In the wake of our seemingly everlasting economic crisis, the Spanish health authorities have decided to exclude single women to access ART treatments – mainly artificial insemination- in the public health care system. “The lack of a male partner is not a medical problem”, has said Ana Mato, our Secretary of Health. Coming from a devout Catholic and extremely conservative politician, her remark, and ultimately, her Department’s policy, have been widely interpreted as another vindication of the idea that only traditional, i. e. heterosexual, families are suitable for rearing children. The spokeswomen of various feminist and lesbian NGOs have entered the public arena to denounce her lesbophobia.
The fact of the matter is that women in Spain, whether married to another woman or single, will still be authorized to be artificially inseminated (in some European countries such as France, Austria or Sweden, for instance, single women are excluded from medically assisted reproduction). Even the fertile, married heterosexual woman might still get artificial insemination – maybe she just wants to do things differently, for a change- although they will all have to bear the costs. The public health care system has, therefore, reconfigured ART as a pure medical remedy for a medical condition: infertility. The days of IA as an “alternative means of reproduction” for “alternative life-styles” are over. But with this new policy the demand made by economically disadvantaged lesbian couples willing to procreate finds an answer along the following lines: “go find a male”. A crude response if there is one.
So, beyond the lesbophobic conspiracy, the debate finally boils down to two complex issues: whether “infertility” is just a brute biological fact – many lesbian advocates are claiming that they are intrinsically “infertile”- and whether public health care systems should only provide health care understood in strict clinical terms. Both questions appear intertwined. Some critics have argued that our public health care system should be configured around the definition of “health” stated in the Preamble to the Constitution of the World Health Organization, which is, as you probably know, highly controversial (it defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”). I would contend that in circumstances such as ours, when resources are very scarce, abiding by this notion of health and the corresponding model of health care, is absolutely unfeasible. As a matter of fact we have traditionally excluded spas, non-conventional medicine, hypnosis or psychoanalysis from public coverage.
But one could also argue that if the underlying justification for denying lesbians access to public ART is prioritization in the distribution of health care, that we ought to take into account the opportunity costs for many orphan diseases and conditions that, being much more impairing and painful, lack sufficient coverage, infertility across the board should not merit public coverage be the couple lesbian or heterosexual. Otherwise we run the risk of unfair discrimination.