‘Okay, but Which One Is Your Mom?’ Experiences of Lesbian-Parent Families and Assisted Reproduction Techniques

Abstract

In Chile, lesbian-parent families have faced legal and social advancements as well as challenges, generating new dynamics through assisted reproduction. The reproductive justice framework allows for an analysis of the inequities and injustices experienced by LGBTIQA+ people in relation to their reproductive rights. Objective: To analyze the narratives of lesbian-parent families who have accessed parenthood through assisted reproduction techniques within the Chilean healthcare system, identifying barriers and facilitators in the process, as well as possible instances of discrimination. Methodology: This research adopted a qualitative approach with a descriptive scope and was based on a constructivist paradigm, utilizing a narrative design and analysis. Four lesbian-parent families participated, selected through purposive or convenience sampling. Results: The findings revealed that the main barriers were related to health insurance coverage and social and geographical factors. Among the key facilitators were support networks, educational level, and healthcare professionals’ guidance. Discussion: The study highlighted the presence of inequalities affecting the exercise of parenthood and the right to form a family, shaped by institutional and social barriers from a reproductive justice framework. Conclusions: The study underscores the need to advance inclusive public policies and systemic changes that recognize and protect family diversity in Chile. Furthermore, it highlights the role of narratives as a tool to make visible and challenge the inequalities surrounding lesbian parenthood.

1. Introduction

In Chile, the community of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and other sexual dissidences, hereinafter LGBTIQ+, has historically been discriminated against and rendered invisible in society, as it challenges the predominant heterosexual, patriarchal, and hegemonic culture [1,2,3,4]. This is the result of various factors, such as social constructions that emerge from social interaction, culture, and the relationship between knowledge and action, which gradually create shared meanings of reality. Similarly, the social perception of the LGBTIQ+ community has been shaped by social stereotypes, which correspond to popular beliefs about certain characteristics that define a social group. These stereotypes negatively impact the community, placing it at a disadvantage compared to the rest of society, and make it difficult to form LGBTIQ+ families [5].

The situation of the LGBTIQ+ community in Chile is similar to that found in other South American countries. In most countries in the region, patriarchy has a strong influence on cultural contexts and family models, fostering stigma toward LGBTIQ+ individuals as being deviant or incapable of forming a family [6]. However, when it comes to the actual possibilities for family formation and reproductive rights, the outlook is uneven, with some countries having more advanced parenting laws than others within the same region [2,4]. For example, in Argentina, Colombia, and Brazil, families formed by same-sex couples have gained legal recognition, which facilitates family formation and the legal legitimization of diversity [7,8]. Meanwhile, in countries like Ecuador, the traditional model of a heterosexual family predominates, even preventing same-sex couples from adopting children [8].

In the specific case of Chile, a highly heteronormative legal and medical culture still prevails, relegating diverse families to a condition of second-class citizenship [1]. LGBTIQ+ activism has played a key role in achieving laws and public policies that protect the rights of this group through the articulation of media, judicial, and legislative strategies, which remain insufficient [9]. In 2021, the Equal Marriage Law was passed [10], allowing same-sex couples to marry, adopt, and facilitate the recognition of their children. Equal marriage has had a positive impact on hundreds of Chilean families; however, it has not resolved other tensions and conflicts that affect the group in very diverse ways regarding parenthood and filiation. By emphasizing marriage over filiation, some lesbian activists felt ignored; access to reproductive technologies remains limited; and trans mothers and fathers are still largely overlooked by the law [9].

In this context, the exercise of parenthood within the LGBTIQ+ community has been particularly affected. Parenthood, understood as the right and the ability to form a family and fulfill caregiving and child-rearing roles, has traditionally been associated with heteronormative models, which have excluded and marginalized diverse families [11]. A recent study by Alday-Mondaca et al. shows that people of diverse gender identities face multiple obstacles in the exercise of motherhood/fatherhood in Chile, including the hegemonic Christian model of gender relations, machismo, stigma, political conservatism, legal obstacles, and discrimination [11]. Within this diversity, lesbian-parent families—composed of lesbian women who take on parental roles—face specific challenges. These families must not only contend with the lack of social and legal recognition but also with stereotypes and prejudices that question their ability to raise children and form functional families. This is despite numerous studies demonstrating that lesbian-parent family structures are equally capable of providing emotionally supportive and safe environments for child development [12,13,14,15].

This research specifically focuses on lesbian-parent families, analyzing how the historical violation of LGBTIQ+ community rights has impacted their right to parenthood in Chile [16,17]. From the framework of reproductive justice and based on the premise that a heteronormative perspective still prevails in this area, the study seeks to explore how the value assigned to lesbian-parent families differs from that of heterosexual families, perpetuating inequalities and limiting the full exercise of their rights.

1.1. Reproductive Justice and Assisted Reproduction

Reproductive justice has been defined, in simple terms, as the freedom and right to have or not have children, as well as to raise them in a healthy and safe environment for all individuals and couples [18]. This perspective requires examining how reproduction is restricted within stigmatized or vulnerable populations, thereby impeding the full realization of reproductive rights [19]. For the same reason, reproductive justice has long recognized the importance of an intersectional analysis of all the conditions that affect the exercise of reproductive rights [19].

This perspective was conceptualized in 1994 by a group of Black women in Chicago, identifying as Women of African Descent for Reproductive Justice, as a response to the limitations of more traditional pro-choice activism [20]. Their holistic approach includes not only the right to remain childless, but also the right to bear and raise children in a safe and supportive environment [21]. The sociopolitical context and available resources are critical to understanding which groups receive protection of their reproductive rights and which do not, influenced by factors such as class, disability, and race [21].

