Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups

Abstract Research question We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.

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Health status of children conceived by assisted reproductive technologies: endocrinologist’s position

Problems of Endocrinology ◽

10.14341/probl9470 ◽

2018 ◽

Vol 64 (4) ◽

pp. 235-243

Author(s):

Zinaida S. Zyuzikova ◽

Natalya N. Volevodz ◽

Olga R. Grigoryan ◽

Elena I. Degtyareva ◽

Ivan I. Dedov

Keyword(s):

Health Status ◽

Assisted Reproductive Technologies ◽

Public Funding ◽

Endocrine System ◽

Married Couples ◽

Later Life ◽

Reproductive Technologies ◽

Male Population ◽

Access To Treatment ◽

Increased Risk

Assisted reproductive technologies (ART) are currently widely used around the world because of the increased prevalence of infertility (presently, about 15% of married couples suffer from infertility), as well as the increased access to treatment and public funding for this method. Hence, the number of children conceived by ART is steadily increasing every year. This review focuses on the pressing problem of the health status of children conceived by assisted reproductive technologies (ART) by analyzing modern publications on the state of physical, gonadal and psychosomatic development, features of the endocrine system and cardiometabolic diseases, the risk of imprinting changes, congenital malformations and oncological disorders. The data presented that there is no increased risk of childhood cancer or deterioration in quality of life. However, it is expected that the cardiovascular and metabolic risk factors found in childhood can worsen in later life and may ultimately be responsible for chronic cardiometabolic disease. Furthermore, the issue of fertility, especially in the male population conceived by ART, remains open, thus requiring additional longer-term research.

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Assisted Reproduction in Spain, Outcome and Socioeconomic Determinants of Access

10.21203/rs.3.rs-176446/v1 ◽

2021 ◽

Author(s):

Ido Alon ◽

Jaime Pinilla Dominguez

Keyword(s):

Assisted Reproductive Technologies ◽

Research Question ◽

Public Funding ◽

Probit Model ◽

Reproductive Technologies ◽

Public Healthcare ◽

Fertility Survey ◽

Public Care ◽

Socioeconomic Determinants ◽

Public Clinics

Abstract Research Question: We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design: We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results: The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions: Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.

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The public health implications of assisted reproductive technologies

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.30.4.03 ◽

2010 ◽

Vol 30 (4) ◽

pp. 119-124

Author(s):

R. Deonandan

Keyword(s):

Public Health ◽

Assisted Reproductive Technologies ◽

Preterm Births ◽

Reproductive Technologies ◽

Health Issues ◽

Policy Makers ◽

Health Implications ◽

The Public ◽

Short And Long Term

Objective The public health implications of Assisted Reproductive Technologies (ART) are largely unknown by researchers and policy makers alike. Outcomes need to be considered, not just as clinical issues, but in terms of effect on public health. Methods Using a qualitative key informant process involving interviews with selected professionals and a review of the medical literature, eight general themes of public health issues associated with ART were identified, and are discussed. Recommendations Short and long-term health outcomes of women undergoing ART procedures, and of their offspring, need to be considered, as do the epidemiological risks associated with donated gametes and the effect on health services of multiple and preterm births, both produced in higher rates by ART. A national surveillance system and greater inter-jurisdictional communication are important strategies for addressing these evolving concerns.

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Contesting the Geneticization Thesis in Human Reproduction: Dealing with Spiral Shaped Processes and Technoscientific Imaginaries

10.20944/preprints201909.0269.v1 ◽

2019 ◽

Author(s):

Ido Alon ◽

Jose Guimon ◽

Rosa Urbanos-Garrido

Keyword(s):

Assisted Reproductive Technologies ◽

Genetic Manipulation ◽

Genetic Diagnosis ◽

Genetic Selection ◽

Reproductive Technologies ◽

Human Reproduction ◽

The Public ◽

Steady Growth ◽

Regulatory Perspective ◽

The Right

This paper questions the potential shift of reproduction towards assisted reproductive technologies due to benefits provided by genetic manipulation of embryos. In order to examine the viability of such a shift and its implications from a regulatory perspective, we relied on two panels of experts from Israel and Spain, using the Delphi method and a series of in-depth interviews. We anticipate, at a first stage, a continuous-steady growth in the use of IVF, supplemented by preimplantation genetic diagnosis and the introduction of CRISPR/Cas. At a second stage, attracting a growing share of fertile people would require developments in genomics. While it is unclear whether these developments will fully materialize, they could be replaced by technoscientific imaginaries generating perceived benefits. We conclude that the regulation of reproductive genetics is becoming more critical and complex. The aim should be to ensure good practices and equity, while providing more information to the public. A broad and inclusive societal debate may overcome the difficulty of drawing a clear line between medical uses and non-medical uses of genetic selection and engineering and may contribute to finding the right balance between allowing autonomous decisions of patients and protecting the public interest.

