Down with the fertility police
Proposals that women who are too fat, too thin or over 40 should be denied IVF are draconian attempts to define what is a ‘good parent’.
Fat people, apparently, don’t deserve to have children. Nor do people who are too old or too young, too thin, or, by default, too poor.
Such are the recommendations of the British Fertility Society (BFS), a group of IVF specialists, which this week has set out to try to clarify guidelines on who should receive fertility treatment on the NHS (1). It’s a good job most people can get pregnant naturally, or the fertility rate really would be in trouble.
The headlines went along the lines of ‘Call for fertility ban for obese’ (2), and focused on the proposal to refuse treatment to women with a body mass index (BMI) above 29 (about 12 stone for a woman of average height) until they initiated a ‘weight reduction programme’ (3), and to refuse free treatment point blank to women with a BMI over 36. But fat women were not the only ones in the firing line: underweight women (about eight stone) would be made to gain weight, and women over 40 would be barred automatically from treatment.
In fairness to the BFS, its intention is to reduce current ‘unequal access’ to NHS-funded IVF treatment, which arises from Primary Care Trusts’ arbitrary use of ‘social criteria’ to determine who should be allowed free IVF. For example, some PCTs refuse to fund couples who already have children, some refuse to treat smokers, and many set different obesity limits, resulting in a bewildering array of restrictions. And some of the BFS’s recommendations are progressive – for example, that single women and same-sex couples should be treated the same way as heterosexual couples, and that couples with children from a previous relationship should not be excluded from access to NHS treatment.
But any use of ‘social criteria’ to bar people from IVF treatment is a problem, because it draws a moral distinction between those who are worthy of being given the chance to be a parent, and those who are not. By these criteria, fat women and older women are being labelled undeserving of a treatment offered to everybody else – being told that they don’t deserve to have a baby, because they’ve left it too late or eaten too many pies.
Medics will argue that there are medical reasons for these restrictions – that IVF treatment is less likely to work for women who are old or fat, and that if it does work, the pregnancy will carry greater risks for mother and child. Well, if that’s the case, tell your patients of the risks, and let the decision about whether to proceed be made by the doctor and the patient, not by a list of standard regulations.
While young women in the peak of health are doubtless the fertility specialist’s preferred patients, presumably they are the least likely to need assistance. Pregnancy, for any woman, is reasonably risky: and if fat women can choose to take that risk when conceiving naturally, why not when they are having fertility treatment? IVF, like most medical procedures, is not something that people generally do for the hell of it; they turn to assisted fertility when nature, or other circumstances, let them down. It’s unpleasant, unreliable and can be bad for your health – yet still people do it, because their desire for a child outweighs those other concerns.
Fertility treatment gives society the ability to overcome one of the unfairnesses caused by nature. Why should we want to compromise that by adding some socially-constructed unfairnesses of our own?
As things currently stand, the BFS’s recommendations probably won’t have a practical impact upon that many people – largely because provision of IVF treatment on the NHS is so limited. PCTs have been instructed by the government to offer women at least one free cycle, which is arguably neither use nor ornament – the need for speed (often precisely because women seeking treatment are older) and for more than one treatment cycle means that many people go private anyway. As ever, it is those who can’t afford the thousands of pounds that fertility treatment requires who end up suffering the consequences of these restrictions most directly.
But the moral impact of these recommendations is widespread, reaching beyond IVF patients to everybody who wants a child. Once again, we are presented with an official viewpoint on what it means to be an acceptable parent – a non-drinking, non-smoking, mature-but-not-old, slim-but-not-too-thin caricature straight out of the New Labour Book of Boring. Fertility treatment is supposed to offer people more choices; instead it has become another stick with which to beat us into conformity.
Jennie Bristow is a freelance writer and mother of two young children.
(2) Call for fertility ban for obese, BBC News, 30 August 2006
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