Download Semen donor recruitment strategies—a non

Human Reproduction vol.12 no.10 pp.2330–2335, 1997
Semen donor recruitment strategies—a non-payment
based approach
Ken R.Daniels1 and Darel J.Hall
Department of Social Work, University of Canterbury, Christchurch,
New Zealand
1To
whom correspondence should be addressed
Actual and projected prohibition of payment for semen
donation in the UK and Canada has increased the need
to examine alternative methods of donor recruitment.
Evidence from a number of sources suggests that there is
a large group of current and potential donors who are
motivated more by meeting esteem needs than by payment.
We develop an argument for using social marketing tools
to create systematically an esteem-based approach to donor
recruitment as an alternative to the payment approach.
We conclude that esteem is a useful method of reciprocating
the gift that donors make.
Key words: donor insemination/payment/recruitment/semen
donors/social marketing
Introduction
The Human Fertilisation and Embryology Authority (HFEA)
in the UK has recently determined (HFEA, 1996) that payment
for gamete donors is to be phased out. The HFEA has
established a Working Group to recommend a timetable to
implement its policy. In a similar move the Canadian Government has introduced to their Parliament a bill (Canadian
Government, 1996) which will preclude the payment of any
monies to gamete donors. The Canadian Bill goes further than
the HFEA determination in that donors cannot be paid either
a fee or expenses. It could be said that with such moves, the
UK and Canada are ‘catching up’ with France, where for 24
years there has been a policy of only recruiting unpaid donors
(Lansac and Le Lannou, 1994). Given that payment has often
been presented as a necessary incentive to the obtaining of
semen donors (Golombok and Cook, 1994) there have been
many concerns expressed (Canadian Fertility and Andrology
Society, 1996; ReproMed Limited, 1996) that the availability
of donors will decline and perhaps even cease, with the result
that couples and individuals will not be able to receive donor
insemination (DI) treatment. While the advent of intracytoplasmic sperm injection (ICSI) is likely to lead to a decrease
in demand for DI, there is no doubt that there will be a
continuing need for DI.
Recruitment of semen donors has always been problematic
(Editorial, 1979; Barratt, 1993; Cook and Golombok, 1995)
and with the developments in the UK and Canada it seems
likely that the problems will increase. Le Lannou and Lansac
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(1993), writing of the French situation, say that recruitment
of donors is a ‘major problem’. However, they quote figures
covering the period 1973 to 1988 in which they show that
during this period a total of 7430 donors were recruited. Using
a formula which takes account of the number of requests for
DI, the maximum number of pregnancies per donor (five) and
the selection rate of donors, they found that in 1989 it was
necessary to recruit a minimum of 600 donors to meet the
3600 requests for DI. They state that in 1989 ‘in fact 740 donors
were enrolled’. The French experience therefore suggests that
non-payment does not necessarily lead to a cessation of supply.
While the focus of this paper is semen donor recruitment,
many of the issues raised can be generalized to oocyte donation.
However, it is our belief that the recruitment of oocyte donors
raises sufficient differences to warrant separate consideration.
Consideration of the appropriateness of selling semen
(Novaes, 1989; Daniels and Lewis, 1996), practice-based
evidence of non-payment programmes of semen donor recruitment, particularly the CECOS experience in France (Lansac
and Le Lannou, 1994) and the above policy changes, have led
the authors to consider an alternative basis for recruiting men
who will provide semen. The paper suggests that an esteembased recruitment model, drawing on marketing concepts as
utilized in public health, should be debated as part of the
evolving practice of DI.
A future paper will outline specific strategies for implementing such a model. It is expected that the model and
strategies will be piloted in three different countries with a
view to testing their utility.
Recruitment without monetary reward
Semen donors have often been seen as the marginalized group
in assisted reproduction equations — not the patient, somewhat
deviant because of their actions, and yet engaging in a necessary
and important activity to achieve a desired outcome. They
have in effect been a means to an end. With or without intent,
the payment for semen has allowed the conceptualization of
the donation process as a commercial transaction ended once
the product, and cash, have changed hands (Novaes, 1989;
Daniels and Lewis, 1996).
