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Vanessa Ikwuazom

Dr. Shannon Stettner

Arts 130 (Reproductive Justice)

1st March, 2020

Assisted Reproductive Technologies

The World Health Organization clinically defines infertility as “the inability of a sexually

active, non-contracepting couple to achieve pregnancy in one year” (World Health Organization,

2009). One way this issue is resolved is by making use of Assisted Reproductive Technology,

which consists of various optional medical procedures for people dealing with infertility.

Multiple studies discuss success stories of pregnancy via the use of  Assisted Reproductive

Technologies such as Vitro Fertilization, Intracytoplasmic Sperm Injection, Gametes

Cryopreservation, and the use of fertility drugs. However, in the world we live in today, some

people still struggle with infertility and do not have access to health care services due to

numerous barriers. This reflects the concept of reproductive justice, which is defined by the sister

song organization as “ the human right to maintain personal bodily autonomy, have children, not

have children, and parent the children we have in safe and sustainable communities”(Rodriguez,

1997). There are people who find it challenging to obtain treatment involving reproductive

technology due to a number of factors, such as race, class and location. By examining how

various factors have an impact on accessing Assisted Reproductive Technologies in the US, this

paper will illustrate how these factors reflect as barriers preventing people from receiving said

treatments.

            The current health care system in the US makes use of a combination of both private

and public healthcare. The US government generally provides public health care through the
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national healthcare systems, meanwhile, private health care is offered by profit-making hospitals

and free-lancing practitioners. With infertility being a well-known issue in the US, one would

expect that its treatment is handled and taken care of by the public health care system to make

sure said treatment is accessible for all in need. However, it is quite an unfortunate fact that

fertility services are not available to all women  In the United States, according to an article

under the women’s health policy, there are “fifteen states in the US that require some private

insurers to cover some fertility treatment, but significant gaps in coverage remain”( Ranji &

Weigel, 2020). This means that to access these reproductive technology treatments most people

have to pay large sums of money out of their pockets,  rather than the US government providing

access towards those facing the issue of infertility with the help of public health care.     

        America has made use of the American Society for Reproductive Medicine (ASRM) to

declare that all  “Assisted Reproductive Technology(ART) centres and insurance providers,

should address and lessen existing barriers to infertility care”( Quinn et al. 1120). This means

that the US government did notice various barriers and factors that made ARTs not accessible to

all. A good example of this would be the expenses involved in making use of Assisted

Reproductive Technology treatments, which are very high and yet the US government still places

these services under private health care. This means that most treatments are accessible only to

those who can afford healthcare insurance. Therefore making it easier for those in higher classes

to receive fertility treatment.

        In an article discussing the Health Disparities in Procreation, the author stated that the

“average fee for a single cycle of In-Vitro Fertilization (IVF) in the United States is between

$10,000-$25,000”(Kissil et al. 199). IVF being a type of ARTs, a woman can need up to 3 cycles

of IVF to accomplish pregnancy. However, with a single cycle of  IVF costing this much, it may
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be tasking for all women to pay for up to 3 cycles. This showcases how the cost of  Assisted

Reproductive Technology reveals what class of society can easily access and make use of this

treatment. The particular reason for this circumstance is that women in the upper class can easily

access these treatments because of their wealth, allowing them to pay for the treatments offered

by the US private health care system. However, women in the lower class may struggle with the

cost of paying for ARTs treatment due to their low-level incomes as well as their status in

society. This further restricts them from getting adequate healthcare to access these much-needed

reproductive treatments.

        Another factor which the US government would have noticed towards making the

declaration through the American Society for Reproduction would be race, whereby women are

restricted access to Assisted Reproductive Technology due to the colour of their skin. This could

be due to intersectionality, where forms of a person's social and political roles merge to establish

various forms of prejudice and privilege. There are various research studies that suggest the

reason why black women do not seek ARTs services is that “medical providers are more likely to

have a variety of negative stereotypes about African American patients”(Kissil et al. 200). These

negative stereotypes towards black women may cause them to fear the kind of service and

treatment they may receive from providers. This results in a majority of them shying away from

receiving ARTs treatments due to the fear of discrimination.

         A summary of a research study on In-Vitro Fertilization towards African American,

Asian, and Hispanic women suggested that when minority groups “attain access to ARTs, they

experience lower success rates compared with non-Hispanic white women”(Ethics Committee of

the ASRM,1106). The suggestion of low success rates of ARTs towards minority women

showcases not only the presence of racism but how not enough research on Assisted
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Reproductive Technology has been conducted towards minority women. This actively

demonstrates that there’s has been a large amount of research of ARTs done towards non-

Hispanic white women and an insufficient amount of research done towards minority women.

The uncertainty of Assisted Reproductive Technology research towards minority women is a

barrier to them because they would fear their chances are very slim towards a successful

pregnancy. This is due to the inadequate conclusion on the research of ARTs towards women of

colour.

