Disclosure and identity experiences of adults abandoned as babies: A qualitative study

Abstract There is intense debate regarding the disclosure experience of those children born from new technologies, surrogacy or adoption, yet no single study of those adopted after being abandoned as infants. This qualitative study examined disclosure for adult survivors of abandonment. Sixteen interviews were recorded and coded. A deductive approach to thematic analysis was used to create higher order themes and sub-themes. Findings are centred around the experience of disclosure, the process of disclosure specifically exploring the role of half-truths and finally the impact of disclosure on the search for identity and self. Disclosure was often delayed with traumatic effect. Adoption disclosure was separated from abandonment disclosure. Abandonment facts were often discovered at life event moments—weddings, death of an adoptive parent or the birth of a baby. Abandoned babies, as adults, often resorted to press/media to track their original circumstances, to seek out relatives and finders. Such searches were emotion filled, at high personal cost and often with dead-end consequences. Naming (e.g. after a railway station or shop name) was often linked to place or person surrounding the abandonment circumstances and this amplified the pain when discovered. Most had a clear concept of their mother, yet none had contemplated or hankered after their father. These rare insights have implications for future research and policy.


PUBLIC INTEREST STATEMENT
The psychological ramifications of infant abandonment are lifelong. As this is such a relatively rare phenomenon, there are scant data on abandoned babies reaching adulthood. As abandoned babies are invariably adopted, studies on adoption conflate this group. This study set out to explore the experiences of abandonment on a group of adult survivors. Using depth qualitative analytical techniques, the experiences and emotional considerations were examined. The implications of the findings suggest a number of policy and provision interventions that could ease the way for such children and adults in the future. This includes the importance of keeping records, the need for training and support around disclosure, managing press and public interest as well as showing kindness and consideration in such areas as child naming and record keeping. The practice of destroying files after 7 years jeopardises their ability to trace their roots. At times of life events, their experiences may become more poignant and warrant support. It seems that the emotional ramifications are lifelong and services are not sufficiently targeted to meet these needs.