Evidence from a number of studies suggests that the money
is in fact a powerful motivating influence for some men,
usually young, unmarried and often students (Cook and Golombok, 1995; Lui et al., 1995; Daniels et al., 1996a). However,
these findings have emerged from studies that were recompense
based, i.e. the respondents were recruited on the basis that
they would be paid and it is to be expected that their views
will reflect this.
© European Society for Human Reproduction and Embryology
Semen donor recruitment
It also appears that arguments could be made for a paymentbased system when the expansion of DI services required
recruitment of larger numbers of donors. One of the groups
for whom payment was attractive was students, including
medical students, and of course, the latter were easily accessible. Students, in general, are also a group who have little
discretionary spending power and therefore a small amount of
money represents a relatively large increase in income. However, once cash ceases to be a significant motivator for people
to donate, as is to happen in the UK and is proposed for
Canada, the exchange process has to be re-conceptualized.
Research into donor motivation provides a contrast between
payment and non-payment systems of recruitment. In a recent
paper (Daniels et al., 1996b) it was shown that men providing
semen at two London clinics differed in a number of important
ways. The paper describes the donors from the clinics, the
first (A) where no payment was made, the second (B) where
ten pounds was paid. Donors at clinic A were settled, at least
moderately successful, had an above-average education, had a
mean age of 40 years, had children, and were motivated more
through altruism; donors at clinic B were unmarried, had no
children, were highly educated (near and recent graduates
predominated), and were motivated more by financial reward.
It was suggested that the characteristics of the men differed
essentially because of the different recruitment policies of the
two clinics. It needs to be acknowledged that the numbers of
men involved in the study were small and that as a result it is
not possible to draw firm conclusions from the results. However, given that this is the first reported study seeking to
compare the semen providers in two clinics who had different
recruitment strategies the results point to important information
that may be of assistance in the consideration of recruitment
policies.
In the paper by Daniels et al. (1996) the two clinics were
referred to as clinic A and clinic B. On further consideration
it also seems that the two groups of providers can be referred
to as provider type A (type A) and provider type B (type B).
The word ‘providers’ is used to cover both those who received
payment and those who did not, thus avoiding the reinforcement
of the notion that those who are paid are in fact ‘donors’. In
summary, type A providers reported they were motivated
mainly by a desire to help — often referred to as being
altruistic, while monetary considerations were the major (but
not only) self-reported factor for type B. That type B report
altruistic motives alongside monetary motives has been
reported earlier (Lui et al., 1995) and is consistent with the
view that gifting (non-commercial activity, akin to altruism)
in modern Western capitalist societies remains a central form
of social transaction (Cheal, 1988).
Other clinics have reported the recruitment of type A
providers in New Zealand (Daniels, 1987; Purdie et al., 1994),
Australia (Nicholas and Tyler, 1983; Daniels, 1989; Blood,
1992), and Sweden (Daniels et al., 1996c) (for a more in depth
discussion see Daniels and Haimes, 1997).
As reported by Purdie et al. (1994), a clinic in New
Zealand targeted parents with young children as potential
semen providers as they had ‘established a social structure for
their lives’ (Purdie et al., 1994). The targeted group can be
characterized as type A. They had a settled notion of their life
as indicated by being in a partnership that had a willingness
to parent children. As with other type A providers they were
of middle to upper socio-economic status, and they were of a
similar age to the proto-type A of clinic A (Purdie et al., 1994:
mean age 36 years, range 19–53; Daniels et al., 1996a: clinic
A, mean age 40 years, range 31–51).
There are also important parallels between the Purdie et al.
(1994) group, Daniels et al.’s (1996) clinic A and the French
CECOS system (Lansac and Le Lannou, 1994). In France
semen providers consist mainly of men in partnerships who
have children. It appears that relative stability, shown in part
by a long-term partnership and children, is an important
predictor of donation, at least for type A men.
It is reasonable to suggest that if a recruitment system is
structured to attract men in partnerships, with children, then
it should come as no surprise that those are the men who
donate. The crucial point is that recruitment systems can be
set up to attract donors who are not motivated by payment,
just as they have been set up in the past to recruit those for
whom monetary reward was the major consideration (Lui and
Weaver, 1996).
