In-Vitro Fertilization and Regulatory Policy in the United States

In recent years, the number of women seeking access to assisted reproductive technology (ART) has increased substantially in the United States; in vitro fertilization, the most popular ART, accounted for the conception of over 70,000 babies in 2018 (CDC 2021). These treatments often cost prohibitive, leading an increasing number of states to introduce legislation either requiring insurance to offer, or in some situations cover the cost of, fertility treatments. At the same time, IVF exists in a charged political atmosphere around abortion. Many of the ethical questions around IVF – such as inequality, personhood, and the destruction of embryos – are also those found in debates around abortion. Using data from 49 state legislatures between 1990 and 2019, we explore the conditions under which states attempt to legislate IVF, especially in the context of abortion. We draw on previous literature exploring women’s health policy and argue Democratic party control is associated with an increase in proposed policies promoting access to IVF. However, unlike women’s health policy more broadly, the unique and disproportionate effect of infertility on women should lead to the effect of party to be conditioned by gender, with both Democratic and Republican women more likely to work to expand access to the procedures, even in states with more restrictive abortion laws. Understanding the conditions under which state legislatures attempt to expand and contract access to health technology speaks to questions of representation and issue framing, as well as health policy.