to this decline include: The introduction of the  birth control pill  in 1960, and its subsequent rapid increase in popularity; the completion of legalization of contraceptives in the 1960s and early 1970s; the introduction of federal funding for family planning in the 1960s and  Title X  in 1970; increased career and educational gains for women and its consequence of increased  opportunity costs ; and the legalization of abortion in 1973.  The decline in the birth rate was associated with reductions in the number of children put up for adoption and a reduction in the rate of neonaticide.


The rate of unintended pregnancy declined significantly from 1987 until 1994, due to increased contraceptive use. [ 27 ] [ 87 ]   Since then, the rate has remained relatively unchanged, as described above. [ 87 ]


A  vaginal syringe  was an object used in the 19th century in the  Western world  for  douching , treating diseases and for  birth control . Vaginal syringes were fairly common at the time, but were not openly discussed because of  taboos  about discussing  feminine hygiene . [ 1 ]  Vaginal syringes were most often made of metal, glass or  Bakelite . [ 2 ]


Vaginal syringes were marketed under various names, such as the ones made by the E. Edwards and Company of New York called "Lady's Friend" or the "Diamond Syringe No. 10." [ 3 ]  It was important for manufacturers to be vague in advertising because they could be arrested on  obscenity  charges, like  Ezra Heywood  was for advertising a vaginal syringe in his  newspaper  in 1882. [ 4 ]  His involvement in the issue led his wife,  Angela Heywood  to speak openly about birth control and feminine hygiene as a woman's "natural right." [ 5 ]  Others, like  Sarah Chase , were arrested for selling vaginal syringes as a method of birth control. [ 6 ]  Vaginal syringes have been recorded in paintings by the 17th century artist,  Jan Steen . [ 7 ]  Women have created and patented vaginal syringes for use as birth control as early as the 1879 model developed by Ann Palmer. [ 8 ]


Vaginal syringes were used to treat maladies such as  leucorrhea  or disease of the " pelvic viscera " by injecting water or water and chemicals into the vagina. [ 9 ]  Vaginal syringes were also used to treat  menstrual cramps . [ 7 ]


The vaginal syringe was also used to promote the  Victorian  notion that  douching  was an appropriate method of feminine hygiene. [ 10 ]  By the 1930s, "many reputable gynecologists" were reporting that "habitual use of a vaginal syringe" was unhealthy. [ 11 ]


The vaginal syringe as a method of birth control was available to women in the early nineteenth century. [ 12 ]  In the 1860s,  Henry Dyer Grindle , advocated using vaginal syringes for the application of  spermicide  into the vagina after  sexual intercourse . [ 13 ]  Women used different types of spermicides with the vaginal syringes including  alum , chloride of  zinc ,  baking soda ,  vinegar ,  borax , white  oak  bark,  carbolic acid  and other chemical combinations. [ 13 ]  Some chemicals which could be used as a douche were "capable of inducing an  abortion ." [ 14 ]


Wildlife contraceptives , sometimes referred to as  wildlife fertility control , are  contraceptives  used to regulate the fertility of  wild animals . They are used to  control population growth  of certain wild animals.


Wildlife contraception has been tested and used in many different species of primarily birds and mammals, likely more that 85 species in total. [ 1 ]   White-tailed deer  may be controlled with contraceptives in  suburban  areas, where they are sometimes a  nuisance . In parts of the United States, does are shot with darts containing a  contraceptive vaccine , rendering them temporarily infertile. [ 2 ]  The  Humane Society of the United States  runs a deer birth control program, but it is experimental; it may not be  cost-effective  in the long run. [ 2 ] [ 3 ] [ needs update ]  It may cost  $ 300 [ 3 ]  to $1000 [ 2 ]  per deer.


One contraceptive vaccine used is  porcine zona pellucida  (PZP), or derivatives. This form of  immunocontraception  prevents sperm from accessing an  ovum . [ 4 ]  Another form of deer immunocontraception, called GonaCon, produces antibodies to  sex drive hormones  in the deer, causing them to lose interest in mating. [ 5 ]  Similar forms of injectable immunocontraceptives are being studied for use in  elk [ 6 ]  and  gray squirrels . [ 7 ]


Oral contraceptives  may also be developed for  population control  among a variety of animals, including  deer ,  feral pigs ,  coyotes ,  cougars ,  dogs  and  cats . [ 8 ]   One product that has been developed for rodents like  mice  and  rats , which originally went by the name  Mouseopause , was approved for commercial use under the name  ContraPest . [ 9 ]  Another project is a five-year development and trial of several oral contraceptives for gray squirrels in the  UK . The project has been supported by the UK's  Department for Environment, Food and Rural Affairs  and aims to "provide an effective, less labour intensive, non-lethal method for managing grey squirrels" by January 2024. [ 10 ] [ 11 ]


Pigeons  have been a target for experimental contraceptives for decades. [ 12 ]  In 2007, the  EPA  registered the first product for oral contraception of  feral pigeons  and other pest birds in the US, called OvoControl P, containing the active ingredient  nicarbazin . [ 13 ]
 www.ovocontrol.com  An oral contraceptive was also introduced in 2005 for the control of  Canada geese , [ 6 ]  but abandoned in 2011 due to regulatory barriers and pressure from hunting groups. [ 14 ]


A slow-release  hormonal contraceptive  implant for female  Tasmanian devils  is under development. While it may seem counter-intuitive to develop contraceptives for an endangered animal, their use is intended to promote the wild behaviour of mating freely, but without certain females over-contributing to the next generation, which "can have long-term genetic consequences for the  insurance population ". Contraceptive trials in male devils showed that their  testosterone  increased, instead of decreasing as other male mammals' testosterone does. [ 15 ]


