Reality Chick

Should IVF Coverage Be Mandatory?

           A couple of Decembers ago, I got an email from Resolve, the national infertility organization — a plea for end-of-year, tax-deductable donations. “Imagine a world where fertility treatment didn’t exist …”  began the missive.

            It had been years since I looked to Resolve for aid in my finally defunct effort to have a family. The organization claims to serve a dual purpose: to prove information and support to those pursuing children, and reconciliation to those who wind up without. But the overwhelming number of communications and services, and the only lobbying activities – urging Congress to pass laws to make insurance coverage for fertility treatment mandatory — were geared towards the baby quest.

              So I deleted their emails after a quick skim. But having planted the idea of a world where fertility treatments didn’t exist, I couldn’t resist an honest answer: “I honestly wish they didn’t!” 

           This spurred an instant response, offering a plea for my “healing” – as if only a wrong-thinking person could even question the fertility system.   

            I hit the reply key, and then typed in: “The fertility industry makes those of us for whom the system didn’t work even more of an anomaly than we already are.”

            Within minutes, a Resolve staffer called. She stressed that Resolve was there to listen to people like me. 

            “Good. All I’m saying is — if infertility is defined as an illness, then that makes those of us without children sick and abnormal, right? I can’t reconcile to my situation if society can’t reconcile itself to me. Plus – I have a real illness – having infertility over the age of 35 isn’t an illness, it’s biology.”

            The staffer was dumbfounded.

            I continued, “I’ve worked hard for the little financial security I have, so I’m really cheap and risk-averse. I knew most IVF’s in my age group failed. If it were a stock, I wouldn’t have bought it. But because it was someone else’s financial risk – I gave it a shot. But I’d never have gambled on it with my own money. I’d never have got sucked into the emotional maelstrom. And if no fertility treatments existed at all, I’d have much more easily accepted my childless state. And so would the rest of the world.”

            A lengthy conversation ensued. I insisted on a precise definition of infertility. At 28 it’s an illness that should be cured when possible, and paid for by medical insurance. At 48, IVF is an artificial prolonging of the motherhood timeline. Was it fair to make other policyholders in the insurance risk pool subsidize that? The Resolve staffer was shocked.

            But this year, the once-taboo arguments I raised are coming out in the open.

            In July, Salon’s Broadsheet column backed the Family Building Act of 2009, which calls for insurance companies to provide IVF coverage. Fifteen states currently require it, and Resolve would like to make it a national mandate.

            The financial logic behind insurer-provided IVF is that those who can’t afford the more expensive and precise IVF procedure use the cheaper fertility drug clomid, which may cause the release of too many eggs, resulting dangerous multiple births that tax the health care system more in the long run.

            Of infertility, Broadsheet columnist Lynn Harris declared, “It appears that we can no longer afford to treat its treatment as a luxury.”  

            Some commenters disagreed, with the predictable advice: You can always adopt. Which prompted corrective replies from other readers who pointed out that adoption is often more expensive and risky than IVF.

Other responder’s put the argument in the context of the larger health care crisis:  “When society can afford insurance coverage to provide life-saving treatments for all the children already here who need them, then we can spend more money creating new children.”

http://www.salon.com/mwt/broadsheet/2009/06/24/ivf_coverage/

Consider Yourself Warned

          In Britain, authorities recommend giving a fertility test at 30, seeing it as an awareness tool. Fertility counseling should go hand in hand with other kinds of sex ed.

http://www.guardian.co.uk/lifeandstyle/2009/aug/09/fertility-mot-children-nhs

             A former chairman of the British Fertility Society said it was crucial to tackle a “widespread misapprehension” about the success rate of fertility treatments. The chances dip sharply with age: from 31% for women aged under 35, to below 5% among women over 41.

 Mommy Oldest

            This summer, the death of a Spanish woman who gave birth at 66, leaving a toddler orphaned (she was unmarried) spawned heated debate on the blogs over whether or not there should be a ceiling-age for fertility treatments.

