This workshop is intended to provide an opportunity for service providers to develop and deepen their knowledge of the legal, social, and practical aspects of LGBTQ family planning, and become aware of information and resources available to prospective parents. Multiple pathways to parenthood for LGBTQ prospective parents including adoption, sperm, egg, and embryo donation, co-parenting, and surrogacy will be examined. The goal of the workshop is to help service providers gain knowledge to use to assist LGBTQ clients in visioning, accessing information and resources in anticipation that our clients are now considering parenthood or may consider parenthood in the future.
Originally presented: Guelph Sexuality Conference, June 19, 2014 Guelph, ON, Canada
Andy Inkster, MA is the Health Promoter for the LGBTQ Parenting Network, Sherbourne Health Centre. In his work, Andy creates resources and develops educational and community-building opportunities for LGBTQ parents and prospective parents. He is one of the co-facilitators of Queer & Trans Family Planning(s), a family planning course developed in partnership between The 519 Church Street Community Centre and the LGBTQ Parenting Network. A queer and trans parent himself, Andy has been involved in queer and trans family planning work since 2005 as a member of the Trans Fathers 2B working group.
Guelph Sexuality Conference: LGBTQ Family Planning 101 for Service Providers
1. LGBTQ Family Planning for
Service Providers
Guelph Sexuality Conference • June 19 2014
Andy Inkster, MA
Health Promoter, LGBTQ Parenting Network
Sherbourne Health Centre, Toronto
333 Sherbourne Street, Toronto, Ontario M5A 2S5 • (416) 324-4100 ext. 5276 • ainkster@sherbourne.on.ca
1
2. Learning Objectives
Understand the various pathways to parenthood
Decision making processes, considerations at each
stage
How & when to bring up future parenting plans or
ideas with clients
Gain knowledge to assist LGBTQ clients in visioning,
accessing information and resources
Knowledge of challenges
Why are you here?
2
3. Why this matters:
Normalizing & modeling parenthood for LGBTQ
people
Visioning for LGBTQ people is an important resilience
strategy
Medical decisions that people who are transitioning
make can impact their future fertility
In a context of societal homophobia, parenting is one
of the flashpoints or triggers for homophobia
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4. Introductions
Why are you here?
What sort of work do you do with LGBTQ people?
Do you think of your clients as prospective or future LGBTQ
parents?
Why or why not?
What do you hope to get out of this session?
What brought you here?
4
5. Adapted from slides developed by
Chris Veldhoven
Queer Parenting Programs Coordinator
for the Queer & Trans Family Plannings course
Pathways to Parenthood
Options for consideration
6. Where are you starting from?
Single?
Partnered? Poly?
Extended Family? Friends?
Exes?
Divorce-extended family?
Married?
Modern family? Post-modern family?
Who’s in your family?
12. Adoption
Hopeful parents often feel they are competing against
each other and societal norms
Lesbian, gay, bi people are often perceived as having
particular strengths by workers
Advocacy skills & having experienced challenges
Come to adoption as a first choice
May be particularly suited to kids who are gender
independent, trans, or LGBTQ identified
Trans people may have particular concerns about
disclosure
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13. Adoption – for trans folks
Trans people may have particular concerns about
disclosure
Strategically disclose to the worker during the homestudy &
backround check process – if it comes up later, it will be
perceived as dishonest
Trans people have adopted and do foster in Ontario
CAS workers often emphasize two years of “stability” –
this may or may not influence their assessment of
trans individuals
13
16. You/Your Current Family
Have a Uterus
Sperm/Egg/Embryo
Have Them
Known Donor(s)
Unknown Donor(s)
Co-parenting
Having Sex
Home Insemination
Assisted Human
Reproduction:
IUI, IVF
17. You/Your Current Family
Have a Uterus
Sperm/Egg/Embryo
Have Them
Known Donor(s)
Unknown Donor(s)
Co-parenting
Having Sex
Home Insemination
Assisted Human
Reproduction:
IUI, IVF
Need a Uterus
18. You/Your Current Family
Have a Uterus Need a Uterus
Sperm/Egg/Embryo
Have Them
Known Donor(s)
Unknown Donor(s)
Co-parenting
Having Sex
Home Insemination
Assisted Human
