Equity of Access
Viewpoint: Jewish-American woman who is also a Public Health Policy Maker in the USA
Our media is flooded with political campaigns and programs that talk about heavily debated topics such as abortion, birth control and Planned Parenthood. However, an interesting statistic to note is that 6.1 million couples struggle with infertility each year. Why is our society so caught up in controlling the wombs of those who are fertile, but fail to thoroughly address a surprisingly large sect of the population that is struggling with infertility? Reproductive technology is not a recent development, and has actually been around for thousands of years. We see the first real situation in the Bible, where Abraham and Sarah struggled to have a child for many years. When they found out Sarah was barren, Sarah sought to have a child in an unconventional way by allowing Abraham to sleep with their servant, Hagar. (cf. Gen. 30) This is a clear example of surrogacy (Seeman, 342). However, since we no longer live in the ancient days; we see a more rigorous process to carry out such a process as surrogacy.
It is well known that every woman has reproductive rights. However, if we look at the definition of reproductive rights, we quickly see that it may not be a right after all. Reproductive right is defined as “the right of an individual to decide whether to reproduce and have reproductive health, and this includes an individual’s right to plan a family, terminate a pregnancy, use contraceptives, learn about sex education in public schools, and gain access to reproductive health services.“(Findlaw) Do all women have equal access or access at all to everything listed above? We can easily terminate a pregnancy for free (and everyone has access to that, for now) but it costs thousands of dollars to start a pregnancy! Do only wealthy people dream of starting a family? A poor barren woman quite possibly has the same want and longing for a biological child as the now infertile CEO of a profitable company. There are medical, social and ethical issues that have greatly persuaded this lack of equity in access the reproductive technologies.
Many may bring up the argument that a low-income household cannot afford to take care of a child, and to a further extent that their infertility was ‘self-caused’ and so a child is not needed to prolong their bad choices. However, a right is inherent. A woman’s color, race, gender, salary or views does not change her inherent right. However, due to social and cultural stigmas, there is now a standard that has to be met for one to carry that right with pride. Currently, we see a specific sect of the population benefiting greatly from something that both the rich and poor pay for. If we allow the advancement and funding of research for IVF and surrogacy to be continuously funded through tax dollars, this can no longer be something that only benefits the elite sect of the population. If the choice to have a child or not is really an inherent right, then equity of access needs to be taken into consideration. I am a major advocate for the use reproductive technologies, specifically IVF and surrogacy. Growing up in a Jewish home and school, these improvements in technology were seen as a way of stewarding the knowledge and wisdom that was given to us by God. In no way are IVF and surrogacy an act of ‘playing God.’(Breitowitz, 327) The infertility issue faced by millions of couples in the USA is not only an issue for the elite class. Middle class and poor families also struggle with issues of infertility, but at the same time, do not have access to this technology. The dominance of white, middle to upper class patients is stifling among surrogacy and IVF treatment centers. This obvious statistic is mostly due to the costs of these technologies. An average round of IVF treatment in the USA costs around $12,000, and that figure does not include the medications that are needed. The cost of gestational surrogacy is anywhere between $100,000 to $150,000. Now realistically, what percentage of the population can afford ‘infertility’?
From this statistic, it becomes evident that income and by default, education, are positively correlated with the use of these technologies. One might bring up the argument that many of these candidates are older couples who are professionals. The idea that many women delay pregnancies for their careers is well known and discussed. It is a major contributor as to why infertility is high among that sect of the population. However, surprisingly, those in lower classes have greater infertility rates because of other issues. If we think about the health issues that are linked to poverty, all these issues affect a woman’s reproductive health in one way or another. Issues such as poor dietary choices, and sexually transmitted diseases are two major reasons why infertility is so high among low-income families. How can a policy-maker like myself sit back and allow this growing disparity to spiral out of control? Funds that would go towards advancing these technologies can be taken to fund projects which deal with educating women about their bodies and screening for certain diseases, which would inevitably lower the infertility rate of many poor women. However, in the meantime, I see it as my mandate to highlight the inequity in our healthcare system, and propose ways for equal access.