Introduction
Child abandonment, the act of renouncing all interests in one's child with no intention of reclaiming them, is a long-standing issue that is illegal in many countries. Yet, abandonment continues and remains a worldwide issue (Pruitt, 2008;Sherr, Mueller, & Fox, 2009;Sherr, Roberts, & Croome, 2017). Rates of abandonment are rarely available (Lee, Li, Kwong, & So, 2006;Sherr et al., 2009). Annual rates range from 3000 babies per annum in Italy (Ferrara et al., 2013) to 16 babies per annum in the United Kingdom ), with poverty (du Toit-Prinsloo, Pickles, Smith, Jordaan, & Saayman, 2016Jacobs, Hornsby, & Marais, 2014) and governmental policy i.e. the one child policy in China (Li, Wu, Ge, & Ma, 2012), being identified as potential drivers of such phenomenon. Estimates of such rates are incomplete, much of the data are drawn from forensic reports identifying abandonment as the cause of death and media articles (Gheorghe, Banner, Hansen, Stolborg, & Lynnerup, 2011). An analysis of UK media articles identified the majority (77%) of abandonments to be of newborn infants. Models of care for such infants differ, inclusive of residential care and family-based settings (Walakira, Ochen, Bukuluki, & Alllan, 2014) and there remains limited literature and policy regarding the long-term care of such individuals within this unique group, particularly with regard to the disclosure of their abandonment status and issues regarding identity.
All children have a right to personal identity (Turkmendag, 2012). Such knowledge of origin is especially important in circumstances linked to non-biological parenting, such as new technologies, adoption or abandonment. With all forms of alternative family provision, the issue of recording genetic parental origins and the subsequent handling and disclosure of such information has been the subject of much debate. The literature suggests that disclosure patterns for children born as a result of new technological interventions differ from those who are adopted as infants for social reasons (Jadva, Freeman, Kramer, & Golombok, 2009). Assisted reproductive technology has legal and social implications, creating organisational needs in biomedicine and adoption agencies, but is all contingent upon the potential identification of the biological parent in the first place. As such, experiences may differ dramatically in the unique situation of children who are adopted as a result of infant abandonment.
There are a number of questions around disclosure of origin, including secrecy that surrounds the information, when and how it is disclosed to the child and the mental health and/or adjustment reactions in the presence of such disclosure patterns. Reppold and Hutz (2009) noted that emotional adjustment of adopted adolescents was moderated by both the manner and the age with which the adoption was revealed. Such findings are endorsed by other studies where late revelation of adoption status was associated with adolescent depression for 68, 14-15 years old, children who had been adopted as infants (Smit, 2002). This review highlighted that adoption issues were life long and explored the need for family-based provision of support. A meta-analysis of 25,281 children adopted and residing in the USA described mental health challenges, referrals and behaviour problems and noted a slight elevation in prevalence for internationally versus locally adopted groups (Juffer & van Ijzendoorn, 2005). Yet, adopted children on the whole have been found to resemble non-adopted children in many mental health measures, although scores are affected by a small minority with specific problems (Brand & Brinich, 1999).
Disclosure of origin is generally seen as a challenge within the literature. The most comprehensive European study (Golombok et al., 2002) compared various forms of family origin (In vitro fertilisation -IVF, donor insemination, adoptive and naturally conceived) and found that only 8.6% of families had disclosed the genetic origins of the child. This study used adopted children as a comparison group, but no data were given on disclosure to this group specifically, let alone if any of the adopted children were abandoned as infants-information often omitted from much of the literature.
The history of secrecy surrounding various birth origins has been challenged, with the emergence of more open debate as new technologies become more sophisticated. Literature suggests that secrecy will have a dangerous and damaging effect on family relationships initially and thereby to the child (Baran & Pannor, 1993;Daniels & Taylor, 1993;Landau, 1998;McWhinnie, 2001;Snowden & Snowden, 1998) as well as medical consequences for the child (unknown genetic history; Tallandini, Zanchettin, Gronchi, & Morsan, 2016). Despite this, disclosure is often found to be problematic, late or avoided (Brewaeys, 1996;Leeb-Lundberg, Kjellberg, & Sydsjö, 2006). In Sweden, for example, where there is legislation to assure openness for donor insemination origins, Gottlieb et al. (2000) found low rates of disclosure (89% not disclosed). A review by Brewaeys (1996) confirmed low disclosure of donor insemination origins in 12 studies. This is in sharp contrast to the views of the offspring who, as they grow, often report a strong desire to have their genetic information and often search for their genetic parents (Beeson, Jennings, & Kramer, 2011).
It is unclear where information from abandoned infants can be gleaned from. For the most part, disclosure and alternative family composition does not come from a study of abandoned babies and even when comparisons are made in empirical studies, abandoned infants are rarely included and adopted children are often the control or comparison group. MacCallum and Keeley (2012) compared children conceived through embryo donation with adoptive and genetically related IVF children. They found the former far less likely to share information with the child; compared with all adoptive mothers and nearly 90% of IVF mothers-noting that often disclosure only occurred with partial explanations. Alexander, Hollingsworth, Dore, and Hoopes (2004) explored issues of disclosure in adopted US children from parental perspectives. They identified five key themes driving disclosure decisions, namely efforts to prevent trauma to the child, respect for the child's differentness and birth history, consideration of developmental decisions in disclosure, the key role of children's questions as motivations for disclosure and finally the parents' feelings about disclosure. Openness about disclosure was studied with a group of 30 donor conceived children (Freeman & Golombok, 2012) who found that disclosure was not associated with significant family functioning or child difficulties but noted that a child's age and sex needed to be considered. This literature suggests that there is both a mental health and human rights issue linked to disclosure of origin for children and that disclosure is not automatic, straightforward or fulsome. There are strong arguments about the rights of the child to know their origins. Blyth (2002) concludes that it is their own definition of best interests which should form the basis for access to information about genetic origins. The right to genetic truth has also been discussed in relation to sperm donorship (Burr, 2010). This notion contrasts to the emerging provision for adults to abandon babies and cut off any means of identification, such as the USA safe haven laws (Kunkel, 2007). Within surrogacy, long-term studies show that disclosure is high (at about 90% in a 10-year follow-up study; Jadva, Blake, Casey, & Golombok, 2012) with beneficial consequences for relationships.
Similarities and insights may be collated from disclosure to children of other dramatic life events. For example, disclosure of parental illness such as cancer (Barnes et al., 2000;Kroll, Barnes, Jones, & Stein, 1998;Morris, Martini, & Preen, 2016) has been shown to be low and avoided. The complex disclosure challenges of family HIV infection have been a challenge and guidance on disclosure has been provided in detail by the World Health Organisation-exploring who should disclose, when to disclose and how to do so (World Health Organisation [WHO], 2011).
Yet those who are adopted after baby abandonment have not benefited from the debate regarding disclosure (Sherr & Hackman, 2002). The complete issue of genetic linkage, biological parental tracing and openness arrangements (Von Korff, Grotevant, & McRoy, 2006) differ dramatically for children who were adopted after being abandoned and thus their experiences may differ. This research aims to develop an understanding of this understudied and unique group of individuals and was set up to provide their perspective, to explore disclosure of abandonment experiences from adult survivors of abandonment and to develop understanding of the impact of such disclosure on subsequent behaviour in order to inform future policy.

