Who Has a Right to Reproduce? The Gap Between Fertile and Infertile Women



by Elaine Reilly Many feminist critiques of the income gap between the rich and the poor can and have been made, but here’s one that isn’t being talked about nearly enough: the costs associated with having children have created a reproductive gap between rich and poor along the lines of fertility.

A lot has been said about the disparity between rich and poor women when it comes to access to reproductive medicine and assistance. It’s an unfortunate truth that the women who most need medical assistance have the hardest time getting it. In the United States, women without insurance aren’t able to see a doctor regularly throughout pregnancy. Complications aren’t caught until delivery, if they can afford medical assistance even then. Abroad, lack of access to medical care has caused complications that are routine in Western medicine such as fistulas to run amok.

For all of the harms that the income gap does to women who are pregnant or plan to become pregnant, that is not my focus today. Instead, I want to shine a light on a gap between infertile and fertile women when it comes to building a family.

What Infertility Is

Historically, womanhood has been strongly tied to motherhood — you’re not a woman until you’ve had your first child, girls are to be raised as mothers-in-training, and a young girl becomes a marriageable adult when she is able to bear children. As the recent allegations about Roy Moore’s conduct with young girls have come forth, it has become apparent that this attitude is still pervasive in pockets of ultra conservative America.

With this pervasive attitude, it should come as no surprise that infertility among women is something that is more often swept under the rug than not. The fact of the matter is that infertility is a reality for many women for lots of different reasons. A short (and incomplete) list might include causes such as:

The reasons behind infertility are as varied as the experiences of women who have trouble with or are unable to conceive. However, one thing remains constant: For women whose infertility poses a challenge to their aspirations of having a family, there is no support comparable to what reproductively healthy women receive when it comes to creating a family.

The Lack of Reproductive Support for Infertile Women

Federal law mandates that insurance companies cover pregnancy care. This means that any insurance bought through the insurance marketplace or obtained through a federal welfare program must provide coverage for pregnant women and their newborn children in relation to pregnancy and childbirth.

This is undoubtledly a good policy that has helped many women since the Affordable Care Act was signed into law in 2010. However, there is a stark difference between the kind of support offered for fertile women. Compared to the federal mandate for pregnancy coverage, only 15 states have laws requiring insurance coverage for infertility treatments like IVF (or in vitro fertilization). Even in these states, gatekeeping mechanisms like a five year history of infertility are required before coverage must be provided.

In addition, laws meant to provide access to reproductive support for infertile women are only targeted at supporting people who can make use of certain ARTs (assisted reproductive technologies). Women whose reproductive systems are completely non-functional for whatever reason receive no insurance coverage whatsoever, whether it be for somewhat common mechanisms like surrogate pregnancy or experimental procedures like uterus transplants.

The Adoption Problem

There is a common knee-jerk response to anyone who brings up fertility troubles in their lives. It is this:

“Oh, but you can just adopt.”

This kind of response shouldn’t need to be talked about, but it’s common enough that I don’t think there’s any other choice. Adoption should not be the go-to solution for anyone struggling with fertility for a variety of reasons:

  • Adoption isn’t exactly cheap and, while there are grants and tax credits meant to incentivize adoption, there are no federal mandates requiring insurance coverage for adoption or anything comparable.

  • Adoption comes with its own unique issues that many people presumably seek to avoid by having their own children. Namely, adopted children don’t always come from loving homes — through no fault of their own, they have their own troubles that make the already difficult task of childrearing even tougher.

  • It is not the duty of the infertile couples to adopt all of the parentless children in the world. People who find room in their lives for a lonely child are amazing, but that path isn’t for everyone and infertile women shouldn’t be shoved into it by the circumstances of their lives.

Why This Matters

This is all too bad, you might think, but what’s the point? Indeed, there are more pressing concerns faced by women across the world and, were I to come across a genie capable of solving one feminist issue through magic, this is probably not the one that I would choose.

However, this doesn’t change the facts. Women across the world routinely find their hearts broken as they battle with or learn of their infertility. These women are not getting the support that they need — they are not getting aid comparable to what their fertile peers receive and that is not okay.

Beyond the lives of the individual women who are affected by infertility, there is something to be said about the kinds of experiences that we pass on to the next generation. Do we want a world in which future generations are raised without exposure to the experiences of infertile women? Do we want a world in which this status quo of brushing infertility under the rug continues? To me, this does not sound desireable.