Does Same-Sex Marriage Legalization Invoke Childbearing Desire in Gay and Bisexual Men in Taiwan: A Panel Study


 Background: Despite the globally rising recognition of same-sex relationships, sexual minority men continue to report lower childbearing desire and intention compared to their heterosexual counterparts, even though both groups tend to consider parenting as valuable. This study capitalized on the prospective process of legalization of same-sex marriage (SSM) in Taiwan to capture changes in gay and bisexual men’s desire and attitudes towards parenthood as a function of the legalization of SSM. Methods: 863 respondents (Mean age = 27.9 years ±5.8) completed an online survey shortly before and 1½ years after the legalization of SSM. They reported their childbearing desire, marital status, and attitudes towards childbearing and marriage. Results: Contrary to our expectation of an increase in childbearing desire due to enhanced legal recognition of same-sex relationships, our study found that fewer participants in the follow-up survey expressed a childbearing desire (59.0% vs 74.2%), and the perceived importance of childbearing dropped mildly (3.48 to 3.26, Cohen’s d=0.269). Those who expressed a consistent childbearing desire attached greater importance to SSM and regarded SSM as a source of a sense of security and recognition by friends/family. The perceived importance of SSM was mildly positively related to the perceived importance of childbearing. Conclusion: Although the decrease in childbearing desire and its perceived importance may be attributable to a lack of access to family building options (e.g., surrogacy and adoption) and the COVID-19 pandemic, our findings illustrate that parenthood can be a logical next-step for Taiwanese male same-sex couples and call for the development of affordable family building options for these men.

COVID-19 pandemic, our ndings illustrate that those who wanted to be married may also consider becoming parents. This result calls for the development of affordable family building options for these men.

Background
The socio-legal recognition of same-sex relationships often co-evolves with the discussion or even leads to the recognition, of sexual minority individuals' access to parenthood. [1] Previous research indicates that sexual minority men largely possess lower childbearing desire and intention than heterosexual men. [2][3][4][5][6][7] The road to parenthood for sexual minority men is often impeded by a myriad of economic (e.g., the high cost of surrogacy), social (e.g., the anticipation of minority stress), and legal (e.g., the lack of protection for the second parent in adoption) barriers, and these are in part attributable to heteronormative expectations regarding parenthood that are endemic in many societies. [8][9] Compared to lesbians, gay men also face additional layers of obstruction resulting from social norms regarding reproduction as an exclusively feminine domain and therefore seeing men as less warm, nurturing, and capable of properly rearing children, [10][11][12][13] together with the practical di culties of nding a surrogate compared to a sperm donor.
Emerging studies have identi ed that legal recognition of same-sex relationships may in uence sexual minority individuals' childbearing desire, intention, and subsequent parenthood experience. [14][15] While over two-thirds of respondents in Perrin et al's. US study reported having experienced stigma based on being a gay father, gay fathers living in states with few legal protections were confronted by more stigma against their parenthood compared to their counterparts living in states with more legal protections. [12] Drawing on the legal consciousness theoretical framework, a change in the 'laws on the books' can translate into how people make sense of and interact with that legal change in their daily life. [15] Therefore, a question remains whether the legalization of same-sex marriage (SSM) can readily shape sexual minority men's desires and perceptions related to having a child even when the methods (e.g., adoption and surrogacy) remain unavailable. [16] This study investigated the institutional dependency of sexual minority men's childbearing desire by examining the effect of SSM legalization in Taiwan.
Childbearing desire among sexual minority men Sexual minority men share similar reasons with their heterosexual counterparts for becoming, or not becoming, a father, such as a quest for life enrichment, expected positive changes from childbearing, continuity of the family line, and consideration of nancial, emotional, and physical costs. [2,[17][18][19] Even those who choose not to pursue parenthood may perceive having a child as desirable and valuable. [3,20] Notably, the emergence of sexual minority men's desire to have a child otherwise termed "procreative consciousness", is sensitive to social climates and legal shifts concerning their partnership and parenthood.
[16] Research has sought to locate an "ah-ha" moment, a de nitive event or turning point when individuals realize that they have the ability, choice, right, or an internal inclination to become a parent.[8, 9,21] These moments can arise from personal experiences or interactions, such as seeing a friend having a child, learning about new assisted reproductive technologies (ARTs), or through discussion with an intimate partner. [9,21] As the procreative identity framework suggests,[8] socioeconomic, legal, and cultural barriers can intensify sexual minority individuals' hesitance or reluctance to seek parenthood. [14,15,22] Several studies have investigated how changes in the legal recognition of SSM may in uence sexual minority individuals' desire, intention towards, or actual, childbearing. For example, Italy recognized same-sex civil unions in June 2016, yet access to parenthood through donor insemination or surrogacy or adoption is still not allowed. [23] Compared with Baiocco and Laghi's estimates, [ 14,15,22,27] To date, no longitudinal research has been conducted to pinpoint the change in sexual minority men's childbearing desire as a function of the legalization of SSM. A unique opportunity to collect prospective data emerged in Taiwan when the Judicial Yuan made the ruling, Interpretation No. 748 in 2017, requiring the Legislative Yuan to either pass a new bill or amend the existing Civil Code to legally recognize same-sex partnerships by May 2019. Capitalizing on this prospective process of legalizing SSM in Taiwan, this study aimed to address an empirical gap, whether the passing of SSM fostered childbearing desire among gay and bisexual men. Based on the foregoing literature review, then, we hypothesized that the passing of SSM legislation would increase Taiwanese gay and bisexual men's childbearing desire. We also inquired about gay and bisexual men's perception of the importance of childbearing to further understand their attitudes about childbearing over the policy shift. Lastly, we accounted for their intention of and attitudes towards getting married since previous studies suggested that childbearing desire and attitudes might be more pronounced among those who consider the legal recognition of same-sex partnership important or relevant to them. [16,28]

