Women’s Attitudes toward Assisted Reproductive Technologies – A Pilot Study among Migrant Minorities and Non-migrants in Germany


Women’s Attitudes toward Assisted Reproductive Technologies 
– A Pilot Study among Migrant Minorities and Non-migrants in 
Germany*

Sonja Haug, Nadja Milewski

Abstract: This study examines attitudes toward assisted reproductive technolo-
gies (ART) among immigrant women and non-migrants in Germany. The social rel-
evance of ART is increasing in Western countries due to overall low birth rates, a 
high rate of childlessness, and a gap between the desired and the actual numbers 
of children. Previous literature has been scarce, however, on attitudes toward ART, 
and immigrant minorities have rarely been included in studies on ART. 

Our working hypotheses are drawn from theoretical considerations on political 
socialisation and cultural integration. The analysis is based on data collected in a 
pilot study in 2014 and 2015. The sample includes 960 women aged 18 to 50 living 
in Germany. About 81 percent of the sample are immigrants who originate from 
Turkey, Poland, the Balkan countries, or countries of the (Russian) Commonwealth 
of Independent States (CIS). We study the social norm to use ART to have a child, 
the personal attitude of whether a woman would use ART herself, and the methods 
that they would consider for their own use. 

Our results show that ART is overall socially acceptable, and the majority of wom-
en said that they would use it if necessary. There is significant variation between 
the origin groups, however. Non-migrants show the lowest acceptance rates and 
migrants from Poland and Turkey the highest approval. There is also variation in the 
ART procedures considered for use with the migrants more approving of heterolo-
gous methods than non-migrants. The differences between the origin groups dimin-
ish only partly when controlling for further explanatory variables, i.e. gender-role 
attitudes, religiosity, and socio-demographic characteristics of the respondents. 

We conclude that attitudes toward ART are shaped less by socio-demographic 
characteristics, but rather by cultural factors and the socialization in the migrants’ 
countries of origin. The diversity in attitudes toward ART by cultural background 
should be acknowledged in research and public discourses on ART as well as in 
regulating policies.

Keywords: ART · Family norms · Women’s social status · Migrant women · Germany

Comparative Population Studies
Vol. 43 (2018): 343-370 (Date of release: 10.04.2019)

Federal Institute for Population Research 2019  URL: www.comparativepopulationstudies.de
       DOI: 10.12765/CPoS-2019-06en
       URN: urn:nbn:de:bib-cpos-2019-06en8

* This article belongs to a special issue on migrant fertility.



•    Sonja Haug, Nadja Milewski344

1 Introduction

Our paper investigates attitudes toward assisted reproductive technologies (ART) 
in the multicultural context of Germany. We ask about attitudes and norms toward 
ART of immigrant women from four regions as compared to non-migrants, which is 
a novelty both in research on migrant integration and in studies on ART. Our work is 
motivated from three perspectives. 

First, we are interested in norms and attitudes toward the use of ART. Previous 
research has focussed on public discourses on bioethics, religious doctrines, social 
concepts, and legal frameworks (Schenker 2005; Serour 2008). Demographic re-
search has paid attention to the prevalence of ART treatments and the contribution 
of ART-related births to overall fertility. Naturally, aspects of need, access to, and ef-
fectiveness of ART have been studied in infertile persons (e.g. Trappe 2017) as well 
as knowledge of ART (e.g. Bunting et al. 2013). Almost nothing is known, however, 
about the social dimension among individuals, whether or not they themselves are 
affected by fertility problems. Exceptions are the recent country-comparative study 
by Djundeva/Szalma (working paper/ 2017) and single-country analyses by Stöbel-
Richter et al. (2009, 2012) as well as by Daniluk and Koert (2012) and by Heikkilä et 
al. (2006) on medical students. Social and cultural aspects, such as attitudes, are 
important for policies regulating ART, which in the long run influence the usage and 
the supply of ART (Präg/Mills 2017a).

Secondly, we focus on immigrants because the scarce previous research has 
suggested that the attitudes and the behaviour related to ART vary by cultural factors 
(Djundeva/Szalma 2017; Präg/Mills 2017a). Cultural diversity has been addressed in 
previous studies, however only between countries, not within countries. Due to 
continuing immigration and a growing share of immigrants at the host populations, 
European countries show increasing cultural diversity (Coleman 2006), which is also 
accompanied by differential fertility trends. The topics of ART, fertility problems, 
or a gap between the desired and the actual number of children have hardly been 
raised in research on immigrant fertility in Europe thus far, whereas for the majority 
populations, childlessness has become an important topic in and of itself. This dis-
crepancy in scholarly interest may be attributed to an overall societal concern with 
“hyper-fertility” of women from non-Western countries, as Inhorn and van Balen al-
ready pointed out in 2002. Two exceptions are a book edited by Culley, Hudson, and 
van Rooij (2009a), which showed how culture shapes the interaction between infer-
tile individuals in the West and their experience with ART (Culley et al. 2009b), and 
a review on the international state of the art by Weblus et al. (2014), which showed 
implications of cultural diversity in patients for reproductive medicine. 

Thirdly, we are interested in variation within migrant groups. Other attitudes re-
lated to reproductive behaviour have been shown to vary not only between mi-
grants and non-migrants, but also among migrant origin groups and generations 
(e.g. Carol/Milewski 2017). 

Our empirical study is based on a data collection from 960 women in Germany, 
which was initiated to investigate attitudes toward ART among immigrants of dif-
ferent origins and non-migrants (Haug et al. 2018). Due to the pilot character of the 



Women’s Attitudes toward Assisted Reproductive Technologies    • 345

research project and the sample size, the analyses are exploratory in nature. Our 
main research question is whether norms and attitudes toward ART differ by origin 
group and migrant generation, i.e. by the socialization context of the migrants. Our 
sample includes the four largest groups of immigrant women in Germany, com-
prising women from Poland, the Balkan countries, the (Russian) Commonwealth of 
Independent States, and Turkey as well as non-migrants living in Germany. These 
countries/regions vary in legal regulations and implementation of ART as well as 
in attitudes (Präg/Mills 2017a/b). We include individual cultural and socio-demo-
graphic control variables in multivariate analyses because the countries of origin in 
our study also vary with regard to religious traditions and attitudes toward gender 
equality (Norris/Inglehart 2012), wich correlate with fertility, family planning, and 
reproductive health. 

