When I was younger and first learning about reproductive health care, my stance on this issue could be easily defined by a single, pithy slogan: my body, my choice. It took me a while to learn the difference between what I thought was an unalienable truth and the immovable fact of reality.
While I certainly still believe that my body and what happens to it should ultimately be my choice and mine alone, I now know that the U.S. government has a vested interest in interfering with this choice and has been doing so for centuries. Even at its founding, this nation’s forefathers debated ideas that would for centuries inform how families were created, who was able to create them, and whether those families would be classified as human or property.
Today, the battle rages on in state legislatures as lawmakers fight to restrict or systematically destroy access to abortions and gender-affirming health care. Evaluated with an eye on reproductive policy trends over these last few years, the successful nomination of Amy Coney Barrett to the Supreme Court, coupled with the continued push for fetal “personhood” bills—or legislation that defines life as beginning when a sperm fertilizes an egg—it’s not a stretch to say that infertility care is up next on the chopping block.
Though the defense of infertility care is indubitably a cornerstone of the fight for access to reproductive care, infertility is all too often framed as one that affects only rich white people. There is a good reason for this belief. A Pew Research Center survey published in 2018 found that among the respondents who had undergone fertility treatments or knew someone who did, 37 percent were white, compared with 22 percent who were Black. The divisions across socioeconomic lines were also evident in the survey, with almost half of all respondents (48 percent) reporting an annual income of more than $75,000.
Infertility care is expensive, even with insurance. A cycle of in vitro fertilization costs $10,000 on average. The cost of one cycle alone is a barrier to access, but one 2015 study found that on average it takes three or four cycles for IVF to be effective in treating infertility. This means that people facing infertility can plan to spend at least $40,000 over a span of a few years in hopes of creating a family of their own. Faced with these numbers, it is perhaps easy to understand why infertility care is often framed as an issue that impacts only moneyed white people.
But the truth is that infertility impacts people across races equally, regardless of whether care is accessible to them. And while the testimonies of Michelle Obama and Gabrielle Union may seem like anomalies at first glance, research points to a systemic problem that disproportionately impacts Black people. A study conducted by the Centers for Disease Control and Prevention found that while people with higher levels of education and household incomes were more likely to seek medical help with getting pregnant, Black people across the board were less likely to seek infertility care.
Beyond the question of affordability, the health-care system’s treatment of Black people is well documented through testimonies such as those of Beyoncé and Serena Williams, both of whom faced life-threatening complications during their pregnancies and while giving birth. The fact that Black people are three times more likely than their white counterparts to die from pregnancy-related causes, when viewed in conjunction with the ways access to reproductive health care has been restricted, paints a clear picture. For centuries, the United States government’s approach to reproductive care has been guided by eugenics. When policies, practices, and price gouging attempt to codify the belief that only the white and wealthy should have children, charging eugenics is just a matter of telling the truth.
I only started to have this realization when I was in college reading up on chattel slavery for my first-ever class on African American history. I learned how slave owners were invested not only in controlling when and how enslaved Black people gave birth but also whether their families were separated during slave auctions. These decisions were informed, in part, by profit—who would sell for more and why. But the slave owners also knew that if they wanted to undermine a Black person’s ties to their community, they could start by destroying families.
After learning this, it became impossible for me to separate the issues of reproductive health care and bodily autonomy. Reproductive health-care policy is informed by the state’s desire to control a person’s ability to create a family on their own terms. By using reproductive policy to dismantle the concept of bodily autonomy, the state places bodies and “personhood” under its own purview rather than that of the individual.
This is why I’ve become so frustrated by the apathy surrounding the encroaching attacks on infertility care. While popular framing may indicate that infertility care is a white-people problem, history shows this isn’t the case. If it wasn’t important, there would not be such a consistent push to define “personhood” in terms that are crafty enough to threaten IVF treatments and other forms of fertility care. In January, South Carolina lawmakers presented another personhood bill, one that clearly defines an unborn baby as “an individual human being from fertilization until live birth.” And though the state senator who introduced it disagreed with the contention that this language would give the state broad license to outlaw fertility treatments, passing this so-called personhood law would make it difficult and dangerous for IVF procedures to be performed in South Carolina.
The fight for reproductive health care must also include the defense and expansion of access to infertility care. Though it took me a while, I have come to realize that infertility care is the crux of the issue of bodily autonomy. After all, when we look beyond pithy slogans, we realize that the fight for reproductive health care is one that requires us to ask ourselves who we could be, who our families could be, and what our communities could be, when we are free from state intervention.