Unlike traditional activism focused solely on abortion access, reproductive justice examines and challenges broader public policies that create reproductive restrictions, such as the prison-industrial complex, food insecurity, gender binaries, environmental racism, access to health insurance, and social assistance programs [20]. Thus, reproductive justice not only aims to guarantee rights but also to dismantle the systems of oppression that condition access to reproduction and parenthood.

In academic terms, reproductive justice constitutes an interdisciplinary framework that combines reproductive rights with social justice, adopting an intersectional perspective to consider individual needs, and orienting towards human rights to ensure that they are protected and respected [21]. This need for an intersectional approach is reinforced by observing that LGBTIQ+ women have historically been ignored in research on sexual and reproductive health, despite having specific needs that must be addressed to improve education and health services for them [22].

In this context, assisted reproductive techniques (ART) can be understood as a concrete expression of reproductive justice because they expand the possibilities of exercising the right to form a family beyond the dominant heterosexual and cisgender model. From this perspective, it is recognized that systems such as heteronormativity and cisnormativity establish structural barriers that hinder LGBTIQ+ people’s access to ART [23,24]. However, in different countries around the world, access to these techniques has evolved from a medical paradigm focused exclusively on heterosexual infertility to a human rights-based approach that incorporates the physical and mental health of all people, regardless of their sexual orientation or identity [25].

1.2. Assisted Reproduction in Lesbian-Parent Families

One of the ways in which families from this community can access parenthood is through Assisted Reproductive Techniques (ART) [21,22,23,24,25,26]. These techniques are understood as a set of biomedical methods that act as facilitators or substitutes for the biological processes involved in human reproduction, initially created to address infertility [27]. There are various ARTs, but for the purposes of this study, three are mentioned: artificial insemination (AI), in vitro fertilization (IVF), and reception of oocytes from the partner (ROPA).

Firstly, AI is considered a low-complexity treatment and consists of artificially introducing sperm into the uterus of the gestating person so that fertilization occurs through conventional means, after undergoing various preparatory procedures [28]. Secondly, IVF is a more complex and costly technique that involves extracting an oocyte, fertilizing it with a sperm sample, and forming an embryo in a controlled laboratory environment before transferring it to the gestating uterus [28]. A subtype of this technique is the ROPA method, where one person in the couple provides the oocytes, while the other is the gestating person who receives the embryos [29].

However, recent studies conducted abroad show that lesbian couples using ART often face multiple difficulties. In the United States, they face multiple disproportionate barriers, including insurance coverage for fertility treatments, federal regulations for sperm donation, and legal definitions of parenthood [30]. In Canada, research shows that greater support from healthcare professionals is needed, that the system is primarily designed for the needs of heterosexuals, and that the procedures are quite expensive [31]. A study conducted in Brazil indicates that lesbians who desire to become mothers are more interested in importing sperm from the U.S. sperm bank, due to the supposedly limited availability of samples and because they provide more information about the donors [32]. Furthermore, reproductive experiences are impacted by diverse intersectional realities of race, gender, sexuality, and class [23].

From a legal perspective, parentage recognition establishes filiation, which is defined as the legal bond that connects a child to their parent(s). This legal determination is fundamental since it entails rights, duties, and responsibilities [33]. Access to parenthood through ART is affected by the lack of legislation in Chile, as there are no public policies regulating these techniques nor legal frameworks protecting the sexual and reproductive rights of same-sex parent families. Currently, the only legal provision is Article 182 of Law No. 21,400 on Marriage Equality [10,34], which states that “the filiation of a child born through the application of assisted human reproduction techniques shall be determined concerning the two persons who have undergone such procedures” [10] (p. 3).

According to Jesam et al. [34], theoretically, same-sex couples and LGBTIQ+ individuals without a partner in Chile have the same rights to access ART as heterosexual couples experiencing infertility. However, these same authors point out that, in practice, the traditional nuclear family model remains dominant, posing challenges for those within the LGBTIQ+ community who wish to pursue parenthood through this means.

An example of this issue is that to access coverage from the National Health Fund (FONASA), a diagnosis of infertility is required for one or both members of the couple, excluding all LGBTIQ+ families, as they do not necessarily meet this criterion [35]. The same occurs with the Chilean private health system, private health insurance providers that allow individuals to access healthcare services through contributions and the contracting of medical services [36].

Given this, accessing coverage for ART requires a medical certification of infertility and prior attempts with low-complexity treatments that have proven unsuccessful before qualifying for high-complexity techniques. It is important to highlight that Chilean private health system providers are required to offer at least the ART services covered by the DAP voucher (Diagnosis-Associated Payment) from FONASA [37].

In contexts like Chile, where legal recognition of LGBTQ+ families and equitable access to ART are still limited [24], ensuring their availability and inclusive regulation constitutes a necessary response to advancing equal rights. In this sense, the possibility of resorting to assisted reproduction allows lesbian women, for example, to create biologically related families, thus becoming an essential tool for realizing the principles of reproductive justice [23].

Based on the above, the objective of this research is to analyze the experiences, barriers, and facilitators encountered by lesbian-parent families in Chile when exercising their right to parenthood through assisted reproduction techniques, considering the social, cultural, and legal dynamics that influence their recognition and legitimacy within a heteronormative context.

2. Materials and Methods

This research is framed within a qualitative approach aimed at describing and understanding the particularities of the studied group. This approach is particularly relevant for exploring and making visible the unique experiences of lesbian-parent families in Chile. The study has a descriptive scope to identify and highlight the key dimensions of the phenomena, contexts, and situations examined. It is based on the constructivist paradigm, which emphasizes the construction of shared meanings derived from social events [38,39].

The methodological design adopted was narrative, focusing on individual experiences expressed through personal accounts. This approach allows for understanding how participants organize, interpret, and communicate their life experiences [40]. Data collection was conducted through in-depth narrative interviews carried out over a period of three months.