Sample
Qualitative data from 16 UK-based adults who identified as being abandoned as infants are reported within this study. Seventy-five individuals were invited to participate in the study using a purposive sampling method in which participants were recruited via UK-based self-help groups for adopted children and the media. The inclusion criteria for this study required participants to be above 18 years of age, have a history of being abandoned as an infant within the United Kingdom and be fluent in the English language. Twenty-five expressed an interest in the study; however, due to difficulties regarding scheduling, only sixteen interviews were conducted. Signed consent was obtained from all participants prior to data collection and no participants refused or withdrew from the study. Study information and relevant contacts were given prior to data collection and no incentives for participation were offered to participants.
Ethical approval was obtained from the University College London ethics committee (2454/001). Data collection took place between October 2010 and November 2011.

Data collection
Semi-structured interviews, following a detailed topic guide consisting of 12 items (see Table 1), were conducted with all participants to develop an understanding of their experience of learning that they had been abandoned as an infant. The interview aimed to elicit information regarding participants' abandonment history, accounts of their abandonment disclosure experience and their own reactions as well as obtaining their views on disclosure and genetic origins. All interviews were conducted with a psychologist, with another psychologist present, and were between 33 and 108 min in duration (M = 61.81, SD = 22. 03). Referral pathways for support were identified and made available to participants but were not taken up by any participants.

Data analysis
All interviews were audio recorded and transcribed verbatim. A data-driven inductive approach to thematic analysis was utilised to interrogate the interviews as no pre-existing framework was used to guide analysis (Braun & Clarke, 2006). All transcripts were hand coded using an essentialist epistemology. A team of psychologists examined similarities and differences within the data by systematically coding each new piece of text with previously theme exemplars. New data compared to already generated themes allowed for themes to be refined and clarified and further themes to be developed. Conceptual maps were used to assess the relationships between themes and higher order themes were developed through clustering. This process was repeated iteratively until saturation of the data was reached. To ensure consistency and rigor, two researchers coded half of the transcripts. The full research team reviewed all themes and the met to resolve any coding discrepancies. Due to the unique circumstances of the participants, names have been omitted and place names have been altered to protect the identity of participants. No other content within the transcripts has been altered.