As with any form of wildlife management, wildlife contraceptives can in some cases cause negative side-effects on the welfare of the treated animals, [ 16 ]  although there is some evidence that it may provide animal welfare benefits as well. [ 17 ]


The  World League for Sexual Reform  was a League for coordinating policy reforms related to greater openness around sex. [ 1 ]  The initial groundwork for the organisation, including a congress in  Berlin  which was later counted as the organisation's first, was orchestrated by  Magnus Hirschfeld  in 1921. It officially came into being at a congress in  Copenhagen  in 1928. [ 2 ] [ 3 ]


The organization advocated a ten-point platform which included:


From September 15 to September 21, 1921, Magnus Hirschfeld organised the First International Congress for Sexual Reform on the Basis of Sexual Science in Berlin, which formed the original groundwork for the League. The World League for Sexual Reform officially came into existence on July 3, 1928, at its congress in  Copenhagen . [ 2 ]  Representatives came from many countries: England, the United States, Canada, Germany, France, Russia, Austria, Switzerland, Czechoslovakia, Italy, the Netherlands, Belgium, Spain, Japan, Norway, Sweden, Denmark, Iceland, Lithuania, Egypt, Liberia, Argentina, Chile, the British Indies, and Malaysia. [ 5 ]


Ralf Dose has written an overview of the League. [ 6 ]  Congresses were held in Copenhagen (1928),  London  (1929),  Vienna  (1930), and  Brno  (1932).  Congress speakers included: Hirschfeld,  Norman Haire ,  Vera Brittain ,  Dora Russell , [ 7 ]   Charles Vickery Drysdale  (from the  Malthusian League ),  Stella Browne ,  Ernst Gräfenberg ,  Marie Stopes ,  M. D. Eder  (a pioneer psychiatrist),  Laurence Housman ,  George Ives ,  Eden Paul ,  Alexandra Kollontai ,  Max Hodann ,  Felix Abraham  [ de ]  (who with Dr  Ludwig Levy-Lenz  performed the world's first sex-change operation in 1931 at Hirschfeld's  Institut für Sexualwissenschaft  in Berlin),  Bernard Shaw ,  Bertrand Russell ,  Ethel Mannin , [ 7 ]   Harry Benjamin , Peter Schmidt,  William J. Robinson  (an American contraception crusader) and  Jack Flügel , a Freudian psychologist who assisted  Norman Haire  and  Dora Russell  organize the Congress and also led the Men's Dress Reform Party. [ 8 ]  Although not a speaker,  Albert Einstein  was in contact with the Congress. [ 9 ]


Magnus Hirschfeld, the British physician  Havelock Ellis  and Swiss psychiatrist  Auguste Forel  were elected the first presidents of the World League. From 1930, Norman Haire and Dane Jonathan Leunbach replaced the elderly and largely inactive Ellis and Forel, but they remained Honorary Presidents. [ 6 ]


In 1928  Francis Turville-Petre , British archaeologist and friend of  Christopher Isherwood , stayed at Hirschfeld's institute in  Weimar   Berlin . Whilst based in Berlin, Turville-Petre was an active member of the  Scientific-Humanitarian Committee , which campaigned for  gay legal reform and tolerance , and attended the Second Congress in  Copenhagen  in 1928.


In 1929 Hirschfeld presided over the third international congress held at  Wigmore Hall , London. [ 10 ]   Harley Street   sexologist ,  Norman Haire  as secretary and  Dora Russell  as treasurer, [ 11 ]  jointly organized the event. [ 12 ]  Hirschfeld's speech praised British scientists as "distinguished pioneers in eugenics". [ 10 ]  A number of British feminists attended the 1929 conference, including  Naomi Mitchison  (whose paper was "Some Comment on the Use of Contraceptives by Intelligent Persons"),  Dora Russell  ("Marriage and Freedom"), Janet Chance, a pioneer of abortion-law reform ("A Marriage Education Centre in London"),  Vera Brittain , a writer and pacifist ("The Failure of Monogamy") and  Stella Browne  ("The Right to Abortion"). [ 13 ]


By 1930, the League claimed to have 182 individuals as members. It also claimed 190,000 members overall, many of them belonging to affiliated organisations. Groups which constituted portions of its worldwide membership included the German National League for Birth Control and Sexual Hygiene, Scientific-Humanitarian Committee,  British Society for the Study of Sex Psychology , and the League for the Protection of Motherhood and Sex Reform. [ 2 ]


In 1932, the fourth international conference of the WLSR was organized and hosted by  Hugo Iltis  in Brno. Plans for a fifth conference in Moscow were scrubbed because of the political stresses caused by the growing power of  Hitler  and  Stalin . [ 14 ]


Many of the WLSR's books and records were destroyed by the Nazis during a raid in Berlin on the institute in May 1933. [ 14 ] [ 15 ]  The League ceased to exist in 1935. [ 2 ]


Sperm donation  is the provision by a man of his  sperm  with the intention that it be used in the  artificial insemination  or other "fertility treatment" of one or more women who are not his sexual partners in order that they may become pregnant by him. Where pregnancies go to full term, the sperm donor will be the biological father of every baby born from his donations. The man is known as a  sperm donor  and the sperm he provides is known as "donor sperm" because the intention is that the man will give up all legal rights to any child produced from his sperm, and will not be the legal father. Sperm donation may also be known as "semen donation".


Sperm donation should be distinguished from "shared parenthood" where the male who provides the sperm used to conceive a baby agrees to participate in the child's upbringing. Where a sperm donor provides his sperm in order for it to be used to father a child for a woman with whom he has little or no further contact, it is a form of third party reproduction.


