Race and Ethnicity as Barriers to ART Access

This chapter analyzes the racialization of infertility care in the United States, and seeks to understand why ART stratifies along race and ethnic lines. Researchers and scholars have proposed several theories, including lower income levels and access to insurance in minority populations, social factors that make women of color less likely to seek treatment for infertility, historic factors that give rise to a continuing aura of mistrust in the doctor–patient relationship, and express and implied discrimination by doctors who view minority populations as less deserving of parenthood than white patients. The chapter shows how these new eugenics, like the old eugenics, can persist only so long as political power structures support and advance their agenda.

Our Eugenics Past

This chapter examines the past eugenics movement in order to evaluate the motivations, patterns, strategies, and language that drew in so many. Searching the parameters of a movement that targeted natural reproduction for lessons about modern methods of assisted conception is both highly logical and utterly counterintuitive. One might insist that eugenics cares about individual reproduction only as it impacts the population, whereas ART cares about the population only as it assists in individual reproduction. However, both eugenics and ART are logically tied by their mutual focus on controlling reproduction. In reviewing and summarizing the detailed accounts of the lives, the lures, and the losses that define the eugenics movement, the chapter focuses on the themes that emerge from the analysis—science, language, tradition, and economics.

The New Eugenics

This chapter calls for the democratization of ART. Exposing the many ways in which reproductive assistance is withheld, denied, deprived, and revoked is to also reveal the widespread need and desire for its adoption. The mismatch between the current use and current need for ART motivates these analyses that critique the law and policy that permit access barriers to persist. The actionable recommendations set out herein can help shift the course of ART access to a more democratic future. Even if no such reforms are taken up, the chapter remains hopeful that external factors will coalesce to widen access to reproductive technologies. Global and national changes that, in some instances, are seemingly unrelated to ART will usher in an era of greater availability and access to reproductive assistance.

The Harms of Procreative Deprivation

This chapter examines how recent efforts to address the harms done to several Americans have taken shape as formal apologies and payments to surviving victims. This contemporary hand-wringing is an important acknowledgment that state-sponsored reproductive deprivation is among the most profound offenses a citizen can suffer. The chapter questions whether the harms from deprivation of assisted conception services are of equal impact to those wrought by unconsensual, unwanted, and procreative robbing surgeries. Whatever the comparison, each person deprived of an opportunity to parent by law, policy, or provider suffers gravely in ways that go beyond the first-line harm of forced childlessness. These harms befall patients, providers, children, and society in various ways, strengthening the case that disparities in access to ART warrant attention and reform.

Disability and Procreative Diminishment

This chapter looks at how today's denials for ART treatment based on a prospective parent's disability are worrying analogues to the eugenics past, an era in which misguided judgments about parental fitness culminated in the involuntary sterilization of thousands of Americans. Whereas past eugenicists coerced the “feeble-minded” into surrendering their reproductive capacity through forced sterilizations, today's practices deprive the differently abled of their capacity to reproduce by withholding the technological means necessary to produce a child. By focusing on the meaning of disability in contemporary society as both an acquired and inherited characteristic, the chapter considers how the presence of a disability in a would-be parent and its likely appearance in any resulting offspring shape the conduct of physicians and patients alike.

The High Cost of Assisted Reproduction

This chapter explores how cost as a barrier to ART access is more complex than just the high price of medical goods and services transacted in the pursuit of parenthood. Reportedly, assisted reproduction generates annual revenues of over $4 billion in the United States, much of it paid out-of-pocket by patients who are underinsured for this aspect of health care. At first blush, it is clear that the synergy between high-priced treatments and low levels of reimbursement produces a world of stratified reproduction in which wealth status determines entry into the procreative marketplace. A deeper analysis does not refute this impression, but also reveals that socioeconomics alone do not fully explain how ART funding works to suppress reproduction by certain “lower resource” individuals.

The Reproductive Revolution

This chapter discusses how the world of assisted reproductive technologies (ART) offers those who cannot reproduce the old-fashioned way various medical techniques aimed at achieving pregnancy by means other than sexual intercourse. By disaggregating sex from reproduction, ART is the story of both technical sophistication and social liberation. The shakeup of long-established medical, social, and familial norms has been one of ART's hallmarks, a distinguishing characteristic that often places it in the crossfire of contemporary culture wars. Though designed as mere medical techniques to overcome infertility, ART's increasing invocation by those historically deprived of reproductive opportunities invites scrutiny into its every use and its very existence.

Social Infertility and the Quest for Parenthood

This chapter talks about how for many couples, their physical expressions of love will never yield a baby. The largest faction of this cohort consists of the medically infertile—those who lack the physical capacity to accomplish the reproductive cycle of conception, gestation, and childbirth through heterosexual intercourse. The other faction of the “nonproductive lovemaking” cohort includes those with social infertility—the inability to conceive and maintain a pregnancy within a particular social structure without medical assistance. People with social infertility may or may not be medically infertile, but the structure of their intimate social relationships, or lack thereof, make sexual reproduction an impossibility. The socially infertile include single and transgender individuals and same-sex couples who lack access to natural reproduction.