2 Background

2.1 Societal context and attitudes toward ART

During the Second Demographic Transition, marriage, sexual activity, and child-
bearing became increasingly disconnected. Modern contraception has made it pos-
sible for women to exert control over their fertility career by separating sexual activ-
ity and fertilisation. These developments were preceded by an attitudinal change, 
i.e. growing individualism and declining religiosity (van de Kaa 1987; Lesthaeghe 
2010). With the rise of ART, in particular since the very first live birth of a baby 
conceived by ART in 1978, persons or couples who are biologically incapable of 
having children, such as in cases of infertility (be it permanent or temporary), single 
women, or same-sex couples, can increase their chances of becoming parents. The 
approaches to the regulation of ART range from the perspective of the patients as 
their right to reproduce to the rights of the unborn child/embryo1 (Serour 2008; 
Čartolovni et al. 2014). Thus, the major changes in family formation and fertility as 
well as in ART touch on the core values of any society and religion. 

Secular societies have been more likely to experience the developments of the 
Second Demographic Transition than societies in which religion plays a major role; 
this coincides with greater acceptance of gender equality. By contrast, more reli-
gious societies continue to show a strong bond between sexual activity and mar-
riage on one hand and marriage and childbearing on the other; at the same time, 
gender inequality is greater (van de Kaa 1987; Norris/Inglehart 2012). In both types 
of societies, however, ART has raised bio-ethical concerns because it separates 

1 Note: Our paper studies attitudes toward ART from the viewpoint of family planning and there-
fore we focus on individuals who may or may not consider using ART for their own family for-
mation. We omit discourses on the status and rights of the embryo/child, such as the question 
of surplus embryos, on the status of donors, which are admittedly crucial in the bio-ethical 
debates surrounding ART, or on the question whether and what aspects should be regulated by 
law (Heikkila et al. 2006). 



•    Sonja Haug, Nadja Milewski346

the sexual act from conception. The question is posed as to when a beginning life 
should be considered an individual person. The major world religions vary in their 
doctrines in their permission on methods of procreation (Serour 2001). Intertwined 
with religious and cultural traditions, the legal regulations also vary greatly among 
countries (Präg/Mills 2017a/b). ART comprise a wide range of third-party assisted 
conception as well as diagnostics. The methods of assisted conception can be dis-
tinguished as homologous methods, i.e. methods where the social parents are also 
the two biological parents (e.g. in-vitro fertilization (IVF), intracytoplasmic sperm in-
jection (ICSI)), and heterologous methods, where a third party is one of the biologi-
cal parents (such as third-party sperm donation, egg cell donation, and surrogacy).

Among infertile persons, ART are often considered the final option to achieve 
the goal of having their own biological child, while alternative methods such as 
adoption or fostering are considered only after reproductive medicine has failed 
(Onnen-Isemann 2000a). Stöbel-Richter et al. (2012) found that German women and 
men generally accept the use of ART. Asked about the social norm, half of the re-
spondents agreed that childless couples should try all available ART to have a bio-
logical child; while about 18 percent disagreed with this statement (Stöbel-Richter 
et al. 2012). Regarding their own attitude, almost a third of the respondents would 
use ART if they were not able to have a child of their own the “natural” way (for 
comparison: only 22 percent would consider an adoption). 

Whereas the general acceptance of ART seems rather widespread in cases of 
bio-medical fertility problems, the individual methods have different levels of ac-
ceptance. Individuals are more likely to approve of homologous methods, such as 
IVF, than technologies involving third parties, like heterologous sperm and egg cell 
donation, embryo donation, or surrogacy (Stöbel-Richter et al. 2009 for Germany; 
Daniluk/Koert 2012 for Canada). 

2.2 Country variation and cultural assimilation among migrants

The context of our study is Germany. More than 18.5 million persons who were 
immigrants themselves or who were born to one or two immigrant parents live 
in Germany, comprising about 21 percent of the general population. The migrant 
population in Germany is heterogeneous with respect to country of origin, legal sta-
tus, period of residence, and population composition. The largest immigrant groups 
originating from a single country are from Turkey (about 3.4 percent of the total 
population) and Poland (about 2.3 percent). Two immigrant groups, those from the 
countries belonging to the former Soviet Union, now the Commonwealth of Inde-
pendent States (CIS) and Ukraine, and those from the Balkan countries formerly be-
longing to Yugoslavia, contribute 3.8 and 2 percent respectively to the population, 
thus accounting for about half of the migrant population in Germany (Destatis 2018). 

Our first working hypothesis concerns the influence of the migrants’ country 
of origin. There is not much literature on the ideational or cultural dimension of 
integration among immigrants in Germany or in other European countries, with mi-
norities from Muslim countries being an exception. Most literature on attitudes and 
values among women from countries with a Muslim tradition indicates that it is 



Women’s Attitudes toward Assisted Reproductive Technologies    • 347

particularly mostly first-generation immigrants who are likely to maintain the atti-
tudes and values dominant in their country of origin during their socialization phase 
abroad. This has been shown for attitudes on abortion (Carol/Milewski 2017), re-
ligiosity (van Tubergen/Sindradottir 2011; Milewski/Otto 2016), and attitudes toward 
gender equality (Röder 2014). These findings are in line with Almond and Verba’s 
(1989) theory of political socialization through school, work, or the media according 
to which the societal climate, e.g. what is created by public discourse, policies and 
their implementation, is reflected in public attitudes.

As the immigrants in our study originate from countries that differ in their preva-
lences and legal regulations of ART, we include a rough summary of the legal condi-
tions in the countries/regions of origin in our study at the time of data collection for 
our analyses (2014/2015) in this section.

Reproductive medicine is a growing health care sector in Germany. Compared 
to other European countries, the treatment rate is comparatively low, however. In 
2010, Germany was ranked 19th of 30 countries in Europe, with about 4000 ART 
treatments per 1 million women aged 15-45. There is large variation in the immi-
grants’ countries of origin in our study. The lowest prevalences were recorded in 
Moldova (less than 1000 treatments). Ukraine, a republic that was formerly a part of 
the Soviet Union and the CIS included in this statistics, ranked 20th. Also rather low-
er prevalences were found for Macedonia (rank 26), Montenegro (27), and Poland 
(29). The same statistics ranked Serbia at 11 and Croatia at 17 – indicating (much) 
higher prevalences of ART than in Germany (Präg/Mills 2017b).

The practice of and access to ART can be regulated in three ways: 1) Guidelines 
contain a set of rules practitioners are expected to follow on a voluntary basis. 2) 
Governmental legislation refers to rules that are inscribed in law to which violation 
is subject to penalty. 3) Insurance coverage regulates the reimbursement of the 
expenses to patients. Almost all European countries regulate access to ART in their 
legislation. However, there is variation in the existence of additional guidelines and 
in insurance coverage. Moreover, a couple’s marital status and sexual orientation 
are often additional requirements for ART, with the majority of European countries 
stipulating that only married (heterosexual) couples can have access to ART treat-
ment (Präg/Mills 2017b). 

