Thursday, September 24, 2009

ARTs: Raising Issues of Accountability and Equality

Today's post is by Dr. Kate Ott, Associate Director of the Religious Institute.

Since the advent of Assisted Reproductive Technologies (ARTs) 30 years ago, millions have used them to try to have children. The Centers for Disease Control and Prevention estimates that one in eight American women of childbearing age has used a fertility service of some kind. The development and use of these technologies have outpaced ethical reflection and critical social engagement on issues of regulation, equal access, and health risk.

ARTs are not new, yet their use remains largely unregulated. Fertility clinics currently self-regulate through membership in the American Society of Reproductive Medicine (ASRM). But, the Centers for Disease Control report that 8 in 10 clinics do not strictly follow ASRM guidelines. With regard to IVF, for example, implanting multiple embryos increases the risks to both mother and children when multiple births occur. Clinics practice multiple implantation often at patient’s request to maximize chances of implantation when costs per cycle are excessive. This practice continues even though current research suggests there is no benefit to implanting more than two embryos. Like IVF, the long-term health implications of some reproductive procedures are still unknown, there is a need for continuing research to determine future risks, and for caution in the use of ARTs that are high risk and low success.

The high financial cost of ARTs creates a class system of those with means and those without. The lack of government regulations and the sporadic, often biased insurance coverage of ARTs compound issues of access. Many insurance companies, fertility clinics, and state laws limit access to ARTs based on marital status, sexual orientation, and socio-economic standing. Granted not all ARTs are the same; they vary in their cost and medical risk. The availability of safe, effective, affordable reproductive technologies must respect the diversity of families in our culture, and not exclude women and men on the basis of partner status, economic circumstance or sexual orientation.

As the Religious Institute stated in the Open Letter to Religious Leaders on Assisted Reproductive Technologies, calls for increased regulation can best address disparities in ART practice if they “promote research to determine the risk of ARTs and raise questions about the use of resources for ARTs that are high risk and low success.” In addition, insurance coverage “for effective and safe ARTs should respect the diversity of family structure and not exclude on the basis of partner status, economic circumstances, or sexual orientation.”

There is a vital role for faith leaders to play in creating intentional dialogue about the effectiveness and safety of ARTs, the relative lack of regulation, and the moral dimensions of their use. We must commit to an ongoing conversation that respects the desire for biological children while honoring reproductive justice. Faith communities can take the lead in this conversation by promoting values that can guide moral and ethical decision-making on the use of ARTs. It is time we raise up our theologies and histories that value nontraditional family structures, uphold the dignity and diversity of human beings, articulate a principle of communal responsibility, and witness against social injustices that perpetuate inequalities based on race, gender, economic class, sexual orientation, age, and ability.

Portions of this blog are taken from A Time to Be Born, available for download at

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