With the changes in the UK and the proposed changes in
Canada, type B providers will not be attracted to programmes;
if they are it will be in reduced numbers and only after
modifying or changing their motivation for being involved.
The choice facing clinics is to try to change or modify type
B motivations, increase the number of type A men, or some
combination of the two.
There has been an assumption that type B men will only
come forward if there is a monetary consideration for them,
but it needs to be noted that this is based on the information
gained from these men. They of course were recruited under
a particular system and will be very influenced by this — it
is what they know. We perhaps need to rethink this assumption,
and test the ideas out on those who are prospective providers,
as suggested by Lui et al. (1995) and Shenfield and Steele
(1997). The discipline of social marketing offers useful insights
to analyse and reconstruct our assumptions and conceptual
models.
Applying social marketing to the recruitment of semen
providers
One of the leading marketing theorists, Professor Philip Kotler,
describes marketing as ‘human activity directed at satisfying
needs and wants through exchange processes’ (Kotler, 1986).
The implication is that means other than monetary reward
exist to satisfy needs or wants of donors.
Kotler further describes social marketing as ‘a strategy for
changing behaviour’ (Kotler and Roberto, 1989). The key
difference is that marketing is more of a matching process,
while social marketing includes the matching process but has
more emphasis on normative behaviour modification.
The goal of social marketing practice is to move a targeted
population towards a desired behaviour. This is achieved
through the best possible understanding of the desired population whose behaviour it is wished to modify. Both marketing
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and social marketing acknowledge that real behaviour change
is difficult to achieve, hence there is an imperative towards
understanding and using people’s existing attitudes, beliefs
and values to encourage the adoption of desired behaviours.
The material that follows is based on knowledge drawn
from the field of social marketing that is consistent with new
approaches to public health and health promotion that places
emphasis on the empowerment of individuals, families and
communities to achieve well-being [see the Ottawa Charter
for Health Promotion (WHO, 1986)]. Many of the policies
and strategies from this field have been used in public health
promotion and are therefore a part of the health system in
general. On the other hand it does not seem as if this knowledge
has been used in the field of semen donor recruitment, perhaps
because it has not been seen to be necessary or appropriate.
A model of non-payment-based gamete recruitment
The basis of our non-payment-based gamete recruitment
approach is the replacement of a money–gamete transaction
process by an esteem–gamete transaction process. The discussion of marketing suggests that so long as esteem meets the
needs or wants of a donor, then an ethical transaction, where
all parties benefit, takes place.
Abraham Maslow (1954) sought to explain individual
motivation through a hierarchy of needs. In order of importance
they are described as physiological needs, safety needs, social
needs, esteem needs, and self-actualization needs. Our approach
characterizes donation as satisfying esteem needs such as
status, recognition, attention, importance and appreciation
(Maslow, 1954). In a needs-based approach to motivation,
money is a means to an end (Maslow, 1954). The needs
to which money is applied by providers in payment-based
recruitment systems have, to our knowledge, not been researched and any speculation we could offer would be of
limited value.
Groups or individuals who can give (or indeed take away) the
donor’s esteem are the donor himself, the donation recipient(s),
clinic staff, the donor’s family, the donor’s friends, the donor’s
colleagues, and society as a whole represented by the esteem
given by strangers. The use of ‘known’ or ‘personal’ donors
(Purdie et al., 1994), along with changing patterns in relation
to donor anonymity (Daniels and Taylor, 1993), suggest
that in the future the offspring of the donor could also
provide esteem.
A useful working analogy is the blood donation system in
New Zealand and other countries such as the UK and Australia.
Blood donation in New Zealand can be described by the
esteem that various groups give the donor. All the relevant
groups associated with blood donation are likely to give
esteem, in fact it is invited by the practice of giving donors a
blood-drop-shaped sticker which bears the legend ‘Be nice to
me — I gave blood today’. Another sticker states ‘Give
life — Give blood’. A smile in the street from a stranger
acknowledging one’s donation is a sign of transmission of
esteem as described by Maslow (1954), and at least anecdotally
can be seen as a powerful motive. This process also acknow2332
ledges and reinforces the social acceptability and value of
the activity.