         Geographically, people may struggle towards accessing ARTs treatment due to the lack

of fertility centres in their area. People who live in rural areas may find it tasking accessing

ARTs treatment compared to those in urban areas. This is because those who live in the outskirts

of cities, like urban areas have smaller populations and are not well equipped with all the

healthcare services needed. As a result, extra costs are wrought towards Assisted Reproductive

Technology, the particular reason for this circumstance is that people who live in rural areas

would have to consider the expenses of travelling towards the city to receive treatment. For

instance, people who live in rural areas would have to pay fees for essentials, such as gas and

hotel expenses, and some may have to pay for ARTs appointments because they are placed under

the private healthcare system. Some women would even have to forfeit their next month's full

pay by taking an unexpected leave off work just to travel in order to recieve ARTs treatment.

          In the US alone not all states have equal access towards infertility care, this is maybe

because  “the distribution of Obstetrician-gynecologists and IVF centres varies widely among

states and locales”(Ethics Committee Opinion,1106). This demonstrates how the rates of

infertility centres vary between states, which also affects the availability of fertility clinical

personnel like gynecologists within states. One would assume that since fertility care is placed
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under the private healthcare system, most fertility clinical personnel would strive to work in US

states where high median incomes are paid. This can be seen as a barrier for people who live in

areas where fertility centres are scarce, giving them no other choice than to pay extra expenses

towards receiving ART treatments.

        Alongside the limitation of fertility centres in the US, there are states where matters are

much worse due to the limited services offered to the different age brackets. An article

discussing the disparities in procreation states that there are up to “15 US states that currently

mandate health insurance coverage for ART, several limit coverage based on woman’s

age.”(Kissil et al. 202). This is showcased as a barrier towards women in their mid to early

forties struggling with infertility and also have no access to ART treatments due to their age. It is

a well-known fact that most women lose the ability to conceive children sometime between their

late 40s to early 50s. However, this restrictive access to ARTs towards women who are still able

to conceive in their early 40s results in them being less hopeful of having children. This is due to

the fact that in some US states, the insurance company coverage towards fertility treatment

restricts women in their 40s from attempting ART treatments.

              The US government has not only managed to restrict middle-aged women from

accessing ART treatments but has also managed to prevent those living with deadly diseases like

HIV from accessing them as well. As of 2003, various states in the US passed on legislation

which “asserts that knowingly inseminating a woman with sperm from an HIV-seropositive male

is a criminal act”(Kissil et al. 202). The US talks about lessening the existing barriers to

infertility care yet found it reasonable to allow states to pass on legislation that prevents people

from accessing ART treatment due to a disease. This restriction of ART treatments towards

people living with HIV is seen as a barrier for both the carrier of HIV  and the ART physician. It
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is a barrier for the carrier of HIV because the restriction of having a child is added towards

various types of stigmatization which the carrier already faces as a result of HIV. It is also a

barrier towards the ART physician because they are unable to render services towards carriers of

HIV, because they may fear getting sanctioned by the law.

             Furthermore, the training involving in handling HIV carriers in a fertility clinic is

quite expensive and challenging. This is due to the legislative restriction in various states in the

US, whereby “government authorities have for the most part refused to sponsor research related

to ART and HIV”(Kissil et al. 203). This prevents infertility clinics from requesting funding

concerning ART treatments and HIV. This can also be seen as a barrier towards ART physicians

because they are unable to render services towards carrier of HIV without properly training

people on how to handle these types of infertility cases, actively demonstrating that a lack of

proper training and legislative prevention would discourage people from accessing ART

treatments.

        Although HIV Carriers face a level of stigmatization towards accessing ART

treatments, there are other individuals who go through stigmatization whilst already accessing

ART treatment due to their Marital Status. An unmarried woman may face discriminations from

her ART treatment provider because some may see no reason why an unmarried individual

would be seeking infertility treatment. This results in barriers towards single women trying to

access ART treatments, with the reason being that they would fear being discriminated against

for wanting a child out of wedlock. However, the reproductive justice agenda states that one

should have the right to “to all reproductive alternatives and the right to choose the size of our

families”(Ross, 2017). Thus, meaning that women should be able to decide the size of their

family and if their family will have a father figure or not.

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           The discrimination of an individual due to their marital status does not only take place

within an infertility clinic. There are cases where there have been “legislative efforts to ban

access to ART for unmarried individuals”(Kissil et al.201). In these, the US government have

made various attempts towards restricting access to  ART treatment for unmarried couples. For

instance, in the US the state of Alabama “a woman cannot undergo artificial insemination

without a written consent from her husband”(Kissil et al. 201). This demonstrates that women

struggling with infertility have limited choices towards their family size in the state of Alabama.