Sperm may be donated by the donor directly to the intended recipient woman or through a  sperm bank  or  fertility clinic . Pregnancies are usually achieved by using donor sperm in  assisted reproductive technology  (ART) techniques which include  artificial insemination  (either by  intracervical insemination  (ICI) or  intrauterine insemination  (IUI) in a clinic, or intravaginal insemination at home). Less commonly, donor sperm may be used in in vitro fertilization ( IVF ). See also "natural insemination" below. The primary recipients of donor sperm are single women and lesbian couples, but the process may also be useful to heterosexual couples with  male infertility . [ 1 ]


Donor sperm and "fertility treatments" using donor sperm may be obtained at a  sperm bank  or fertility clinic. Sperm banks or clinics may be subject to state or professional regulations, including restrictions on donor anonymity and the number of offspring that may be produced, and there may be other legal protections of the rights and responsibilities of both recipient and donor. Some sperm banks, either by choice or regulation, limit the amount of information available to potential recipients; a desire to obtain more information on donors is one reason why recipients may choose to use a known donor or private donation (i.e. a de-identified donor). [ 2 ]


A sperm donor is generally not intended to be the legal or  de jure  father of a child produced from his sperm. The law may however, make implications in relation to legal fatherhood or the absence of a father. The law may also govern the fertility process through sperm donation in a fertility clinic. It may make provision as to whether a sperm donor may be anonymous or not, and it might give an adult donor conceived offspring the right to trace his or her biological father.


In the past, it was considered that the method of insemination was crucial to determining the legal responsibility of the male as the father. A recent case (see below 'Natural Insemination') has held that it is the purpose, rather than the method of insemination which will determine responsibility.
Laws regulating sperm donation address issues such as permissible reimbursement or payment to sperm donors, rights and responsibilities of the donor towards his biological offspring, the child's right to know his/her father's identity, and procedural issues. [ 3 ]  Laws vary greatly from jurisdiction to jurisdiction. In general, laws are more likely to disregard the sperm donor's biological link to the child, so that he will neither have child support obligations nor rights to the child. In the absence of specific legal protection, courts may order a sperm donor to pay child support or recognize his parental rights, and will invariably do so where the insemination is carried  out by natural, as opposed to artificial means. [ 4 ] [ 5 ] [ 6 ]


Laws in many jurisdictions limit the number of offspring that a sperm donor can give rise to, and who may be a recipient of donor sperm. [ 7 ]


In 2017, a lawsuit was brought in  U.S. District Court for the Northern District of Illinois  regarding  autism  diagnoses among multiple offspring of Donor-H898. [ 8 ]  The suit asserts that false information was presented regarding a donor who should not have been considered an appropriate candidate for a sperm donation program because of a diagnosis of  ADHD . Reportedly, the situation is being studied by some of the world's foremost experts in the genetics of autism because of the numbers of his offspring being diagnosed with autism.


The purpose of sperm donation is to provide pregnancies for women whose male partner is infertile or, more commonly, for women who do not have a male partner. The development of fertility medicine such as ICSI has enabled more and more heterosexual couples to produce their own children without the use of third-party gametes which has reduced the demand for sperm donation from this social group. However, at the same time, social attitudes and the social/legal framework has changed in that single women and  LGBT+  women and couples can more easily have their own biological families and do so with the aid of sperm donation. The desire to have a baby is a natural human instinct and increasingly single women and LGBT+ couples form the highest percentage of those using sperm donors in order to have a baby. Some fertility centers offering sperm donation do so exclusively for these two groups of women.


One of the intentions of sperm donation is generally that there should be no direct physical or genital contact between the parties. The sexual and physical integrity of both parties is preserved and in this sense the introduction of donor sperm into a woman by artificial means may be seen as satisfying a social rather than a purely medical need. A woman who becomes pregnant by a sperm donor will be the recipient of his genetic material but the two may never even meet. Artificial insemination, which is the normal method of introducing donor sperm into a woman's body, thus becomes a substitute for  sexual intercourse . If the woman becomes pregnant, the resulting pregnancy will be no different from one achieved by intercourse, and the sperm donor will be the biological father of her child in the same way as if intimate sexual relations between the donor and the woman had taken place. In this context, artificial insemination using donor sperm may also be referred to as ' assisted insemination ' since the sperm is provided by a third party and is then transferred to the recipient woman by means other than bodily contact.


Donor sperm is prepared for use in  artificial insemination  in intrauterine insemination ( IUI ) or  intra-cervical insemination  (ICI). In most situations, the majority of women seeking sperm donation, being either single or women in a lesbian partnership, do not themselves have "fertility issues" in greater proportion to the rest of the female population although donor sperm is often prepared for use in other assisted reproductive techniques such as  IVF  and  intracytoplasmic sperm injection  (ICSI). Sperm banks and fertility clinics often offer, for example, donor sperm for use in IVF to facilitate treatments in which one lesbian partner will produce an egg which is fertilised by sperm from a donor, and the egg is then inserted into the other partner. A variation of this is when each partner carries the fertilised egg of the other, usually fertilised by sperm from the same donor, and often where the pregnancies run simultaneously. Donor sperm may be used in  surrogacy  arrangements either by artificially inseminating the  surrogate  (known as traditional surrogacy) or by implanting in a surrogate embryos which have been created by using donor sperm together with eggs from a donor or from the 'commissioning female' (known as  gestational surrogacy ). [ 9 ]  Spare embryos from this process may be donated to other women or surrogates. Donor sperm may also be used for producing embryos with donor eggs which are then donated to a female who is not genetically related to the child she produces.


