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

The reliability coefficients were greater than .70 (Nunnally, 1978) supporting the consistency of the measure.

DISCUSSION

This study looked at access to infertility care and access was the dependent variable. The Indicators of Access to Infertility Care Scale (Griffin, 1999) was designed to measure 'indicators of access to infertility care' (Table 6). The independent variable of 'state mandated comprehensive infertility insurance' (potential cause of dependent variable 'access') is identified as a form of 'social redress' in the context of Mithaug's theory (1996). The condition of 'mandated infertility insurance' was definitely a factor in whether or not 'access to infertility care' was realized by infertile women. It appeared to also be a factor in the subsequent decisions they made regarding family building.

The women who responded to this study numbered 242 and came from 40 different states in the United States. As reported, respondent women from states with mandated infertility health care insurance scored significantly higher in access than their counterparts in non-mandated states (Table 2). The women in the mandated states were on average older (M = 36.3 vs M = 33.5) and there were less of them in active treatment (38.5% vs 54.3%). Having less women in treatment in states that had mandated comprehensive insurance runs contrary to popular perception. An articulated policy argument is that to mandate comprehensive coverage would increase the use of the treatments (Milsap, 1996). That argument did not hold up in this study.

The group with mandated infertility insurance was also found to have more adopted children rather than biological children (15.4% vs 2.2%). This finding is contrary to much of the literature on the speculated effects of mandated infertility insurance, as well, (Britt, 1997; Milsap, 1996). However, it is a consistent finding in the application of the theory used. The opportunity to make a choice on your own behalf generally dictates that it will be one that is good for that individual (Mithaug, 1996).

Identifying 'mutable' (those that you can effect a change upon) causes of non-access was identified multiple times in the literature on access to health care in general and has specific implications for infertility care, as 'mandating or legislating' is action oriented and concrete (Aday, Andersen & Flemming, 1980; Andersen, 1995). Mandating access to health care for women also has a long history. The 1978 Anti-Pregnancy Discrimination Act and the Women's Health Equity Act (1991) are perfect examples.

Adjusting the 'opportunity context' through 'social redress' has a great impact in the area of infertility care. The concern in this study was 'equitable or fair access to infertility care' and the social redress was state mandated comprehensive infertility coverage. How individual women entered or did not enter the infertility care system was greatly affected by their geographic location and the social opportunity context or mandated infertility insurance. The qualitative question of whether or not the individual felt that they had a 'fair chance' to be treated for infertility correlated with the access score findings. Women who had high access scores felt that they had a 'fair' chance to be treated, women who had low access scores did not feel that they had a fair chance.