Thursday, February 3, 2011

Does Subsidizing IVF Decrease Adoption Rates?

That's one of the questions answered by this paper, Trading-Off Reproductive Technology and Adoption: Does Subsidizing IVF Decrease Adoption Rates and Should it Matter? Here's the abstract:
For those facing infertility, using assisted reproductive technology to have genetically related children is a very expensive proposition. In particular, to produce a live birth through in vitro fertilization (IVF) will cost an individual (on average) between $66,667 and $114,286 in the U.S. If forced to pay these prices out of pocket, many would be unable to afford this technology. Given this reality, a number of states have attempted to improve access to reproductive technology through state-level insurance mandates that cover IVF. Several scholars, however, have worried that increasing access in this way will cause a diminution in adoptions and have argued against enactment of state mandates for that reason.

In this paper, which was selected for presentation at the 2010 Stanford-Yale Junior Faculty Forum, we push against that conclusion on two fronts.

First, we interrogate the normative premises of the argument and expose its contestable implicit assumptions about how the state should balance the interests of existing children waiting for adoption and those seeking access to reproductive technology in order to have genetically related children.

Second, we investigate the unexamined empirical question behind the conclusion: does state subsidization of reproductive technologies through insurance mandates actually reduce adoption; that is, is there a trade-off between helping individuals conceive and helping children waiting to be adopted? We call the claim that there is such an effect the “substitution theory.” Using the differential timing of introduction of state-level insurance mandates relating to IVF in some states and differences in the forms these mandates take, we employ several different econometric techniques (differences-in-differences, ordinary least squares, two-stage least squares) to examine the effect of these mandates on IVF utilization and adoption. Contrary to the assumption of the substitution theory, we find no strong evidence that state support of IVF through these mandates crowds out either domestic or international adoption.
The article is an interesting read;  in addition to concluding that no evidence suggests that state support of IVF crowds out adoption, the article tackles the much more difficult question -- even if IVF subsidization did diminish adoption, should the state nonetheless support it?


SustainableFamilies said...

The gov should totally help families afford IVF. The gov should also offer a comparable amount of funding in enrichment, parenting support, and quality of life enhancement for poor parents.

Lorraine Dusky said...

And what does the cost of IVF do to the cost of our insurance and medical care in this country? I've heard of people getting multiple approvals from their insurers.

Linda said...

"is there a trade-off between helping individuals conceive and helping children waiting to be adopted?"

People who go through IVF and other expensive infertility treatments want BABIES. They don't want "CHILDREN" who are waiting to be adopted. If they did, we would not have children languishing in foster care, and we would not have coercive "pre-birth matching" schemes, or people going overseas to get babies.

Having a child is not a "right", and neither is adopting a child. Being infertile or incapable of carrying a pregnancy is NOT a "need", nor is it a life threatening health crisis. As far as adopting's a WANT, not a NEED.

The only thing the government should be doing is providing affordable birth control, affordable health care and offer more programs to help women and children stay together.

Kate said...

Ditto to most of what Linda just said, especially the first part! There's no shortage of prospective adoptive parents for healthy babies and young toddlers, and finding homes for older or special needs children is way more complicated than just putting a little extra pressure on infertile couples. The attitude that adoption is a wholly interchangeable experience with having a biological child also contributes to the marginalization of birth parents and the losses experienced by adoptees.

There is a case to be made for providing some sort of coverage for IVF though - when people have to pay out of pocket for infertility treatment, they'll often opt for things that increase the chance of twin or higher order multiple pregnancies, which can lead to much higher costs than providing a few rounds of single embryo transfer IVF.

Anonymous said...

i think the state of Boston pays/co-pays for 3 treatments of IUI/IVF. My relatives in Mass. used the program (and had a child). when they moved to NJ they could no longer afford IVF for a second child (and they did not adopt.)

i don't think there's a correlation. i suspect that most couples move from IVF to donor eggs/sperm to conceive.

Reena said...

I don't think there is a tradeoff between IVF and adoption.

Not everyone who is IF moves on to adoption if IVF does not work and not everyone who adopts is IF. I don't believe there is a correlation.

I support health innsurance coverage for IVF and other IF treatments-- within reason. Health insurance does cover plenty of elective surgeries that are not really needed, so I don't see that as being any different from IF treatments. I do think there should be some kind of limit though-- if a couple or a woman tries IVF 3-4 times and it doesn't work,it probably isn't going to.