Procedures of any kind (e.g., artificial insemination or IVF) using donor sperm to impregnate a female who is not the partner of, nor related to the male who provided the sperm, may be referred to as "donor treatments". [ 2 ]


The majority of sperm donors today are aware that their sperm will mainly be used to enable single women or coupled lesbians to have children by them.


A sperm donor may donate sperm privately or through a  sperm bank , sperm agency, or other brokerage arrangement. Donations from private donors are most commonly carried out using  artificial insemination .


Generally, a male who provides sperm as a sperm donor gives up all legal and other rights over the biological children produced from his sperm. [ 10 ]  Private arrangements may permit some degree of  co-parenting , although this will not strictly be sperm donation, and the enforceability of those agreements varies by jurisdiction.


Donors may or may not be paid, according to local laws and agreed arrangements. Even in unpaid arrangements, expenses are often reimbursed. Depending on local law and on private arrangements, men may donate anonymously or agree to provide identifying information to their offspring in the future. Private donations facilitated by an agency often use a "directed" donor, when a male directs that his sperm is to be used by a specific person. Non-anonymous donors are also called "known donors", "open donors" or "identity disclosure donors". [ 2 ]


A review of surveys among donors came to the results that the media and advertising are most efficient in attracting donors, and that the internet is becoming increasingly important in this purpose. [ 11 ]  Recruitment via couples with infertility problems in the social environment of the sperm donor does not seem to be important in recruitment overall. [ 11 ]


A sperm donor will usually donate sperm to a sperm bank under a contract, which typically specifies the period during which the donor will be required to produce sperm, which generally ranges from six to 24 months depending on the number of pregnancies which the sperm bank intends to produce from the donor. If a sperm bank has access to world markets by direct sales, or sales to clinics outside their own jurisdiction, a man may donate sperm for a longer period than two years, as the risk of  consanguinity  is substantially reduced and a sperm bank will have to adhere to local laws, although these may vary widely. [ 12 ]


The contract may also specify the place and hours for donation, a requirement to notify the sperm bank in the case of acquiring a sexual infection, and the requirement not to have intercourse or to masturbate for a period of usually two–three days before making a donation. [ 13 ]


Sperm provided by a sperm bank will be produced by a donor attending at the sperm bank's premises in order to ascertain the donor's identity on every occasion. The donor  masturbates  to provide ejaculate or by the use of an electrical stimulator, although a special  condom , known as a  collection condom , may be used to  collect the semen  during sexual intercourse. The ejaculate is collected in a small container, which is usually  extended with chemicals  in order to provide a number of vials, each of which would be used for separate inseminations. The sperm is frozen and quarantined, usually for a period of six months, and the donor is re-tested prior to the sperm being used for artificial insemination. [ 2 ]


The frozen vials will then be sold directly to a recipient or through a medical practitioner or fertility center and they will be used in fertility treatments. Where a woman becomes pregnant by a donor, that pregnancy and the subsequent birth must normally be reported to the sperm bank so that it may maintain a record of the number of pregnancies produced from each donor.


In some jurisdictions, sperm may be donated through an agency. The agency may recruit donors, usually via the Internet. Donors may undergo the same kind of checks and tests required by a sperm bank, although clinics and agencies are not necessarily subject to the same regulatory regimes. In the case of an agency, the sperm will be supplied to the recipient female fresh rather than frozen. [ 14 ]


A female chooses a donor and notifies the agency when she requires donations. The agency notifies the donor who must supply his sperm on the appropriate days nominated by the recipient. The agency will usually provide the sperm donor with a male collection kit usually including a  collection condom  and a container for shipping the sperm. This is collected and delivered by courier and the female uses the donor's sperm to inseminate herself, typically without medical supervision. This process preserves anonymity and enables a donor to produce sperm in the privacy of his own home. A donor will generally produce samples once or twice during a recipient's fertile period, but a second sample each time may not have the same fecundity of the first sample because it is produced too soon after the first one. Pregnancy rates by this method vary more than those achieved by sperm banks or fertility clinics. Transit times may vary and these have a significant effect on sperm viability so that if a donor is not located near to a recipient female the sperm may deteriorate. However, the use of fresh, as opposed to frozen, semen will mean that a sample has a greater fecundity and can produce higher pregnancy rates.


Sperm agencies may impose limits on the number of pregnancies achieved from each donor, but in practice this is more difficult to achieve than for sperm banks where the whole process may be more regulated. Most sperm donors only donate for a limited period, however, and since sperm supplied by a sperm agency is not processed into a number of different vials, there is a practical limit on the number of pregnancies which are usually produced in this way. A sperm agency will, for the same reason, be less likely than a sperm bank to enable a female to have subsequent children by the same donor.


Sperm agencies are largely unregulated and, because the sperm is not quarantined, may carry  sexually transmitted diseases . This lack of regulation has led to authorities in some jurisdictions bringing legal action against sperm agencies. Agencies typically insist on  STI testing  for donors, but such tests cannot detect recent infections. Donors providing sperm in this way may not be protected by laws which apply to donations through a sperm bank or fertility clinic and will, if traced, be regarded as the legal father of each child produced. [ 14 ]


Couples or individuals who need insemination by a third-party may seek assistance privately and directly from a friend or family member, or may obtain a "private" or "directed" donation by advertising or through a broker. A number of web sites seek to link recipients with sperm donors, while advertisements in gay and lesbian publications are common.


Recipients may already know the donor, or if arranged through a broker, the donor may meet the recipients and become known to them. Some brokers facilitate contact that maintains semi-anonymous identities for legal reasons. Where a private or directed donation is used, sperm need not be frozen.