2.1. Population and Selection Criteria

The target population consisted of LGBTIQ+ families who have accessed parenthood through ART within the Chilean healthcare system. Participants were selected through purposive non-probabilistic convenience sampling [41], in which the research team defined the participating families based on pre-established inclusion criteria.

The inclusion criteria were as follows:

• LGBTIQ+ adults in relationships self-identified as lesbian parents who have formed their families through ART within the Chilean healthcare system.
• LGBTIQ+ adults in relationships self-identified as lesbian parents who are currently undergoing pregnancy through ART within the Chilean healthcare system.
• Adults who self-identify as lesbian mothers, whether single or in polyamorous relationships, who are currently undergoing pregnancy or have previously had children through ART within the Chilean healthcare system.

As an exclusion criteria:

• LGBTIQ+ adults in relationships self-identified as lesbian parents who have formed their families through ART abroad.
• LGBTIQ+ adults in relationships who do not identify as lesbian parents.
• Single lesbian or lesbian in polyamorous relationships who did not wish to have children or were not undergoing a pregnancy process.

It is important to clarify that although the third inclusion criterion was considered for the selection of participants, the research team was unable to find anyone who was in this situation, therefore the study sample was only made up of cisgender lesbian couples.

2.2. Interviews and Proposed Analysis

The in-depth interviews were conducted in a confidential and trusting environment, allowing participants to express their experiences and perspectives freely and in detail. Each interview lasted between 60 and 90 min, was recorded, and subsequently transcribed for a comprehensive analysis. The research team ensured the protection of personal data and obtained informed consent from all participants at every stage of the study.

The proposed analysis followed a narrative approach structured at three levels: thematic, structural, and dialogic [42].

• Thematic analysis focused on identifying and organizing the core content of the narratives, highlighting recurring themes and key experiences shared by participants.
• Structural analysis examined the organization and structure of the stories, observing how events were sequenced and framed within participants’ lived experiences.
• Dialogic analysis explored the interaction between interviewees and the research team, considering how meaning was constructed within the conversation.

The analytical process began with a general reading of all interview transcripts to familiarize the researchers with the content and gain a holistic understanding of the experiences described. Following this, paragraphs were numbered and categorized according to the themes addressed in each segment, enabling an initial coding of key topics.

A second, more in-depth reading was conducted, allowing for the refinement of the analysis and the consolidation of eight key categories related to the most relevant themes.

The study’s data collection consisted of four in-depth interviews with lesbian-parent couples. Participants were contacted via email and social media, ensuring a selection process that maintained their privacy and respected their informed consent.

Through this proposed analysis, the study aimed to deconstruct and understand the lived experiences of lesbian-parent families, emphasizing the complexities, challenges, and inequalities they face within the Chilean socio-legal and cultural framework.

Interviews were conducted with each of the couples contacted, with both mothers participating simultaneously. The interview was structured with open-ended questions about the following four aspects: family history and background, assisted reproduction process, facilitators, and obstacles.

2.3. Ethical Aspects

Regarding ethical guidelines, this research was based on international regulations, including the Declaration of Helsinki [43], the International Ethical Guidelines for Biomedical Research Involving Human Subjects [44], and the Yogyakarta Principles [45]. These frameworks establish essential guidelines for research involving human participants by setting standards and principles to protect their rights, dignity, and well-being, ensuring privacy, confidentiality, informed consent, and autonomy, among other considerations.

The ethical criteria followed in this study included protection through privacy and anonymity, confidentiality of information, informed consent, provision of information on risks and benefits, respect for autonomy and well-being, and voluntary participation [46]. All these aspects were incorporated into an informed consent form, which was presented and signed by participants before the interviews began.

Based on these considerations, a research project was developed and submitted to the Ethics Committee for Human Research at the Faculty of Medicine of the University of Chile. It was approved in September 2023 under protocol number 079-2023.

2.4. Positionality of the Authors

Positionality refers to how the researcher makes sense of the problem, in relation to the study participants, the research design, the context, and the process [47]. So we consider it important to clarify our position. This research was conducted by a team of six health professionals, consisting of a non-binary gay person, a cisgender gay man, and four cisgender women (three heterosexual and one lesbian). It is taken into account that the gay researcher is a member of a same-sex parent family and is the initial motivation for the research topic, given his closeness to the topic and his knowledge of the difficulties experienced by LGBTIQ+ families in Chile.

Regarding the roles of each member, it was decided that the four women would conduct the interviews with the lesbian participants, since there is evidence showing that gender concordance between interviewer and interviewee decreases social distance and can improve rapport, comfort, and data quality [48,49,50]. The interviewers had no prior relationship with the women who participated. It should also be noted that none of the researchers interviewed are mothers, so the interviews were conducted openly, without prejudice, and with great curiosity to know the details of the experiences reported. The interviewers assumed a critical and situated perspective, which influenced the listening and interpretation of the narrative material [47].

3. Results

3.1. Characterization of the Participating Families

The study included the participation of four lesbian-parent families who accessed parenthood through ART in Chile. Participants were selected through purposive non-probabilistic sampling, considering the diversity of methods used, geographical location, and the period in which the ART process took place. The families were coded as families A, B, C and D, and the participants were assigned the numbers 1 and 2 according to their membership in each family. Below is a general description of the families interviewed:

• Family A: A1 and A2—Self-managed Parenthood

A1 and A2 always knew they wanted to start a family, but in 2014, access to assisted reproduction for lesbian-parent couples in Chile was still highly restricted. Faced with institutional barriers and a lack of legal recognition, they decided to undergo an at-home artificial insemination, a process that allowed them to maintain control over their path to parenthood without relying on the healthcare system. Over the years, they have built a support network that has helped them navigate the challenges of parenting in a context that continues to render diverse families invisible.

