Research suggests US insurers should cover fertility treatment

Researchers from the University of Michigan (UoM) have uncovered some interesting facts about infertility treatment in states with mandatory health insurance. Unfortunately, only 17 states in the US currently have fertility insurance coverage laws. The World Health Organisation defines infertility as a disease of the reproductive system. This is defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.

Fertility is a human right

  • 1948 UN Universal Declaration of Human Rights: “Men and woman of full age, without any limitation due to race, nationality or religion, have the right to marry and to raise a family”
  • 1994 UN International Conference on Population and Development: “Reproductive health therefore implies that people have the capability to reproduce. They have the freedom to decide if, when and how and have the information and the means to do so.”

Healthcare professionals also support the notion that fertility is a right. In 2003, the International Federation of Obstetricians and Gynaecologists stated, “Women and men have the right to the highest available standard of healthcare for all aspects of their sexual and reproductive health.”

Fewer women die when insurers cover infertility treatment

One important aspect of this new research at the UoM shows that fewer women die when insurers cover infertility treatment. Their research finds that when states require coverage of fertility treatment, 20% fewer mothers die during pregnancy, childbirth, or shortly after birth.

The study, led by UoM’s Dr. Joelle Abramovich, examined maternal death rates in states that mandated coverage of fertility treatment. Between 1977 and 2001, that was 15 states compared to those that didn’t. Dr. Abramowitz said, “Previous findings suggest that the mandates were effective at increasing access to infertility treatment. But less work has explored how mandates affected maternal health outcomes.” Her team was able to show that, for white women, there were 3.4 fewer deaths per 100,000 births. This is a 20% decrease from the mean of 16.9 deaths per 100,000 in states that mandated coverage of fertility treatments.

You read that right, a 20% decrease in deaths. This came as a surprise to the researchers as well! Dr. Abramowitz says, “I would have expected, prior to this research, that there would be an increase in maternal mortality. But there are reasons why we would expect to see a decreased risk as well,”

What are the reasons?

One reason might be simply that women included in the analysis were likely more affluent (white women aged 35-49). As such they may have had better access to private health insurance in order to benefit from the mandates. Although the state mandates for insurance coverage were associated with fewer maternal deaths, this did not apply to black women. In the US baseline maternal mortality rates differ by race, a separate and equally shocking issue. This is because minorities don’t appear to have the same access to employer-sponsored insurance coverage.

Dr. Abramowitz believes a fuller understanding of the effect of the state mandates is important. It can inform future policy decisions as well as leading to a more complete picture of women’s health. The decision seems to be a no-brainer: states should mandate insurance cover for fertility treatments.

Dr. Abramowitz said, “We should care about the health of women undergoing these treatments and the outcomes for them. But instead we’re focused on their fertility and the outcomes for their children. Finding these effects suggests the importance of more research on women’s health and maternal mortality. A lack of good data prevents such research. Collecting better data would allow researchers to better investigate determinants of maternal health, thereby saving women’s lives and improving their well-being.”