Reproduction:
IUI, IVF
Co-parenting
Traditional Carrier
Gestational Carrier
19. “3rd Party” Reproduction
Known or unknown egg, sperm, and embryo donors
Gestational carriers
Non-genetic parenting
Complications & considerations for LGBTQ people in
fertility clinics
19
28. Child Free
Adoption Have a Uterus Need a Uterus Community
Public
Private
International
Kinship
Fostering
SAFE Home Study
PRIDE Training
Matching
Finalization
Sperm/Egg/Embryo
Have Them
Known Donor(s)
Unknown Donor(s)
Co-parenting
Having Sex
Home Insemination
Assisted Human
Reproduction:
IUI, IVF
Co-parenting
Traditional Carrier
Gestational Carrier
Co-parenting
Step-parenting
Parenting in
Community
Mentoring
Fostering
Pathways to Parenthood
Developed by Chris Veldhoven, Queer Parenting Programs Coordinator, The 519 Church Street Community Centre
30. Objective 2
Have a sense of decision making processes,
considerations at each stage
30
31. Child Free
Adoption Have a Uterus Need a Uterus Community
Public
Private
International
Kinship
Fostering
SAFE Home Study
PRIDE Training
Matching
Finalization
Sperm/Egg/Embryo
Have Them
Known Donor(s)
Unknown Donor(s)
Co-parenting
Having Sex
Home Insemination
Assisted Human
Reproduction:
IUI, IVF
Co-parenting
Traditional Carrier
Gestational Carrier
Co-parenting
Step-parenting
Parenting in
Community
Mentoring
Fostering
Pathways to Parenthood
32. Decision to become a parent
Parent? Or not?
Many people will be in this place for a long time
Timing
Mismatch between biology and social expectations for people
with eggs – fertility decreases starting in mid-20s
People with sperm have more options with timing
With surrogacy, finding a gestational carrier
Pressure for “perfect” timing – may be greater for
LGBTQ people than straight and cisgender peers
32
33. Decisions in Adoption
Open adoption
Questions around what degree of openness
Legal questions – is openness enforceable?
Openness in adoption is generally preferred, to the
extent that it is desired, and is safe and healthy for
children, parents, and birth parents
33
34. Decisions in Adoption
“Special Needs”
What are you prepared to handle?
Interestingly – nobody asks that about giving birth, and
perhaps we should
Age of a child
How many – sibling sets
34
35. Decisions in Pregnancy
Who goes first?
If there are two moms who are capable of being pregnant this
decision could be easy, or it could be hard
What if it doesn’t work?
How long to keep trying?
What interventions to pursue?
35
36. Decisions – Eggs? Sperm?
Does one partner wish to carry the other partner’s
egg?
Costly, invasive
Inseminate with sperm from both intended fathers?
With gestational carrier surrogacy, it is possible to implant
eggs fertilized by sperm from two different people
Egg freezing: typically half eggs and half embryos are
frozen, and that means choosing a source of sperm
now – whether a donor or partner.
36
37. Decisions – Donors
Known or unknown egg and sperm donors?
Both are possible
Sperm banks provide a third option “Identity Release”
Sometimes one partner feels strongly about a known
donor, while another feel strongly about having an
unknown donor
Why might a nongestational mother or a trans father
feel strongly about having an anonymous donor?
37
38. Decisions – Embryo Donation
Receiving embryos
Embryo donations are often made in a process that resembles
adoption – people who have embryos choose from profiles of
hopeful recipients
Embryo donation may also be possible between friends
Donating Embryos
Families may be unsure of what to do with “leftover” embryos
once their families are complete
LGBT families may be more likely to explore embryo
donation because of the acceptance of donors
38
39. Decisions – Uterus
“Traditional” or gestational carrier?
Gestational carrier is generally more accepted in a fertility
clinic, but it’s possible to do at-home traditional surrogacy
In Canada? – Unclear legalities
In the US? – Very expensive
Abroad? – Unclear visa regulations, ethical concerns
Finding a gestational carrier is the hardest part of the
eggs + sperm + uterus = baby equation
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40. Objective 2
Have a sense of decision making processes,
considerations at each stage
Questions?
40
41. Objective 3
How & when to bring up future parenting plans or
ideas with clients
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42. How & When
Brainstorm
What are some moments when potential parenthood
could be discussed?