It is also shown that women are also restricted access to ART treatment unless they have consent

from their spouses.

           An individual's sexual orientation also plays a role in accessing ART treatment. This is

because same-sex couples may be discriminated against by their ART physicians. This may be

because most people believe the common roles needed when raising children are the mother and

father figures. In the US, several states work towards restricting same-sex couples struggling

with infertility from accessing infertility. A good example would be “ Florida, Nevada, and

Texas where gestational services are limited to married couples.”(Kissil et al.202). This shows

that same-sex couples needing gestational ART treatment may not be able to access these

treatments due to legislative choices against them.

        To sum up everything that has been stated so far, the US government declared that the

restrictions and barriers surrounding ARTs treatments be reduced by Assisted Reproductive

Technology centres and insurance providers to make it accessible for all. However, the number

of obstacles put in place by the same government make it quite difficult for their demands to be

fully met. The government placing infertility care under the private health care system makes it

challenging for those without access to proper insurance. It is also quite challenging for women
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of colour to receive these ART treatments due to fear of discrimination and inadequate treatment

concerning the outcome of ARTs towards them. Lack of adequate infertility treatment, in most

states in the US, plays a key role towards the restricted access of Arts, because people are

required to travel and pay extra cost to access these Arts treatments. The US seems to also find it

fitting to restrict women in their early 40s from accessing this ART treatment. This may be seen

as a result of them seeing no need to waste resources on women that already have slim chances

of giving birth at such an advanced age. Lastly, the discrimination of various people like; HIV

carriers, single women and same-sex couples would discourage a majority of people from getting

ART treatments due to the fear of being stigmatized.

References
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“Disparities in Access to Effective Treatment for Infertility in the United States: An Ethics
Committee Opinion.” Fertility and Sterility, vol. 104, no. 5, Elsevier Inc, 2015, pp. 1104–10,
doi:10.1016/j.fertnstert.2015.07.1139.

The article addresses various disparities that occur towards accessing effective treatment
for infertility the US , including access towards ART treatments .The article demonstrates how
individuals in the US struggling with infertility tend to face challenges like economic, racial,
ethnic and geographic barriers towards accessing ART treatments .The intriguing aspect of this
article is that it examines how these various factors spread across different sets , it also has quite
an opinionated conclusions on ways the US government could establish strategies to increase
access to ART .

Kissil, Karni, and Maureen Davey. “Health Disparities in Procreation: Unequal Access to
Assisted Reproductive Technologies.” Journal of Feminist Family Therapy, vol. 24, no. 3,
Taylor & Francis Group, 2012, pp. 197–212, doi:10.1080/08952833.2012.648139.

The authors of this article aimed at uncovering how an increase in ART in the US did not
necessarily mean there was an increase in access towards all women . The article reviews how
there is a level of marginalized access ART concerning various people as well as various
obstacle individuals face .The obstacles were based on a person n class, race and ethnicity, age,
marital status, sexual orientation, and disability. The author reflected each factor effectively and
gave examples to further back up hoe each factor affect an individuals access to ART. I made
use of this article to further elaborate on how each factor likelly increases the barriers various
people in the US face towards receiving infertility healthcare

Missmer, Stacey A., et al. “Cultural Factors Contributing to Health Care Disparities Among
Patients with Infertility in Midwestern United States.” Fertility and Sterility, vol. 95, no. 6,

This article was written for the purpose of identifying the cultural differences in access to
infertility care in the US .The author insinuated that while the demand for infertility treatment
increases in the United States, the US government seems to pay less attention towards cultural
barriers to care and cultural meanings to infertility should be more addressed .The author then
eded on an opinionated conclusion on how the US health care system needS to be employed if
they hope for an equal access is to be realized as equal utilization for women of color seeking
infertility care.

Quinn, Molly, and Victor Fujimoto. “Racial and Ethnic Disparities in Assisted Reproductive
Technology Access and Outcomes.” Fertility and Sterility, vol. 105, no. 5, Elsevier Inc, 2016,
pp. 1119–23, doi:10.1016/j.fertnstert.2016.03.007.

Rodriguez, L. (1997). Reproductive justice. Retrieved March 01, 2021, from

https://www.sistersong.net/reproductive-justice

Ross, L. (2017, November). Reproductive justice agenda. Retrieved March 08, 2021, from
http://nativeshop.org/programs/reproductive-justice/repro-justice-agenda.html
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Ranji, U., & Weigel, G. (2020, September 15). Coverage and use of FERTILITY services in the
U.S. Retrieved March 02, 2021, from https://www.kff.org/womens-health-policy/issue-
brief/coverage-and-use-of-fertility-services-in-the-u-s/

World Health Organization. (2009). Infertility definitions and terminology. Retrieved March 01,
2021, from https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-
of-work/fertility-care/infertility-definitions-and-terminology