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Friday 28 October 2016

Reframing the Debate Around State Responses to Infertility: Considering the Harms of Subfertility and Involuntary Childlessness


    1. Rebecca C. H. Brown*
    1. Health Services Research Unit, University of Aberdeen
    1. *Corresponding author: Rebecca CH Brown, Health Services Research Unit, Third Floor Health Sciences Building, University of Aberdeen, Aberdeen AB25 2ZD. Email: rebecca.brown@abdn.ac.uk
    1. Wendy A. Rogers
    1. Department of Philosophy, Macquarie University
    1. Vikki A. Entwistle
    1. Health Services Research Unit, University of Aberdeen
    1. Siladitya Bhattacharya
    -Author Affiliations
    1. Division of Applied Health Sciences, University of Aberdeen
Public Health Ethics(3):290-300.doi: 10.1093/phe/phw005
  1. Division of Applied Health Sciences, University of Aberdeen


Abstract

Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies (ART). Policies regarding who can access ART and with what (if any) support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem to suppose. Instead, we propose that debates about appropriate state responses should consider the various implications for health and broader well-being that may be associated with difficulties starting a family. We argue that the harms and disruption to valued life projects of subfertility-related suffering may provide a stronger basis for justifying state support in this context. Further, we suggest that, whilst ART may alleviate some of the harm resulting from subfertility, population-level considerations can indicate a broader range of interventions aimed at tackling different sources of subfertility-related harm, consistent with broader public health aims.