Private donations may be free of charge — avoiding the significant costs of a more medicalised insemination - and fresh rather than frozen semen is generally deemed to increase the chances of pregnancy. However, they also carry higher risks associated with unscreened sexual or body fluid contact. Legal treatment of donors varies across jurisdictions, and in most jurisdictions (e.g., Sweden) [ 15 ]  personal and directed donors lack legal safeguards that may be available to anonymous donors. However, the laws of some countries (e.g., New Zealand) recognize written agreements between donors and recipients in a similar way to donations through a sperm bank. [ 14 ]


Kits are available, usually on-line, for  artificial insemination  for private donor use, and these kits generally include a collection pot, a syringe, ovulation tests and pregnancy tests. A  vaginal speculum  and a  soft cup  may also be used. STI testing kits are also available but these only produce a "snap-shot" result and, since sperm will not be frozen and quarantined, there will be risks associated with it. [ citation needed ]


Insemination through sexual intercourse is known as natural insemination (NI). Where natural insemination is carried out by a person who is not the woman's usual sexual partner, and in circumstances where the express intention is to secure a pregnancy, this may be referred to as "sperm donation by natural insemination".


Traditionally, a woman who becomes pregnant through natural insemination has always had a legal right to claim child support from the donor and the donor a legal right to the custody of the child. Conceiving through natural insemination is considered a natural process, so the biological father has also been seen as the legal and social father and was liable for child support and custody rights of the child. [ 16 ]


The law therefore made a fine distinction based on the method of conception: the biological relationship between the father and the child and the reason for the pregnancy having been achieved will be the same whether the child was conceived naturally or by artificial means, but the legal position has been different. [ 17 ]  In some countries and in some situations, sperm donors may be legally liable for any child they produce, but with NI the legal risk of paternity for a donor has always been absolute. Natural insemination donors will therefore often donate without revealing their identity.


A case in 2019 in the Canadian province of Ontario has, however thrown doubt on this position. That case held that where the parties agreed in advance of the conception that the resulting child would not be the legal responsibility of the man, the courts would uphold that agreement. The court held that the method of conception was irrelevant: it was the purpose of it which mattered. Where an artificial means of conception is used, the reproductive integrity of the recipient woman will not be preserved, and the purpose of preserving sexual integrity by employing artificial means of insemination will not over-ride this effect.


Many private sperm donors now offer both natural and artificial insemination, or they may offer natural insemination after attempts to achieve conception by artificial insemination have failed. Some sperm donors are influenced by the fact that a woman who is not the donor's usual sexual partner will carry his child whatever the means of conception, and that the actual method by which his sperm is introduced into the woman's body is of a lesser consideration than this fact. Women may seek natural insemination for various reasons including the desire by them for a "natural" conception. [ 18 ] [ 19 ]


Natural insemination by a donor usually avoids the need for costly medical procedures that may require the intervention of third parties. It may lack some of the safety precautions and screenings usually built into the artificial insemination process [ 20 ]  but proponents claim that it produces higher pregnancy rates. [ 14 ] [ 21 ]  A more 'natural' conception does not involve the intervention and intrusion of third parties. However, it has not been medically proved that natural insemination has an increased chance of pregnancy.


NI is generally only carried out at the female's fertile time, as with other methods of insemination, in order to achieve the best chances of a pregnancy. [ 22 ]


A variation of NI is PI, or partial intercourse, where penetration by the donor takes place immediately before ejaculation, thus avoiding prolonged physical contact between the parties.


Because NI is an essentially private matter, the extent of its popularity is unknown. However, private online advertisements and social media comments indicate that it is increasingly used as a means of sperm donation.


A sperm donor is usually advised not to ejaculate for two to three days before providing the sample, to increase sperm count. A sperm donor produces and collects sperm at a sperm bank or clinic by  masturbation  or during sexual intercourse with the use of a  collection condom . [ 13 ]


Sperm banks and clinics may "wash" the sperm sample to extract sperm from the rest of the material in the semen. Unwashed semen may only be used for ICI (intra-cervical) inseminations, to avoid cramping, or for IVF/ICSI procedures. It may be washed after thawing for use in IUI procedures. A  cryoprotectant   semen extender  is added if the sperm is to be placed in frozen storage in  liquid nitrogen , and the sample is then frozen in a number of vials or straws. One sample will be divided into one–twenty vials or straws depending on the quantity of the  ejaculate , whether the sample is washed or unwashed, or whether it is being prepared for IVF use. Following analysis of an individual donor's sperm, straws or vials may be prepared which contain differing amounts of motile sperm post-thaw. The number of sperm in a straw prepared for IVF use, for example, will be significantly less than the number of motile sperm in a straw prepared for ICI or IUI and there will therefore be more IVF straws per ejaculate. Following the necessary quarantine period, the samples are thawed and used to inseminate women through artificial insemination or other  ART  treatments.


Sperm banks typically screen potential donors for  genetic diseases ,  chromosomal abnormalities  and  sexually transmitted infections  that may be transmitted through sperm. The screening procedure generally also includes a quarantine period, in which the samples are frozen and stored for at least six months after which the donor will be re-tested for  sexually transmitted diseases  (STIs). This is to ensure no new infections have been acquired or have developed during the period of donation. Providing the result is negative, the sperm samples can be released from quarantine and used in treatments.  Children conceived through sperm donation  have a birth defect rate of almost a fifth compared to the general population. [ 23 ]


The number of donor samples (ejaculates) that is required to help give rise to a child varies substantially from donor to donor, as well as from clinic to clinic. However, the following equations generalize the main factors involved:


For  intracervical insemination :


The pregnancy rate increases with increasing number of motile sperm used, but only up to a certain degree, when other factors become limiting instead.