Sample recruitment
Adopting a prospective design, this study recruited a panel of self-identi ed gay and bisexual men living in Taiwan via Facebook advertising between May 11 and 23, 2019. Four parameters were entered in the metrics to circulate the advertisement to Facebook users who indicated in their pro les that they were: (1) men, (2) aged ≥ 18 years, (3) residents of Taiwan, and (4) interested in lesbian, gay, bisexual, and transgender community-related issues and information. Interested users were transferred to the online survey platform, SurveyMonkey, to read the full information about the study and eligibility criteria, including (1) being assigned male at birth, (2) being aged 18 years or older, (3) self-identifying as gay or bisexual, and (4) residing in Taiwan. Consenting respondents spent approximately 20 minutes completing the survey and were requested to provide contact details (e.g., email, mobile phone number, or communication mobile applications) to receive an e-coupon for NT$100 (~ US$3, all currency conversions as of June 2021) as an honorarium. Between September 14 and October 16, 2020, personalized invitations and information about the follow-up survey were sent to respondents who had provided contact details in the baseline survey. Consenting respondents spent approximately 13 minutes completing the survey and were prompted to leave their contact information again to receive an honorarium. We relied on the respondents' contact information to link the data from the two waves of data. The study protocol was reviewed and approved by the Human Research Ethics Committee at XXX University (blinded for review).
In the baseline survey, 1,422 respondents completed the questionnaire. Forty-one were removed for being (1) minors (n = 3), (2) heterosexual (n = 24), or (3) repeat respondents according to their IP address (n = 14). Thus, the nal sample size for the baseline survey was 1,381. The follow-up survey collected 952 responses (attrition rate = 31.1%), of which 89 were discarded because: they were from a minor (n = 1), from repeat respondents (n = 8); or had missing values in the full survey (n = 25), questions on the variables of interest (n = 30), or the age question (n = 5). Responses were also discarded if they had error messages (n = 1), were unmatched with the corresponding data in the baseline survey (n = 1), or selfidenti ed as heterosexual (n = 18). The size of the nal analytic sample was 863. Demographic data for respondents from the follow-up survey are presented in Table 1.   Note. All sociodemographic and variables are from baseline 1; M = mean, SD = standard deviation; *** p < .001, ** p < .01, * p < .05, ns = non signi cance Measures Demographics. Respondents' age, monthly income, education level, employment status (in employment or not in employment), and sexual orientation (gay or bisexual) were collected.
Childbearing desire. Respondents' childbearing desire was sought using a binary question: "would you like to have your own child in your life?" We created a classi cation to represent any change in respondents' childbearing desire across two time points. Those who reported childbearing desire at both waves were labelled as Consistent Yes; those without a childbearing desire at both waves were labelled as Consistent No. The Withheld group refers to those who had a childbearing desire at baseline only while the Emergent group refers to those who developed a childbearing desire at follow-up.
Perceived importance of childbearing. We used three questions developed by Lo et al. to assess the perceived importance of having one's own child to oneself, [29] to one's present or future partner, and to someone with whom one has a present or future intimate relationship. Respondents answered these questions on a ve-point Likert scale ranging from 1 ("very unimportant") to 5 ("very important") (Cronbach's alpha = .83). The change in perceived importance was calculated by the numerical difference (follow-up score -baseline score).
Attitudes towards same-sex marriage. In the follow-up survey, we asked whether the respondents would like to get married in the future (intention of same-sex marriage); the response options comprised "yes", "possibly, "no", and "already married/engaged." We also asked the extent to which the legalization of SSM was personally important to them, with options ranging from 1 ("not at all important") to 4 ("very important"). Another two sets of multiple-choice questions pertained to the personal meaning of legalization of SSM ("The legalization of SSM symbolizes the government's recognition of SSM"; "SSM provides legal protection to same-sex partners"; "The legalization of SSM increases acceptance of sexual minority people by friends and families"; "The legalization of SSM forges my romantic relationship) and reasons for getting married (To actualize my life plans; To obtain legal protection for my relationship and rights; To give us a sense of security; To make friends and families recognize my intimate relationship)".