In Germany, legislation regulates access to ART. Whereas all homologous tech-
niques are allowed, there are various regulations regarding heterologous tech-
niques: The donation of a sperm cell is permitted only if the name of the donor is 
known. By contrast, egg cell donation, surrogacy, or the use of egg or sperm cells 
after the death of the owner is considered a misuse of ART. ART is limited to married 
heterosexual couples. Health insurance covers the costs only up to the age of 40 for 
women and 50 for men (Trappe 2017).

Russia appears to be the most liberal European country regarding access to and 
coverage of ART. It offers homologous and heterologous techniques, such as surro-
gacy as well as gamete and embryo donation. The costs are covered by the national 
health plan, commercial arrangements are possible, and single women can have ac-
cess to ART (Svitnev 2010; Präg/Mills 2017b). In contrast, the most restrictive case 
is Poland (Krawczak 2016). Until 2015, ART had been neither legal nor regulated by 



•    Sonja Haug, Nadja Milewski348

state law. Due to non-regulation, this health care sector was commercialised and 
the owners of the respective treatment clinics decided what methods were offered, 
e.g. egg and sperm cell donation are possible. Only in 2015 did the Infertility Act 
move ART into legislation and introduce a reimbursement plan. Access is granted 
only to married couples as in most European countries. The access to information 
on the supply of ART is limited, however, coinciding with a reluctance among Polish 
politicians to engage with the topic (Krawczak 2016).

The other immigrants’ countries of origin included in our study lie somewhere 
between liberal Russia and conservative Poland. Turkey allows the use of ART for 
married couples only, costs are partially covered, and only homologous methods 
are approved (Gürtin 2011). Croatia and Slovenia also grant access to couples in a 
stable relationship. Furthermore, Croatia provides access for single women; costs 
are, however, only partially covered. Slovenia provides patients of ART treatments 
with a full reimbursement. In Croatia, heterologous methods are allowed (Čartolovni 
et al. 2014; Präg/Mills 2017b). 

Because the societal climate regarding ART varies between the countries of ori-
gin, we assume the migrant groups from these regions in our study will also show 
differences in their attitudes toward ART after migration. As compared to Germany, 
we assume that migrants from Poland may be the least approving of ART because 
the long resistance of the Polish government to legally regulating ART. The various 
access restrictions may have also fostered a negative perception of ART (despite 
the wide range of methods supplied), and the treatment rate is the lowest in Europe. 
By contrast, we would expect persons from the former Soviet Union to be more 
accepting of ART due to the laws and practices there, which are more liberal than 
in any other country included in our pilot study. For migrants from Turkey and the 
Balkan countries, we expect them to show attitudes that differ from those from the 
“extreme” cases of CIS and Poland because the legal framework and the usage also 
ranges in the middle, i.e. rather similar to Germany. 

Our first working hypothesis on the country of origin of the migrants thus is: 
Women from Russia and other CIS countries are expected to be more likely to ap-
prove of ART while women from Poland are expected less likely than Germans and 
migrants from Turkey and the Balkan countries (H1). 

Our second working hypothesis concerns the role of cultural integration across 
migrant generations. Previous empirical studies have provided mixed evidence on 
other attitudes toward sexuality and family as well as religiosity in the second gen-
eration (Diehl/König 2009; Carol/Milewski 2017; Kalmijn/Kraaykamp 2017). Classical 
assimilation theory (Gordon 1964) would propose that subsequent migrant genera-
tions gradually adapt to the destination society. The second generation has been 
described as being between two cultures, in particular when the cultural distance 
between their parents’ origin and the destination is rather large, as in the case of 
Muslims migrating to Europe. On the one hand, descendants of immigrants may be 
influenced by channels of political socialization at destination and the institutional 
context for larger parts of their life course. Thus, their attitudes may rather resem-
ble those of non-migrants than those of their parents. On the other hand, additional 



Women’s Attitudes toward Assisted Reproductive Technologies    • 349

factors may also play a role in the descendants’ attitudes, such as intergenerational 
transmission of the parents’ culture and the socialization into a minority group. 

Thus, our second working hypothesis: If the attitudes toward ART in the first 
migrant generation differ from that of Germans, we assume that the attitudes of the 
women of the second migrant generation range between those of the first genera-
tion and the non-migrants (H2). 

2.3 Religion and gender roles

Our third working hypothesis concerns the role of further explanatory variables 
in shaping attitudes toward ART. We are interested in cultural factors, which have 
been shown to influence the usage of ART (Präg/Mills 2017a). 

Family and reproduction are an essential part of all religions, hence research on 
bio-medical ethics discourses about the influence of religion has a long tradition 
among scholars worldwide. In collectivistic societies and in religious communities, 
having children is important for intergenerational transmission and support for old 
age as well as for the continuity of the lineage. Whereas most world religions see 
marriage as an essential part of the life course, their doctrines perceive fertility and 
infertility differently (Serour 2008). 

The Christian churches – the traditionally dominant religions in Europe – vary 
in their allowance of ART in general and in the methods used in particular. The Ro-
man Catholic doctrines (influential in Poland, Croatia, Serbia, Bosnia-Herzegovina, 
and parts of Germany) perceive conception as depending on sexual intercourse of 
the spouses. Therefore, the Vatican rejected assisted reproduction as early as 1956 
(a declaration of Pope Pius XII). Tolerable exceptions may be made in cases where 
natural intercourse is not substituted and where the unit of the married couple is 
preserved. The doctrines of the Eastern Orthodox Church (represented in Russia 
and also in Croatia) are similar, allowing only medical, hormonal, corrective or re-
constructive surgical treatment of infertility and rejecting methods of third-party-
assisted conception. The Protestant denominations in Germany are more liberal in 
their stance toward the use of ART. Preferably, homologous rather than heterolo-
gous methods may be used because the former preserve the unit of the marriage 
(Schenker 2000, 2005). 

In Islam (dominant in Turkey, parts of Bosnia-Herzegovina, Albania, Kosovo), de-
spite the existence of various schools, the importance of marriage, family forma-
tion, and procreation is a common feature in the doctrines. Islam permits the use 
of ART as long as they are used for married couples who have bio-medical fertil-
ity problems. In Sunni Islam, the authenticity of the lineage must be ensured. This 
means only homologous techniques are permitted as long as the marriage is valid 
and both spouses are still alive (Serour 2008). 

Despite these differences between the religious doctrines, previous research 
on ART usage suggests that religious affiliation may not matter as such (Präg/Mills 
2017a), but rather personal religiosity. Religiosity can take different forms (believing, 
bonding, behaving and belonging) (Saroglou 2011), and the influence of religion in 
daily life may vary by life domain. The personal implementation of religion in daily 



•    Sonja Haug, Nadja Milewski350

life may exert an independent effect on attitudes, independent of the country of 
origin and the religious affiliation as shown for other attitudes toward gender, fam-
ily, and sexuality.

