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Assisted Reproduction: A Comparative Review of IVF Policies in Two Pro-Natalist Countries

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Abstract

Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic ‘challenge’ created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with both—the state’s and the market’s involvements—carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are expected. For a range of reasons the two countries contrast sharply, however, in terms of their capacity to intervene in the health system, and also in terms of the political will to act on matters of reproduction. This paper examines how assisted reproduction, as reflected by present policies in both countries, influences women’s welfare and considers whose interests the practices of assisted reproduction in these countries actually serve. By reviewing some of the present data on women’s status in Bulgaria and Israel and assessing both states’ policies and involvement in assisted reproduction this paper helps to identify some of the intended and unintended consequences of assisted reproduction policies in different countries.

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Notes

  1. Foucault would say that this concern arose at a specific moment—18th century—when the ‘population’ was created as an object of policy [14].

  2. From these countries 36 would not make an exception even to save a woman’s life [5]. The World’s Abortion Laws available at http://www.reproductiverights.org/pdf/pub_fac_abortionlaws.pdf.

  3. Assisted reproduction is a medical treatment to overcome infertility. But as any other reproductive method IVF can be extended into the realm of population policies; whether for family planning, religious motives and/or demographic purposes. There is an extensive range of examples of reproductive policies such as social benefits for working mothers, social benefits from a third child on, the prohibition of abortions (still in eighty percent of countries), the use of cheap abortions instead of contraceptives in some countries, education programs for family planning in others. And, as it happens in Israel, IVF free of charge up to two children. Reproductive policies affect the whole population; but particularly women.

  4. Of course, there are other important distinctions such as comparative wealth, GDP and its distribution, income stratification, inequality, etc., however they are beyond the scope of this paper.

  5. The figures are calculated at the exchange rate of 1 USD = 1.41,506 BGN (19/07/2007).

  6. This has naturally developed as business which generates further incomes both for the clinics and the state.

  7. A study conducted at Yale University in 1992 looked at 579 women who overall underwent 1,257 cycles of IVF. Only 129 viable pregnancies occurred [22].

  8. It is interesting to note here what happens with adoption, the possible alternative to assisted reproduction. In Israel the number of people wanting to adopt exceeds the number of children waiting for adoption. In Bulgaria, it appears that it is foreigners who are more interested in adopting Bulgarian children then the Bulgarians themselves.

  9. Although women sign an informed consent form, this is a formality which aims at protecting physicians.

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Authors and Affiliations

  1. School of Politics and Communication Studies, University of Liverpool, Roxby Building, Liverpool, L69 7ZT, UK

    Ekaterina Balabanova

  2. Health Care Ethics and Law, Department of Health Systems Management, Yezreel Valley College, Emek Yezreel, 19300, D.N. Yezreel, Israel

    Frida Simonstein

  3. Center for Women’s Health and Promotion, Ben Gurion University, Beersheba, Israel

    Frida Simonstein

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  1. Ekaterina Balabanova
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  2. Frida Simonstein
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Correspondence to Frida Simonstein.

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Balabanova, E., Simonstein, F. Assisted Reproduction: A Comparative Review of IVF Policies in Two Pro-Natalist Countries. Health Care Anal 18, 188–202 (2010). https://doi.org/10.1007/s10728-009-0123-2

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