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Situating Canada’s Commercial Surrogacy Ban in a Transnational Context: A Postcolonial Feminist Call for Legalization and Public Funding

McGill Law Journal ◽

10.7202/1035385ar ◽

2016 ◽

Vol 61 (1) ◽

pp. 31-86 ◽

Cited By ~ 2

Author(s):

Maneesha Deckha

Keyword(s):

Assisted Reproductive Technologies ◽

Public Funding ◽

Reproductive Technologies ◽

Feminist Perspective ◽

Human Reproduction ◽

Domestic Sphere ◽

Commercial Surrogacy ◽

Assisted Human Reproduction ◽

Global North ◽

Postcolonial Feminist

In large part due to feminist interventions in the early 1990s about the dangers of assisted reproductive technologies (ARTs) for women, Canada banned several practices related to ARTs when it enacted the Assisted Human Reproduction Act (AHRA) in 2004. Notably, the AHRA prohibited commercial surrogacy. Feminists feared that a market in surrogacy would exploit and objectify marginalized Canadian women who would be pressured into renting out their wombs to bear children for privileged couples. Since the early feminist deliberations that led to the ban, surrogacy has globalized. Canadians and other citizens of the Global North routinely travel to the Global South to source gestational surrogates. In doing so, they partake in an industry that heavily depends on material disparities and discursive ideologies of gender, class, and race. Indeed, the transnational nature of surrogacy treatment substantially reshapes the earlier feminist commodification debates informing the AHRA that took the domestic sphere as the presumed terrain of contestation. Due to the transnational North-South nature of surrogacy, a postcolonial feminist perspective should guide feminist input on whether to allow commercial surrogacy in Canada. I argue that when this framework is applied to the issue, the resulting analysis favours legalization of commercial surrogacy in Canada as well as public funding for domestic surrogacy services and ancillary ARTs.

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The Public Funding of Vocational Education and Training in Scotland

Scottish Affairs ◽

10.3366/scot.1999.0054 ◽

1999 ◽

Vol 29 (First Serie (1) ◽

pp. 84-103 ◽

Cited By ~ 2

Author(s):

John Fairley ◽

Andy McArthur

Keyword(s):

Vocational Education ◽

Public Funding ◽

Education And Training ◽

Vocational Education And Training ◽

The Public ◽

And Training

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Re-imagining Reproduction: Unsettling Metaphors in the History of Imperial Science and Commercial Surrogacy in India

Somatechnics ◽

10.3366/soma.2015.0149 ◽

2015 ◽

Vol 5 (1) ◽

pp. 88-103 ◽

Cited By ~ 14

Author(s):

Kalindi Vora

Keyword(s):

Assisted Reproductive Technologies ◽

Reproductive Technologies ◽

The Body ◽

Body Parts ◽

Colonial History ◽

Women's Bodies ◽

Commercial Surrogacy ◽

Art Practices ◽

History Of ◽

Travel Industry

This paper provides an analysis of how cultural notions of the body and kinship conveyed through Western medical technologies and practices in Assisted Reproductive Technologies (ART) bring together India's colonial history and its economic development through outsourcing, globalisation and instrumentalised notions of the reproductive body in transnational commercial surrogacy. Essential to this industry is the concept of the disembodied uterus that has arisen in scientific and medical practice, which allows for the logic of the ‘gestational carrier’ as a functional role in ART practices, and therefore in transnational medical fertility travel to India. Highlighting the instrumentalisation of the uterus as an alienable component of a body and subject – and therefore of women's bodies in surrogacy – helps elucidate some of the material and political stakes that accompany the growth of the fertility travel industry in India, where histories of privilege and difference converge. I conclude that the metaphors we use to structure our understanding of bodies and body parts impact how we imagine appropriate roles for people and their bodies in ways that are still deeply entangled with imperial histories of science, and these histories shape the contemporary disparities found in access to medical and legal protections among participants in transnational surrogacy arrangements.

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