Without children, there is no society. Thus any society that seeks perpetuity will support the raising of children and in some form provide toward needs such as nutrition, education and medical care. But what about financing the beginning of life when the biological method has misfired? Should artificial conception be funded by society, whether through state provisions or via private health insurance?
The issue is under debate in almost every society, including here in Lebanon. The debate revolves around advanced techniques in reproductive medicine, such as in-vitro fertilization (IVF), and it is charged with ideological, religious, cultural, demographic, financial, medical and bio-ethical aspects. But to bring the issue down to earth, the question that people ask if they desperately want a child is: “Why is IVF not paid for by health insurance?” Private providers, still behind the curve in terms of even maternity leave, are probably not the best place to start. However, as the Lebanese state and its agencies have provided maternity-related medical care at overall rates of almost 95 percent in public hospitals, and more than 75 percent in private ones, it is a valid question for Lebanese society if the state shouldn’t fund IVF treatments for childless persons who want to conceive and cannot do so otherwise.
Admittedly there are many aspects to this issue, but here we will look at IVF from a strictly economic perspective. On the simplest denominator, the fertility branch of the medical economy is a business activity that displays pronounced profit-seeking behaviors. It moreover is a market where there is a tight supply of qualified medical providers and a demand that is not only growing but also urgent, in the sense that a successful conception by IVF statistically requires numerous attempts and has to be accomplished before age 40 or 42, depending on local regulations. Attempts later in life have a dramatically reduced chance of sucess. The combination of desperate demand and a poorly regulated market opens the possibility for deception and abuse. This means that society needs to assume oversight of the supply side through precise operating standards that go beyond supervision of technical or medical competency, and of the market through a competent regulatory framework. Society must also decide what controls there must be over the demand side of fertility seekers. (An example of a country in our region that has been proactive on the issue and has departed from stonewalling against IVF was interestingly, the Islamic Republic of Iran.)
Lebanese society, with its well known bent for ignoring the rule books, will need to very carefully regulate all three elements of supply, market, and demand side if it desires a platform where the pleas for children by the childless can be answered without opening the doors for unbearable supply-side corruption and market distortions. There is another locale in the neighborhood that not only accepts IVF, but also claims to be the paradise of IVF. According to a May news article by Israeli writer Viva Sarah Press, the health ministry of Israel has announced that the number of babies conceived by IVF has risen to more than 4 percent of all births, and a 2011 story in the New York Times (NYT) called Israel “the world capital of in-vitro fertilization”. The practical factor driving Israel’s high rate of IVF treatments is that they are fully covered by the mandatory national health insurance. The rationale behind the societal willingness, according to the NYT story, was on one hand appreciation of family and on the other hand the desire to counter birth rates in Palestine.
Political demographics aside, the fundamental issue is that life is not to be denied and that children are the greatest opportunity to fill it with meaning — Lebanese society needs to discuss where it stands on helping those who cannot have children.