Infertility and reproductive rights

Infertility and Reproductive Rights

The problem is as old as the New Testament: In it, Mary's cousin Martha, an aged woman, had never had a child. Miraculously, she conceived and gave birth to John, later to be known as John the Baptist. At least 2000 years ago, the fact of being childless was looked upon by society as something to be lamented, the childless couple as a family unit to be pitied.

Nothing much has changed, if the media attention given to infertility and reproductive rights discussions are any indication. In a world that, at the same time, worries about over-population, it seems a contradiction, at best, to be concerned about not being able to conceive children; it would seem, in an era when birth control products are widely advertised on television, to be an anomaly. However, it is an anomaly that stirs violent passions, particularly among those who consider it an inalienable right, much like those granted in the U.S. Constitution, to bear children.

As of 1995, the National Center for Health Statistics reported that there were 6.1 million women between the ages of 15 and 44 who were experiencing an "impaired ability to have children" (NCHS Web site, 2005). In addition, they reported that there were 2.1 million married couples unable to have children; 9.3 million women were using infertility services (NCHS Web site, 2005).

There was a time when such statistics might not even have been kept; before the women's movement, women were considered to be disabled when they were pregnant. Moreover, they were considered disabled in a shameful way, and their 'condition' was never spoken of except in hushed tones in mixed company if it was referred to at all. In the rare cases of women working while pregnant, they were likely to be fired; women's function was considered to be childbearing but only -- at least in middle-class families -- within the confines of the home (Kaminer, 2000).

However, feminists finally succeeded in outlawing pregnancy discrimination in the workplace in the 1970s. They were so successful in changing the viewpoint of pregnancy from that of disability that today, women often claim to be disabled by infertility (Kaminer, 2000). It is tempting to wonder whether such women will demand blue 'wheelchair' tags for their cars and full ADA entitlements, and, in fact, Kaminer notes that it is ironic that demands for expanded health care coverage have encouraged some to seek to define infertility as a disability under federal law. This would make treatment for infertility mandatory in health care plans...even if it stopped short of offering infertile women 'preferred' parking status. (One would have to wonder, if that were accomplished, whether men who were one-half of an infertile couple would also then be able to lay claim to parking stickers. While this is, admittedly, tongue-in-cheek, federal mandates being what they are, it might not be as ridiculous as it sounds.)

Beyond 'infertility disability' humor, however, there are true divisive aspects to the problem. Often, it is considered not only a woman's problem, but also a problem exacerbated by the decision of the population of professional women to delay childbearing to the point that it becomes biologically difficult. They demand expensive infertility treatments, arguably ones not available to younger women who have not delayed childbearing but are nevertheless having trouble conceiving. In this case, the medical problem becomes a sociological problem as well, tearing at the fabric of society, fraying the cloth of feminist solidarity built up throughout the 1970s' feminist movement successes.

Adding fuel to the controversy, a 1998 Supreme Court decision strengthened the case of infertility rights proponents by holding, in Bragdon v. Abbott, that a woman who was an asymptomatic HIV sufferer was covered by the Americans with Disabilities Act (ADA) because her disease effectively prevented her from having children. This was possible because the ADA defines a disability as any impairment that substantially limits a person's ability to perform one or more major life activities (Kaminer, 2000).

Those who believe the fertility rights movement has gone too far contend that it is ludicrous to classify the inability to bear children, for whatever reason, along with conditions that render people unable to walk, see, hear or breath without assistance. That faction contends that while the inability to bear children may be personally troublesome to those whom it affects, it does not lead to economic discrimination and social isolation of the sort 'true' disabilities engender and thus should not be classified with them and obtain funding and so on (Kaminer, 2000). In fact, Kaminer notes, for women, childlessness is still a professional advantage; it might also be considered an economic advantage across the board, considering the cost of childcare which is less likely to be provided along with employment of non-professional women than for professional women, making having children much more expensive for those women than for others. In short, not only is childbearing a professional disadvantage for women; for those least able to afford children, it is also an added financial burden. Viewed this way, it would appear that, as Kaminer contends at the outset, concern about infertility is a 'disease' of the wealthier class of women. Moreover, if that is so, then it can hardly be worth of ADA concern; it assumes the character of face-lifts and tummy tucks.

Moreover, infertility is relative, defined by society as much as by medicine. In the United States, epidemiologists define infertility as one year of unfruitful unprotected intercourse (Kaminer 2000). And yet, many people simply are unlucky, or have failed to engage in intercourse, for one reason or another, at the fertile interludes during that year. In the thirteenth month, they may conceive. Indeed, it is reasonable to wonder why it is measured by epidemiologists at all; it will not kill you or impair your independence and even mental health is not at risk for many who successfully adapt.

The issue of social justice also enters the debate. While spending inordinate sums of money on infertility treatments would be fine if the globe enjoyed unlimited resources, when one must prioritize, expensive infertility treatments seem selfish at best in view of the fact that 40 to 50 million Americans -- never mind billions globally -- have no health coverage at all. Medical ethicists are adamant that the funds for infertility treatment are funds misdirected in a most uncompassionate manner in such a universe.

This dichotomy leads directly to the application of 'situation ethics' to the field of infertility and reproductive rights. Situation ethics demands that actions be governed by their likely outcome rather than fixed rules (Taylor, 1999). The extraordinary measures involved in curing infertility present situations far removed from biological imperatives, and they even call into question the concept of parenthood, to the point that courts are full of cases trying to establish whether a biological or a 'choice' parent has rights over a child.

Applying situation ethics to the entire issue of reproductive rights, however, would be likely to produce a different outcome than applying situation ethics case by case. For example, if Ms. XYZ wants a baby, can afford the treatment and can also afford to raise the child, this will harm no one, correct? Therefore, applying situation ethics, there is no reason not to treat Ms. XYZ for infertility. However, if we apply those ethics to the whole issue, treating Ms. XYZ will, in fact, produce an undesirable outcome for those who would be helped if the infertility treatment money were to be spent providing birth control pills in the poorest segments of the globe. Situation ethics cannot, in fact, be defined at all; it seems more like an excuse for selfishness, anarchy or any other sociologically unsound and morally insupportable action anyone cares to engage in.

The imbalance in the world of infertility v. contraception, rich v. poor, selfish v. selfless is obvious in still another aspect of 'reproductive rights' as practiced in developed nations: "reproductive tourism." The inconsistency of laws, from state to state and nation to nation, governing use of the most extreme of modern reproductive technologies has created a class of infertile women and couples who shop globally for the infertility treatments they want, from conceiving at all to choosing the gender of the baby (Wilson Quarterly, 2004).

Aside from the ethical concerns regarding this quest to fulfill a function previous generations sought to avoid (the development of reliable birth control methods was a milestone in women's history), Platell (2004) argues that insistence on a woman's right to bear children, and moreover on the medicalization of the quest, returns women to the condition of being little more than childbearing machines, the very condition the women's movement worked so long and hard to overcome.

Some critics think the basis for the drive to write 'reproductive rights' in stone is a baby-boomer drive to achieve immorality, coupled with public confusion about the limits and limitations needed for technology (Duin, 1999). The baby-boomer part of that equation may or may not be true; the confusion about technology is palpable in the debate between fundamentalists who think any tinkering with the origins of life is wrong, and technocrats who believe science should be pushed to whatever ultimate conclusion it can achieve.