Bioethics Blogs

Insurance Coverage for Oncofertility: Concerns about Socioeconomic Disparities

In a recent blog, I asserted that assisted reproductive technology (ART) should be a higher priority for the global South because of the severe health, social, and economic effects infertility can have on women there. The most common response to this claim is that resources should first be devoted to treating and preventing life-threatening conditions, such as malaria and HIV/AIDS, rather than conditions that are perceived as merely social and/or psychological. The same response is often used when people suggest that ART should receive higher priority in the global North. Whereas many global North countries provide national health coverage for ART, the US does not. However, there has been movement toward coverage for ART in the US in the last couple of decades and currently 14 states require health insurance companies to cover ART (though there is a wide range of what is covered and under what circumstances). Unfortunately, oncofertility (fertility preservation for cancer patients) is not covered in any of these state laws.

While I understand the argument that limited healthcare resources should be dedicated to the most “pressing” conditions, it is also important to recognize the potential side effects of choosing not to provide coverage for oncofertility and other types of ART. One concern with the lack of coverage for ART is that it reinforces socioeconomic inequalities. The primary users of ART are white, educated, middle- and upper-class not because this group is the most likely to be infertile, but because they are the most likely to be able to afford the high cost of ART out-of-pocket expenses.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.