The esteem-building process in blood donation contrasts
with some of the practices that have been employed with
semen donors. We are aware of clinics in which: donors were
directed to a toilet to provide their semen, to a room that was
locked from the outside or to a room that did not lock;
interaction was with staff who were embarrassed and uncomfortable about receiving the semen, who treated the exchange
in a very ‘business-like’ manner, or who had no or little
interaction with the provider.
Offering esteem to prospective donors needs to be accompanied by an understanding of the influences on the prospective
donor’s decision to donate.
The implication for the recruitment of gamete donors is that
the recruiter must seek to understand the societal messages,
including advertising and public relations, that are significant
in the decision to donate, as well as the people that play an
influential role. The use of advertising requires a great deal of
thought and planning, some programmes being frustrated
that their efforts to recruit via advertising (often involving
professional public relations personnel) have brought few
tangible results.
The recruitment approach we describe has three strategy
areas. The first concerns the prospective donors: understanding
who they are and what they are like. The second concerns
maximizing the benefits of donation to attract and retain
donors, through an esteem-based approach. The third concerns
understanding the influence of other people in the decision to
donate. A comprehensive recruitment policy will focus on all
these areas.
It should be noted that the following strategies have been
developed in relation to Western cultures and their applicability
to other cultures needs further consideration.
The prospective donors
Blood donation provides a guide to the upper limit percentage
of the population who might reasonably consider donation.
Between 5 and 6% of the New Zealand population, for
example, are blood donors. The numbers ceasing to donate
are about the same as the number who are added to the donor
register — between 0.5 and 1% of the population, or 27 593
people in the year to June 1996 (New Zealand Blood Transfusion Trust, 1996).
One way of communicating with potential semen donors is
to identify blood donors who are a reasonable fit to type A
characteristics. Blood donors have been targeted by some DI
programmes in the past, but we suggest in a rather passive
way, e.g. displaying a poster. This is similar to some advertising
which has the effect of the need being recognized, but does
not lead to a response (Purdie et al., 1994). The steps to this
could include a preliminary demographic screening, invitation
focus groups from the group that demographically matched
the required type, design of appropriate communication strategy. The communication strategy should consist of a mixture
of advertising, public relations, promotions, personal contact
(Kotler, 1986).
The above exercise can also be undertaken with existing
Semen donor recruitment
donors. The recruiter may find that this process, which of
itself gives esteem, may engage providers thought to be
motivated by money alone and encourage them to continue
donating on a different basis.
What becomes apparent with our emphasis is that recruiters
must become engaged in a continuous dialogue with donors
and identified groups that are potential donors to understand
them better. At the same time this may have an effect of
persuading some people to become donors during the process.
The above process is potentially time-consuming and more
expensive to establish. However, resource commitment should
reduce to a minimum once effective systems have been put in
place, as existing donors would be encouraged and are likely
to play an active role in recruiting others whom they know.
A recruiter with available resources, or who is forced to
change, could seek to identify segments of the wider population
that have a close fit to type A characteristics, and the social
organizations they belong to, and commence communication
with them. Census data in New Zealand, and no doubt
in many countries, provides powerful demographic data. A
partnership with a firm which targets customers with characteristics that show a close fit to the target market of the potential
donor is the kind of example that could be considered.
Recruitment outside the majority culture requires a specialized method best constructed in conjunction with the leaders
of the minority culture targeted.
Maximizing the benefits of donation through esteem
Since esteem is the basis of our transaction model it requires
a commitment to valuing donors themselves rather than just
what they produce. Hence the clinic and its staff need to
orientate thinking to that approach.
One implication of this concerns the collection of semen.
Some thought needs to be given to the space allocated for
semen provision, also to the personal dynamics involved in
handing over the container of semen: are the donors happier
to hand the container over to a person or leave it in the room;
is it an issue about who they hand the container to? Thought
could be given to home collection by medical courier. There
may be some advantage in encouraging partners to accompany
donors as a recognition and affirmation of the partner’s role(s)
in the donation process. These considerations are based on
discovering what current donors like and appreciate and
building this into the system. Such an approach further conveys
self-esteem in that it values the opinion of the participants.
Costs to donors have to be known so that they can be
balanced and exceeded by benefits that the gamete recruiter
offers donors.