Reflexivity
Data collection and analysis were undertaken by research psychologists under the supervision of an academic with a clinical psychology background. Researchers were encouraged to reflect on their interactions with participants and the data under supervision and how this may have influenced data collection and analysis. Themes within the data were discussed collectively by the research team.

Participants
Semi-structured interviews were undertaken with 16 participants (7 males). Participants ranged from 26 to 76 years of age, with the majority (15), above 43 years.

Thematic analysis
Three interconnected themes were identified within the data: The fundamental experience of disclosure; distillation and distraction-the role of half-truths; knowing and the search for identity and self. Table 2 displays these themes and their associated sub-themes. (1) Tell me about how and when you discovered that you were an abandoned baby-a "foundling'"?
(2) Tell me about/describe the moment you found this out? How old were you? Who told you? What happened after you were told, was it an open frequently discussed subject or a closed one?
(3) What do you know of the circumstances surrounding your discovery? Do you have any newspaper cuttings?
(4) Tell me about who discovered you?
(5) Have you ever or do you still maintain a relationship with your "finder" or any hospital staff and what is it like?
(6) Tell me about what happened to you after you were found, were you adopted/fostered?

The fundamental experience of disclosure
For most, the timing and the mode of abandonment disclosure, including who disclosed to them, were found to be prominent features of the experience. The sub-themes of timing and mode are outlined below.

Timing
Disclosure was either an unfolding reality known since early childhood or an abrupt event, later in life. Such disclosure was often coupled with other life events and the source of the disclosure varied considerably. Those who were disclosed to early on reported always knowing about their abandonment and had the knowledge integrated as they grew up were found to be the minority. These recollections were less dramatic and emotion laden. They were either an active integration of the information from young childhood or an early mention with little follow-up. Being told when young may also bring with it some specific difficulties in that the detail is not clearly recalled and the topic (perhaps a taboo) is not mentioned again, leaving the child unclear while the adult assumes disclosure has already occurred.

I've had this scrap book so I've always known. (Male, 26)
The majority of participants were those who were told later in life. Such accounts were found to be more troubled as they were often found to occur at a dramatic life event including on their wedding day, following the birth of a child or in times of grief.

Day their child was born
That's what stuck with me until I think my second daughter arrived and my adoptive mother said well of course you realize . . . (Female, 64) Death of adoptive mother I didn't (know) I was abandoned until I was 33 years old-it was the day after my mother, my adoptive mother-now I know she's my adoptive mother-died. (Male, 50) . . . then my wonderful mother died. The very night she died my father produced adoption papers. (Female, 64) For some, the reaction was compounded by the nature of the double shock, often adoptive parental death coincided with abandonment revelations.
A shock, it was a sudden death, it was the shock of . . . the phone call finding out that she had died and the next day . . . finding out that she wasn't in fact my mother and that I was not only adopted but had been abandoned. (Male, 50)

Mode: the person disclosing
The person who disclosed was not always an adoptive parent and this may have compounded the shock. For some, there was no person, but they discovered their circumstance upon perusing papers or legal documents.
Psychiatrist . . ..and one day he (Psychiatrist) just turned round and said to me he told me that I you know I had no mother or father or no relations whatsoever. (Male, 67)

School friend
I was at boarding school and one of the girls said to me something about being adopted and I was sort of just gobsmacked and how they knew I have no idea. (Female,70) Brother (My brother) said to me 'have you ever thought about tracing your mum' and . . . he said 'oh you wouldn't be able to you were found in a box or something'. Now I thought he was joking because he's the joker of the family. (Female, 43)

Distillation and distraction-the role of half truths
A second theme centred on the link between adoption and the experience of abandonment disclosure. A further sub-theme, Comprehension takes time: emergent secrecy and silence, was formulated regarding the role secrecy within participants' comprehension and reaction towards disclosure.
Adoption was usually the first revelation and abandonment details were often withheld, discussed later or emerged later. The respondents saw this as a series of half-truths. They were more likely to be told of their adoption than the fact that they were abandoned. The pattern emerged of later revelations of abandonment or subtle hints with no direct information; thus, for some of the survivors, there was a double disclosure moment.
. . . (I knew at) a reasonably early age that I was adopted and all that but I didn't know that I was actually abandoned at all until erm, I can well remember it when on my wedding day. (Male, 70)

