Several thousand dollars for fertility treatment? Even as I gasped in shock at the high cost, the subject of the documentary film I was watching exhaled in relief because she was able to afford it. "This is worth it," she told her partner, and I could tell by the emotion in her voice that she meant it.
But I wondered how low-income and poor people were able to afford infertility treatment when the cost is so high and coverage so limited. I know a lot of people who intend to have a baby but could not afford thousands of dollars if they were diagnosed with infertility and I imagine that they would be devastated. The desire to become a parent is not connected to an individual's ability to afford infertility treatments. Yet treatment for infertility remains prohibitively expensive to many women and couples.
In many
ways, access to and the affordability of infertility treatments speaks
to our society's view of who is considered worthy of motherhood.
Infertility is defined as the inability to conceive a child after attempting to do so over the course of 12 months, and it can affect men and women. Approximately 10 percent of the population will experience infertility, reflecting a diverse group of people representing all socioeconomic levels and backgrounds. There are many different causes of infertility. About one-third of all infertility cases can be attributed to males, another one-third to females and the remaining one-third to either a male or female condition or to an unidentifiable cause.
Coverage of infertility treatment
is usually limited
whether it is provided through public or private insurance. Many
insurance plans do not provide coverage for the more advanced and expensive
procedures or treatments and only one-quarter of states require private
plans to cover certain forms of infertility treatment with the specific
details of that mandated coverage varying widely from state to state.
Currently 15 states require insurance coverage for infertility treatments.
The result is that many
people are not able to treat infertility due to the high costs associated
with medical treatment and lack of adequate insurance coverage.
Some women have even taken to purchasing the drugs required
for some treatments online through the so-called "black market"
where fertility patients often sell left over medication at a discount
in an attempt to recoup some of their investment. Despite the
risk of purchasing counterfeit or potentially damaged medication, some
patients go online to cut treatment costs where they can. And some
doctors are concerned that women may be self-medicating without medical
supervision and thus putting their health at risk.
When I looked online for information about infertility coverage for low-income or poor women, I stumbled on a blog whose author stated, "I thought that the cure all for infertility was to just go on welfare. In no time you'll have one on each tit and another in the oven." The post mocked a pharmacy client on Medicaid who had requested a prescription be filled for a medication to treat infertility. The author was disgusted that anyone on public assistance would try to get pregnant and assumed that the client was trying to exploit the system. Many of the comments posted expressed the view that low-income people shouldn't be allowed to treat infertility because they wouldn't be able to provide for a child on their own. Other comments boldly claimed that society had the right to deny medical treatment for infertility to poor women because they were on public assistance.
Decades after eugenics was debunked and fell out of favor as a movement
to "improve society," the residue lingers: there is a strongly
held belief that pregnancy and income should be connected. President
Reagan tapped into that sentiment with his infamous comment about a "welfare queen," but the core belief is as old as
the American Dream: people who are poor are considered lazy, deserving
of poverty and undeserving of anything it takes money to buy.
Low-income women who are faced with infertility and seek treatment are
suspected of trying to work the system and defraud society.
The belief that low-income and poor people do not have the right to medical treatment for infertility is disturbing enough on its own but it is particularly disturbing when you add in the factor of time. A woman's ability to conceive and carry a pregnancy to term begins to decline significantly when she reaches her mid-thirties with that rate of decline accelerating as she enters her forties. The window of time in which a woman can successfully treat infertility leads many women to adjust priorities and pursue pregnancy despite their current economic status.
This election year, universal healthcare coverage is a key issue, but universal coverage for infertility treatments has not been part of the discussion even though infertility treatment remains economically out of reach for many who need it. As a reproductive justice issue, the right to choose is clearly being denied those seeking treatment for infertility. But the reproductive rights of low-income and poor people continue to be held hostage to the values of a society that associates money with a person's worthiness to receive medical treatment.
As some supporters of universal healthcare push for mandates that would require every American to be insured, the lack of clarity over what specifically will be covered leaves low-income and poor women vulnerable to the whims of those who feel pregnancy is a privilege reserved for some and denied to others. As a result, many people confronted with infertility will weigh their dream of becoming parents against the limits of their income and continue to face high costs and limited coverage even if universal healthcare becomes a reality in America.
