Amos Grünebaum: Reproductive Freedom Requires Reproductive Access, Including the Ability to Afford It

Amos Grünebaum, Professor of Obstetrics and Gynecology at Donald and Barbara Zucker School of Medicine, shared on LinkedIn:

“IVF that is medically available but financially unreachable is not reproductive freedom.

It is reproductive privilege allocated by income.

For many women and couples, the barrier is not a lack of desire, medical eligibility, or willingness to undergo treatment.

It is money.

They may postpone care while reproductive potential declines, accept less effective treatment, exhaust their savings, incur substantial debt, or abandon treatment altogether.

Reproductive Freedom Requires Reproductive Access, Including the Ability to Afford It

‘Equality between men and women, starting with our ability to control our own bodies, is the beginning of democracy.’ – Gloria Steinem

I agree with Gloria Steinem.

The ability to decide whether, when, and how to have children affects nearly every part of a woman’s life: her health, education, relationships, career, financial security, and future.

But reproductive freedom cannot mean only the freedom to prevent or end a pregnancy. It must also include a meaningful opportunity to build a family when infertility makes conception difficult or impossible.

That is where our public discussion remains painfully incomplete.

We celebrate IVF as a triumph of modern medicine. We share inspiring stories about families created against the odds. We speak about fertility treatment as though the existence of the technology establishes reproductive choice.

It does not.

IVF that is medically available but financially unreachable is not reproductive freedom. It is reproductive privilege allocated by income.

For many women and couples, the barrier is not a lack of desire, medical eligibility, or willingness to undergo treatment. It is money. They may postpone care while reproductive potential declines, accept less effective treatment, exhaust their savings, incur substantial debt, or abandon treatment altogether.

The technology exists. The clinic is nearby. The physician is ready. Yet the patient cannot receive care because she cannot afford the price of admission.

That is not meaningful access.

We must also name racism. Racial inequity in reproductive healthcare is not limited to individual prejudice. It can operate through unequal insurance coverage, differences in access to specialists, delayed evaluation, undertreatment, geographic barriers, and the dismissal of patients’ symptoms and priorities.

When race and income interact, the people already facing the greatest barriers are often the least able to obtain fertility care. A system that offers advanced reproductive technology while predictably excluding many of the women who need it cannot honestly call itself equitable.

We would not describe another important medical treatment as accessible merely because a hospital possesses the technology. We should not apply a weaker standard to infertility care. A treatment available primarily to people with substantial income, generous insurance, or access to family wealth is not equally available.

Reproductive freedom must include the freedom:

• Not to become pregnant
• To continue a pregnancy
• To receive safe and respectful maternity care
• To preserve fertility when medically indicated
• To obtain evidence-based infertility treatment
• To make reproductive decisions without coercion, discrimination, or financial exclusion

Infertility is not a lifestyle preference, and its treatment is not a luxury purchase. Parenthood should not be auctioned to those with the greatest ability to pay. A woman’s opportunity to build a family should not depend primarily on her employer, ZIP code, race, bank balance, or willingness to assume crushing debt.

Financial exclusion is still exclusion. Calling unaffordable treatment ‘available’ merely disguises that exclusion in the language of choice.

Gloria Steinem connected control over reproduction with equality. That principle must apply in both directions: the freedom not to have a child and the freedom to seek effective medical care when one wants a child.

Legal permission is not enough. Scientific capability is not enough. A clinic with an open door is not enough if the price prevents most patients from walking through it.

If reproductive freedom is truly central to equality, affordable fertility care must be part of it.

Otherwise, we have not created reproductive freedom.

We have created reproductive freedom for those who can pay.”

Other articles featuring Amos Grünebaum on Fertility News.