The donor incurs costs that can include time, monetary,
social support and psychological costs (Frederiksen et al.,
1984), or, from a slightly different perspective, monetary, time,
and perceived (psychological, social and physical) risks (Kotler
and Roberto, 1989).
The major explicit financial cost is travel. All other things
being equal there is likely to be a negative relationship between
travel costs and number of donors on low incomes. This may
be an important consideration in contexts where desired ethnic
minorities are more prevalent in lower income strata.
Paying for travel expenses is different to paying for donation,
especially considering that type B providers are usually single
and that type A providers have partners and children to
consider. One New Zealand donor with a ‘young family and
the heavy financial commitments that this entails’ said that:
‘... some recompense for the rather lengthy trip to the none
too centrally located National Women’s Hospital would be
greatly appreciated’ (New Zealand Department of Justice,
1985). Thus the desire not to disadvantage his partner and
children seems to be the motivating factor for the desire for
expense payment.
The voluntary community work sector model offers a further
reason for acknowledging the propriety of expense payment,
at least in the New Zealand experience. Many organizations
that rely on volunteer labour, for example the St John’s
Ambulance Service, pay volunteers a mileage allowance. The
general position seems to be that volunteers should not be
required to impoverish themselves while performing a service
to the community, coupled with a pragmatic understanding of
the economic situation of volunteers.
Donation costs the donor his valuable time. One implication
of this is that the recruiter must seek to minimize time spent
on non-essential components of donation such as excessive
form-filling or waiting.
Physical risks, while real, are more easily quantifiable than
psychological or social risks. However, it is likely, particularly
with ova donation, that the perceived physical risks of the
relatively uninformed are of a magnitude far greater than the
actual physical risks. Hence the communication strategy must
instil trust and confidence in the recruiter’s message of the
actual physical risks involved.
The related area of new knowledge about physical wellbeing that a donor may receive has costs and benefits that
need to be considered. A recruiter may find that a potential
semen donor has a sexually transmitted disease or other illness.
The reaction of the potential donor is difficult to predict,
perhaps unhappy to have a disease while being grateful for its
early discovery. However, our approach of esteem-building
would, we argue, help to ameliorate the negative outcomes for
the potential donors: our approach attempts to give esteem to
those that even consider donation — that is a worthy act itself
whether it leads to donation or not. One Swedish clinic
conducts a full medical check-up of the donor as part of its
approach to recruitment, valuing the man as a whole person.
The check-up also has clear benefits for the donor within the
overall framework of the transaction.
One of the psychological risks referred to in the literature
is that of possible contact with offspring in the future (Lui et
al., 1995: Cook and Golombok, 1995). The secrecy that has
surrounded DI, and especially the identity of the donors, is
beginning to change (Daniels and Taylor, 1993; Daniels and
Lewis, 1996). The advent of parent groups of DI offspring
advocating their rights to information, and of donors prepared
to be identified, are all evidence of a changing culture.
Available research in New Zealand (Daniels, 1987; Purdie et
al., 1994 and earlier 1992), Australia (Kovacs et al., 1983;
Rowland, 1984; Daniels, 1989; Blood, 1992), Sweden (Daniels
et al., 1996c), the UK (Daniels et al., 1997), and one clinic in
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K.R.Daniels and D.J.Hall
the USA (Mahlstedt and Probasco, 1991) suggests that those
donors who are more open to possible contact in the future
are again type A donors. Therefore, at least for these men,
psychological risks may not be a major issue.
The influencers on the donation decision process
In terms of the initial decision to donate, some literature
suggests that the female partner is important in the role in
initiating the decision process, acting as a powerful influencing
role on the potential donors’ attitudes, and may have the power
of final decision or veto (Purdie et al., 1994). Regarding type
A providers, we know these women are probably heterosexually
inclined, have young children, and are at least middle class.
A New Zealand study (Purdie et al., 1994) accessed couples
through antenatal classes. Ways of communicating with women
and men with the highest potential could be through schools,
both of which have a large number of parent volunteers (which
is itself a positive indicator that a person would at least be
open to communication about donation). Groups that continue
to be potential targets include husbands of obstetrics patients
and men considering vasectomies. In France, 38% of donors
during the period 1973–88 were recruited as a result of being
referred by DI candidates (Le Lannou and Lansac, 1993).