With these numbers, one sample would on average help giving rise to 0.1–0.6 children, that is, it actually takes on average two to five samples to make a child.


For  intrauterine insemination , a  centrifugation fraction  ( f c ) may be added to the equation:


Only five million motile sperm may be needed per cycle with IUI ( n r =5 million)


Thus, only one to three samples may be needed for a child, if used for IUI.


Using  ART  treatments such as  IVF  can result in one donor sample (or ejaculate) producing on average considerably more than one birth. However, the actual number of births per sample will depend on the actual  ART  method used, the age and medical condition of the female bearing the child, and the quality of the embryos produced by fertilization. Donor sperm is less commonly used for  IVF  treatments than for  artificial insemination . This is because  IVF  treatments are usually required only when there is a problem with the female conceiving, or where there is a 'male factor problem' involving the female's partner. Donor sperm is also used for  IVF  in  surrogacy  arrangements where an embryo may be created in an  IVF  procedure using donor sperm and this is then implanted in a surrogate. In a case where  IVF  treatments are employed using donor sperm, surplus embryos may be donated to other women or couples and used in  embryo transfer  procedures. When donor sperm is used for  IVF  treatments, there is a risk that large numbers of children will be born from a single donor since a single ejaculate may produce up to 20 straws for IVF use. A single straw can fertilise a number of eggs and these can have a 40% to 50% pregnancy rate. 'Spare' embryos from donor treatments are frequently donated to other women or couples. Many sperm banks therefore limit the amount of semen from each donor which is prepared for  IVF  use, or they may restrict the period of time for which such a donor donates his sperm to perhaps as little as three months (about nine or ten ejaculates).


In the US, sperm banks maintain lists or catalogs of donors which provide basic information such as racial origin, skin color, height, weight, color of eyes, and  blood group . [ 26 ]  Some of these catalogs are available via the Internet, while others are only made available to patients when they apply for treatment. Some sperm banks make additional information about each donor available for an additional fee, and others make additional basic information known to children produced from donors when those children reach the age of eighteen. Some clinics offer "exclusive donors" whose sperm is only used to produce pregnancies for one recipient female. How accurate this is, or can be, is not known, and neither is it known whether the information produced by sperm banks, or by the donors themselves, is true. Many sperm banks will, however, carry out checks to verify the information requested, such as checking the identity of the donor and contacting his own doctor to verify medical details.


In the UK, most donors are anonymous at the point of donation and recipients can only see non-identifying information about their donor (e.g., height, weight, ethnicity, etc.). Donors need to provide identifying information to the clinic and clinics will usually ask the donor's GP to confirm any medical details they have been given. Donors are asked to provide a pen portrait of themselves which is held by the  HFEA  and can be obtained by the adult conceived from the donation at the age of 16, along with identifying information such as the donor's name and last known address at 18. Known donation is permitted and it is not uncommon for family or friends to donate to a recipient couple.


Qualities that potential recipients typically prefer in donors include the donors being tall, college educated, and with a consistently high sperm count. [ 27 ]  A review came to the result that 68% of donors had given information to the clinical staff regarding physical characteristics and education but only 16% had provided additional information such as hereditary aptitudes and temperament or character. [ 11 ]


Sexually active  gay men  are prohibited or discouraged from donating in some countries, including the US. [ 28 ]  Sperm banks also screen out some potential donors based on height, baldness, and family medical history. [ 26 ]


Where a donor donates sperm through a sperm bank, the sperm bank will generally undertake a number of checks to ensure that the donor produces sperm of sufficient quantity and quality and that the donor is healthy and will not pass diseases through the use of his sperm. The donor's sperm must also withstand the freezing and thawing process necessary to store and quarantine the sperm. The cost to the sperm bank for such tests is considerable, [ clarification needed ]  which normally means that clinics may use the same donor to produce a number of pregnancies in multiple women. [ 29 ]
The number of children permitted from a single donor varies by law and practice. These laws are designed to protect the children produced by sperm donation as well as the donor's natural children from  consanguinity  in later life: they are not intended to protect the donor himself and those donating sperm will be aware that their donations may give rise to numerous pregnancies in different jurisdictions. Such laws, where they exist, vary from jurisdiction to jurisdiction, and a sperm bank may also impose its own limits. The latter will be based on the reports of pregnancies which the sperm bank receives, although this relies upon the accuracy of the returns and the actual number of pregnancies may therefore be somewhat higher. Nevertheless, sperm banks frequently impose a lower limit on geographical numbers than some jurisdictions and may also limit the overall number of pregnancies permitted from a single donor. The limitation on the number of children which a donor's sperm may give rise to is usually expressed in terms of 'families', on the expectation that children within the family are prohibited from sexual relations under incest laws. In effect, the term  family  means a "woman" and usually includes the donor's partner or ex-partner, so that multiple donations to the same woman are not counted in the limit. The limits usually apply within one jurisdiction, so that donor sperm may be used in other jurisdictions. Where a woman has had a child by a particular donor, there is usually no limit on the number of subsequent pregnancies which that woman may have by that same donor.


There is no limit to the number of offspring which may be produced from private donors.


Despite laws limiting the number of offspring, some donors may produce substantial numbers [ 30 ]  of children, particularly where they donate through different clinics, where sperm is onsold or is exported to different jurisdictions, and where countries or jurisdictions do not have a central register of donors.


Sperm agencies, in contrast to sperm banks, rarely impose or enforce limits on the number of children which may be produced by a single donor partly because they are not empowered to demand a report of a pregnancy from recipients and are rarely, if ever, able to guarantee that a female may have a subsequent sibling by the donor who was the biological father of her first or earlier children.


