Children are Not Commodities, Nor Are They a Lifestyle Choice
But since we live in capitalistic America, let’s go ahead and discuss this in that context.
Note: The topic of having children and infertility is fraught with emotion— desire, envy, anger, hope, joy—as well as judgements, misogyny, and white supremacy. Way too much to cover in 1,000 word essay (that was supposed to be only 500 words). The focus here (I hope it’s successful!) is on making the case for the medical necessity of IVF.
(Photo from February of 2013, the morning of our first IUI, when I felt so hopeful and had no idea it would take another 8 years to get to our baby. Jonathon and I went to brunch and he had me in stitches.)
There was a major reproductive ruling in Alabama last week—frozen embryos are now considered people, and someone can be held liable for destroying them. This means that parents, doctors, embryologists, nurses—anyone who might, intentionally or otherwise, destroy an embryo can be criminally charged.
Because of this ruling, most IVF clinics have stopped procedures until they know what protections they will have.
Meanwhile, a group of parents in Minnesota are pushing for a law that would require all health insurance companies to cover the cost of IVF. The comments in the Star Tribune article demonstrate evidence on how little the wider public knows about reproduction and IVF. Here’s a sample:
Wanting a child and not being able to concieve is not the end of the world. There are options, like adoption.--avejoecon
Lots of people would like things they can’t afford. The question is when should the rest of us be required to pay for them, and how much should we have to pay? Are the folks who want me to pay for IVF treatments planning to pay for some things I would like? I’m guessing not. --Amused83
Just to be clear - after all the angst over the cost of insurance in the last decade, we need to think clearly before adding another item to the list. Unlike treatments that prolong life, this would cover an elective procedure. It certainly is emotionally compelling but if granted then it opens the door for cosmetic surgery, liposuction, and other electives. Sorry, but no. We have bigger priorities. --JeffG
No one should be forced to pay for someone else to have something that is their choice to have. Pay for it if you want it. --avejoecon (again!)
Although fertility treatment coverage would be a boon to those struggling to conceive - how many treatments should be covered under insurance beyond the first one? Treatments are expensive, may be mentally and physically difficult for the participants. Often several cycles for success. Infertility is not a cancer. The patient can continue to seek other options to creating a family and live a full life.--LibraryKat
There are three main themes in these comments that have me riled up:
The continued assumption that having a child is a commodified choice you make like buying a car or going on vacation or, as noted by one commenter above, having cosmetic surgery.
That it’s not really a quality of life/health issue. It’s not like “cancer” or “treatments that prolong life.”
The argument that insurance rates will go up.
I don’t think any (healthy, self-reflective) person would say that a child is an object. A child is a dynamic human being with desires and needs and intelligence and perspectives and emotions. An adult who wants a child is a human who has a primal desire to procreate. Primal meaning a drive like sleep, hunger, sex.
Getting pregnant, growing an actual human being, is about as close as one can get to the metaphysical realm, to touching the veil between two worlds. It’s so mysterious. A woman’s body makes a brain! A heart! Toe and fingernails! Eye lashes! 50% of the time, a woman’s body makes a scrotum and a penis! What! It’s totally wild and unendingly fascinating! It’s transformative!
And reproduction is viscerally, physically present in/on the human body. There’s only one tiny little part of the sexual organs that is only there for pleasure—everything else does double duty. Most adult women cycle every month which means that they are consistently well-aware of the body’s ability or inability to reproduce.
And yet we talk about IVF in just financial terms, that it’s a vanity project that only serves the parents. That it’s like liposuction or a face-lift.
Which it is not! Because, and here’s where I go capitalistic, for our society to continue to run at the pace it’s at, we need children who can grow into adults who can replace us oldies when we are dead. I know! It’s hard to imagine life without ourselves in it! But right now, fertility rates are dropping, and I passionately believe they will continue to do so (at least in the US) as the basic cost of living becomes increasingly unaffordable for Gen Z and Gen Alpha.
We are all so stuck in our American independence that we don’t see how much we rely on other people to be valuable contributors to society. Parents and caregivers, those who are doing the upfront difficult work of keeping babies alive and striving to start their lives in as healthy a manner as possible are laying the foundation for them to be successful later in life. Which means that someday, when you need (fill in the blank—brain surgery, a latte, a therapist, someone to wipe your ass, whatever), a person is there who had a parent/caregiver that set them up to succeed. Whoa! Amazing!
You know what doesn’t really serve the vaster society? Erectile dysfunction medicine and treatment but those are often covered because that’s a quality-of-life issue. A man having a working penis-for-pleasure is not going to generate social security funds. Babies that grow into children that grow into adults generally work in some capacity which means contributing to social security funds.
It’s a quality-of-life issue.
Infertility takes a significant toll on mental health. The level of stress, anxiety, and depression is on par with those suffering from HIV and cancer. It takes a toll on physical, social/relational, and spiritual health. Our sexual/reproductive organs shape our identity and perception of self and when those things do not work the way they are supposed to it can be devastating, a real wrecking ball to one’s identity.
If our societal ideation of health is that “being healthy” encompasses the whole person then of course fertility treatments should be considered a part of that. Health insurance is meant to treat issues that affect the quality of life.
Regarding insurance rates going up—this generally doesn’t happen because women who can access IVF treatments sooner rather than later tend to have lower-risk pregnancies. They opt to transfer one embryo instead of two thus lowering the risk of a twin (or more—embryos can split after transfer) and thus reducing risk of early delivery and time in the NICU. They decide to pursue treatment as soon as they know they need IVF rather than waiting years until they can afford it which means they are less likely to be dealing with complications from experiencing a geriatric pregnancy.
One last note before I sign off on this already unwieldy newsletter: adoption is not a treatment for infertility.
Again:
Adoption is not a treatment for infertility.
There are tons of ethical and financial concerns that are inherent in adoption, much too much for me to cover here and now. It is an incredibly nuanced topic, and I shouldn’t be, but I’m surprised that it’s still tossed out so casually as an option when someone can’t get pregnant.
I’m truly devastated for the fertility patients in Alabama. As soon as Roe v. Wade was overturned, the IVF community knew this was coming. We just didn’t think it would happen so soon and so decisively.
(p.s. I’ve written about this here in biological-human-experience and economic terms. I am well aware of the environmental impact of having a child but, and this decision came after much in-depth research and reflection, I don’t feel like anyone should miss out on, what to me, is a transformative human experience if they want it. Not having a kid is not going to save the world from climate change. Giant corporations can! Celebrities decreasing their use of private jets can! There are all sorts of bigger entities that can halt climate change and it’s really shitty to make people feel like they are the sole cause for destroying the world because they want a basic primal human experience. If you feel strongly about climate change, call your reps asking for stronger climate change policies.)
Further reading:
40 years later, why is IVF still not covered by insurance? Economics, ignorance and sexism—CNN, July 25th, 2018
Infertility, Inequality, and How Lack of Insurance Coverage Compromises Reproductive Autonomy —AMA Journal of Ethics, Dec 2018
For the Sake of Consistency and Fairness: Why Insurance Companies Should Cover Fertility Preservation Treatment for Iatrogenic Infertility—Cancer Treat Res., National Library of Medicine