The religious perceptions of marriage, fertility, and family are highly intertwined 
with gender roles, in particular with the status of women. People in more religious 
societies show attitudes leaning toward gender inequality and more conservative 
family values (Norris/Inglehart 2012). This association is particularly strong in the 
Muslim religions. Therefore, infertility treatment is considered important in Islam. 
“The social status of Muslim women, their dignity and self-esteem are closely re-
lated to their procreation potential, both for the family and society as a whole. Child-
birth and rearing are regarded as family commitments of both partners and not 
just biological and social functions” (Serour 2008: 35). By contrast, in the Christian 
churches, the suffering of persons who are involuntarily childless is perceived as 
natural and is to be accepted (Schenker 2005). Thus, infertility or childlessness may 
have greater social consequences and may cause greater personal suffering for re-
ligious people and people in collectivistic cultures, where family is the main source 
of pride, or in cultures where the birth rate is high and childlessness is rare (Culley 
et al. 2009b).

The immigrants in our study come from countries where the social status of a 
woman largely depends on her motherhood status and where – unlike Germany – 
childlessness in particular is rare. At more than 20 percent, Germany has the highest 
level of childlessness in Europe (Sobotka 2017). Immigrant groups in Germany – as 
in other European countries – have higher fertility levels than the native population, 
in particular the first generation from countries with replacement fertility levels or 
above. For the countries of origin included in our study, this pertains mainly to wom-
en from Turkey, who exhibit higher fertility transitions in Germany than both non-
migrant Germans and those staying in Turkey (Milewski 2010; Baykara-Krumme/
Milewski 2017). Women from countries where fertility rates are similar to Germany 
(such as former Yugoslavia) show a rather similar or lower fertility compared to 
non-migrant Germans. The rates of childlessness, however, are on average lower as 
compared to non-migrant Germans (Milewski 2010). This indicates that immigrant 
women maintain the family values from their countries of origin, which see mother-
hood as central for women. A possible gap between desired and actual numbers 
of children, which may suggest a demand for ART, has not yet been investigated in 
work on migrant fertility.

Our third working hypothesis is based on the assumption that immigrants of dif-
ferent origins and non-migrants in Germany may vary in their gender-role attitudes 
and their religiosity from and between each other. Our third hypothesis: We expect 
that controlling for gender-role attitudes and individual religiosity reduces the main 
effects (if any) of the origin groups in attitudes toward ART (H3). 



Women’s Attitudes toward Assisted Reproductive Technologies    • 351

3 Empirical material

3.1 Data 

The data we used in this paper were drawn from a data collection carried out in 2014-
2015 as part of a research project on the influence of social networks on knowledge 
transfer regarding reproductive health (NeWiRe) carried out by a project team at the 
Eastern Bavarian Technical University (OTH) Regensburg. The data were collected 
via a standardised telephone survey (CATI) of women living in Germany who were 
between 18 and 50 years old. The targeted sample size was 1000 respondents. 
Some parts of the questionnaire of our data collection replicated a survey dating 
from 2003 (Stöbel-Richter et al. 2009). Unlike Stöbel-Richter’s project, one specific 
goal of the NeWiRe survey was to include, in addition to German native-born wom-
en, immigrants of the first and second generations. The target groups were the four 
largest immigrant groups living in Germany based on the criteria “migrant back-
ground” as used in official statistics and in the microcensus, meaning either foreign 
citizenship, own migration experience, or having at least one parent who had immi-
grated to Germany (Destatis 2018). The sample for the NeWiRe survey (Haug et al. 
2018) was drawn by Humpert & Schneiderheinze GbR and Prof. Dr. Rainer Schnell, 
using disproportionally layered random sampling by means of an onomastic (name-
based) procedure. Potential participants’ landline numbers or mobile phone num-
bers were selected from the German telephone directory based on an index of first 
or family names (Humpert/Schneiderheinze 2000; Schnell et al. 2013).2

As a result of this sampling method, 1001 interviews were conducted.3 The ques-
tionnaire was available in German, Turkish, Polish, Russian, and Serbo-Croatian; the 
interviews were carried out by bilingual interviewers in order to allow respondents 
to switch between German and their respective mother tongue or second language 
at any point during the interview.4

2 A screening procedure was conducted preceding the interviews. Respondents were asked 
about their native country (i.e. country of birth), the native countries of their mother and their 
father, their first and any second citizenship to define their migrant background according to the 
definition used in German official statistics. The application of the onomastic method worked 
very well for persons of Turkish descent, where about 88 percent of the respondents were cor-
rectly identified, as well as for persons from Poland (86 percent) and from the CIS (94 percent). 
The correct identification of the migrant background was rather modest in the case of people 
originating from the Balkan countries (61 percent), resulting in a lower coverage rate of this 
group. The response rate was higher for the sample group of CIS (37 percent), Poland (29 per-
cent), and Turkey (25 percent), but relatively low for the Balkan countries (18 percent) and non-
migrants (17 percent). 

3 18 percent with non-migrant women, 25 percent had a migrant background from CIS countries, 
19 percent from Poland, 19 percent from Turkey, and 15 percent from Balkan countries formerly 
belonging to Yugoslavia and Albania.

4 In the groups from “Turkey,” “the CIS,” and “Poland,” more than half of the interviews were 
conducted in the respective native languages compared to only 9 percent of the interviews in 
the group of “the Balkan countries” (Haug et al. 2018).



•    Sonja Haug, Nadja Milewski352

The final sample used consisted of 960 women (41 respondents were excluded 
from the analyses due to missing or unreliable information on their migrant back-
ground). About 81 percent of the women in our sample belonged to a migrant mi-
nority group and 19 percent were non-migrants. Among the immigrants, we distin-
guished the generations by the respondents’ country of birth. About two-thirds of 
them had migrated to Germany themselves or with their parents (the mean length 
of stay was 24 years), while the remaining third was born in Germany. 