In the media, there have been reports of some donors producing anywhere from over 40 offspring  [ 31 ]  to several hundred [ 32 ]  or in one case, possibly over 1000. [ 33 ] [ 34 ]


Where a female wishes to conceive additional children by sperm donation, she will often wish to use the same donor. The advantage of having subsequent children by the same donor is that these will be full biological siblings, having the same biological father and mother. Many sperm banks offer a service of storing sperm for future pregnancies, but few will otherwise guarantee that sperm from the original donor will be available.


Same sex couples looking to conceive with donor sperm also oftentimes use the same donor for multiple children in order to foster a greater biological connection between their children. In cases where both parents feel that pregnancy is appealing to them, they may decide to take turns getting pregnant in which case the siblings are only biologically related on the donor side.


Sperm banks rarely impose limits on the numbers of second or subsequent siblings. Even where there are limits on the use of sperm by a particular donor to a defined number of families (as in the UK) the actual number of children produced from each donor will often be far greater.


Since 2000, donor conceived people have been locating their biological siblings and even their donor through web services such as the  Donor Sibling Registry  as well as DNA testing services such as  Ancestry.com  and  23andMe . By using these services, donors can find offspring despite the fact that they may have donated anonymously. [ 35 ] [ 36 ] [ 29 ]


The majority of donors who donate through a sperm bank receive some form of payment, although this is rarely a significant amount. A review including 29 studies from nine countries found that the amount of money donors received varied from $10 to €70 per donation or sample. [ 11 ]  The payments vary from the situation in the United Kingdom where donors are only entitled to their expenses, to the situation with some US sperm banks where a donor receives a set fee for each donation plus an additional amount for each vial stored. At one prominent California sperm bank for example, TSBC, donors receive roughly $50 for each donation which has acceptable motility/survival rates both at donation and at a test-thaw a couple of days later. Because of the requirement for the two-day abstinence period before donation, and geographical factors which usually require the donor to travel, it is not a viable way to earn a significant income. Some private donors may seek remuneration although others donate for altruistic reasons. According to the  EU Tissue Directive  donors in EU may only receive compensation, which is strictly limited to making good the expenses and inconveniences related to the donation.


Equipment to collect, freeze and store sperm is available to the public notably through certain US outlets, and some donors process and store their own sperm which they then sell via the Internet.


The selling price of processed and stored sperm is considerably more than the sums received by donors. Treatments with donor sperm are generally expensive and are seldom available free of charge through national health services. Sperm banks often package treatments into three cycles, and in cases of IVF or other ART treatments, they may reduce the charge if a patient donates any spare embryos which are produced through the treatment. There is often more demand for fertility treatment with donor sperm than there is donor sperm available, and this has the effect of keeping the cost of such treatments reasonably high.


There is a market for vials of processed sperm and for various reasons a sperm bank may sell-on stocks of vials which it holds (known as "onselling"). Onselling enables a sperm bank to maximize the sale and disposal of sperm samples which it has processed. The reasons for onselling may be where part of, or even the main business of, a particular sperm bank is to process and store sperm rather than to use it in fertility treatments, or where a sperm bank is able to collect and store more sperm than it can use within nationally set limits. In the latter case, a sperm bank may sell on sperm from a particular donor for use in another jurisdiction after the number of pregnancies achieved from that donor has reached its national maximum.


Many donees do not inform the child that they were conceived through sperm donation, or, when non-anonymous donor sperm has been used, they do not tell the child until they are old enough for the clinic to provide contact information about the donor. Some believe that it is a human right for a person to know who their biological mother and father are, and thus it should be illegal to conceal this information in any way and at any time. For donor conceived children who find out after a long period of secrecy, their main grief is usually not the fact that they are not the genetic child of the couple who have raised them, but the fact that the parent(s) has/have kept information from or lied to them, causing loss of trust. [ 37 ]


There are certain circumstances where the child very likely should be told:


The parents' decision-making process of telling the child is influenced by many intrapersonal factors (such as personal confidence), interpersonal factors, as well as social and family life cycle factors. [ 38 ]  For example, health care staff and support groups have been demonstrated to influence the decision to disclose the procedure. [ 38 ]  The appropriate age of the child at disclosure is most commonly given at between seven and eleven years. [ 38 ]


Single mothers and lesbian couples are more likely to disclose from a young age. Donor conceived children in heterosexual coupled families are more likely to find out about their disclosure from a third party. [ 39 ]


Having contact and meeting among families sharing the same donor generally has positive effects. [ 40 ] [ 41 ]  It gives the child an  extended family  and helps give the child a sense of identity [ 41 ]  by answering questions about the donor. [ 40 ]  It is more common among  open identity -families headed by single men/women. [ 40 ]  Less than 1% of those seeking donor-siblings find it a negative experience, and in such cases it is mostly where the parents have disagreed with each other about how the relationship should proceed. [ 42 ]


Parents of donors, who are the grandparents of donor offspring and may therefore be the oldest surviving progenitors, may regard the donated genetic contribution as a family asset, and may regard the donor conceived people as their grandchildren. [ 43 ]


A review came to the result that a minority of actual donors involved their partner in the decision-making process of becoming a donor. [ 11 ]  In one study, 25% of donors felt they needed permission from their partner. [ 11 ]  In another study, however, 37% of donors with a partner did not approve of a consent form for partners and rather felt that donors should make their own decisions. [ 11 ]  In a Swedish study, donors reported either enthusiastic or neutral responses from their partners concerning sperm donation. [ 11 ]


