Participant Observation

At both clinics, I undertook participant observation to explore matching related activities. Participant observation involves the researcher taking part, to various degrees, in the “daily activities, rituals, interactions and events of a group of people as

Fieldwork Activity

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one of the means of learning about the explicit and tactic aspects of their life routines and culture” (DeWalt and DeWalt, 2002: 1). This entails viewing phenomena from the perspective of those being studied in their own settings (Bryman, 1988;

Hammersley and Atkinson, 2007; Silverman, 2001) by looking, listening, watching and asking as part of the observational process (Lofland et al., 2006).

The method of ‘participant observation’ was used to explore the organisation of matching within the clinical context in which it takes place, thus enabling insight into the contextual factors which shape the different stages of the matching process (Denscombe, 2007; Hammersley and Atkinson, 2007). As a participant observer, the researcher participates (to varying degrees), observes and records events as they occur (Lofland et al, 2006; Hammersley and Atkinson, 2007). In this study, I adopted the role of the ‘Moderate Participant’ (Spradley, 1980) and ‘Observer as Participant’

(Gould, 1958), where one is identifiable as a researcher, occasionally interacts with participants, but generally ‘shadows’ a person rather than actively participating in the research setting.

During observations, I focused on and documented conversations, comments, actions, interactions and negotiations between clinicians, donors, recipients, recipients’

partners and myself. I tried to note details about the structure of each observation, such as where it took place, the duration, the physical location, who was present and the general atmosphere. This was to enable me to contextualise my analysis and interpretation of the data at a later stage. I primarily undertook what can be classed as general/unstructured observations of the egg donation process and organisation of the clinics and focused observations of matching activities.

Early general observations at each clinic included general and broad observations about the physical and socio-cultural organisation of the clinics and clinicians roles

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and routines. Later general observations included observation of egg-donation related activities, including internal clinic ethics committees, biomedical procedures in the laboratory, general patient consultations and work-shadowing nurses. ‘Hanging out’

in communal areas of the clinics, such as the staff kitchen or staff room also proved valuable as this enabled insight into the organisation and culture of the clinic, facilitated relationship building with staff and contributed to legitimising my presence in the clinic.

Focused observations of ‘back-stage’ matching activities were centred around the practice of matching, but included observation of other matching activities, such as:

the monitoring and updating of patients records, the un-matching of donors and recipients and matched donors and recipients going through treatment cycles. When observing matching sessions, I paid particular attention to facets such as: the structure, process and tools employed; clinicians’ interpretation and negotiation of patient characteristics; and clinicians’ reasoning for matching, or not matching, particular donors and recipients. A clear view of clinicians’ matching tools during observations allowed me to additionally document the characteristics/information about donors and recipients that clinicians drew on when matching.

Over time, I recorded information about the matches made at each clinic for a large number of cases. At Creative Fertility I documented information about 152 matches and at The Fertility Centre I documented/collated information about 65 matches.

However, the collection of this data differed between each clinic.

At Creative Fertility for each match that I observed I systematically recorded: (a) the recorded ethnicity and physical characteristics of matched donors and recipients, (b) where relevant, their social characteristics and additional recorded information, (c) clinicians’ reasoning for making the match and (d) whether the matches had been

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accepted or declined by recipients and if a reason had been given by recipients.

During fieldwork, I collated and input this information onto an excel spreadsheet.

Near the end of fieldwork, I returned to the clinic to check the accuracy of the information that I recorded against the clinic’s own records (which I was given supervised access to) and to collect information that I had missed.

At The Fertility Centre, I also recorded the physical characteristics of matched donors and recipients, although it was more difficult to systematically record these. This is because the clinic did not always record the characteristics of recipients separately from recipients’ preferences and because I did not observe all of the matches in the clinic being made (unlike at Creative Fertility). However, my role as ‘data-inputter’ at the clinic (explained further below) meant that I could record the ethnicity, height and weight of all the donors and recipients who had been matched during the period of observations. This enabled me insight into information about matches even I did not observe them directly.

As fieldwork progressed observations were expanded to include front-stage’ matching activities, including ‘Initial Donor Consultations’, ‘Initial Recipient Consultations’

and ‘Donor Offering Consultations’. During these observations, particular attention was paid to the interactions between clinicians, patients and technology and the ways in which donor and recipient characteristics were operationalised and mediated.

Field Notes

The data gathered from observations took the form of field notes, which form the fundamental basis of ethnographic work (Spradley, 1980). Field notes enable researchers to capture details of the setting and the context of events, actions and meanings; they can serve as aide memoires; and can be a tool for processing and clarifying fieldwork experiences (Franklin and Roberts, 2006).

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The taking of field notes was a process, which involved making ‘condensed’ notes during observations with a note-pad and pen, in public view, writing up ‘extended’

notes as soon as possible on a computer the same evening, and keeping a reflexive diary (Spradley, 1980). ‘Condensed’ field notes included short-hand notes, quotations, comments, phrases, descriptions of events, and key words or symbols that could trigger memories about events (Lofland et al, 2006; Pope, 2005). Condensed field notes were between 6-15 pages, and were written up in fuller form later in the day with further details and reflections. It usually took between 4-9 hours to write up extended notes for a standard day of observations at the clinic. In my reflections, I noted my own thoughts, feelings, responses to and interactions with others.