3.2 Variables and method 

Our analyses consist of three parts. The first dependent variable is the social norm 
on the use of ART (Models A). We used the statement reading “Involuntarily child-
less couples should make use of all possibilities of reproductive medicine to have 
biological children” (960 respondents answered this question). The answers were 
collected on a 5-item Likert scale ranging from “completely disagree” to “complete-
ly agree.” We used linear regression models and display these results as beta coef-
ficients. Second, we analysed the more personal attitude by using the question “If 
you wanted to have children but were unable to have children ‘naturally,’ would you 
in principle make use of medical procedures to be able to have a biological child?” 
(947 respondents answered this question) (Models B). Three answers were possible 
(“yes, definitely,” “yes, maybe,” and “no”). For the analysis, the categories “yes, 
definitely” and “yes, maybe” were combined to yes (1) versus “no” (0). We used 
binary logistic regression models and display these results as odds ratios. These 
two variables, i.e. the social norm and the personal attitude, correlate significantly 
(Spearmans’s rho=0.35), but are no substitutes for each other. We investigate both 
outcomes because the question on the norm specifically addresses infertility in 
childless couples whereas the question on the attitude is phrased more generally 
using the word “naturally.” Thirdly, we analysed the methods of ART that would 
be considered for use (Models C). The respondents who indicated that they would 
“in principle make use of medical procedures to be able to have a biological child” 
were asked in a follow-up question which methods they would use (864 respond-
ents answered this question). The questionnaire listed six procedures that belong to 
three basic types. First, hormone treatment influences the preconditions of a pos-
sible conception. Second, insemination and IVF are homologous methods. Third, 
sperm and egg cell donation as well as surrogacy are heterologous methods. The 
respondents could either agree or disagree to each of these six procedures; mul-
tiple answers were possible. In clinical practice, hormone treatment is not only a 
stand-alone treatment, but also a component of other technologies. Similarly, IVF is 
a homologous method, but also a component of heterologous methods. In addition, 
heterologous methods are more controversial because they involve a third party; 
and they are – to date – not legal in Germany, or only under certain conditions. 
Therefore, we distinguished between those respondents who would use at least 
one heterologous method (1) and those who would use only homologous methods 
(0) and carried out a binary logistic regression on the type of ART.



Women’s Attitudes toward Assisted Reproductive Technologies    • 353

In order to account for cultural differences between the main groups, we used 
a variable for individual religious behaviour related to family planning by querying 
the degree of agreement with a statement on family-planning methods: “I practise 
family planning conforming to religious rules.” As an indicator for gender-role at-
titudes, the respondents were asked how much they agreed with the statement “A 
woman needs her own children to live a fulfilled life.” The answers to the questions 
on religious family planning and gender-role attitudes were possible on a five-item 
Likert scale. 

Further independent variables captured the socio-demographic characteristics 
of the respondents in order to control for compositional differences between the 
groups under study. Age and age-squared were used as metric variables. The vari-
able “union status” measured whether the respondents had a cohabiting partner 
(be it either a marriage or a non-marital cohabitation) or not. A parenthood variable 
indicated whether the respondents had children or not. The level of educational 
attainment was measured by the highest school degree obtained (none/lower sec-
ondary education (corresponding to Hauptschule), intermediate secondary educa-
tion (corresponding to Realschule or Mittlere Reife), upper secondary education 
(corresponding to Abitur or Fachhochschulreife)). 

3.3 The sample and data quality

The sample consisted of five country groups of origin. Table 1 gives a descriptive 
overview of the sample by country of origin, which also enables evaluation of the 
data quality of our pilot project.

About 19 percent were German non-migrants, 26 percent of the women came 
from the CIS countries, about 20 percent from Poland, and another 20 percent from 
Turkey, and 16 percent originated from a country in the Balkan region. If we take 
country of origin and migrant generation into account simultaneously, the share of 
the second generation was about 2 percent in the group from the women from CIS 
countries, about 10 percent among Polish respondents, 32 percent among Turks, 
and 27 percent among those from the Balkan countries.5 According to the German 
microcensus, the share of the second generation is about one third; their share is, 
however, much lower for the relatively new immigrant groups from Poland or CIS 
countries (Destatis 2018).

Despite a similar age structure, we found significant differences between the 
groups by country of origin in the explanatory variables: The percentage of single 
women and childless women was significantly lower among the immigrants than for 
non-migrant Germans. The groups in our sample also varied significantly regard-
ing their schooling with the migrant groups on average lesser educated than the 
German non-migrants. There was, however, a substantial difference between the 

5 In the migrant groups coming from Turkey and from the Balkan countries, we distinguished be-
tween the first and the second migrant generations; due to the small sample size of the second 
generation in the groups from the CIS countries and Poland, no distinction could be made there 
in the multivariate analyses.



•    Sonja Haug, Nadja Milewski354

Tab. 1: Description of the sample, by country of origin (%)

Non-migrants Migrants
Germany CIS Poland Turkey Balkan

countries countries

Migrant generation 
1st generation na 98.4 89.9 67.9 74.0
2nd generation 1.6 10.1 32.1 26.5

Age (mean) 39 38 38 36 38
Union status**

Single and no cohabitation
(not married/ divorced/ 
widowed) 35.4 18.7 27.1 22.5 19.9
Married or non-marital
cohabitation 64.6 81.3 72.9 77.5 80.1

Parenthood***
No, childless 25.8 8.7 20.7 20.3 13.2
Yes, children 74.2 91.3 79.3 79.7 86.8

School education***
None, primary, lower
secondary 9.3 10.3 4.8 35.3 20.5
Intermediate secondary 42.3 57.5 31.4 33.2 38.4
Upper secondary 47.3 30.2 56.9 27.3 39.1
mv 1.1 2.0 6.9 4.3 2.0

Religious affiliation***
Roman catholic 40.1 11.5 92.6 0.5 34.4
Protestant 29.1 38.1 0.5 1.1 1.3
Muslim 2.2 0.4 0.0 92.5 39.7
Christian orthodox 0.0 24.2 0.0 1.1 12.6
None 23.1 17.9 4.8 1.6 9.3
mv 5.5 7.9 2.1 3.2 2.6

Family planning conforming to religious regulations***
“Completely disagree” 53.8 34.1 14.4 5.3 31.1
“Disagree” 21.4 26.2 22.3 8.6 10.6
“Neither nor” 11.0 12.7 9.6 3.2 15.2
“Agree” 8.2 16.7 30.3 26.7 23.8
“Completely agree” 3.8 9.5 21.8 54.5 17.9
mv 1.6 0.8 1.6 1.6 1.3



Women’s Attitudes toward Assisted Reproductive Technologies    • 355

migrants’ by their country of origin, i.e. women from Poland were the highest edu-
cated on average in our sample, with a low share of low education and a rather high 
share of upper secondary schooling. The group from Turkey had the lowest educa-
tion with the highest shares of lower secondary (or less) schooling and the lowest 
share of upper secondary schooling in our sample. The groups from CIS and Balkan 
countries were in the middle.