Moments when potential parenthood should be
discussed?
Moments when potential parenthood must be
discussed?
42
43. How & When
Key Moments for trans people
- Pre-hormones
- Pre-surgery
Resource: Reproductive options for trans people
Fact Sheet from Rainbow Health Ontario
43
44. Trans Youth
Puberty blocking drugs – prior to Tanner Stage II (early
puberty) may cause permanent sterility.
(Many unknowns)
Youth may not be well positioned to make fertility
preservation decisions
Sperm freezing is non-invasive, cost-effective, and
technologically sound
Freezing eggs is invasive, costly, and technologically
complex – requires choosing a source of sperm
(typically anonymous donor)
44
45. How & When
Relationship Counselling
Joint reproductive decisions can be a source of conflict
for many partners
Jealousy – What if one partner gets a genetic
connection, and one does not?
Insecurity – the non-gestational partner may feel a
sense of being displaced as a mother
45
46. Resources
Brochures, booklets, & info sheets from
LGBTQ Parenting Network:
LGBT Adoption in Ontario (booklet)
Assisted Human Reproduction Guidebook
Brochures:
Parenting options for GBQ Men
Choosing a sperm donor: Known or Unknown?
Insemination procedures
Co-parenting
46
48. 48
Joint programs of Queer Parenting Programs at
The 519 Church Street Community Centre and the
LGBTQ Parenting Network at Sherbourne Health Centre.
Dykes Planning Tykes
This course emphasizes donor insemination, adoption,
and co-parenting for lesbian, bi, and queer-identified
women.
12 week & Weekend Intensive
Daddies & Papas 2B
Emphasizes adoption, surrogacy, and co-parenting for
gay, bi, and queer-identified men.
12 week
Queer & Trans Family Planning(s)
Depends on participant interest and need.
Weekend
Family Planning Courses
49. Objective 4
Gain knowledge to assist LGBTQ clients in visioning,
accessing information and resources
49
51. Financial Barriers
Assisted human reproduction can be very expensive:
Anonymous donor sperm $900+/cycle
Surrogacy with anonymous donor egg, IVF, &
gestational carrier $50,000+
Adoption has a wide range:
Adoption – private $20K+
Public adoption – free or close to it
PRIDE training $750/person
51
52. Challenges in AHR
Assisted human reproduction
Square peg in a round hole
Fertility clinics are set up for heterosexual cis people who
are infertile.
“Any pregnancies since I last saw you?”
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53. Challenges in Adoption
Myths around adoption
From other LGBTQ parents
From extended family and community
Internalized myths
Fitting into expected models of family
53
54. When Plans go Awry
Infertility & “Still Trying”
Pregnancy loss / miscarriage
Prenatal diagnosis
Abortion
Infant loss
Adoption uncertainty, stress, and disruption
Relationship breakdown (partners, co-parents, and
community)
Postpartum & Postadoption depression
54
55. Long Pathways - Roadblocks
Fertility & Infertility
- LGBTQ people often inhabit a grey zone – neither
infertile, nor fertile
- Infertility is very stressful
- (in)fertility support groups and
resources tend to be heterocentric
and cisnormative
55
56. Surprise!
LGBTQ people have sex
Sexual behaviour doesn’t always match identity
Bi people
Testosterone is not a contraceptive & it only takes one
Your adopted child’s future siblings
A child in your community
Planning for one – getting multiples
56
57. LGBTQ Youth &
Pregnancy Involvement
Pregnancy involvement rates are
higher among LGBTQ youth than
among straight cisgender youth
57
58. Entitlement
In order to advocate for themselves with medical
providers, or with adoption workers, LGBTQ people must
feel entitled to receive the level of care they need.
58
59. Learning Objectives
Understand the various pathways to parenthood
Decision making processes, considerations at each
stage
How & when to bring up future parenting plans or
ideas with clients
Gain knowledge to assist LGBTQ clients in visioning,
accessing information and resources
Knowledge of challenges
What did you get out of today?
