Where There is Love, There is Life
Last month I turned (gulp) 36! I hate to admit it but with each passing year in my 30’s, the pressure and conversations around whether or not to start a family are mounting.
I am a cisgender woman, and proudly queer. Whilst there are many things about my identity that I find joyful, discussing the concept of a family with my wife is not one of them.
Not least because it is scary (of course it is!), or because we will likely face discrimination, or because it is a life-changing decision that should not be taken lightly. But because of the sheer deliberateness that is required to make such a decision when you are queer. As other queer folks will be acutely aware (and of course depending on the road one chooses to walk down), I cannot have a family without lots and lots of planning. Myself or Ella will not accidentally fall pregnant and be forced (for want of a better word) into making a decision. We must have conversation after conversation about whether this is something we truly want, and if so, consider what options are available to us. All the while, the clock continues to tick away, and our biology seems to work against us.
This is not to say that heterosexual couples do not plan their families. But queer couples and solo parents have to explicitly opt-in rather than being potentially presented with a choice from which to opt-out. Importantly, the psychology of opting-in is different to that of opting-out. Take for example the UK policy on organ donation, which switched from opt-in to opt-out in 2019, after rates of organ donation remained perilously low. It’s much harder to actively opt-in, when it comes to big decisions.
Let’s say Ella and I decide we do want to start a family - then what? Cue a barrage of questions with no easy or straightforward answers: How exactly do we go about this? Who will carry the baby? Whose egg will we use? What medical support is there for us? Will we be discriminated against? What does it mean to be a mother in a queer relationship? And how much will it cost?! This list goes on.
In the UK, and according to the NHS, there are several routes for queer individuals to start a family, including IVF, surrogacy, adoption, and fostering. But here’s the kicker; many of these are not offered as standard practice to queer couples or solo parents through the NHS, and therefore involve a hefty financial investment. The ‘Gay Tax’ as it has been termed, refers to the rounds of private fertility treatments (up to 12!) same-sex couples and solo parents must go through before being considered for IVF across the majority of NHS trusts in the UK. This often amounts to tens of thousands of pounds.
For clarity, heterosexual couples are required to try to conceive naturally for a period of time (up to 2 years), and if unsuccessful, can receive IVF and/or IUI for free. Funding decisions for IVF are determined by integrated care boards (ICBs) around the country.
As it stands, many of the ICB’s policies that make the decision on who is offered IVF on the NHS are under review, after a same-sex influencer couple took their local ICB to the high-court on grounds of discrimination. The couple dropped the case when the ICB agreed to give same-sex couples and solo parents the same access to fertility treatment as heterosexual couples. This was swiftly followed by a Governmental policy u-turn on access to fertility treatment. Yet more than a year later, many couples are still having to wait for equal access to actually happen. In fact, our own local ICB - South East London - offers 1 free round of IVF, but only after paying for 3 rounds of IVF privately, and after all that, the ICB does not even offer a full cycle.
The number of free rounds of IVF varies by area as determined by the ICBs, and notably more affluent areas seem to allow for more than a single free round of IVF. This raises a number of questions around how deeply inequitable it is to be an individual trying to become a parent in the UK. Whether you are a solo parent, a heterosexual couple with fertility issues, or a same-sex couple, there is no consistent application of support or funding, which often means it is those who are wealthier or from a higher socioeconomic status that have the resources (time, money, etc) to start a family.
Not surprisingly, access to fertility care for people of colour is poor, with evidence suggesting that treatment is less successful for Black patients specifically. This is, in part, due to systemic racism in the UK healthcare system that leads to poorer standards/quality of care. Given that we are an interracial couple, this adds another layer of concern when debating whether to start a family. To top it all off, mixed heritage lesbian couples have fewer resources to hand to navigate fertility treatments (including a dearth of Black sperm donors in the UK), and most of the existing research has focused exclusively on the experience of white lesbian couples.
So where does that leave us? At best we might start a family, at worst our financial security, job security, and health could suffer.
Our fears are partly rooted in research and data, but they ultimately reflect a wider phenomenon in many western countries, in which trust in public and governmental institutions is diminishing. In fact, a report focusing on health and empowerment by the Edelman Trust earlier in 2024, found that across 16 global countries and 15,000 respondents, individuals only trusted their workplace to address their health needs. Furthermore, trust in healthcare companies more generally decreased across the board, with the UK falling 5% points from 2023 to 2024.
As a result of this lack of trust, and as the data can attest, many of us are looking to our workplaces and organisations to provide the support that we sorely need. This means organisations are likely feeling the pressure themselves to right the inequities that persist in our societies. Here, organisations have an opportunity to provide their queer employees with financial aid towards fertility treatment, and to build progressive policies around paid leave for fertility treatments, paternal leave, surrogacy, and caring responsibilities. But it is vital that organisations continue to listen to the needs of their queer employees, and direct their efforts accordingly.
Reproductive health benefits have not only become more mainstream (the fertility benefits provider Fertifa has seen client numbers quadruple since the start of 2022), but the costs are often negligible too. A Mercer study revealed that 97% of employers who offered an allowance for fertility treatments didn’t end up spending more on a net basis.
Employers who care about true equity can position themselves as pioneers by offering their people something deeply meaningful - the opportunity to start a family in a supportive and caring context.