            In Newsweek, African American writer Raina Kelly spoke out: “Sometimes for the sake of the children-to-be, we may have to put away our longings and grieve for the children we might have had rather than go to the ends of the earth to get them. We have to think about the children, not just the having them.”

http://www.newsweek.com/id/208022

Some feminist voices argue that the reproduction playing field should be leveled – that if men can become parents at sixty, then so should women. Personally, I wonder if this is something to envy – but I’d hate to see reproduction outlawed for one sex and not the other. 

The Motherlode on Stillbirth

In her New York Times Motherlode column, Lisa Belkin asked readers how to respond to a family who’s experienced stillbirth. Again, sparks fly in the comments section, with one commentator saying that words like “tragedy” should be reserved for mass events, like the Holocaust or Hurricane Katrina.

http://parenting.blogs.nytimes.com/2009/08/13/when-a-full-term-pregnancy-ends-tragically/

Which button do I push for a dead baby?

            Stillbirth is more common that Down’s Syndrome, SIDS and HIV – one in every 160 pregnancies. Few expectant parents are aware of this, and so come to it completely unprepared — in an increasingly impersonal medical environment with no protocol for addressing it.

            NPR’s Tell Me More recently ran a segment featuring two parents of stillbirths who are trying to do something about that.

http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=111063912&m=111063895

Guest Sherokee Isle, who suffered a stillbirth in 1981, is trying to make sure hospitals have on hand a copy of her book, Empty Arms: Coping After Miscarriage, Stillbirth and Infant Death.

            She and fellow guest Alan Goldenbach, who recently wrote of his wife’s stillbirth in The Washington Post  (http://www.washingtonpost.com/wp-dyn/content/article/2009/07/06/AR2009070602918.html) point out that parents-to-be aren’t told that when movement slows down near due date, it’s a danger sign. They are lobbying for more research to find out why stillbirths occur.

In June of 2008, then-Sen. Barack Obama introduced the Preventing Stillbirth and SUID Act of 2008, but it was unable to gain much traction. (”SUID” stands for “sudden unexpected infant death.”) Sen. Frank R. Lautenberg (D-N.J.) continues the effort, “We need to know more about stillbirths to help increase awareness and prevention,” Lautenberg said. “We are crafting legislation to improve data collection so we can better understand what’s causing stillbirths and help parents looking for answers.”

Nadya Suleman has had extensive plastic surgery to resemble another famous mother, Angelina Jolie. While her octuplets have turned into a national freak show and blog snark-fest, it’s not hard for me to follow her logic.

In the third issue of Exhale I discuss “Octomom” as a natural product of a deregulated fertility industry,  and highlight a memoir by another mother whose judgement was questioned. 

Creation Fixation

             Today, you have to explain your decision not to utilize the new technology if you have even the vaguest desire to have children.  Why suffer the stigma of being different in an increasingly conformist society, where being married and childless is seen as more odd than being a never-married parent, a single mother of many?

            From a front-row seat, I saw how the sexual revolution impacted my parents’ generation, who came of age and married in the fifties. It hit like a hurricane, breaking apart marriages, spawning a generation of latchkey kids, sending women to conciousness-raising groups and out into the work-force. In the same way that the pill ushered in both the sexual revolution of the sixties and the feminist resurgence of the seventies, the fertility frenzy has impacted society of the nineties and aughts; the outside of the envelope is being pushed further and further out. The business world, education system, dating conventions and even family pecking order rely heavily on the idea that the fertility industry is a safety net.  When I started a new job at 35, I was warned, off the record, not to get pregnant the first year, then brightly advised: “That’s what we have our fertility benefit for.”

But it doesn’t work for everyone; it didn’t for me. In my recent interview on Belief.net, sparked by my last month’s Exhale column, I wonder if the answer isn’t advising young women to freeze their eggs, but rather, retuning society to make it easier economically for young women to start their families at more appropriate ages: http://blog.beliefnet.com/beyondblue/2009/01/christina-gombar-an-interview.html.

The Right to Reproduce?