Comprehension takes time: emergent secrecy and silence
Reactions, though often profound, were also often delayed. The period after disclosure is often typified by silence, lack of discussion or taboo.
. . .for the next 20 years it wasn't really mentioned. (Male,46) Dialogues of silence often accompanied the reaction descriptions. These silences worked both ways-adoptive families kept silent, partial silence and secrets about the abandonment history while searching, delving and curiosity attempts were seen as secretive.
. . . when I . . . got this birth certificate and I saw this on it . I thought oh my goodness me I need to do a bit of delving here but I didn't want my parents to know. (Female, 64) I tried to talk to my adoptive mother and she just wasn't going to have it, she just wasn't prepared to speak to me about it at all. (Female,53) 3.5.1. Knowing and the search for identity and self For many, their names-and hence their identify-were interwoven with their abandonment circumstance. This often meant that disclosure also resonated with comprehension of the origins of their name which confounded their sense of not belonging. They were often named to mark the abandonment event, such as the place of abandonment, the name of the finder or the timing of the abandonment. This was often recalled as hurtful and a challenge to self-identity and feelings of worth. Three sub-themes were developed including: The search for validation, Searching for Roots and Identity and self. These subthemes are outlined below.

The search for validation
A common theme was one of searching for validation, key players or parents-often many years later. This included revisiting the scene of their abandonment, trying to reconnect with named individuals from the time of their discovery and for a few searching for a parent-invariably a mother. Many reported positive emotions linked to any finder reunifications and recalled them warmly, while others faced the frustration of dead end searches and scant information.
I got some letters from women who said they'd been nurses there at the time. We've done lots of traces but the shop's been pulled down. (Female,47) I have been in touch with the police officer who was responsible for picking me up from the house that I was abandoned. (Male, 50) The press and media played a key role-a sort of necessary evil. At times, they are the only source of record for the abandonment event, they are the only pathway to endeavour tracing or searching for past links, but involvement with the media came at an emotional cost for some, but with excitement and reward for others.
So I spent a day there going through these decaying newspapers looking for even a mention of a kid being dumped. Not a word. (Male,68) Took me back to where I was found, interviewed me for the policeman who found me.

Searching for roots
Many describe some sort of search to seek out individuals, visit places or resolve gaps. One participant even had their DNA analysed to show their heritage. Such searches were reported as overwhelming and all consuming, with some respondents wanting to put the search aside and get on with their everyday life.
It was something I had to do just to try, just to see if anyone would come forward. . .. It's the not knowing that makes you want to search. (Male,26)

Identity and self
The interviews seemed to point to disclosure being bound up with the individual's sense of identity. Confusion and questions were common. Much of the identity discussion and the search drivers were mother focused-few think or hanker after a father. They were specifically asked about their father during the course of the interview and the responses tended to be one of surprise, lack of thought on the topic or disengaged from their father with few if any thoughts.
The strange thing is I don't ever think about having a birth father. I have absolutely no clue, but never once do I think about having a birth father, which is a little bit bizarre. (Female,47)