• Family B: B1 and B2—Seeking Recognition in the Healthcare System

B1 and B2 opted for artificial insemination at a clinic, a process that in 2016 was still complicated for same-sex couples. Although they were able to access the technique, they faced administrative barriers and discriminatory attitudes within the healthcare system. However, their determination and the support of their close circle helped them overcome these obstacles. Today, they hope their story will contribute to raising awareness about the realities of lesbian-parent families and promoting changes in public policies.

• Family C: C1 and C2—Sharing Motherhood Through the ROPA Method

C1 and C2 found the opportunity to share biological motherhood through in vitro fertilization (ROPA method). This method, which allows one mother to provide the egg while the other carries the pregnancy, provides them with a unique experience of bonding with their child. However, the journey was not easy: they encountered high costs, bureaucratic hurdles, and a lack of legal recognition of both mothers from birth. Despite these challenges, their experience has strengthened their bond and motivated them to advocate for greater equity in access to parenthood.

• Family D: D1 and D2—Accessing ART Outside the Metropolitan Region

For D1 and D2, accessing in vitro fertilization (IVF) in the Araucanía Region posed an additional challenge. Unlike families living in the capital, access to specialists and assisted reproduction centers was more limited, requiring travel and additional costs. Their path to parenthood, which took place between 2022 and 2023, has been marked by resilience and the search for alternatives in a context where heteronormativity continues to dominate the healthcare system. Their story highlights territorial inequalities and the need to expand access to ART in regions outside the country’s central areas.

3.2. Narrative Analysis

The following section presents the results from a narrative analysis, considering the three levels proposed by Riessman [51]: structural, dialogic, and thematic.

Regarding the structural analysis, the in-depth interviews were structured around key questions designed to gather information on ART processes. However, the narratives were conveyed chronologically, with events recounted in the first person and interwoven with personal anecdotes. In some instances, the participants reflected on past experiences in greater depth to provide as much precise information as possible. The narratives mentioned various individuals involved in the process, such as support networks and healthcare professionals.

In the dialogic analysis, it was evident that the interviews were conducted through an open and horizontal conversation between interviewees and interviewers. The format aimed to create a welcoming and comfortable atmosphere, fostering openness to personal experiences and opinions. Participants led the conversation throughout the interviews, while the interviewers played the role of facilitators. Notably, both the interviewees and interviewers were women, which may have contributed to establishing a sense of trust.

Finally, in the thematic analysis, the study’s specific objectives served as guiding principles for identifying the most relevant data. Through categorical analysis, the content was divided into four main thematic sections:

• Experiences and ART methods: Includes expectations and lived experiences related to access to assisted reproduction.
• Barriers: Identifies the challenges encountered during the process.
• Facilitators: Highlights factors that facilitated access and positive experiences during assisted reproduction.
• Strategies for family configuration: Actions taken to navigate discrimination and structural inequalities affecting lesbian-parent families.

3.3. Experiences and ART Methods

Family A underwent at-home artificial insemination (IAA) in their residence, located in the Metropolitan Region. The process was guided by a midwife from A1’s Family Health Center (CESFAM), who provided all the necessary instructions and recommendations to carry out the procedure at home.

The donor was a friend, as they lacked the financial resources to go through a fertility clinic. Initially, the plan was for him not to play a paternal role in the child’s life but only to provide his last name for inheritance purposes. However, over time, he has come to be recognized as part of the family, which makes this family one with two mothers and one father:

“C (the donor) now sees her more often, especially as she has grown up, because in the end, he has been very respectful of what we agreed on (…) after all, he is someone who loves her, who is present, who cares for her, so why would I take that away from her? They have developed a beautiful father-daughter relationship.”

(A1, Family A)

Family B underwent artificial insemination at a clinic they found through a magazine, selecting it based on its respectful and non-discriminatory treatment. The clinic was located in the Metropolitan Region, in the Farellones area. For sperm selection, B1 and B2 chose a donor from the California Sperm Bank, which had an agreement with the clinic. They opted for an open donor so that their child would have the opportunity to contact him upon turning 18. Additionally, through the bank’s network, they were able to connect with other families who had used the same donor, which they found reassuring, as their daughter has seven biological siblings. In the case of hereditary diseases or medical complications, they now have a support network:

“We got in touch during the pandemic… I remembered that we had registered at some point in the California Sperm Bank, which has a sibling registry. So, you register your pregnancy there, and if other people who used the same donor also sign up, you can connect with them.”

(B2, Family B)

Family C has had two pregnancies through ART using the ROPA method, with the first pregnancy being the primary focus of the interview. Both mothers are medical professionals and were able to gather information about reproduction clinics through recommendations from gynecologist friends and other colleagues. They underwent treatment at two clinics in Santiago, as their first attempt was unsuccessful, leading them to choose a clinic with more advanced technology. Like Family B, they purchased gametes from a sperm bank affiliated with the clinic and chose an open donor, valuing the child’s right to know their genetic background, which is also understood as a right within the framework of reproductive justice:

“We specifically chose a donor who was… fully open in terms of identity so that when L turns 18, she can reach out to the donor and obtain all the relevant information, including his full name […] It’s about her right to her own identity or any questions she may have in the future. It was very important for us that L could access that information.”

(C1, Family C)

Finally, Family D underwent IVF at a clinic in Viña del Mar, a city located in the Valparaíso Region, approximately two hours from Santiago. A relative recommended the clinic. Since they live in southern Chile, they had to travel long distances to undergo assisted reproduction, making it difficult for both mothers to participate in the entire process:

“Well, F accompanied me to the first in-person appointment, which was on January 3 this year. But due to work commitments, F had to return to Victoria, and I stayed in Viña because… there are three key stages in the process. I could have traveled back and forth, but all that commuting would have affected the procedure…”

(D2, Family D)

Like Families B and C, they selected a donor from the clinic’s database, ruling out the possibility of using a known donor out of concern that he might later seek legal parental recognition. Unlike the other families, this clinic did not offer the option of an open donor, so they had access only to the donor’s medical history and general characteristics.