Semen from such donors is not used for the referring couples’
own treatment. This method of recruitment has obvious potential and also needs to be considered.
In terms of esteem-building from the sources identified
above, there are many possibilities. Esteem enhancement by
people close to the donor would probably consist in part of
giving those people information, and reinforcement for their
involvement and assistance. There also seems to be a place
for esteem for the donor’s partner, and perhaps their offspring,
recognizing their part in the process. For some this may mean
sharing news of the birth of a child.
At the wider social level, there seems to be a need to create
a climate of acceptance of the diversity in the ways families
are formed within the wider population. The use of mass
media is a useful tool at raising awareness of diversity, the
first step in acceptance. The use of this material by television
programmes has a powerful impact on its normalization.
Recruiters will be better served being pro-active in the mass
media. A number of these strategies are likely to require a
pooling of resources between competing recruiters.
Jarillo and Stevenson (1991) identify two conditions for
successful co-operation: the co-operation has to increase efficiency, and co-operation has to be achievable and sustainable.
We suggest that the changes in the way recruitment may be
undertaken provide a necessity for collective planning, at least
in the initial phase of re-orientating to a non-payment-based
recruitment system.
The key to achieving and maintaining co-operation is trust
(Jarillo and Stevenson, 1991). This is achieved when the
expectations of the partners are that they will benefit in the
long-term, therefore the importance of ‘winning’ at each
decision point becomes reduced. Again as recruiters move
towards a new system a longer-term perspective should prevail.
2334
Conclusion
This paper has suggested that recent and proposed policy
changes in the field of gamete donor recruitment in two
countries require clinics to re-conceptualize the basis of their
recruitment programmes. We suggest that a number of studies
have shown that a desire to help infertile couples is a powerful
motive and that this is related to what we have called esteem
needs. This was summed up by one donor who said that
donors ‘need recognition’ and further that: ‘... while blood
donors receive recognition from the community in the form
of being held in high regard and being granted time off work,
there is no equivalent reward system for sperm donors’ (New
Zealand Department of Justice, 1985).
Several strategies are outlined based on a non-payment
approach to recruitment: these are offered for discussion
and debate.
References
Barratt, C.L.R. (1993) Donor recruitment, selection and screening. In Barratt,
C.L.R. and Cooke, I.D. (eds), Donor Insemination. Cambridge University
Press, Cambridge.
Blood, J. (1992) Survey of Sperm Donor attitudes to the Central Register.
Abstract of Presentation at the XIth Annual Scientific Meeting of the
Fertility Society of Australia, Adelaide, December 2–5, 1992.
Canadian Fertility and Andrology Society (1996) Response to Bill C-47:
Human Reproductive and Genetic Technologies Act. A submission to the
Canadian Government.
Canadian Government (1996) Bill C-47: Human Reproductive and Genetic
Technologies Act.
Cheal, D. (1988) The Gift Economy. Routledge, London.
Cook, R. and Golombok, S. (1995) A survey of semen donation: phase II —
the view of the donors. Hum. Reprod., 10, 951–959.
Daniels, K.R. (1987) Semen donors in New Zealand: their characteristics and
attitudes. Clin. Reprod. Fertil., 5, 177–190.
Daniels, K.R. (1989) Semen donors: Their motivations and attitudes to their
offspring. J. Reprod. Infant Psychol., 7, 121–127.
Daniels, K.R. and Taylor, K. (1993) Secrecy and openness in donor
insemination. Politics Life Sci., 12, 155–170.
Daniels, K.R. and Lewis, G.M. (1996) Donor Insemination: The gifting and
selling of semen. Social Sci. Med., 42, 1521–1536.
Daniels, K.R. and Haimes, E. (eds) (1997) International Social Science
Perspectives on Donor Insemination. Cambridge University Press,
Cambridge (in press).
Daniels, K.R., Curson, R. and Lewis, G.M. (1996a) Semen donor recruitment:
a study of donors in two clinics. Hum. Reprod., 11, 746–751.
Daniels, K.R., Curson, R. and Lewis, G.M. (1996b) Families formed as a
result of donor insemination: The views of the semen donors. Child Fam.
Social Work, 1, 97–106.
