Medical need and medicalisation in funding assisted reproduction: A right to health analysis

Abstract

Assisted reproductive technologies (ARTs) promise childbirth to those who are involuntarily childless. Despite an increase in their availability, they remain inaccessible because they are expensive. Some jurisdictions fund or subsidise ARTs. Central to ART funding decisions is the question of whether they are medically needed. This arises first at the stage of whether ARTs are funded at all, and second, in determining who, among those that are involuntarily childless, should access funded ARTs. I compare four representative models to demonstrate that centring medical need at these two stages raises problems of (a) undermining the welfare of ART seekers; (b) discrimination against same-sex couples and single women; (c) prioritising the medical needs of some groups over others; (d) budgetary competition with other medical services; and (e) inconsistent practices across jurisdictions. This has the effect of intensifying the stratified pressure to have children faced by women across the world. Drawing on this, I argue that centring medical need in ART funding is inconsistent with the international human right to health. I further claim that an alternative reproductive health approach to funding has the potential to undo the exclusionary nature of the social pressure to have children.