The collected experiences reveal that families used different ART methods, that these procedures were mostly conducted in the private healthcare sector, and that there was a preference for selecting an open donor. On the other hand, new family arrangements demonstrate the existence of family diversity, which is expressed in the case of the donor who was a friend of the couple and who fulfills a “paternal role” or by the possibility of having “genetic siblings” abroad.

3.4. Barriers

3.4.1. Health Insurance and Coverage Barriers

Of the four families interviewed, three were enrolled in ISAPRE (private health insurance) at the time they began the assisted reproduction process, while one was covered by FONASA (public health insurance). Despite having health coverage, none of them received full financial support for the procedures associated with ART. For example, the gestational mother from Family B decided to switch to an ISAPRE plan that included maternity coverage; however, it did not cover hormone treatments or other necessary procedures, forcing them to pay for most expenses out of pocket.

“At that time, ISAPRE plans were not even required to include maternity coverage. So, I switched to a plan that had coverage, but the coverage was terrible…”

(B2, Family B)

Meanwhile, Family D mentioned that they had the opportunity to access the PAD benefit (a subsidy provided to couples experiencing difficulties conceiving). However, since they were enrolled in ISAPRE, they were unable to qualify for it:

“At that moment, we saw it as a possible option because there was the PAD voucher through FONASA, but we couldn’t access it because I was in ISAPRE at the time.”

(D1, Family D)

However, even the family that underwent the procedure through FONASA encountered coverage issues, with only approximately 15% of costs being reimbursed. Additionally, there was a widespread perception that accessing fertility treatment through FONASA is complicated and bureaucratic:

“There’s the option of doing fertilization through FONASA, but I don’t know how complicated it is… It seems like you need to go through a lot of steps, like, you need to have a lot of things in place before you can even qualify for insemination.”

(A1, Family A)

Additionally, Families B and C had to pay for other medical procedures prior to ART, including treatments for conditions that posed risks to pregnancy. ISAPRE covered these surgeries but in the case of Family B, the treating physician had to justify the operation by omitting any reference to ART.

“So, he said it would be better to have the surgery first, and then… it would be more likely that there wouldn’t be any issues. So, we did that… And all of this was outside any possible health coverage. The surgery itself was covered because… it was classified as a standard medical procedure, so ISAPRE covered it and all that, but […] the doctor labeled it as treatment for chronic pain.”

(B1, Family B)

Finally, it is important to highlight that in all four interviews, participants emphasized the high cost of purchasing donor samples, which is not covered by either the public or private healthcare systems. This demonstrates that the conditions for accessing health services (regulated by private insurance) limit who can reproduce and how, giving priority to heterosexual couples and those with sufficient financial means.

3.4.2. Social Barriers

Participants mentioned multiple situations and concerns that could be understood as social barriers, often linked to the fear of forming a diverse family. Some of these barriers stem from ignorance and discrimination by others, while another significant obstacle is the perceived risk of discrimination.

The most evident barrier was that not all assisted reproduction services accepted same-sex couples, which limited the number of clinics they could access:

“There were only two or three places where they offered assisted reproduction treatments for people who were not heterosexual couples. For example, traditional clinics would still require the woman and her husband, or the father, not just a donor.”

(A2, Family A)

Although discrimination from healthcare professionals was not the majority perception, some participants pointed out the lack of training, which could lead to pathologizing attitudes and a lack of empathy. Participant D2 from Family D shared her experience:

“In the emergency room, I was seen by a gynecologist (…) and he made a rather unfortunate comment. First, he was surprised that I had undergone in vitro fertilization. I told him it wasn’t due to infertility, but because I had a female partner. (…) Then he asked me about my profession. I told him I was a biology teacher, and he said, ‘Oh, how unnatural for a biology teacher to resort to this.“

(D2, Family D)

Similarly, participants from Family B recounted that they began their fertility treatment around 2014, and their midwife had to learn alongside them about options for same-sex couples. This highlights how assisted reproduction was originally designed for heterosexual couples:

“It all started because the midwife had to open her perspective a little because, in her world, this wasn’t even an option. She told me that she couldn’t refer us to an insemination center because those places were designed for heterosexual people.”

(B1, Family B)

Another barrier mentioned was the lack of training among Civil Registry officials, making it difficult for families to register their children. C1 from Family C detailed that some staff members were not prepared to handle registrations for same-sex parent families, and the necessary forms were not always updated:

“It was really frustrating to register our daughter at the Civil Registry. Some of the original documents still list ‘father’ and ‘mother’ by default. […] Now, when you request a birth certificate, it shows ‘Parent 1’ and ‘Parent 2,’ but in our particular case, it wasn’t as difficult. However, I know many other LGBTI families who faced a really hard time at the Civil Registry with untrained officials who still make ignorant remarks about marriage equality.”

(C1, Family C)

As a final social barrier, B2 from Family B mentioned that only their close friends and family knew about their sexual orientation and family plans, but they had not disclosed it in their workplaces. This indicates that coming out in a professional setting is perceived as a greater risk:

“We were in a different situation because, of course, with our friends and family, we were out of the closet, but not at work. […] We were really aware of it, and it was something we told ourselves: ‘Before Laura is born, we have to resolve this issue because it’s our problem. It can’t be that later L won’t be able to call us ‘Mom’ in public.”

(B2, Family B)

3.4.3. Geagraphic Barriers

Finally, geographic distance and the limited availability of assisted reproduction services were also considered barriers by some participants. According to the families’ experiences, a few years ago, one of the only clinics that provided ART procedures for LGBTIQ+ families was located on the road to Farellones, in the mountainous area of the Metropolitan Region, approximately one hour from Santiago. Family B reported that accessing this clinic was not only costly in terms of transportation but also time-consuming:

“But it was like going to the end of the world, every time we went, it felt like a road trip.”