59
61. Andy Inkster
Health Promoter
LGBTQ Parenting Network
Sherbourne Health Centre
333 Sherbourne Street
Toronto, ON
M5A 2S5
www.LGBTQParentingNetwork.ca
61
(416) 324-4100 ext. 5276
ainkster@sherbourne.on.ca
/LGBTQPN
@LGBTQPN
Editor's Notes
Andy Inkster, MA is the Health Promoter for the LGBTQ Parenting Network, Sherbourne Health Centre. In his work, Andy creates resources and develops educational and community-building opportunities for LGBTQ parents and prospective parents. He is one of the co-facilitators of Queer & Trans Family Planning(s), a family planning course developed in partnership between The 519 Church Street Community Centre and the LGBTQ Parenting Network. A queer and trans parent himself, Andy has been involved in queer and trans family planning work since 2005 as a member of the Trans Fathers 2B working group.
This workshop is intended to provide an opportunity for service providers to develop and deepen their knowledge of the legal, social, and practical aspects of LGBTQ family planning, and become aware of information and resources available to prospective parents. Multiple pathways to parenthood for LGBTQ prospective parents including adoption, sperm, egg, and embryo donation, co-parenting, and surrogacy will be examined. The goal of the workshop is to help service providers gain knowledge to use to assist LGBTQ clients in visioning, accessing information and resources in anticipation that our clients are now considering parenthood or may consider parenthood in the future.
Why are you here? Think about that for a minute, and we’ll go around the room in a few minutes to give a quick introduction and to talk about why each of you is here and what you want to get out of this workshop.
Other ideas?
I want to acknowledge that Chris Veldhoven, one of the conference co-chairs, and someone I have had the pleasure of working with for nearly 20 years originally developed these slides for the Queer & Trans Family Plannings Course, which is a joint program between Queer Parenting Programs at The 519 and the LGBTQ Parenting Network at Sherbourne Health Centre.
I have since redesigned and changed the slides a bit, and adapted them a bit to this presentation, but the original concept and much of the language is his.
Queer & Trans Families start from a variety of places
Single parents by choice *may* be more common in our community – we don’t have hard data
The nuclear family is a western, modern cultural construct – for newcomer, immigrant, and non-western cultures may be a source of tension, may involve navigating a broader network of relations than two partners.
It’s important to note that we don’t all start from the same place – some families may include children already, and some include partners while some do not.
It’s also important to note that LGBTQ people are writing their own scripts – but due to increasing acceptance and “scripting” – conventional norms affect us as well. We may find ourselves waiting until after marriage, but we may not.
We will go over each pathway in some depth, but here is the rough overview.It’s important to remember that remaining child-free is an option – for those “considering” in a partnership, it’s not uncommon to have one partner who is more invested in parenting than another.
Sometimes people start out along one pathway, discover it’s not working for them, and switch.People may also have stronger feelings toward one pathway than another – it’s not uncommon for someone to know that adoption is part of their future, for example, or for other people to not ever consider it because the genetic connection to their child is important to them.
Finally, it’s not all about what individuals want – logistics, finances, and medical considerations are all part of the decision-making process.We have separated out have a uterus from need a uterus to pull issues of donor conception away from issues related to surrogacy.
In a lot of the infertility conversations, donor gametes and surrogacy occupy some of the same decision making space, but for LGBTQ people, it makes sense to separate them a bit.
Adoption is at once the most understood, and most common pathway to parenthood, but also has the most myths around it.
There are, broadly speaking, four types of adoption:
Most adoptions completed by LGBTQ people in Toronto are PUBLIC adoptions – through CAS
Kinship and fostering are not necessarily part of this list in quite the same way, but generally involve the same process
Private adoptions are less common, but still completed quite frequently, in fact, some adoption agencies report more demand for gay men from birth families than there are profiles available
International adoption is generally not an option for most LGBTQ families – there are exceptions, such as bi-identified heterosexual couples, some trans families – but in general, most LGBTQ families cannot realistically consider international adoption.
The adoption process in Ontario has been harmonized, so that private and public adoption workers do the same homestudy with Ontario families.
PRIDE training has nothing to do with LGBTQ pride, it stands for Parent Resources for Information Development and Education
One way to speed up an adoption process is to pursue a private homestudy and private PRIDE training, and then a public adoption
Adoptions are generally finalized six months after a permanent placement is made. This can be extended in cases where termination of parental rights has not happened.
The adoption process involved a lot of dealing with institutions and bureaucracy – while the intended parent(s) may be focused on themselves, and their desire to become parents, the process of public adoption is focused on the well-being of a child.
