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Current birth registration systems fail to serve adequately the interests of those born as a result of gamete and embryo donation and surrogacy. In the UK, changes to the birth registration system have been piecemeal, reactive and situation-specific and no information is recorded about gamete donors. Birth registration has thereby become a statement of legal parentage and citizenship only, without debate as to whether it should serve any wider functions. This sits uneasily with the increasingly accepted human right to know one's genetic and gestational as well as legal parents, and the duty of the State to facilitate that right. This commentary sets out one possible model for reform to better ensure that those affected become aware of, and/or have access to, knowledge about their origins and that such information is stored and released effectively without compromising individual privacy. Among other features, our proposal links the birth registration system and the information stored in the Human Fertilization and Embryology Authority's Register of Information, although further work than we have been able to undertake here is necessary to ensure a better fit where cross-border treatment services or informal arrangements have been involved. The time for debate and reform is well overdue.

Background: While studies of ex-orphanage care show adverse effects on development, the longer-term impact on mid-life psychosocial functioning and physical health has not been established., Methods: Orphanage records provided baseline data on a sample of 100 Hong Kong Chinese girls who were subsequently adopted into the UK. A mid-life follow-up using standardised questionnaires and face-to-face interviews assessed current circumstances, life satisfaction and mental and physical health outcomes. Comparisons were made with age-matched UK-born adopted and nonadopted women., Results: Half the group spent between 1 and 2 years in orphanages, average age at adoptive placement was 23 months and 72% participated in the follow-up. Despite this poor early start, mid-life outcomes were commensurate with the comparison groups in terms of mental and physical health measures. Serious psychiatric and social difficulties were largely absent. Although the timing and extent of exposure to orphanage care did not influence outcome, participants' reports of poorer quality adoptive family experience and a negative view of their adoption were significantly associated with poorer mental health outcomes (difference in means = 0.76, 95% CI 1.33-0.19, p = .01; difference in means = 1.2, 95% CI 0.68-1.73, p = .01, respectively)., Conclusions: Moderately depriving orphanage care did not predict enduring adverse consequences in mid-life but subsequent poor adoption experience was associated with outcome., (© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.)

The debate about the information needs of donor-conceived people is reaching an important stage. The recent Government consultation about providing information on sperm, egg and embryo donors (Department of Health, 2001) has meant that the subject is receiving much public attention. More importantly, it is becoming increasingly evident that donor-conceived people themselves are beginning to have a voice about their experience of not being able to access basic information about their genealogical heritage. Gollancz (2001) raised some pertinent issues about the rights and needs of donor-conceived people to have access to identifying information about their genetic parents. Recent research is also providing powerful messages about the information needs of donor-conceived people. For example, the study by Turner and Coyle (2000) of 16 donor-conceived adults between the ages of 26 and 55 asked about identity experience, including issues of secrecy and disclosure of their donor-conceived status, and also investigated the experience of trying to trace and search for a genetic father (the donor), the current perception of donor insemination and how families could manage openness versus secrecy. The findings identify many similarities between adopted and donor-conceived people. But in what ways is adoption similar to donor conception? And can donor conception learn anything from adoption? This paper will explore some of the relevant lessons learned from adoption to draw out some of the issues, experiences and dilemmas shared by adopted people, donor-conceived people and their families, using the findings of The Children's Society's research study.