Regarding their religious affiliations, the groups from Poland and from Turkey 
were dominated by one religious affiliation; more than 90 percent of the Polish be-
longed to the Roman Catholic Church and more than 90 percent of the Turks in-
dicated a Muslim affiliation. The groups from the Balkan, from CIS countries, and 
from Germany each showed a composition of two religious denominations, but also 
rather high shares of non-religious persons. As the variable “religious affiliation” 
correlates highly with the country of origin, we could not use this indicator in our 
multivariate analyses, however. Personal religiosity, measured as the role of religion 
in contraception, differed significantly between the German non-migrant group and 
the migrant groups. Only 12 percent of the German respondents said that they prac-

Non-migrants Migrants
Germany CIS Poland Turkey Balkan

countries countries

“A woman needs her own children to live a fulfilled life.”***
“Completely disagree” 17.6 2.4 8.0 4.3 8.6
“Disagree” 13.7 8.7 12.2 7.5 8.6
“Neither nor” 19.8 8.3 12.2 5.9 10.6
“Agree” 28.0 21.0 23.4 27.8 27.2
“Completely agree” 20.9 58.7 43.6 53.5 45.0
mv 0.0 0.8 0.5 1.1 0.0

Reproductive treatment experience
Yes 8.2 6.0 8.5 6.4 7.9
No 91.8 94.0 91.0 93.6 91.4
mv 0.0 0.0 0.0 0.0 0.7

n 182 252 188 187 151
% at total sample 19.0 26.3 19.6 19.5 15.7

Tab. 1: Continuation

Note: Significance for bivariate association between variable and migrant status (chi2 or 
t-test); *p<=.05; **p<=.01; ***p<=.001.
CIS: Armenia, Belarus, Kazakhstan, Kyrgyzstan, Russian Republic, Tadzhikistan, Turkmeni-
stan, Uzbekistan, Ukraine;
Balkan countries: Bosnia, Croatia, Kosovo, Macedonia, Montenegro, Serbia, Albania.
mv=missing values, na=not applicable.

Source: NeWiRe survey 2014-2015. N=960



•    Sonja Haug, Nadja Milewski356

tised family planning conforming to any religious regulations, but 83 percent of the 
Turkish migrants and 53 percent of the Polish migrants agreed to this statement. 
The statement measuring gender-role attitudes “A woman needs her own children 
to live a fulfilled life” received much more agreement among migrants, in particular 
women from CIS countries and Turkey, with about 80 percent or more each, com-
pared to 49 percent among non-migrants. Women from Poland and from Balkan 
countries were in the middle with about 70 percent agreement to this gender-role 
item.

When we compare the socio-demographic structure of the sample in our pilot 
project to previous literature and data on the population of Germany, we believe 
that the quality of our sample is rather good. As an additional indicator of the data 
quality, we can use the prevalence of ART usage. In our sample, the percentage 
of women who had ever received any reproductive medical treatment was about 
7 percent. The rate was even higher in the German sub-sample (8 percent) than 
among the migrant groups. This is a much higher rate than what has been stated 
in the scarce literature to date (2 percent, Stöbel-Richter et al. 2012). This increase, 
however, seems not implausible considering the rise in the number of children born 
after medical treatment according to the German in-vitro fertilization register (IVF 
register) in the recent decades (Haug et al. 2018; Trappe 2017; Passet-Wittig 2017). 
The rate that we estimated is similar, however, to 8 percent in a sample of childless 
migrants in Smidt/Wippermann’s study (2014). 

The willingness to use ART is much higher in our sample than that of Stöbel-
Richter (2009, 2012); a plausible reason may be measurement issues. The first ques-
tion in our study referred to ART in general and then to different methods separately 
(see Table 5), whereas Stöbel-Richter’s study asked for “all reproductive options.”

4 Results 

Social norm on the use of ART 

Figure 1 displays the bivariate results for the social norm to use ART by origin group. 
In the total sample, almost 80 percent agreed (strongly) that involuntarily childless 
couples should make use of all available ART; 10 percent disagreed (strongly). There 
was variation by migrant background: The approval rates were higher among mi-
grants, with at least 80 percent in each origin group, than among the non-migrants, 
of whom only 66 percent agreed. The disagreement was 12 percent among Ger-
mans and 15 percent among Turks; women of the other origin group showed disa-
greement rates below 10 percent. 

Table 2 displays the result of the multivariate analyses of the social norm to use 
ART. In Model A1, we distinguished between the countries of origin and between 
the migrant generations when possible, testing our working hypotheses 1 and 2 
on the role of the country of origin and the migrant generation. The lowest agree-
ment to the norm was estimated for the Germans (who were in the reference cat-
egory). The highest agreement was found for women from CIS countries and Poland 



Women’s Attitudes toward Assisted Reproductive Technologies    • 357

(which consisted in both groups mainly of first-generation migrants). Women of the 
first generation from the Balkan region and from Turkey ranged between the Polish 
women and those from CIS countries on one hand and the German respondents on 
the other. By contrast, women of the second migrant generation from Turkey and 
the Balkan countries did not show significant differences compared to Germans, but 
significantly lower levels than their first-generation counterparts. Then we tested 
our third working hypothesis on the role of differences in the cultural and socio-
demographic composition of the groups by inserting the control variables in the 
Models A2 (adding age, age-squared, union status, parenthood, education) and A3 
(adding gender attitudes and religiosity). The pattern of significant country differ-
ences in the first generation and the significant differences between the migrant 
generations remained, and the coefficients only slightly changed despite these con-
trols, however. 

Fig. 1: Social norm on the use of ART, by country of origin (%)

0

10

20

30

40

50

60

70

80

90

100

Germany CIS
countries

Poland Turkey Balkan
countries

6
6

22

43

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54

3
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56

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31

49

4
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32

47

"Completely disagree" "Disagree" "Neither nor"

"Agree""Completely agree"

Non-migrants Migrants Total

in percent

Note: Differences by country background are significant on the 0.001 level.

Source: NeWiRe survey 2014/2015. N=945



•    Sonja Haug, Nadja Milewski358
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Women’s Attitudes toward Assisted Reproductive Technologies    • 359

Personal attitudes toward the use of ART

Figure 2 displays the bivariate results for the personal attitude toward the use of 
ART by origin group. The willingness to use reproductive medicine if faced with 
an inability to conceive in order to have biological children is rather high in the 
total sample: 69 percent of the women would “definitely” use ART, and another 
21 percent said that they would “maybe” use it. Accordingly, only 10 percent re-
jected the possibility of ART usage. The size of the non-users corresponded with 
those who did not share the norm on the use of ART. Similar to the analyses of the 
norm, the attitude toward the use of ART was the lowest in the group of German na-
tives, of whom only 55 percent would “definitely” use ART and another 30 percent 
answered “maybe.” Accordingly, 14 percent rejected personal use of ART. Among 
migrant women, there was variation by country of origin: The highest share of “defi-
nite” use was found for women from Poland (79 percent), followed by those from 
Turkey (75 percent) and CIS countries (71 percent). Women from the Balkan coun-
tries ranged with 64 percent “definite” use in the middle between Germans and the 
other migrant groups, but their share of non-intention to use ART was equal to that 
of Germans (10 percent). The share of those who rejected ART treatment was the 
lowest in the CIS group (6 percent).

