Jamille Fields, Resident Blogger (Law Students for Reproductive Justice Fellow at the National Health Law Program)
Reproductive Justice is defined as the right to have children, the right to not have children, and the right to parent those children in a safe and healthy environment. The Repro community is most often associated with the right to not have children, but I would like to focus today on the first right listed—the right to have children. Recently, Domenico Dolce (the Dolce in Dolce and Gabana) made news with his derogatory comments about in vitro fertilization. I won’t warrant them with the dignity of repeating them here. But, as celebrities—rightfully–sounded off rebuking his comments, I was reminded that infertility treatment is something that many everyday women and men don’t even consider as an option. As usual, money has a lot to do with it.
Only fifteen states require insurance companies to either cover or offer coverage of infertility diagnosis or treatment. Even among these states the level of coverage varies. Among these states, thirteen have laws that require insurance companies to cover infertility treatment, but three of these states—California, Louisiana, and New York– specifically exclude in vitro fertilization. According to a recent Kaiser study, 22 states Medicaid programs cover infertility testing and only 16 states cover some level of infertility treatment. And, even in those states, the treatment and testing is only covered in limited circumstances.
More attention needs to be paid to the issue of infertility. Around 12% of women of reproductive age had difficulty getting pregnant or carrying a pregnancy to term and about 9% of men between the ages of 15 to 44 reported some form of infertility. These estimates are likely underestimated given infertility isn’t often discovered until individuals are attempting to get pregnant. The information available notes that Latino, black, and white women had similar rates of difficulty getting pregnant, and Asian women had a lower rate. Due to lack of documentation on infertility, it is largely unknown if racial and ethnic disparities exists between those able to get pregnant.
What is known, however, is that there are racial and ethnic, as well as income, disparities in the conditions that have a causal relationship with impaired fertility. For instance, environmental and occupational hazards are suspected to decrease sperm quality, and communities of color are more likely to work in strenuous jobs and live in neighborhoods with polluted and unsafe environments. Communities of color, also, often have higher rates of chronic illnesses, such as cancer and HIV, and the treatment for these illnesses can cause infertility. Untreated STI infections, such as chlamydia, can also lead to infertility and there are higher rates of chlamydia among people of color.
There are also racial and ethnic differences in those who are seeking infertility treatment. According to the CDC, 12% of women or their partners have ever used some form of infertility treatment. Assisted reproductive technologies (ARTs such as in vitro fertilization or IVF) were used in 1.6% of total births in the U.S., however, one study published in 2008 found that 84.6% of ART cycles involved white women. This is largely contributed to the economic access to infertility treatment.
As for next steps, more research needs to be done to understand the causes of infertility. And, more states need to require insurance, both public and private, to cover infertility testing and treatment. This will give more women and men who want to have children the tools to do so.