Statistical analysis
The change in childbearing desire before and after the legalization of SSM was analyzed by McNemar's test and the change in the perceived importance of childbearing was analyzed by a paired-samples t-test.
The relationship between the change in childbearing desire and the attitudes, personal meaning, and reasons for getting married were investigated by chi-square tests. The associations between the change in perceived importance and the attitudes, personal meaning, and reasons for getting married were explored by analyses of variance (ANOVAs) with LSD post hoc analysis. Statistical signi cance was indicated by p < .05, and all analyses were conducted with Statistical Package for the Social Sciences (SPSS) 25.

Sample characteristics
The mean age of respondents was 27.9 years (SD = 5.8; range = 18 to 50); 84.7% self-identi ed as gay  Sexual orientation and education level were related to the changes in childbearing desire. Speci cally, bisexual respondents comprised a higher proportion of Consistent-Yes and a lower proportion of Consistent-No and Withheld. The Consistent-Yes group also had a higher educational level than the Withheld group (p = .024), and in turn, the Withheld group was more highly educated than the Emergent group (p = .025). The Consistent-No group was also more highly educated than the Emergent group (p = .005). Overall, the respondents reported a mild but signi cant decrease in the perceived importance of childbearing after the legislation, from a mean of 3.48 (SD = .84) dropping to 3.26 (SD = .88), t (862) = 8.00, p < .001, Cohen's d = 0.269. We further divided the sample into three groups according to the changes in the perceived importance of having a child, namely "no change" (follow-up -baseline score within 0.5SD), "increase" (follow-up -baseline score above 0.5SD), and "decrease" (follow-up -baseline score below 0.5SD). While about half of the respondents (52.7%) were classi ed as "no change", 33.5% reported a decrease and 13.8% indicated an increase in the perceived importance of having a child. The shift in the perceived importance of parenting was not signi cantly related to age, income, education, employment, or sexual orientation.
Attitudes towards same-sex marriage More than half of the sample (57.6%) reported an intention to engage in SSM in the future while 36.0% reported they would possibly marry a same-sex partner. Only 4.1% reported not considering getting married and 2.3% were already married or engaged. 44.8% of the sample regarded the legalization of SSM as important to them while 42.3% reported it as very important to them. 95% of the respondents agreed that the legalization was important because it provided legal protection to same-sex partners; 81.9% agreed that the legalization symbolized the government's recognition of SSM; 68.4% agreed that it forged their romantic relationship, and about half of the sample (50.6%) noted that it increased friends' and families' acceptance of sexual minority people. Regarding the reasons for getting married, 87.4% and 80.8% of respondents saw marriage as a means to obtain legal protection for their relationship and rights, and to give them a sense of security, respectively. Less than half of the sample indicated that they would marry to actualize life plans (44.0%) or to make friends and families recognize their intimate relationship (31.9%).
Association between attitudes towards same-sex marriage and the change in the desire for and perceived importance of childbearing Intention to marry was related to the change in childbearing desire ( Table 2). 70% of those who married/ became engaged reported a childbearing desire in both waves while only 17.1% of those with no intention of marrying reported a childbearing desire. The proportion of Consistent-No was 10.0% in married/engaged respondents and 54.3% of the Consistent-No group did not consider getting married.
Withheld was more common among those who were unsure or not interested in marrying (Possibly = 23.8%; No = 28.6%) than among those who were interested in marrying or were already married/engaged (Yes = 14.3%; Married / Engaged = 15.0%). Lastly, the percentages of Emergent were low across all four groups.
The intention to marry was signi cantly associated with the change in the importance of having a child, F The decline in importance was also signi cantly stronger among those who did not intend to marry than those considering getting married (p = .042).
The extent to which marriage was perceived as important was related to the change in childbearing desire, F (3, 849) = 4.619, p = .003 (Table 2). Post-hoc analyses show that those with a consistent childbearing desire attached higher importance to same-sex marriage than those who had no desire for a child across both surveys (p = .001) or withheld their desire (p = .028). Considering same-sex marriage to "give us a sense of security" and "to make friends and families recognize my intimate relationship" were related to the change in childbearing desire (Table 2). Respondents endorsing these two reasons for marrying were more likely to have a consistent childbearing desire. Lastly, the extent to which the legalization of SSM was viewed as important was also related to the greater importance of having a child (r = .074, p = .030). Personal meaning of the legalization of and reasons for engaging in SSM were not signi cantly related to a change in the importance of having a child.