In private adoption, the process is weighted in favour of the birth mother (or birth family) quite heavily, until finalization.
This fundamental mismatch can make this process challenging for hopeful parents.
The reality of adoption is that there are many more children in need of permanent families than there are suitable permanent families. However, the match is crucial, rather than the quantity. Because racial matching is prioritized, there is a particular need for latin@ families
I’ve pulled trans folks out here because the reality is that we just don’t know that much about how trans people fare in adoption – I have anecdotal reports from transmasculine people who have adopted in Toronto and across the US. In some cases, they have been matched with Gender Independent or trans youth and children.
Questions about adoption?
I have separated out issues of donor conception and surrogacy – while some of the infertility community and some of the literature around surrogacy mixes the two issues, in LGBTQ family planning, they are generally considered distinctly. We will first look at donor conception, when there is a uterus available “in house.”
Secondly “Have a Uterus” means not just having a uterus, but being willing and able to use it. And it could mean there are two uterii in the family
What makes a baby?Sperm, eggs, uterus
LGBTQ families who include a trans partner may have all their gametes lined up and ready to go – for example, for a lesbian family that includes a trans woman and cis woman.
Many families only have one set of gametes in-house, for example two women may have only eggs
The question of using sperm from a known or unknown donor can be very difficult or it can be quite simple
The somewhat unique issue of “double donor” – where a queer family needs donor sperm, but due to infertility discovers they also need donor eggs – is somewhat specific to LGBTQ families.We will return to talk about donor conception in some depth.
Ways to introduce the sperm to the egg
IUI – insemination
IVF – in vitro fertilization
Need a uterus might include a single or gay male couple (or more), a transwoman partnered to a man (cis or trans), or two trans men partnered to each other.
Importantly, some of these decision will be different:
Gestational carrier – a person who carries an embryo/fetus they are not genetically connected to, the egg comes from either a parent or a known or anonymous egg donor
Traditional carrier – a person who carries an embryo/fetus they are also genetically connected to
For example, while a cis woman and her transman partner might do home insemination, if a woman is carrying her partner’s egg, they would have to do IVF. Traditional surrogacy can be done with insemination, but surrogacy with donor egg requires IVF.People make choices for other reasons, too – for example, the non-gestational partner may feel strongly that she wants inseminations to take place in a clinic setting, to further remove the donor from the equation.
Other people may feel more comfortable if their partner has sex with another person in an anonymous encounter.
We will return to some of these quandaries at the end, I just want to flag them now as points to bring up
“Third Party Reproduction” is the term the fertility industry uses to talk about egg, sperm, and embryo donation, as well as surrogacy.
The term really showcases the couple-centric nature of the fertility industry, which we will address in a moment.
Parenting in community – what does this mean? - Parenting with several parents
Being involved in a child’s life as a parent
Co-parenting in a group, i.e. a gay couple and a lesbian couple, or two single people parenting “just as friends”
Step-parenting and blended families are common – this is a good example of one of the ways in which you don’t always get a choice.
Parenting in community can mean deliberately resisting the norms of the nuclear family
Some LGBTQ people may be drawn to mentoring whether as a parenting activity or not
While not every mentoring relationship needs to be foster parenting, there is a need for foster homes that are equipped for teenagers, and LGBTQ teenagers in particular may have difficulty finding suitable foster placements. Often when a child in care comes out, the foster family’s worker has to work very hard to find a suitable placement. LGBTQ adults may consider fostering LGBTQ teens as a pathway to parenthood where they have particular expertise.
However, because Fostering is tied to the Children’s Aid Society, homestudy, training, system, it makes sense in our model to keep fostering in the yellow path. But, I wanted to add this roundabout pathway to fostering, because fostering can also happen informally – for example the queer teenager who spends most of her time with her friend’s family because her own isn’t supportive.
I specifically tied Fostering to Parenting in Community to capture those informal arrangements, and to co-parenting because for many foster parents, fostering is about co-parenting with the child’s worker and the agency that has formal decision making power, as well as the child’s parents to the extent they are able, if reunification is the goal for that family.
Questions about parenting in community?
What does it mean to be child free?
Child Free by choice or child free by circumstance – many people may choose to be child free
Many people who are Child Free may delight in spending time with other people’s kids, while still not desiring to have one or more of their own.