Daniels, K.R., Ericsson, H.-L. and Burn, I.P. (1996c) Families and donor
insemination: the views of semen donors. Scand. J. Social Welfare, 5, 1–9.
Daniels, K.R., Lewis, G.M. and Curson, R. (1997) Information sharing in
semen donation: The views of the donors. Soc. Sci. Med., 44, 673–680.
Editorial (1979) Artificial insemination for all? Br. Med. J., 2, 458.
Frederiksen, L.W., Solomon, L.J. and Brehony, K.A. (eds) (1984) Marketing
Health Behavior: Principles, Techniques, and Applications. Plenum Press,
New York.
Golombok, S. and Cook, R. (1994) A survey of semen donation: phase 1 —
the view of UK licensed centres. Hum. Reprod., 9, 882–888.
Human Fertilisation and Embryology Authority (1996) Fifth Annual Report.
London.
Jarillo, J.C. and Stevenson, H.H. (1991) Co-operative strategies: the pay-offs
and the pitfalls. Long Range Planning, 24, 64–70.
Kotler, P. (1986) Principles of Marketing. Prentice-Hall, Englewood Cliffs, NJ.
Kotler, P. and Roberto, E.L. (1989) Social Marketing: Strategies for Changing
Public Behaviour. Macmillan, New York.
Kovacs, G.T., Clayton, C.E. and McGowan, I. (1983) The attitudes of semen
donors. Clin. Reprod. Fertil., 2, 397–399.
Semen donor recruitment
Le Lannou, D. and Lansac, J. (1993) Artificial procreation with frozen donor
semen: the French experience of CECOS In Barratt, C.L.R. and Cooke,
I.D. (eds), Donor Insemination. Cambridge University Press, Cambridge,
pp. 152–169.
Lansac, J. and Le Lannou, D. (1994) Sperm Donation and Practice of AID in
France. J. Assist. Reprod. Genet., II, 231–236.
Lui, S.C. and Weaver, S.M. (1996) Attitudes and motives of semen donors
and non-donors. Hum. Reprod., 11, 2061–2066.
Lui, S.C., Weaver, S.M., Robinson, J. et al. (1995) A survey of semen donor
attitudes. Hum. Reprod., 10, 234–238.
Mahlstedt, P.P. and Probasco, K.A. (1991) Sperm donors: their attitudes toward
providing medical and psychological information for recipient couples and
donor offspring. Fertil. Steril., 56, 747–753.
Maslow, A.H. (1954) Motivation and Personality. Harper and Brothers,
New York.
New Zealand Blood Transfusion Trust (1996) New Zealand Blood Transfusion
Services Annual Statistics 1.7.95–30.6.96.
New Zealand Department of Justice (1985) New Birth Technologies: A
Summary of Submissions Received on the Issues Paper. Government Printer,
Wellington, New Zealand.
Nicholas, M.K. and Tyler, J.P.P. (1983) Characteristics, attitudes and
personalities of A.I. donors. Clin. Reprod. Fertil., 2, 389–396.
Novaes, S.B. (1989) Giving, receiving, paying: gamete donors and donor
policies in reproductive medicine. Int. J. Technol. Assess. Health Care, 5,
352–355.
Purdie, A., Peek, J.C., Irwin, R. et al. (1992) Identifiable semen donors —
attitudes of donors and recipient couples. NZ Med. J., Feb, 27–28.
Purdie, A., Peek, J.C., Adair, V. et al. (1994) Attitudes of parents with young
children to sperm donation—implications for donor recruitment. Hum.
Reprod., 9, 1355–1358.
ReproMed Limited (1996) Response to Health Minister David Dingwall’s
moratorium to ban the sale of human sperm. Company news release.
Rowland, R. (1984) Attitudes and opinions of donors on an artificial
insemination by donor (AID) programme. Clin. Reprod. Fertil., 2, 249–259.
Shenfield, F. and Steele, S.J. (1997) What are the effects of anonymity and
secrecy on the welfare of the child in gamete donation? Hum. Reprod., 12,
392–395.
World Health Organization (1986) The Ottawa Charter for Health Promotion,
1(4), iii.
Received on January 2, 1997; accepted on July 8, 1997
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