Discussion
This longitudinal study is the rst to document the changes in sexual minority men's childbearing desire and attitudes when SSM became legal in Taiwan. This study is also the rst to provide longitudinal data illustrating any impact of SSM legalization on the childbearing desire of sexual minority men. Overall, we found a modest decline in both the desire and the perceived importance of having a child among respondents. Our hypothesis, therefore, was not supported. Why might this be the case?
A rst practical issue relates to the changing nature of family formation between 2019 and 2020 in the context of the COVID-19 pandemic. In common with other social and economic shocks in the recent past, [30][31][32] the disruption in both daily life and the economy brought by the pandemic may impose a negative effect on fertility rates. [33] Again, in common with previous shocks, preliminary evidence suggests that fertility preferences among heterosexual couples may have shifted in response to the pandemic, especially where the economy has been hit the hardest. [34] This might have a stronger impact on non-heterosexual individuals compared to their heterosexual counterparts, [35] because of the signi cant postponement or suspension of ARTs. [36,37]In Taiwan, fertility rates fell to a record low in 2020, declining further in early 2021.
[38] Previous evidence from Taiwan suggests a robust link between economic resources, non-economic values, and fertility preferences. [39][40] Although local ARTs are currently out of reach for Taiwanese gay and bisexual men, [41] rendering their suspension less of a factor to decreased childbearing desire, amidst the grim economic outlook., our ndings may be partially confounded by the pandemic-caused revision of fertility preferences both among heterosexual couples and sexual minorities. This requires further investigation.
Secondly, Kolk and Andersson investigated the effects of two decades of legalization of marriage and parenthood equality policies on Swedish family dynamics and their results may shed light on the reasons behind our study's unexpected nding. [42] Using population-based registry data for 1995-2021, they found that neither the legislation of registered partnerships nor adopting fully gender-neutral marriage legislation markedly increased actual childbearing in same-sex marriage. Rather, the subsequent increase in childbearing was the result of legal changes in the joint adoption of a child and access to donor insemination for women in same-sex cohabitating relationships. Notably, the increase in childbearing following these legal changes was observed among women only, but not men in SSM. Across the two decades of legal changes in Sweden, men in SSM had consistently low rates of childbearing because the options for family building (e.g., surrogacy, second-parent adoption) remained costly and inaccessible.
Similarly, the legal means to have a child remain limited for Taiwanese sexual minority men. According to Taiwan's Arti cial Reproduction Act, only heterosexual and legally married couples are currently allowed to undertake ARTs to conceive a child. [41] While adoption has yet to be permitted for married same-sex couples, gay and bisexual people are routinely discredited in the determination of quali cation as single adoptive parents. Against this legal and structural backdrop, the legalization of SSM alone is unable to elevate sexual minority men's childbearing desire if the means and avenues remain absent. Further studies are warranted to observe the trend of childbearing desire among same-sex couples when the legal barriers to reproduction are lifted.
This study is also the rst to quantitatively relate changes in sexual minority men's childbearing desire and attitudes to their attitudes regarding SSM. Although sexual minority men's childbearing desire and the perceived importance of childbearing were found to be fairly stable over the study period, the legal access to SSM appears to have implications for the issue of childbearing only for those who considered or entered marriage. Married or engaged respondents expressed a high level of childbearing desire across time whereas those who felt unsure or reluctant to marry reported little or declined desire. Those who considered SSM important to them reported a constant childbearing desire, while married or engaged sexual minority men even expressed increased importance of having a child. These ndings suggest that the legal status of same-sex partnerships is heavily involved in the desire to become parents and form families.
[16] It might also re ect that sexual minority men in Taiwan tend to see marriage and parenthood as intertwined issues.
This study also illustrates the underlying link between access to SSM and childbearing desire. While previous studies indicate that sexual minority men's desire to marry and have a child might be underpinned by an intent to assimilate into a heteronormative society, [43] this study found that a sense of security and obtaining support from friends and family were cited as the key reasons for obtaining legal marital status to sustain their childbearing desire. Similar to heterosexual couples, sexual minority men are inclined to rear a child in a legally recognized relationship for the sake of relationship stability and resources and entitlements attached to legal marriage. [44] Knowing that the current social and welfare systems continue to disadvantage non-marital child childbearing, sexual minority men's intention or decision to marry becomes a critical factor for developing a desire to have a child.
This research provides important evidence that SSM legalization has fostered childbearing desire among those intending to marry or who have already registered their partnership. This nding has two important implications. First, despite the progression towards marriage equality in Taiwan and many other countries, legal and viable methods of bearing a child remain beyond the reach of married same-sex couples, whether through surrogacy or adoption. Those who can afford the time and monetary costs might be forced to realize their aspirations elsewhere. Given that those who are considering marriage are more likely to desire a child, policymakers should engage in reciprocal communications with them to understand their needs while conveying the legal concerns from the policymakers' perspectives. Such processes should be instrumental in responding to the unique needs of those seeking childbearing.
Second, the study ndings provide information for policymakers to gauge the possible number of sexual minority men who might want to have a child and consider resource allocation and deliberation on policy changes related to reproduction.