In our final diagram, we positioned Child Free near “community” – and point out that many of these choices are still an option for people who consider themselves “child free.”
I want to also point out that “Child Free” invokes the idea of volition, or choice – childfree is not the same as “Child Less” – childlessness implies a lack.
Child free can be a place of choice, or it can be a place of acceptance after having moved through child lessness.Choosing to be child free is likely to be an emergent issue for LGBTQ people as parenting becomes more normalized for LGBTQ people.
Questions about being Child Free?
Handout – decision making at each stage
Basically, every box represents a decision. There are decisions to be made at each stage.
Decisions are built into the PRIDE training and SAFE home study process – however, that reflection is coercive and not entirely free – most people in the process of adoption report managing their worker’s impression of them to one degree or another.
In fertility and pregnancy, there are decisions as well, but a less reflective process – unlike adoption, where the legislation, regulations, interests of the worker, and the process are weighted toward the child and the birth family, in the fertility system, it’s an industry, and a commercial marketplace.
Decisions are required, but not as much of a space is created for them to take place.
T
Remember – while some hormonal treatments may cause sterilization, not all do
Some surgical procedures may cause sterility, but not all do
For trans men, banking eggs is VERY invasive and expensive
For trans women, sperm banking is much cheaper, but still expensive
Youth who are transitioning may not be ready to think about parenting, but if genetic connection is important to them, they may need to make decisions.
Some definitions of family are move valued – monogamous, partnered – coupled
Challenges of using known donors
Some definitions of family are move valued – monogamous, partnered – coupled
Challenges of using known donors
Infertility – talk about that in a minute
Being LGBTQ may put people at higher risk of some complications, such as postpartum depression – a history of depression makes postpartum depression more likely. We know that bi-identified people are at particularly high risk of depression due to social pressures, and trans people also have higher rates of depression – for these families, seeking support for PPD may be more difficult than for straight, cis people
Gestational carriers – PPD is in part a hormonal and chemical reaction – gestational carriers may not feel well supported and may experience a sense of loss as the attention turns from them to the baby
Pregnancy loss – especially if the pregnancy is in someone else’s body, how is that experienced? How does a gestational carrier experience pregnancy loss?
Prenatal diagnosis – this one is very tricky, there may be a period of mourning and loss, or a decision may be made to terminate a much-wanted pregnancy.
Intended parents and gestational carriers
Infant loss – is always, obviously, very hard for parents, families, and communities – LGBTQ people may experience loss or grieving differently – we don’t know.
Adoption disruption – more prevalent is uncertainty and stress. Because of how parental leave is structured, many parents may experience reentry into the workplace at the same time as finalization, and the stress associated with this time can be very difficult. If the birth family is still attempting to pursue reunification, finalization can be delayed. Even in the best possible cases, this can be a time of uncertainty and the unknown, and most people feel a sense of relief once the adoption is finalized.Parents may also feel a sense of loss and grief – for the times they weren’t with their child before their child came into their lives, or sympathy for and empathy with the birth parent or family
We may not think that LGBTQ people can have surprise pregnancies or end up with children without planning – but it happens
This is for a variety of complicated reasons, including:- Trans youth may not think of their sexual behaviour as putting them at risk of pregnancy
Lesbian or queer women who have sex with men may be less likely to use oral contraception or Nuvaring or similar
Gay/bi/queer male youth may be under pressure to prove their heterosexuality
Finally, heterosexual sexual behaviour may be about proving they aren’t LGBTQ
Who would let someone like me become a parent?
Internalized homophobia and transphobia
Entitlement as a resilience strategy
This workshop is intended to provide an opportunity for service providers to develop and deepen their knowledge of the legal, social, and practical aspects of LGBTQ family planning, and become aware of information and resources available to prospective parents. Multiple pathways to parenthood for LGBTQ prospective parents including adoption, sperm, egg, and embryo donation, co-parenting, and surrogacy will be examined. The goal of the workshop is to help service providers gain knowledge to use to assist LGBTQ clients in visioning, accessing information and resources in anticipation that our clients are now considering parenthood or may consider parenthood in the future.
Why are you here? Think about that for a minute, and we’ll go around the room in a few minutes to give a quick introduction and to talk about why each of you is here and what you want to get out of this workshop.