            Nadya’s case raises the very uncomfortable issue of whether or not having as many children as she wants, by whatever means, is as much a feminist issue as abortion rights.   In the Guardian, Jennifer Block wonders if it’s not time to “take a close, hard look at our healthcare priorities. While we have the technology and expertise to keep a 1.5-pound premie (Suleman’s tiniest) alive outside the womb, standard American maternity care is resulting in poorer and poorer outcomes for the vast majority of mothers and babies.”

http://www.guardian.co.uk/commentisfree/cifamerica/2009/feb/10/nadya-suleman-octuplets-ethics

Birthing versus Parenting

            “Any fool can have a child.” Our new president’s words, not mine – said on the campaign trail, speaking to an African American audience. Properly raising children, President Obama says, is another issue entirely.  Perhaps for their own safety, it’s a blessing that Nadya Suleman’s children will be living in a fish bowl.

In a blog post titled, “They Shoot Horses, Don’t They?” author Karen de Balbian Verster discusses her dilemma after witnessing the abuse of one of her daughter’s playmates. She also sites an alcoholic woman who boasted of abusing her dog, but succeeded in adopting a Chinese infant.    

            De Balbian Verster asks: “I wonder why we as a society allow people who are unfit parents to become parents in the first place? It’s a slippery slope, I know, but shouldn’t there be some conditions in place before one has a child? Things like another parent, mental health, financial stability? It seems like too little, too late to worry about these things after the child has been starved in the basement, burned by cigarettes, or sexually abused. But since we can’t seem to ban assault rifles, I’m afraid licensing parents must remain a futuristic concept.

http://mysite.verizon.net/kdebv/2008.12.01_arch.html

An “Unfit Mother” Reflects

             Polio survivor Anne Finger was told she was unfit to give birth: it was dangerous, she was disabled, she was unmarried. Her 1990 book, Past Due, a Story of Disability, Pregnancy and Birth tells what happened when she defied standard advice.

        After suffering polio as a toddler, Finger grew up subject to one butchering operation after another in the vain attempt to bring life back to her atrophied leg muscles. Because of her horrendous experiences with the medical establishment, when she decided to become a mother, she eschewed traditional medicine and chose midwifery, despite the fact that she was an atypical, and potentially high risk obstretric patient.  The midwife miscalculated, the labor went on too long, and her son wound up inhaling his own fecal matter. Death, or a life sentence of severe disability was predicted by the angry medical establishment that she finally reverted to.

            Despite her son’s full recovery, Finger’s trauma – first under the knife of post-polio childhood surgeries, then a well-meaning midwife unequal to the task of her  complicated delivery, and finally, the shaming of the medical establishment – scarred he.: Her thoughts, during those terrible days when her son struggled for life:  “I do know that if he dies, I will think that technology is the monstrous, inhuman, a mad scientist’s creation; and if he lives, I will think it a miracle.”

          One could as easily apply these words to the current fertility industry frenzy: “I have the places where I draw my lines about what I would and would not do; and other people … people I respect, have different lives. But I’m aware too of how social pressure can work to keep people in line: how when a technology is available it becomes harder and harder not to utilize it. If you’re over 35 and pregnant, you have to explain your decision not to have amnio, justify yourself.”

Overfertility in the Age of The Feminine Mystique

        Richard Yate’s dark 1960 novel, Revolutionary Road, is now a gripping movie starring Kate Winslet. While the narrative is one of over-fertility rather than infertility, the story throws into dramatic relief how fragile and tenuousness is this largely taken-for-granted business of birth, for the child, for the mother. How destructive, yet somehow inescapable, the issue of maternal identity – for better or in this case, for worse.

Blogs and Bits

 http://www.moretolife.co.uk

       This British site for involuntarily childless includes U.S. news, coping strategies, and personal stories. A good resource for those who wind up without.

Therese Borchard's Beyond Blue

My interview in Therese Borchard’s blog, Beyond Blue, reached 3 million subscribers through Belief.net, and was picked up worldwide.  I argue that women without children wouldn’t feel so depressed if society were more accepting:

http://blog.beliefnet.com/beyondblue/2009/01/christina-gombar-an-interview.html#more