Fig. 2: Personal attitude toward the use of ART, by country of origin (%)

0

10

20

30

40

50

60

70

80

90

100

Germany CIS
countries

Poland Turkey Balkan
countries

14

30

55

6

23

71

10

12

79

8

17

75

14

23

64

10

21

69

"No" "Yes, maybe" "Yes, definitely"

Non-migrants Migrants Total

in percent

Note: Differences by country background are significant on the 0.05 level.

Source: NeWiRe survey 2014/2015. N=947



•    Sonja Haug, Nadja Milewski360

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Women’s Attitudes toward Assisted Reproductive Technologies    • 361

Table 3 displays the results of the multivariate analyses of personal attitudes to-
ward the use of ART. Similar to the social norm, the chances to approve of ART was 
elevated in the groups from Poland and the CIS countries as well as in the first mi-
grant generation from Turkey and the Balkan region (but, due to a large confidence 
interval, not significantly in the Balkan group). Again, no significant differences were 
found between women of the second generation and non-migrants (Model B1). The 
pattern of country differences and generational differences remained when we 
inserted the socio-demographic controls (Model B2). Model B3 controlled for the 
indicators of gender-role attitudes and religiosity, without causing much effect on 
the group differences by migrant origin and generation. Women from Turkey in the 
first generation were about 4 times more likely to say that they would use ART than 
Germans; the likelihood among women from Poland and those from the CIS coun-
tries was more than double that of the Germans. Although not significant, the first 
generation from the Balkan countries were 60 percent more likely to say that they 
would use ART compared to Germans (Model B3).

Methods of ART considered for personal use

Table 4 displays the descriptive results of the methods of ART that the respondents 
would use themselves. Hormone treatment and insemination received the highest 
acceptance rate with about 82 to 89 percent in the whole sample and rather modest 
variation by country of origin. The lowest acceptance was found in the group from 
CIS countries (about 67 percent). IVF was met with lower acceptance, but still re-
ceived about 70 percent in the whole sub-sample with only little difference by coun-
try of origin. The lowest acceptance was estimated among women from the Balkan 
countries (about 65 percent). The respondents were much less open to heterolo-
gous procedures. Note that egg cell donation and surrogacy are currently not al-
lowed under German law, and sperm cell donation only when the donor is disclosed 
(see section 2.2). In the total sub-sample, sperm and egg cell donation received 
about 15 percent acceptance, and surrogacy was approved in only about 8 percent 
in the total sample. The non-migrants were the least accepting followed by women 
from the Balkan countries and Turkey. Approval of the three heterologous methods 
was the highest among women from the CIS countries and Poland. Among them, 
about 17 to 22 percent would utilise sperm or egg cell donation (which are legal in 
Russia and Poland), and about 10 percent would apply surrogacy (which is allowed 
in Russia). 

Table 5 displays the results of the multivariate analyses of the possible use of 
heterologous methods. Similar to the results on the determinants of the norm and 
the attitude toward the use of ART in general, women from Poland, the CIS coun-
tries as well as first-generation migrants from Turkey and the Balkan region showed 
higher chances of approving of heterologous methods than Germans (Model C1). 
We again found the pattern of differences between the first and second generations 
from Turkey and the Balkan countries, with the migrant descendants showing lower 
acceptance than their mothers’ generation. At the same time, the odds ratios of the 
second generation were not different or even lower than that of the Germans. We 



•    Sonja Haug, Nadja Milewski362

should note here, however, that the sample size is rather small and the confidence 
intervals rather large, which rendered most of the group differences insignificant at 
the 5 percent level. Another similarity to the analyses of the norm and the general 
attitude is that the insertion of the socio-demographic controls (Model C2) and of 
the cultural variables (Model C3) did not alter the pattern of the group differences 
by region of origin and migrant generation.

Effects of the cultural indicators and further control variables

The control variables used showed similar effects in the three analyses. Significant-
ly elevated approval rates were found among women who believe that a woman 
should have a child to have a fulfilling life as compared to those who did not support 
this statement. In other words, gender-role attitudes have a significant effect on 
the social norm and the personal attitude toward the use of ART as well as on the 
method considered for use. Regarding religiosity, the women in our sample who 
said that they practised family planning conforming to religious regulations did not 
show significant differences in their approval rate of the social norm to use ART and 
were significantly more likely to consider ART for their own use than those who did 
not follow religious guidelines. Whereas religiosity did not play a significant role in 
the general norm and attitude, it had a significant impact on the method considered 
for personal use. The religious women in our sample were less likely than the non-
religious women to approve of heterologous methods. This result corresponds with 
the somewhat restrictive view on the use of reproductive medicine of not only the 
Catholic, but also the Protestant and Islamic religious communities. 

Germany CIS Poland Turkey Balkan Total
countries countries

Hormone treatment*** 91.0 66.9 94.7 84.3 80.8 82.3
Homologous methods

Insemination*** 92.9 86.0 94.7 88.4 83.8 89.1
In-vitro fertilization*** 71.8 71.6 71.2 75.6 64.6 71.3

Heterologous methods
Sperm cell donation 12.8 18.2 18.8 14.0 12.3 15.6
Egg cell donation*** 9.6 17.4 21.8 12.2 12.3 15.0
Surrogacy** 6.4 10.2 10.0 5.2 5.4 7.8

At least one heterologous method 18.6 27.1 28.8 22.1 20.0 23.8
n 156 236 170 172 130 864

Tab. 4: Procedures of ART considered for potential own use, by country 
background (%)

Note: Significance for bivariate association between variable and migrant status (chi2 
test); *p<=.05; **p<=.01; ***p<=.001.

Source: NeWiRe survey 2014/2015



Women’s Attitudes toward Assisted Reproductive Technologies    • 363

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•    Sonja Haug, Nadja Milewski364

No significant effects were found in the three analyses for the socio-demograph-
ic controls age, union status, parenthood, and education. The only exception was 
the age in the analysis of the type of methods. Heterologous methods were more 
approved the older the women were. 

5 Discussion and conclusion

Our paper examined norms and attitudes toward the use of various methods of 
ART, comparing women of several migrant origins and generations to natives in 
Germany. 