At the beginning of fieldwork in each clinic some clinicians appeared slightly disconcerted at my writing of notes. These clinicians peered in to see what I was writing or asked me what I was writing about. I tried to be as open as possible with participants about what I was writing, and the purpose of making notes, and often found myself positioning my note-pad so that it was relatively visible to those I was observing. Over time, and the development of rapport and trust, clinicians appeared to normalise my note taking as part of my presence in the clinic and did not raise any further questions or comments.

As I became more familiar with the research settings and more apt at field-notetaking, my field notes became more systematic. I began to document conversations, comments, interactions, behaviours, practices and aspects of the clinics culture in more detail. I had begun writing verbatim what I had heard, even if I did not understand the jargon, with single words triggering a rich reconstruction of observed events (Fielding, 2001). I used a coding system to distinguish between individual donors and recipients so that I could track which donors had been matched with which

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recipients over the period of observations (as the majority of donors and recipients were matched more than once).

3.5.2 Interviews

Semi-structured in-depth interviews were undertaken with clinicians and recipients.

As highlighted by Silverman (2001: 54), although observational work can tell us about how people respond in particular settings, it is unable to explain how people constitute that setting or the meaning they attached to their actions. Thus, whilst observations of donor-recipient matching enabled insight into participants’ practices, interviews with these participants allowed insight into the subjective assumptions, motivations, values, emotions, experiences, meanings and beliefs which informed and shaped their practices (Denscombe, 2007: 174). Therefore interviews were used to explore complex and subtle phenomena that had been observed, rather simply for the straightforward collection of factual information (ibid). A topic guide was used to undertake interviews. The topic guide was informed by issues that had been identified in the literature review and from prior ethnographic observations at each clinic.

The topic guide for clinicians (Appendix 6) explored: clinicians professional background; how clinicians operationalised donor/recipient characteristics; clinicians’

perceptions of the purpose of matching, of recipient preferences, and of the role of the welfare of the child in matching; clinicians’ conceptualisation of ethnicity and ‘ethnic matching’, and clinicians perceptions of a ‘good match’ and an ‘unacceptable’ match.

The topic guide for recipients (Appendix 7) explored recipients’: trajectory towards egg donation; experience of the matching process; preferences for donor characteristics; and decision to accept or decline donors. Where recipients’ partners attended interviews they were also asked about their views of the matching process.

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Interviews with clinicians were undertaken in a private room in their respective clinics, at their request. The location of recipient interviews, at their request, appeared to be shaped by recipients’ stage in the treatment process; on the whole, recipients who had finished their treatment chose to be interviewed outside of the clinic (Creative Fertility) whilst recipients who were still attending the clinic for treatment chose to be interviewed inside of the clinic (The Fertility Centre). The location of recipient interviews for participants from each clinic is outlined in Table 3.7, below:

Table: 3.7 Locations of Recipient Interviews

Clinic Inside Clinic Home/Outside Clinic Telephone

Creative Fertility 2 2 3

The Fertility Centre 9 2 1

The majority of interviews lasted between 60-120 minutes and were digitally recorded, including all clinician interviews. Digitally recorded interviews were

transcribed verbatim by me. Two recipient interviews were not recorded because a) of a methodological oversight on my part, not realising that I could have recorded my first telephone interview and b) the recipient requested that I did not record the interview. In both of these cases I took hand-written notes. By this time I had become accustomed to writing shorthand notes, which made this process easier.

The undertaking of individual and joint (couple) interviews had an influence on the dynamics of the interviews. On the one hand, interviews with recipients alone enabled in-depth insight into their own unmediated perceptions and experiences of their infertility and donor selection. On the other hand, interviews with couples enabled insight into couples’ negotiation of recipients’ infertility and encouraged spontaneous

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discussion about matching, whilst also providing an opportunity for couples to corroborate or challenge one another’s stories (Valentine, 1999).

3.5.3 Documentation

A range of documentation was collected during this study, both inside and outside of the clinic. Collected documentation within the clinics included paper and electronic items such as clinic price-lists, websites, published leaflets, standard e-mails, anonymised donor ‘pen-portraits’ (i.e. messages from donors to persons born of their donation which recipients were given access to) and standard template forms to record donor/recipient characteristics, recipient preferences and to offer donors to recipients.

These latter forms contained the characteristics (and categories) used by clinicians for allocating donors to recipients and to offer donors to recipients. I also used the clinics’

databases/patient files to crosscheck and collate information about the characteristics of matched donors and recipients. In this respect, the secondary data collected at each clinic were regarded as “static” or “immutable things” but as data in their own right and as a “key component of dynamic networks” (Prior, 2008).

I also reviewed government legislation, i.e. the HFE Acts 1990 and 2008, and policy/guidance from the HFEA and Department of Health in relation to egg donation, with a specific focus on the welfare of the child and donor-recipient matching and the implications for the reproduction, clinician autonomy and dominance and recipient agency (explored in Chapter 4).

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