Limitations
Several limitations and methodological concerns relating to the study are noteworthy. First, despite the relatively large sample size and the panel design allowing for controlling within-subject changes, the study sample was not representative, so the external validity (e.g., generalizability) of the ndings is undetermined. Second, as already observed, the follow-up survey took place during the COVID-19 pandemic, which could strongly undermine respondents' mental health and childbearing aspirations. [45] This signi cant historic event might be partly responsible for the observed decline in childbearing desire and highlights the need for further investigation into the interplay between childbearing desire and largescale socio-economic changes. Third, we acknowledge that the de nition of childbearing desire in this study may not adequately grasp the full spectrum of ideation as regards family formation (i.e., from ideals through to intentions). Furthermore, while this study was formulated on the hypothesis that legal recognition of same-sex relationships in uences childbearing desires of sexual minority men within a short period (i.e., 1½ years between the two waves of data), parenthood equality policy may also in turn in uence the uptake of SSM in the longer term. [42] Therefore, continuous follow-up studies are recommended to observe longer-term changes in sexual minority men's family dynamics, including SSM and childbearing, as well as attitudes and decisions regarding these events, when adoption and assisted reproduction become available for them.

Conclusion
The very existence of gay fathers in Taiwan is a clear indication that some gay and bisexual men do not feel a need to forgo their childbearing desire. This study offers a snapshot of the childbearing desires among sexual minority men in Taiwan, identi es the reproductive implications of legalizing SSM, and informs ongoing discussions about sexual minority men's emerging rights to parenthood.
Abbreviations SSM: same-sex marriage Declarations Ethics approval and consent to participate The study protocol has been reviewed and approved by the Human Research Ethics Committee of the University of Hong Kong (#1904014). All study respondents provided their consent to participate.

Consent for publication
Not applicable Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to protection of respondents' privacy but are available from the corresponding author on reasonable request.

Competing interests
The authors declare that they have no competing interests.

Funding
This study was supported by the Research Grants Council Early Career Scheme #27616418 Author's contribution YH secured project funding, collected the data, interpreted the ndings and co-wrote the manuscript; BHPL analyzed the data and co-wrote the manuscript; MWF contributed to the literature review and edited the manuscript; SGB reviewed and co-wrote the manuscript. All authors have read and approved the manuscript