Americans going through fertility challenges in the United States might be jealous of those in the United Kingdom and their access to universal healthcare. The United Kingdom’s National Health Service (NHS) provides medical services free of charge, and that even includes fertility treatments. Brits love their healthcare so much that they even celebrated the NHS — through dance — during the 2012 Olympics’ opening ceremonies. But a report published earlier this month, might temper that trans-Atlantic envy.
Recently, the British Pregnancy Advisory Service (BPAS) used freedom of information laws to obtain the policies of England’s 135 clinical commissioning groups (CCGs), the regional rulemaking bodies as to which patients are eligible to receive fertility services and which are not. The discrepancies between the different regions’ rules were jarring and have led to essentially a postcode (the equivalent of what we Americans call a ZIP code) lottery. One patient might not be eligible for services that she would be eligible for, if only she were to live in the next shire over.
No Partner, No Treatment
Among the more disturbing of the discrepancies are the varying relationship requirements of the different regions. Almost half (48%) would not allow single women to obtain treatment according to their criteria. But of those, over 20 regions allowed for unmarried women to receive treatment, but only so long as they were able to prove they were in a “stable” relationship. Even within those regions, the definition of “stable” relationship varied. One region required evidence of three years in a relationship, another two years and proof of being “financially interdependent.” Wouldn’t financial independence be, like, better?
The varying — and frequently offensive — criteria did not end there.
Ageism. Fourteen of the regions refused to provide services for women over the (extreme geriatric) age of 35.
Weight discrimination. Over 96% of the regions would not provide treatment to women with a body mass index (BMI) of over 30.
Secondary infertility-ism. It is not uncommon for a person to experience infertility after having a child. This is referred to as “secondary infertility.” These patients were largely out of luck when it comes to eligibility for treatment in the varying regions. The study showed that most regions were only willing to provide treatments to those who had not had any children.
Smoking-ism. 116 of the regions (86%) deny treatment if either the patient or her partner smokes. Actually, I guess if you have to ration fertility care, maybe that one isn’t as bad.
Attorney Louisa Ghevaert, a leading UK fertility and family law specialist, described how the “current NHS IVF postcode lottery creates inequality, discrimination, unfairness, and misery for many, and that this needs to change.”
Should We Be Throwing Stones?
That’s a lot of discrimination! Good thing we live in the United States. Right? Well, maybe not.
First, of course, we do not, for the most part, have a system of socialized medicine. Instead, we rely on insurance to make medical services, including fertility treatment, affordable. Here, whether you have insurance that will provide some level of coverage for fertility treatments is also partially a lottery, based on who your employer is. If you work for Starbucks, Google, or Facebook, you’re in luck!
Additionally a growing number of states (19 so far) have passed fertility care access insurance mandates requiring that insurance providers in the state — that are subject to state law (a majority are governed by federal law under ERISA) — provide some level of fertility coverage. My home state of Colorado managed to squeak through a fertility access bill this last session, right before shutting down the legislature due to the pandemic.
Those Americans not provided fertility coverage through their employer or state mandates are generally out of luck. And that’s a majority of Americans. The options then are to pay tens of thousands, or more, out of pocket, or consider medical tourism, traveling to another country to find more affordable treatment. Either way, access becomes sharply limited along socio-economic lines.
The (Start To) An Answer
Given the declining fertility levels and high demand for fertility treatments, Ghevaert proposes a multistep solution, including the formation of a dedicated Ministry for Fertility to provide future direction specifically for the fertility sector. (Like a federal Department of Fertility; not like the Ministry of Magic, unfortunately.) This would bring greater cohesion, promote and prioritize the fertility space, and overcome the current fragmented approach.
Also, she explains, the “UK would be well serviced by a top level multidisciplinary strategy group to drive change and innovation, as well as identify and mitigate risk with joined up thinking between the technology, science, healthcare, fertility, education, economic and other sectors.” She proposes that such a strategy group should operate on a continuous basis, and be made up of strategic thinkers outside of the elected political elite. That sounds bloody brilliant (as the Brits would say). Can we get one of those too?
Ellen Trachman is the Managing Attorney of Trachman Law Center, LLC, a Denver-based law firm specializing in assisted reproductive technology law, and co-host of the podcast I Want To Put A Baby In You. You can reach her at babies@abovethelaw.com.