I draw on the example of Israel, and their views and laws on reproductive technologies. Israel has the most fertility clinics per capita in the entire world. (Kahn 2000) And shockingly, these clinics are not only visited by the 10% of the population that can afford IVF out of pocket. Fertility treatments are fully subsidized by Israeli national health insurance. These treatments are available to all Israeli’s regardless of their religion, or socioeconomic background. Strange phenomenon? Yes. Israel’s stance on fertility treatment is birthed out of the idea of procreation being one of the most important mandates of their religion. (Prainsack, 184) Now we cannot compare Israel and the USA for many different reasons, including the fact that as a country, our laws are not directly affected by or tied to a specific religion, as in Israel. However, one thing that the USA does boast about is the idea of freedom. Freedom of choice, freedom of speech, and freedom to have certain inherent rights are all at the forefront of all our political debates and campaigns, however we fail to see the inherent rights of those who may not contribute as much to society as they are expected to. These people are shunned, marginalized, unjustly attacked among other things. These people are also passively stripped of their rights by societal and political powers. If a country like Israel can rally around the mandate of a religious text and find ways to ensure this mandate is supported, how much more can the American people rally around the inherent right of every person. Whether Melania Trump or Jane Doe who just got done working her 15-hour shift at Taco Bell, they both deserve equal access to the very thing this country fought for – freedom!
There is an argument about medical necessity vs. medical legitimacy that always surfaces when we talk about allocation of funding to certain healthcare pockets. Many people believe that insurance companies should not cover infertility treatments because it is seen as ‘optional’ medical intervention. A big reason why it is not seen as a medical necessity is due to the alternate options that are available to expand a family, such as adoption. However, this argument makes reproduction into a privilege and not a right. There is no debating that these technologies and procedures are costly. Making these procedures accessible to everyone will put an unhealthy strain on our healthcare industry. However, I oppose the idea that wealth equates to rights. This breeds an unhealthy dichotomy within our population where one person’s womb and to a greater extent, their bodies and space, is seen as more important than another’s. I am not suggesting that this is a simple task that will happen overnight; I am suggesting that greater effort and resources be put into the equity of access to these technologies, instead of requesting more funding to make this industry more profitable and therefore more exclusive.
I leave you with this scenario. If we compare infertile newlyweds (age: 29) who are in the low-income bracket to a 45-year-old woman who waited until she peaked in her career to think about having kids with her husband; would both couples be great fits to try IVF or surrogacy? I think yes! Do both these couples have equal chances of starting a family through those methods? No. Does this match up seem fair to you? Do both these women not have equal reproductive rights? If you answered no and yes respectively, then the issue of equity of access to IVF and surrogacy should be a burden for you too. I am endorsing the continued funding of these technologies, under the strict guide that we 1) find a way to make these technologies available to a higher percentage of the population and 2) commit more time and resources to focus on preventative measures for infertility, in the cases where it can be prevented.
Breitowitz, Y. “What’s So Bad About Human Cloning?” Kennedy Institute of Ethics Journal, vol. 12 no. 4, 2002, pp. 325-341. Project MUSE, doi:10.1353/ken.2002.0023
Prainsack, Barbara. “’Negotiating Life’: The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel.” Social Studies of Science, vol. 36, no. 2, 2006, pp. 173–205. JSTOR, www.jstor.org/stable/25474440.
American Pregnancy Association, Statistics, http://www.americanpregnancy.org
Seeman, Don. “KIN, GENE, COMMUNITY REPRODUCTIVE TECHNOLOGIES AMONG JEWISH ISRAELIS.” N.p., n.d. Web.
“What Are Reproductive Rights?” Findlaw. N.p., n.d. Web. 21 June 2017.