Discussion
This rare insight into the adult perspective for those abandoned as infants may serve to identify future challenges as well as provide a deeper understanding and support system for them. The reports clearly identify a theme of secrecy, no disclosure or partial disclosure. There are positive stories surrounding those who are told from very early on, who do not recall a time of ignorance. For these individuals, there is no disclosure moment or disclosure crisis. For some, in the presence of secrets and silence, disclosure occurred as a painful detractor at unique life changing moments such as marriage or childbirth. This seemed to heighten distress around disclosure. For many, there was the pain of double disclosure as the information regarding adoption was separated from the information on abandonment and they were faced with additional disclosure.
Abandoned babies are often the source of media intrigue. Indeed at times, the media have been the sole source of information for academic as well as personal information ). Many of those interviewed had mixed feelings about the media, yet recourse to earlier media coverage was the only birth memento they had-which was cherished. Such information played a key role in their searches after disclosure.
For this group, genetic knowledge was not available and they found this difficult-both for the lack of medical and genetic knowledge, but also for the sense of loneliness and lack of identity that occurred. Disclosure of abandonment was often associated with a search to find evidence, places or people linked with their story. Any links with person or place connected to the moment of abandonment/discovery were welcomed. Although many had clear ideas of their mother and talked about being abandoned by her, most had never contemplated their father, held conceptions of their father or ached to meet him. This would challenge the purely genetic roots theory about disclosure, thus encouraging a more psychological explanation about life meaning and the importance of personal identity.
In many cases, disclosure occurred later in life which may be a reason why the results of this study are skewed towards interviews with older individuals who have experienced different adoption procedures than the current rules. Disclosure occurred for some participants after the death of an adoptive parent or on an individual's wedding day. If an individual does not find out, they are abandoned until later in life they are unable to participate in research earlier. This may help explain why only one participant was 26 years of age whilst the rest were over 40. Similarly, their accounts may reflect out-of-date adoption and social support policies that may have been modernised or enhanced since new legislation and management have emerged. However, it does not discount their experience and given that the ageing population may well have disproportionate numbers affected by these experiences, handled under older philosophies or practices, their needs ought to be included and incorporated rather than dismissed because things may be different for tomorrow's abandoned babies.
Limitations of the study are linked to the age skew of the sample and the inability to separate and differentiate between adoption and abandonment experiences. Yet, in reality, these may well be a fused experience and the added burdens and issues linked to abandonment may need to be considered. Qualitative methodology gives insight into the experiences in depth and is particularly appropriate for difficult to reach or rare groups such as these. Non-response bias for this particularly rare group is also an issue regarding the generalisability of the data. Nevertheless, this exploratory analysis provides insight from which further research emanate and from which theoretical ideas can be drawn. This study focuses on individuals who had been abandoned as infants and does not focus on the wider family of such individuals and how this may have impacted on the disclosure experience and vice versa. Future research may be best placed to focus on the role of such relationships within the disclosure experiences of this group.
The advent of new legislation (such as the UK Children Act in 1975 and the Adoption Act in 1976) may have provided a pathway to address the needs of such groups and to ensure the importance of adequate emotional care. Yet, these legislative provisions have not filtered through retrospectively to those who are still experiencing the effects, evidenced by our group and experienced by generations today (Nelson, Fox, & Zeanah, 2013). There needs to be some clarity on defining disclosure which may vary from an intention to tell, brief mention and full disclosure with dialogue (Readings, Blake, Casey, Jadva, & Golombok, 2011). These data indicate that policy and guidance on disclosure for abandoned babies are needed. There is a gap in policy provision for handling abandoned babies and this element needs to be considered ). Such policy needs to provide advice on the best source of disclosure, the optimum timing of disclosure, the process of disclosure over time, the importance of records, mementos and links to finders. Training and intervention guidance on disclosure from illness such as HIV (Rochat, Stein, Cortina-Borja, Tanser, & Bland, 2017;World Health Organisation [WHO], 2011) or cancer may be adapted and provided to adoptive parents to assist them in contemplating issues of disclosure early on and aiding with the facilitation of the process. The practice of naming abandoned babies after finders or places of location should be reconsidered-given the negative impacts on the children and their self esteem when they discover these links later in life. The needs of abandoned babies cannot be simply subsumed under the general needs of adopted children as they have specific unique characteristics to be considered. The timing, nature and process of disclosure are important in their life experience and adaptation and adoptive parents should be provided with guidance, support and advice very early on to obviate unnecessary trauma and secrecy.