It is considered common for donors to not tell their spouses that they are or have been sperm donors. [ 44 ]


Within heterosexual couples, many men report resisting or having difficulty accepting sperm donation from another man, as it is often viewed as being akin to being  cuckolded . [ 45 ] [ 46 ]


Studies have indicated that donor insemination mothers show greater emotional involvement with their child, and they enjoy motherhood more than mothers by natural conception and adoption. Compared to mothers by natural conception, donor insemination mothers tend to show higher levels of disciplinary aggression. [ 39 ]


Studies have indicated that donor insemination fathers express more warmth and emotional involvement than fathers by natural conception and adoption, enjoy fatherhood more, and are less involved in disciplining their adolescent. Some donor insemination parents become overly involved with their children. [ 39 ]


Adolescents born through sperm donation to lesbian mothers have reported themselves to be academically successful, with active friendship networks, strong family bonds, and overall high ratings of well-being. It is estimated that over 80% of adolescents feel they can confide in their mothers, and almost all regard their mothers to be good role models. [ 39 ]


A  systematic review  came to the result that  altruism  and financial compensation are the main motivations to donate, and to a lesser degree procreation or genetic fatherhood and questions about the donor's own fertility. [ 11 ]  Financial compensation is generally more prevalent than altruism as a motivation among donors in countries where the compensation is large, which is largely explained by a larger number of economically driven people becoming donors in such countries. [ 11 ]  Among men who do not donate, the main reason thereof has been stated to be a lack of motivation rather than concerns about the donation. [ 11 ]


Reluctance to donate may be caused by a sense of ownership and responsibility for the well-being of the offspring. [ 47 ]


In the UK, the  National Gamete Donation Trust [ 48 ]  is a charity which provides information, advice and support for people wishing to become egg, sperm or embryo donors. The Trust runs a national helpline and online discussion list for donors to talk to each other.


In one Danish study, 40% of donors felt happy thinking about possible offspring, but 40% of donors sometimes worried about the future of resulting offspring. [ 11 ]


A review came to the result that one in three actual donors would like counselling to address certain implications of their donation, expecting that counselling could help them to give their decision some thought and to look at all the involved parties in the donation. [ 11 ]


A  systematic review  in 2012 came to the conclusion that the psychosocial needs and experiences of the donors, and their follow-up and counselling are largely neglected in studies on sperm donation. [ 11 ]


Anonymous sperm donation occurs under the condition that recipients and offspring will never learn the identity of the donor. A non-anonymous donor, however, will disclose his identity to recipients. A donor who makes a non-anonymous sperm donation is termed a  known donor , an  open identity donor ,  or an  identity release donor .


Non-anonymous sperm donors are, to a substantially higher degree, driven by altruistic motives for their donations. [ 49 ]


Even in the case of anonymous donation, some information about the donor may be released to recipients at the time of treatment.  Limited donor information  includes height, weight, eye, skin and hair colour. In Sweden, this is the extent of disclosed information. In the US, however, additional information may be given, such as a comprehensive biography and sound/video samples.


Several jurisdictions (e.g., Sweden, Norway, the Netherlands, Britain, Switzerland, Australia and New Zealand, etc.) only allow non-anonymous sperm donation. This is generally based on the principle that a child has a right to know his or her biological origins. In 2013, a German court precedent was set based on a case brought by a 21-year-old woman. [ 50 ]  Generally, these jurisdictions require sperm banks to keep up-to-date records and to release identifying information about the donor to his offspring after they reach a certain age (15–18). See  Sperm donation laws by country .


The popularity of  personal DNA testing  has brought into question the possibility of assuring a donor's anonymity. Even sperm donors who have chosen anonymity and not to contact their offspring through a registry are increasingly being traced by their children. It has become relatively easy to identify one's sperm donor using inexpensive testing services and their databases. Even DNA matches at a third or fourth cousin level can provide clues which enable one to identify their biological father. It has become common practice for people who were conceived via an anonymous sperm donor to ascertain who their biological father is via this method. For example, at least one child found his biological father using his own DNA test and internet research and was able to identify and contact his anonymous donor. [ 51 ]


For most sperm recipients, anonymity of the donor is not of major importance at the obtainment or  tryer -stage. [ 49 ]  Anonymous sperm is often less expensive. Another reason that recipients choose anonymous donors is concern about the role that the donor or the child may want the donor to play in the child's life or potential legal claims to parenthood. These fears were especially strong for lesbian couples wishing to conceive using a sperm donor prior to legalization of gay marriage or second parent adoptions in their area, because they worried that the sperm donor would be legally viewed as having greater claim to parenthood than the non-biological "social parent" of the child, particularly in the cases of the death of the legal parent or in a separation. [ 52 ]  Sperm recipients may prefer a non-anonymous donor if they anticipate disclosing donor conception to their child and anticipate the child's desire to seek more information about their donor in the future. A Dutch study found that lesbian couples are significantly more likely (98%) to choose non-anonymous donors than heterosexual couples (63%). Of the heterosexual couples that opted for anonymous donation, 83% intended never to inform their child of their conception via sperm donation. [ 53 ]


For children conceived by an anonymous donor, the impossibility of contacting a biological father or the inability to find information about him can potentially be psychologically burdensome. [ 54 ]  One study estimated that approximately 67% of  adolescent   donor conceived children  with an identity-release donor plan to contact him when they turn 18. [ 39 ]


Some people point out that parents who opt to use a sperm donor to conceive rather than adopting children do so because they value a biological connection to their children. At the same time, because the donation is anonymous they deny their children the opportunity to connect with half of their biological tree. This can be viewed as hypocritical of the parents, and is an argument against anonymity for donors. [ 55 ]