(B1, Family B)

Similarly, participants from Family D, who are from southern Chile, had to undergo their entire assisted reproduction process in Viña del Mar. Although their decision was not directly influenced by this factor, they later discovered that there were no assisted reproduction clinics in the Araucanía region. They also noted that healthcare access difficulties extend beyond ART and affect other medical services within their region:

“The problem is the centralization, you know? Everything has to be in the Metropolitan or Valparaíso region. […] Here in Victoria, we had to go to Temuco for all the medical tests because there aren’t many clinics here that offer these services. Those specialists simply aren’t available here, those gynecologists aren’t here, so that was also a big barrier for us.”

(D1, Family D)

The barriers described show that access to ART is not enough; true reproductive justice also requires there being no practical barriers to exercising the right to reproduce.

3.5. Facilitators

3.5.1. Support Networks

The three families living in Santiago participated in an LGBTIQ+ WhatsApp group, which allowed them to connect with others who shared similar experiences. They identified this group as a significant source of support in various aspects of parenthood. It served as a valuable resource where members shared information about schools, preschools, doctors, and positive or negative experiences in different spaces, helping create safe environments for participation.

“It led me to look for this group of other families to show my daughter that she wasn’t the only one (…) She can’t grow up without seeing other families like hers, feeling so… so left out.”

(A1, Family A)

For a similar reason, Family B sought to maintain contact with other families who had conceived children using the same donor. Most of these families live in the United States, except for them, and they are part of a Facebook community.

“I think it’s good for her, at least knowing that they are there. And who knows… I imagine that in adolescence, when you’re questioning everything in life, she might appreciate having that connection—not necessarily with us, but with someone else who might be experiencing something similar.”

(B2, Family B)

Another essential support system mentioned by Families C and D was family and friends. C1 pointed out that neither of their families were homophobic, acknowledging that this is not the case for everyone and that family rejection can be a significant obstacle for some. In the case of D1 and D2 from Family D, they shared that their family support network was fundamental during the process, as they had relatives in the region where they underwent assisted reproduction, who provided housing and emotional support for the gestational mother throughout that period.

“We are very fortunate in many ways because our families… none of them are homophobic, we never had any issues. I get along very well with my father-in-law… and Ceci with my parents as well… but there are many families who don’t have that reality. It’s tough to have to rely on others’ goodwill when legal filiation rights don’t exist. If I were to die… L would have been left in legal limbo… she would’ve been under my parents’ care, and that thought really disturbed me.”

(C1, Family C)

On the other hand, Families A and B reported that while family support was not a facilitating factor in their process, it was not a barrier either. B1 and B2 mentioned that by the time they decided to have a child, their families had already had time to adjust and had gone through the process of accepting their sexual orientation.

“I mean, fundamentally, neither of us were in our first same-sex relationship. So that process had already happened before. In the end, my family liked you, they accepted you, and in your case, it was something similar. So, by then, there was less resistance.”

(B1, Family B)

3.5.2. Educational Level and Access to Information

Regarding education, both mothers in Family C are medical professionals, and one of the mothers in Family D is a biology teacher. They identified that having university studies related to the subject was a facilitating factor, as it allowed them to fully understand the procedures. They noted that technical or specialized language is often used when explaining these methods, which can be a challenge for those without a background in science or healthcare.

“I was surprised by how little they explain. And I thought… maybe because we’re doctors, they don’t explain as much to us. But friends who have undergone fertility treatments also said they weren’t given much information, as if they were expected to already know everything. So I think education level plays a big role—it’s a major facilitator.”

(C1, Family C)

3.5.3. Professional Support During the Process

Another facilitating factor identified by the families was the support and guidance from healthcare professionals during the reproduction process. For example, Family A credited their ability to access parenthood to the guidance of a midwife at their local CESFAM (Family Health Center).

Additionally, in two interviews, participants emphasized the importance of psychological therapy, as the experience can be emotionally challenging, even with other support systems in place.

“I had my wonderful psychologist (…) and I would tell her about these things, and she would say, ‘No, but look, this exists.’ I felt like I was the only lesbian teacher in the world, like… like I almost couldn’t be a teacher if I was a lesbian, as if it went against the rules.”

(A1, Family A)

3.6. Strategies for Family Configuration

The narratives analyzed suggest that lesbian-parent families not only face challenges during assisted reproduction processes but also develop various strategies related to family formation and their presentation to society. Within an overwhelmingly heteronormative framework, lesbian-parent families challenge the traditional family model [16,42]. As a result, they often feel that their family structure is constantly questioned, as one participant mentioned:

“I think it’s difficult sometimes for people to consider you a couple… a family like any other (…) sometimes it feels like we’re second-class families.”

(C1, Family C)

The perception of being relegated to a “second-class” family shows that they must carefully navigate their family configuration and avoid exposing themselves to potential risks. It also shows that LGBTQ+ families face social delegitimization and struggle for recognition of their emotional and kinship ties. All families reported that they had to develop strategies to avoid discrimination, with their children’s well-being as their primary concern. These strategies include the following:

• Seeking social circles that do not question their family structure.
• Educating their children about family diversity.
• Concealing their relationship in certain situations as a precautionary measure.
• Allowing the donor to be legally registered as the father for legal protection.

Participants noted that they were cautious about which places they visited, such as when selecting schools for their children. As mothers, they felt the need to prepare their children for potential rejection or questioning:

“We move in a fairly progressive social circle, and that helps. But still, when we were looking at preschools, we asked ourselves: Are we going to introduce ourselves right away and say, ‘This is L, and we are both her moms’? And if they give us weird looks, we’ll just leave.”

