Insured Women's Access to Infertility Care: How 'Fair' Is It Even With Family Healthcare Insurance?

Journal of Multicultural Nursing & Health, Fall 2003 by Griffin, Martha

OBJECTIVE: to examine the process of accessing infertility care in the context of an 'equitable opportunity to do so' (Mithaug, 1996) by comparing two groups of insured women who had 'family insurance coverage'.

DESIGN: A comparative survey design examined the perceptions of women who lived in States that mandated comprehensive infertility coverage and States that did not. A convenience, nonrandom sample of 242 women from 40 different States (102 women from states with mandated infertility coverage and 138 from states without coverage) who had accessed infertility care, through their health insurance, completed the Indicators of Access to Infertility Care Scale (Griffin, 1999). The two measures assessed were, perceptions of entry barriers to infertility care (Entry) and perceptions of having had a fair chance to pass through infertility treatment (Passage).

RESULTS: The women from states that did not have mandated comprehensive infertility insurance scored significantly higher in their perceptions of barriers to infertility care and scored significantly lower in their perceptions of having had a fair chance to pass through the infertility treatment system than did their counterparts in states with mandated infertility health insurance. CONCLUSIONS: Mandated comprehensive insurance coverage for infertility enables women to make family building decisions based on their own needs and appears to give them a sense of having had a fair chance to do so. It also seems to allow for the monitoring of expenditures for infertility treatment and thus imposes a minimal level of regulation.

KEY WORDS: Women's Health; Access to Infertility Care; Mandated Insurance; Marginalized Health Care; Equity in Health Care.

Evidence suggests that almost everyone shares consensual, unconscious perceptual biases against women (Benokraites, 1997; Winston & Bane, 1993). Expounding on the term 'marginalization' as explored in nursing (Hall, Stevens & Meleis, 1994; Stevens, 1992), women with infertility can be described as having been marginalized to the maximum. As a group seeking health care access, they have existed outside the mainstream of society for decades. The status of women in society is said to be reflected in the nature and degree of reproductive health care that women can receive (Siebel & Bernstien, 1995). However, given the documented necessity for the following legislation : 1978, Pregnancy Anti-discrimination; The Women's Health Equity Act, 1990 (Sharp, 1990) and all the individual state bills enacted to prevent 'Drive-by 24 hour delivery's', suggests that support for family building relative to women's reproduction is hard fought._

BACKGROUND AND SIGNIFICANCE

It is well known that women use health services more frequently than men but are more likely to encounter barriers (Clancy & Massion, 1992). Even women with identified "good health insurance" have experienced substandard comprehensive reproductive care (Women's Research & Education Institute, 1994 p. 34). Additionally, 86% of all private health insurance plans specifically exclude comprehensive infertility coverage (Alan Guttmacher Institute, 1995) and only 79% of the plans cover mamography or pap smears (Women's Research & Education Institute, 1994). This study explores the perceptions of this group of marginalized women who sought treatment for infertility.

The past two decades has seen the specialty of women's health emerge. Holism is the central theme. Although there may be situations that address women's health holistically, there still exists huge gaps and fragmentation (Raftos, Mannix & Jackson, 1997). It is therefore thought, that what must occur first, is to equitably address their reproductive needs. Bias, discrimination and bureaucracy should not be what dictates the status of women (Women's Research & Education Institute, 1994). Women explicate all forms of infertility treatment, regardless of the individual partner of causation.

Progress in health care advances for those with infertility are three decades old. The birth of the first invitro fertilization baby was in 1978. Nationally, the first baby born of assisted methods, recently turned 20. These events heralded interest, specialization and thus scientific advancement in reproductive endocrinology and technology. However, none of these contemporary scientific advances spontaneously opened access to care for infertile women (Griffin & Panak, 1998; Van Steirteghem, 1998).

The private insurance industry, that insures 68-72% of the United States population (Altman, 1992), did not align advancements in infertility treatment methods with client access to the same degree of alignment that they did for the advancements in other conditions. Public policy decisions that impact women seeking infertility treatment should be based on science not on bias or prejudice (Guzick, 2002; Jenker, 1991).

Recently, in Christchurch, New Zealand, a change was made in their public health policy on treatment for infertility. It has opened access to thousands of infertile couples ("More Funds Pledge:. 2000). This change in public policy came after an audit of health care spending revealed that government expenditures for reproductive health services amounted to $10 million dollars on abortion and $2.2 million on infertility. This provocative finding resulted in a 'public outcry' that prompted change.