I agree the government should also provide more services for families and women with children.

Kris said...

There are so many other services that should be covered but often aren't. I pay for Speech and OT out of pocket for my son - more than $900 EVERY MONTH because insurance won't cover it for developmental delays. If insurance/government won't pay for services NEEDED by kids who already exist, why should it pay to produce more kids?? I personally am not willing to see my taxes go up to pay for infertility treatments while I am still paying for all my son's therapy out of pocket. If IVF is covered, it should be for a very limited number of tries. The couples I have known who went the IVF route did not adopt and had no intention of doing so. Just sayin....

Anonymous said...

There are substantial resources availible for low income families and struggling families already in place or in other words: family preservation.

The rally cry to give more or redistribute wealth is just that: noise. It doesn't look at the real issue.

There are massive abuses in the numerous programs already in place; generations of families living off of welfare and enjoying a surprisingly decent quality of life. People that have never worked a day in their life and truly have not experienced what real poverty is, as most low income families in this country have so much more than those of other nations. Shockingly more.

I see here many folks saying adoption or having a child is not a right. O.K. fine.

Why then is it a societal burden
(or fundamental right?) to provide all the needs for those that find themselves pregnant and unable to care for their offpsring. Is that a given right then too? And what is the standard of living that should be sustained? And for how long? Until said child graduates High School? What if that young unwed mother( just one example, certainly not representative of all circumstances)continues to find herself "expecting and unprepared financially"? Are their limits?

Who decides? On who's authority and moral compass do we base that on?

Simply stated is it really the task and burden of infertile couples or honestly anyone to subsidize another's ill informed decision or accident? Were is the individual responsibility and accountability? For the mother AND the father?

And don't we already provide support in the form of welfare, WIC, Social Security benfits, free or subsidized health care, Head Start and more?

Where does it end? No one wants to see a child or family suffer but truly.....where does it end?

Frankly I feel the same way about IVF; I don't believe the rest of us need to fund another family's family planning beyond what we already do.

Reena said...

Anonymous said...

The welfare scenario is largely a myth-- but putting that aside.

A big issue for many single moms is daycare and the cost of daycare. If they go to work- who watches their children? The job needs to pay enough to cover daycare and still have some left over. If their income is on the margin (here I am using margin in a true ecnomic definition) they make too much they may lose other resources such as food stamps etc. that they would still need because they are right on the cuff.

If government funds were used to provide more subsidies in the area of daycare-- more single moms and/or less wealthy families could work.

Kris, I also have a child who requires speach therapy and a variety of other services related to hearing loss. Most, if not all states have a program called Early Intervention that provides services to children until age three. AFter that time the public school systems are required to provide services to children who score below average on various assessment tests. Try looking into that. If your child requires more or you would like them to recieve more or different quality care, health insurance can cover it as long as you get a referral to the specialist from your doctor. We have gone through all of this and our health insurance company is paying-- we pay the co-pays. Have you asked your speach therapist or OT about health advocates in your state?

Anonymous said...

@ Reena,

I appreciate what you are saying and there is some validity to that.

However its hardly the only big issue. As an adult adoptee and Obstetrics Nurse I can't even begin to share the flagrant and gross misuses of government aid, subsidized health care and benefits I have witnessed. Women refusing to list a biological father on a birth certificate (despite the fact that he is present for the birth and they reside in the same home) so that they may qualify for more benefits; women on their fourth child, with no means of support and 4 different bio. fathers. (none of whom are taking responsibility btw) and so on.

I'm sure everyone here could share a story, leaning on one side of the issue or another, but reasonable access to child care alone doesn't resolve the issue at hand.

My point was and continues to be: why should others pay? Why?

Is it morals and ethics only? Because we claim to be a civilized nation and peoples? And again, who's moral compass do we follow? Who has the final say if we fund IVF for one family and not another? If we fund childcare for one family or single women and not another?

The task of following up on such aid programs and flushing out the abusers is enormous. The abuse is there and more rampant than some might suspect. Reform those areas and we might have a reasonable start.

I'm not advocating that we don't assist, but I was pointing out that if parenting and adoption are not a "right" (and clearly it isn't), why then is forced subsidy of another family simply because they are fertile a presumed "right"?