Call for Cultural Considerations When Screening Oocyte Donors and Gestational Carriers

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Wiyatta Fahnbulleh, PsyD, and Pamela Blackwell, PsyD, LMSW, led the discussion, “Cultural Diversity and Considerations for Psychological Assessment When Screening Oocyte Donors and Gestational Carriers: What are the Limitations of Our Data?” during the American Society for Reproductive Medicine (ASRM) 2023 Scientific Congress & Expo in New Orleans, Louisiana.

The presentation focused on the limitations of traditional psychological assessments, the impact of cultural bias, and the importance of understanding how individuals from different racial and ethnic backgrounds approach these tests. Fahnbulleh and Blackwell provided valuable insights and recommendations for addressing these challenges in the scope of third-party reproduction.

Fahnbulleh began by highlighting the limitations of conventional psychological assessments, particularly the Minnesota Multiphasic Personality Inventory (MMPI-3) and the Personality Assessment Inventory (PAI). She likened them to superheroes, with unique abilities to delve into the intricacies of an individual's psyche; however, they come with certain limitations that need to be acknowledged.

One significant limitation of these assessments is the potential for cultural bias. The MMPI and PAI were primarily developed based on Western Caucasian norms, which may not be applicable to diverse racial and ethnic groups. Fahnbulleh explained cultural misalignment can lead to misinterpretations and misunderstandings in assessment results, potentially excluding well-suited candidates.

Various cultural norms and values, as well as language and communication styles, can significantly influence the responses of individuals from different backgrounds. For example, some cultural groups may prioritize nonverbal communication and express emotions differently, which can affect their responses to standardized assessments.

Fahnbulleh shared examples of how cultural bias can manifest in assessment results. In one case, a Latin American donor exhibited elevated scores related to mania, which were misinterpreted due to cultural differences in expression and communication. In another case, a Native American individual's nonverbal communication style led to misinterpretations of their responses.

"When we approach these assessments with the assumption of cultural universality, as opposed to cultural specificity, we overlook the wealth of diverse cultural perspectives regarding concepts such as emotions, personality, and mental health," she emphasized. "The assumption presumes that certain psychological constructs are universally comprehended and experienced in identical ways across all cultures."

Emphasizing the importance of addressing cultural sensitivity in psychological assessments, Fahnbulleh and Blackwell recommended that researchers and developers invest in better sampling methods, including probability sampling, to ensure a more diverse normative sample.

A more diverse sample can reduce the effects of racial socialization and alienation. To combat the impact of cultural bias, it was suggested that clinicians engage with donors or individuals undergoing assessments to provide context for the questions and build trust. With open patient communication and clarification, donors can better understand the assessments, leading to more accurate results.

Blackwell touched on the concept of hypervigilance and cultural mistrust as adaptive responses to cultural racism. She stressed that hypervigilance can manifest in assessment responses and how it may be misinterpreted as mental health concerns. Her recommendation was for clinicians to acknowledge these coping strategies and provide a supportive environment for donors.

"When I say ‘coping strategies’ I mean hypervigilance and cultural mistrust are adaptive responses to cultural racism,” Blackwell said. “In 1968, researchers Grier and Cobbs named it ‘healthy cultural paranoia’ and stated that it seems to protect BIPOC people from harmful effects that they continue to endure due to discrimination."

In closing, Fahnbulleh and Blackwell recommended further research as an assessment improvement, collaboration with communities of color, advocation for inclusive assessment practices, and practicing cultural humility, sensitivity, and inclusivity.

“Embrace the call to action we've discussed today, where by working together, we can ensure that our practices truly reflect the tapestry of human experiences,” Fahnbulleh said. “Let this presentation be a catalyst for transformation in third-party reproduction, let our shared commitment to cultural sensitivity and inclusivity guide us as we strive to provide the best possible care for individuals and communities, leaving no one behind in their pursuit of happiness.”