In discussing whether infertility should be considered an issue of public health concern, several arguments in opposition frequently occur. The debate over the public importance of unwanted childlessness is usually made in the context of attempted resolution of infertility either through pursuit of treatment or adoption. The public import of infertility is often contested because of perceived negligible health effects, attitudes towards overpopulation, and concern over the best use of limited health resources. These three arguments are repeatedly voiced in the discussion of infertility as a matter of public concern.
The public significance of infertility is often dismissed because of perceived negligible health effects. However, the consequences of infertility vary considerably, from an almost universal decrease in well-being in infertile individuals, to significant emotional and psychological effects, disruption in social relationships and, at the severe end of the spectrum, death due to domestic violence, suicide or starvation and disease exacerbated by neglect. Direct disease-related sequelae such as untreated infectious or parasitic disease and exposure to toxicants can also seriously threaten the health of infertile individuals. Denying that the emotional and psychological problems resulting from infertility are also health harms is a classic and persistent tactic that results in health care discrimination. Ultimately, the idea that infertility is not a public health care priority because it does not have devastating or life threatening consequences is fallacious–the effects of infertility are unfortunately severe and public recognition of these harms is needed.
Another argument made against the consideration of infertility as an issue meriting public attention and funding concerns the pressures of population growth. It is often argued that public resources should not be used to help infertile couples reproduce when the planet is already home to a huge (and growing) population which may not be able to be sustainably supported. The ICPD definition of reproductive health states that individuals should reproduce “if, when and as often as they wish” and human reproduction is widely considered an inalienable right. This right however seems to apply more to some groups than others. Ginsburg and Rapp have coined the term “stratified reproduction” to describe the power relations by which some categories of people are encouraged or empowered to reproduce while others are devalued. Infertile people are in essence not encouraged to reproduce because the costs to society are too great–there are already enough people on the planet to merit the expenditure of resources to allow for more. Attempts to limit the reproduction of fertile couples against their wishes are nevertheless consistently met with protest. If the argument is made that infertility treatment should not be provided because of the pressures of overpopulation why use medical treatment to save lives? If medical technology is used to prevent suffering of the ailing why should it not be used to alleviate the suffering caused by infertility?
The overpopulation argument is also used to encourage infertile couples to adopt children with the rationale that it is better to give a home to an unwanted child than pursue costly infertility treatment. The degree to which adoption is culturally and individually acceptable varies however and, as discussed previously, studies show a general lack of adoptable children and social customs that resist both giving up and taking in children in many places. Denying treatment for infertility is ultimately an ill considered population control measure; assurance of universal education or improved access to contraceptives would be more effective means to reducing population pressures. Whether used against the funding of infertility treatment or in favor of adoption, the overpopulation argument denies the importance of reproductive autonomy and distributes social responsibility for population pressures unfairly on the infertile.
Infertility is often denied classification as a public health issue because of concerns over the cost of treatment. Can a right justifiably be denied on the basis of scarcity of economic resources? That very argument has been used to deny the right to education and women’s rights. Upon examination, governmental budgets frequently reveal mismanagement of funds or hidden priorities not the inability to finance rights. Creative solutions to infertility treatment should be examined instead of outright rejection of funding for treatment. Where concerns over resources are justifiably significant, attentions should be directed towards prevention and other effective, low-cost solutions to infertility.
Inhorn and van Balen ask “Can infertility be considered part of national and international efforts to promote family planning and women’s reproductive health? Or is it a “luxury disease”, a waste of valuable resources, given the inability to have children is not (apparently as least) life threatening and may be perceived as mitigating population pressures?” The arguments against considering infertility as a public concern lack a comprehensive understanding of health as well as psychological, economic, political, and moral issues; there are significant reasons why infertility should be considered an issue of public health concern.
