Who Gets to Have a Baby in America? On the High Cost of Fertility in America
For as long as people have had children, some groups and individuals have had their procreation encouraged, subsidized, even prized—think of queens celebrated for bearing male heirs to their royal mates, or the “Better Baby” and “Fitter Family” contests of
Since the dawn of human procreation, certain groups and individuals have been encouraged, subsidized, and even celebrated in their desire to create offspring, while others have faced discrimination, state neglect, or outright attacks on their ability to reproduce. This phenomenon, known as selective pronatalism, has a long history, reaching its most extreme form in Nazi Germany's Lebensborn program and court ordered sterilizations of what they deemed genetically inferior individuals.
Today, selective pronatalism persists in various forms, often embedded in laws, social messaging, insurance coverage, and fertility clinic criteria.
The Universal Declaration of Human Rights states that men and women of full age have the right to marry and to found a family, regardless of race, nationality, or religion. However, nowhere has it been established that fertility care is a right. While some argue that fertility care should be universally accessible as basic healthcare, a physiological definition of infertility – a diagnosis typically necessary for insurance coverage in the US – excludes queer and single people.
Mara Pellittieri, a communications professional based in Takoma Park, Maryland, tried to access infertility coverage through her spouse's employer, who set a strictly physiological definition based on regular, unprotected intercourse. This definition leaves many couples unable to receive the necessary help.
Some legal scholars and advocates argue for the right to equality in accessing fertility care, suggesting that treating individuals differently based on their likelihood of sexual intercourse with a fertile partner is unconstitutional. The American Society for Reproductive Medicine now includes the need for medical intervention, such as the use of donor gametes or embryos, in its definition of infertility.
However, there are still limits to this accessibility, as third parties like egg donors or surrogates may not be covered.
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