Our first working hypothesis (H1) concerned the role of the country of origin. 
In line with theoretical considerations on the political socialization and the lasting 
impact of socialization in migrants even after their international move, we expected 
the societal climate in the migrants’ countries of origin and in Germany to be reflect-
ed in the individual attitudes toward ART. In detail, we assumed that migrants from 
Poland would be the least approving of ART and persons from the CIS countries 
the most approving. For Germans as well as women from the Balkan countries and 
Turkey we expected a position in the middle between these positions. Our results, 
however, only partially supported this hypothesis. Contrary to our hypothesis, the 
least approving origin group were the non-migrants, which we had expected to be 
found in between the various migrant groups. They had the lowest approval rates in 
all three outcome variables, i.e. the norm that childless people should make use of 
ART and their personal attitude whether they would use ART themselves, and the 
question if they would use heterologous methods. Confirming our hypothesis, per-
sons from the CIS countries had much higher approval rates in all three outcomes. 
Not in line with our hypothesis, the attitudes of women from Poland, Turkey, and 
the Balkan region were significantly elevated as compared to Germans and rather 
similar to that of the women from CIS countries. The results of our study suggest 
therefore that it may be an overall societal climate where having children is valued 
that may support the acceptance of ART. In all other country groups in our study, the 
women more strongly supported the statement that childless couples should use 
ART. Thus, the legal regulations in a country are only one determinant of attitudes 
toward ART; liberal laws – as in Russia – are associated with high approval of ART. 
But also women from Poland, which has a long period of non-regulation, restricted 
access to information, and a more negative discourse, as well as women from coun-
tries with stricter regulations and limited access (Turkey, Balkan countries) showed 
higher approval than Germans. This also means that attitudes and prevalences do 
not necessarily coincide; Germany ranks in the middle of European ART usage, 
Poland at the end of the treatment ranking – yet the attitudes of women from these 
countries are opposite.

We turn to our second working hypothesis (H2): We investigated possible differ-
ences between the migrant generations. According to classical assimilation theory, 
we expected women of the second migrant generation to show lower acceptance 
levels of ART than those in the first generation. Our results delivered evidence for 



Women’s Attitudes toward Assisted Reproductive Technologies    • 365

this hypothesis (although we must acknowledge that we were only able to test this 
hypothesis for the groups from the Balkan countries and from Turkey; the numbers 
in the second generation of the other two immigrant groups were too low, up to only 
10 percent). The norms and attitudes toward ART did not vary much from those of 
the non-migrants in our sample and not significantly so; but they were much lower 
than that of the first generation in all three outcomes.

When we compare the results of our study to other papers on attitudes, norms, 
and values of immigrants, they are similar with respect to differences between 
migrants and non-migrants, and they also depict the in-between position of the 
second generation compared to the first generation and to non-migrants. Previous 
research found more traditional values – i.e. supporting gender inequality – among 
migrants, but large differences were found between immigrants from Muslim coun-
tries and those with other religious predominance. The variation between women 
from countries with Muslim and Christian minorities was not significant in our study. 
As suggested above, we see the reason for this common feature between women 
from countries with different religious traditions in their joint characteristics of plac-
ing a central role on motherhood for women’s status. 

In order to investigate the causes for the differences between the origin groups, 
we formulated a third working hypothesis on the role of cultural and socio-demo-
graphic control variables, whereby controlling for group differences in composition 
would account for differences in attitudes toward ART (H3). We included individual 
agreement whether a woman needs a child in order to have a fulfilled life and an in-
dicator for personal religiosity in our analyses, in which the women stated whether 
they practiced contraception according to their faith. The inclusion of the two con-
trols did not significantly affect the main patterns of group variation; therefore our 
working hypothesis was rejected. 

Another difference to previous research is that the norms and attitudes in our 
study are of an innovative nature, whereas previous research has focused instead 
on topics where the dividing line between the religious East and the non-religious 
West is apparent and where the migrants’ maintenance of the cultural traditions of 
their origin was demonstrated. In our study, all migrants, in particular those of the 
first generation, appear to be more “open minded” in their norms and attitudes to-
ward the use of ART. The remaining question, however, is why these respondents 
approved or disapproved of ART. The norm-variable that we used referred specifi-
cally to “childless couples” who are the people using ART. Using ART in order to 
treat infertile couples also is linked to “traditional” family attitudes and gender-role 
models – despite the innovative nature of the conception method. The norm of 
bearing children is so established that these “modern” ART are seen as a way of 
supporting age-old expectations. Perhaps these attitudes would differ if the ques-
tion was about subsequent parities or about single women or same-sex couples, 
which are also contested topics in the legal debates and are not tolerated by most 
religions included here. 

It seems that religiosity played a rather minor role, indicating that private reli-
gious practice does not necessarily follow theoretical religious doctrines in norms 
and values. An alternative explanation is that ART seem not in contradiction to most 



•    Sonja Haug, Nadja Milewski366

religious regulations as long as the unit of the couple is preserved, which is the case 
in the phrasing of the item we used for the norm. When they were asked about het-
erologous methods, the respondents with higher religiosity were far more reluctant 
than the non-religious women in our sample to consider them for use. This is again 
an indication of the continuation of traditional family values in attitudes toward ART.

Another aspect that may play a role is the treatment of information in heterolo-
gous methods, where a third party comes into play. Questions such as whether the 
donors should be anonymous or not, should the surrogate mother’s name appear 
on the birth certificate, or would the donors have any obligations to the potential 
children may play a role in shaping these individual attitudes. Future research will 
need to investigate this more thoroughly in order to understand the comparatively 
low attitudes toward ART among non-migrants in our sample, which at first sight 
suggest a more traditional attitude. It is known from research on the childless popu-
lation in Germany that most people do not use fertility treatment, even when they 
have a diagnosis of impaired fertility and have heard of different methods (Wip-
permann 2014). Would the ethical arguments as well as the financial and emotional 
costs of ART weigh more? Or might it be that childlessness and small numbers of 
children are more common in Germany, and that the social consequences of having 
no children or not as many as desired are not as detrimental as in “traditional” soci-
eties – as suggested by the rather low share of German respondents in our survey 
who said that having biological children is important for a woman? 

Acknowledgements
The research project NeWiRe 2015 (Der Einfluss sozialer Netzwerke auf den Wissen-
stransfer am Beispiel der Reproduktionsmedizin) was funded by the German Feder-
al Ministry of Education and Research (BMBF, grant number 1GP1304). The authors 
thank Karsten Weber, Matthias Vernim and Edda Currle for their contributions to this 
research project and Renée A. Lüskow for English language editing. The telephone 
survey was conducted by Infas Institut für angewandte Sozialwissenschaft. 

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•    Sonja Haug, Nadja Milewski370

Date of submission: 03.08.2018  Date of acceptance: 20.02.2019

Prof. Dr. Nadja Milewski (*). University of Rostock, Institute of Sociology and 
Demography. Rostock, Germany. E-mail: nadja.milewski@uni-rostock.de
URL: https://www.isd.uni-rostock.de/en/isd/lehrstuhl/jp-demo/milewski/

Prof. Dr. Sonja Haug. Ostbayerische Technische Hochschule Regensburg (OTH). 
Regensburg, Germany. E-mail: sonja.haug@oth-regensburg.de
URL: https://www.oth-regensburg.de/professoren-profilseiten/professoren-s/prof-dr-
habil-sonja-haug.html



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 2018

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