(B2, Family B)

The daughter of Family A attends a school where most parental relationships are heterosexual, and her classmates are not accustomed to interacting with LGBTIQ+ families. This led her to feel uncomfortable, as she did not want to disclose that she had two mothers. For this reason, most interviewees actively educate their children about family diversity from an early age, sometimes using inclusive audiovisual materials to help them normalize their family structure:

“We have seen how sometimes people ask her questions. One time, a friend’s child asked her, ‘Okay, but which one is your mom?’ And she answered, ‘Both.’ Then he insisted, ‘But who’s your real mom?’ And L just repeated, ‘Both.’ From a very young age, we made sure she had access to inclusive resources. Actually, before she was even born, someone gifted us a children’s book called ‘The Family Book.’ It says, ‘All families are different—some are big, some are small, some have many kids, some have none, some have two moms, some have two dads…”

(B1, Family B)

Interviewees stressed that this education must start at home, as it is unlikely to be addressed in schools.

Another strategy used by families is hiding or downplaying their romantic relationship to avoid harm. This is evident in the experiences of Family C:

“C2 and I don’t hold hands in public (…) because I’m afraid that some crazy person might hurt us, and I won’t put L at risk. I also don’t take her to Pride marches because I feel like it could expose her. Our society is still fragile in that sense… people still attack same-sex couples on the streets.”

(C1, Family C)

Finally, participants emphasized the difficulties in obtaining legal recognition for lesbian-parent families. Families B and C spent months or even years without any legal recognition of the non-gestational mother. In the case of Family A, the gestational mother and the donor are listed as the legal parents, leaving the non-gestational mother without any legal recognition to this day.

4. Discussion

This study provides insight into the diverse experiences of lesbian-parent couples who have accessed ART in Chile, highlighting their lived experiences and perceptions. The results show that while there are various ART options available for same-sex female couples, they must navigate economic, social, and geographic barriers that complicate access to these procedures. From the perspective of reproductive justice, it is not enough to have available techniques: everyone must have equal access, regardless of social class, sexual orientation, or geographic location [52]. Furthermore, the challenges extend beyond the ART process to include family configuration and social acceptance.

The experiences shared in this study reveal a recurring sense of discrimination or anticipation of discrimination among the interviewees. This aligns with the systematic and ongoing questioning that the LGBTIQ+ community has historically faced, highlighting the gap in rights between heterosexual and non-heterosexual individuals [53]. While Chile has made significant legal advancements in protecting gender and sexual diversity rights, acts of discrimination persist and LGBTIQ+ families continue to be regarded as “second-class families” [2]. This also increases “minority stress” in LGBTIQA+ families, which has been defined as the set of mental and physical health consequences of identity-based (sexual and gender) stigma and discrimination faced by LGBTQ+ people, including their families [54].

This finding is consistent with Palma et al. [5], who argue that significant barriers still prevent the LGBTIQ+ community from fully participating on equal terms. In the healthcare sector, multiple barriers have been identified that hinder or restrict access to services for LGBTIQ+ individuals [1,55]. Specifically concerning ART, previous studies have also concluded that parenthood access remains restricted for lesbian-parent couples [15,30,31,32,33]. Evidence of this restriction can be seen in Chile’s ART policies, which facilitate access only for individuals diagnosed with infertility—excluding diverse families. There have even been documented cases of LGBTIQ+ couples who, as an exception, had to use an infertility diagnosis to qualify for ART [56]. From a biopolitical perspective, the restriction of access to ART based on medical infertility diagnoses highlights how reproductive rights are regulated through normative frameworks that privilege traditional heterosexual family structures over other forms of family.

Economic factors and healthcare coverage were also key in the process. Not all families interviewed had the full financial resources to proceed, as treatment was costly, and coverage was minimal. This remains a significant limitation for LGBTIQ+ families, as health insurance plans only cover treatments under the PAD voucher when an infertility diagnosis is confirmed [17,26]. In addition, couples received little guidance from public and private institutions offering these services, further illustrating that in Chile, ART access is facilitated primarily for those with medical conditions, excluding other reasons and restricting the right of any person to form a family.

New barriers and obstacles appear once the lesbian family is established as such and must present itself to society. Participants detailed that they still need to adopt strategies of resistance or concealment to avoid discrimination against both them and their children, which has been similarly reported in other studies [3,57,58]. A key concern is that participants feel responsible for ensuring their children understand and recognize family diversity, as most schools do not teach this. The lack of inclusive educational materials that represent diverse family structures remains an unmet responsibility of the state [59], as the continued reinforcement of the traditional heterosexual family ideal perpetuates discriminatory practices based on sexual orientation. This concern is also shared by heterosexual women and same-sex couples who wish to become parents, as they fear that their children may be discriminated against due to their parents’ sexual identity [6,60].

While all interviewees were able to participate in assisted reproduction processes, from a reproductive justice perspective, it is concluded that in Chile, assisted reproduction is not guaranteed as a right for LGBTIQ+ families, and that access to it depends on many factors that exacerbate inequalities. An intersectional analysis highlights at least four dimensions that hinder the process: sexual orientation, educational level, economic status, and geographic differences. This is consistent with other studies in Chile that have shown that socioeconomic status and place of residence determine the possibilities of forming a family [24,55]. Private clinics are concentrated in large cities, which excludes women from rural areas or the south of the country. In addition, not all health and social institutions are prepared to support assisted reproduction for a couple made up of two women, reflecting the hegemonic institutional and cultural heteronormativity [1].

The results, in turn, open new debates regarding the place occupied by lesbian couples who want to become mothers within a context of greater reproductive injustice that encompasses other marginalized and excluded groups. The present results are consistent with other research indicating that white lesbian women, with better economic and social status, are ultimately the ones who gain access to assisted reproduction, and therefore find themselves in a position of “privilege” compared to other women, such as black women or those with disabilities [61].

