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5 Equity, Access, and Cost Considerations Associated with IVG
Pages 67-78

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From page 67...
... (Ikemoto) • The history of eugenic practices indicates that a desire to ­genetically modify future generations in a hunt for an ­assumed "perfect" race, baby, or future generation is a real issue and not merely a dystopian fiction.
From page 68...
... The panelists included Lisa Ikemoto of the University of California, Davis School of Law, a legal expert in reproductive and genetic technology markets and reproductive justice; Amrita Pande of the University of Cape Town, South Africa, a sociologist who researchers transnational reproductive care within the context of the Global South; and Lorian Hardcastle of the University of Calgary, Canada, a professor researching health system financing and regulation of governance of the health care system. Ogbogu tasked the panelists with "examining how access and cost challenges [of IVG]
From page 69...
... Lessons from cross-border commercial gestational surrogacy in the Global South reveal that this process is even more exploitative for women, especially women of color, than egg provision, she said. Pande reflected on the potential impact of gestating embryos conceived through IVG and IVF: 1 According to the World Health Organization, "primary infertility" refers to a person who has never been able to conceive or carry a baby to term; "secondary infertility" is defined as the inability to conceive or carry a baby to term after giving birth.
From page 70...
... Regulations tend to restrict access and increase cost to intended parents. Within the United States, socioeconomic status influences who is targeted by surrogacy agencies; people from Ivy League colleges are approached for gamete provision, not surrogacy, whereas military spouses have previously been the target of surrogacy agencies, she said.
From page 71...
... Referencing past eugenic practices worldwide and current practices, such as embryo sex selection or genetic disease screening, Pande said that "the desire to genetically modify the future generation in a hunt for an assumed ‘perfect' baby, ‘perfect' future generation is not science fiction." She questioned the desire to invest in a technology that could contribute to making prenatal selection routine, emphasizing that it could be "acutely dangerous" at this politically divisive moment. In addition, the potential to couple IVG with gene editing tools, such as CRISPR, that could be used to make heritable genetic changes "should make us all worried," Pande warned.
From page 72...
... These are not "individual, innocuous choices made by intended parents," she said, but rather "fundamentally reaffirm existing structures of inequality and legitimize new forms of race and gender-based inequalities." Echoing Ikemoto, Pande said that use of these technologies assumes that certain traits, often viewed as disabilities, ought to be eliminated even though treatments and accommodations can provide a "quality of life worth living." These conversations need to be grounded in disability justice, Pande shared, to provide different perspectives on this problem and fresh solutions. Limiting the Number of Embryos Created Given how expensive IVG might be if ever available clinically, a virtual participant asked panelists to discuss whether the market might limit the number of embryos that could reasonably be made per household.
From page 73...
... A potential demand by scientists for embryos for research purposes, if legally permit ted, could also compete with demands from those pursuing repro duction. Hardcastle noted that many countries, including Canada, already have long waitlists for both publicly and privately funded fertility services.
From page 74...
... Pande shared similar observations from her work in cross-border reproductive care, wherein people travel "all across the world in the hope that there is somewhere to find low-cost IVF, but they never really do." Both Ikemoto and Pande felt that IVG, like IVF, would likely remain expensive. The cost of IVF has not decreased as many predicted because of add-on services, Hardcastle added.
From page 75...
... However, regulations can also be used to ease cost barriers. For example, Canada offers federal and provincial tax credits to eligible individuals seeking reproductive services.
From page 76...
... Hardcastle concluded, "I think that it will not just be a question of will this be funded or won't it but rather under what circumstances and what criteria would be attached to public funding." Societal Context Pande reflected on the changing sociocultural and political tides that could influence governments to publicly fund fertility treatments. At ­present, there is no incentive to publicly fund fertility treatments in the Global South, she said, where the governments of many countries are encouraging women and families not to have babies as part of their national population control efforts.
From page 77...
... REPRODUCTIVE STRATIFICATION Ikemoto noted that reproductive IVG can be rationalized, in part, based on its potential to help "achieve equality for LGBTQ couples" by enabling them to have children who are genetically related to both parents. However, the potential users identified by private equity and other technology investors are likely to be stratified by income, at least for initial use cases, she continued, with affluent gay couples a main target.
From page 78...
... He asked panelists to reflect on discrepancies between cost and price in countries with and without publicly funded access to ART. Hardcastle responded that the price the government is willing to pay for a given ART in jurisdictions in which most of the treatments are covered by public funding or national health insurance can become the de facto price also charged to individuals or private insurance providers.


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