On the other hand, these experiences exemplify that lesbian mother couples build diverse family relationships and perceive the lack of visibility of family diversity in Chile. Queer kinship allows us to understand how lesbians who access ART reconfigure the idea of filiation without being completely absorbed by the hegemonic logic of the nuclear family [23]. Similarly, queer kinship challenges traditional gender roles, questions how kinship is understood, and reduces the pressure to fulfill an ideal of motherhood [61].

Finally, it is also important to recognize that these experiences have evolved over time. The narratives suggest that healthcare professionals have gradually begun to integrate the realities of LGBTIQ+ families into ART processes, leading to a potential reduction in discriminatory practices over the years. Consistent with this, participants primarily identified healthcare professionals as facilitators in the ART process. However, the risk of discrimination means that families with lesbian parents often take precautions, such as seeking care from professionals recommended or recognized as safe by other diverse families. Importantly, comprehensive and nonjudgmental care by healthcare professionals working with the LGBTIQ+ population leads to greater treatment adherence and higher levels of satisfaction [55,62].

5. Conclusions

The experiences presented in this study help shed light on the realities of lesbian-parent couples who have accessed various ART in Chile. However, these processes have involved multiple challenges, primarily due to economic, social, and geographic barriers. In this regard, the study concludes that while ART procedures are available in Chile, lesbian-parent families face significant obstacles in accessing them.

Additionally, this study reveals that the risk of discrimination is not limited to the ART process itself but extends to the formation of new families and their social recognition. It becomes evident that the recognition of lesbian-parent and gay-parent families’ rights remains a challenge for the Chilean state. The prevailing heteronormative cultural framework has largely invisibilized the existence and participation of non-traditional diverse families, relegating them to a “second-class” status.

The narratives shared in this study highlight a series of urgent challenges that must be addressed to ensure the full exercise of the rights of lesbian-parental families, within the framework of Reproductive Justice. At a minimum, there is a need for better training and education for healthcare professionals, ensuring the recognition of family diversity in state institutions, updating forms and protocols to reflect diverse family structures, improving financial access to ART, and promoting the inclusion of family diversity in school settings. While legislative progress has been made regarding LGBTIQ+ rights, many forms of discrimination and invisibility persist, leaving lesbian-parent families vulnerable to exclusion and bias.

In line with the above, authors such as Miwa et al. [18] and Ross and Solinger [21] argue that assisted reproduction should not be thought of solely as an individual right, but as part of a structural framework of justice. Queer reproductive justice is not limited to technical access to ART, but requires dismantling the conditions of exclusion that LGBTIQ+ people face [20]. This implies systemic institutional and cultural changes, including automatic recognition of co-motherhood, public coverage for all non-heteronormative forms of reproduction, and inclusive health and school education.

Regarding the study’s design, it is crucial to emphasize the importance of accessing lesbian-parent families’ narratives to better understand and make visible the inequalities they face. Narrative research plays a key role in amplifying the voices of people who experience exclusion or discrimination in silence. The findings challenge the notion of the heteronormative nuclear family as the only valid model in Chile and illustrate the continuing influence of heteronormativity on sexual diversity, particularly among lesbian mothers.

6. Study Limitations

This study provides valuable insights into the experiences of lesbian-parent families accessing ART in Chile. However, several limitations must be acknowledged:

• Sample Size and Representation. The study was conducted with a limited number of participants, all of whom identified as lesbian-parent couples. As a result, the findings do not represent the full spectrum of diverse families within the LGBTIQ+ community who have accessed ART, such as transgender parents, non-binary individuals, or polyamorous family structures. Future research should aim to incorporate a broader range of family compositions to gain a more comprehensive understanding of ART experiences in non-traditional families.
• Geographic Scope. Most of the participants resided in urban areas, particularly Santiago and Viña del Mar. Therefore, the study does not fully capture the experiences of families in rural or more remote regions, where access to ART services may be even more restricted due to geographic and infrastructural limitations. Expanding the geographic scope in future studies would provide a more complete perspective on regional disparities in ART access.
• Time Constraints. Given the limited timeframe for conducting this research, the study focuses primarily on the immediate ART process and early stages of family formation. It does not explore long-term experiences, such as the impact of ART-conceived family structures on children’s development, legal challenges over time, or evolving societal perceptions. Longitudinal studies could provide a deeper understanding of these aspects.
• Focus on ART Barriers and Facilitators. While this study centers on the challenges and facilitators of ART access, it does not extensively address other factors influencing the parental experiences of lesbian-parent families, such as legal recognition, institutional discrimination beyond ART, or parenting dynamics over time. Future studies could explore these broader aspects to provide a more holistic view of family life after ART.
• Self-Selection Bias. Participants were recruited through intentional and convenience sampling, meaning that families who had particularly challenging or positive experiences with ART may have been more inclined to participate. This could have influenced the findings by over-representing certain perspectives while excluding others. Future studies could employ a more randomized or stratified sampling method to reduce potential bias.

Despite these limitations, this study offers a meaningful contribution to the understanding of lesbian-parent families’ experiences with ART in Chile, highlighting key areas for future research and policy improvements.

7. Strengths of the Study

This study makes an original contribution by shedding light on family experiences that have been scarcely documented in the Chilean context, particularly from a reproductive justice perspective. The research benefits from a qualitative design that enabled an in-depth exploration of the participants’ lived experiences and the meanings they construct, capturing nuances often overlooked in quantitative studies. Furthermore, the reflexive approach adopted throughout the study—both theoretically and methodologically—strengthens the internal coherence of the analysis. Lastly, the use of situated narratives allowed for the articulation of structural and affective dimensions, providing a richer understanding of diverse family practices.