LinkedIn logos are being edited, and progress flags are being dusted off for the big event – Pride 2023 is upon us, and for myself it’s a time to reflect on the progress so far. As an LGBTQ+ person passionate about DEIB in the workforce, I’ve always tried to apply a queer critical lens to the industry I’m a part of, from technology, engineering, and now to the medical devices industry. Hawksley and Sons is an organisation that has been integral in supplying medical devices and technology for over 150 years now, with a more recent dedication to the ever-growing area of andrology and fertility.
As my knowledge has grown in this field, I was surprised how little LGBTQ+ people are included in the fertility narrative. The market potential is big too – data from fertility clinics show that lesbian couples are one of the fastest growing groups within maternity services. (NGA Law, 2014) Many trans people also opt to freeze their eggs or sperm, yet I’ve not encountered a fertility podcast touching on these processes. For the vast majority of LGBTQ+ couples, some sort of fertility treatment is the only option available if you want a biological child, and with more people coming out as LGBTQ+ than ever before, I can’t help but feel that the medical community has missed a trick here.
As often is the case, the right for queer couples to get access to fertility treatment started in a campaign. In July 2022, the government released their plan to remove additional barriers LGBTQ+ couples face in accessing fertility treatment on the NHS. This was after lesbian influencers Megan and Whitney Bacon-Evans challenged the NHS on their policy in 2021, stating they were “shocked and devastated to discover the discrimination” faced. (BBC, 2021) Under previous rules, same-sex couples had to pay for 12 IUI treatments to ‘prove’ medical infertility, before receiving NHS help. By contrast, the majority of cisgendered heterosexual couples, were only required to try to conceive for two years. (Guardian, 2021) This meant that same-sex couples encountered the “LGBT Tax”, having to pay for artificial insemination privately – an option costing thousands of pounds and not available to most, and that’s before you take the LGBTQ+ pay gap into account.
The government’s 2022 Women’s Health Strategy pledged to remove this, meaning same-sex couples have similar rights to heterosexual couples in that they have the potential to access IVF treatment under the NHS, and rules of egg and sperm storage have also been made more flexible – you can store them up to 55 years with consent renewal every 10 years. However, even with the pledge in place, many local IBCs choose how to delegate NHS funding, meaning numerous health boards in England still require female same-sex couples to self-fund at least six cycles of IUI before they are eligible for IVF treatment under the NHS. Others even stretch so far as 12 weeks. (Stonewall, 2023) Although this impacts the English population as a whole, this system disproportionately affects the queer community in their ability to start a family, IVF often being the only option. To add to this, LGBTQ+ people remain largely invisible in datasets and policy. Fertility clinics don’t report whether a surrogacy is with a heterosexual couple or a same-sex male couple, similarly, no figures exist on trans pregnancies.
This has major implications. Darwin and Greenfield write “How characteristics/minority groups are recorded has implications for the ability to commission or adapt services to meet local needs”. (2019) The complexities of queer families create different barriers when having children to a cis-het couple – whether that be mental health struggles, parental policies at work, or stigma and difficulties in accessing treatment. Not only are clinics potentially missing out on one of their biggest target audiences, but these barriers, if not faced head on, negatively impact society as a whole.
Intersectionality is also important to be mentioned here. Research states that people from ethnic minority backgrounds undergoing fertility treatment are less likely to have a baby than their white counterparts, with black patients having the lowest chances of successful treatment. (HFEA, 2018) People who are disabled have also reported barriers to access. In an Access Fertility article, Nia, who is registered blind and has a condition called Hypopituitarism, shares the difficulties she faced during her IVF treatment, from transport problems to medication administration. (2019) Barriers to access in fertility treatment is a universal difficulty for minorities, and for those who may identify with more than one of the above (as let’s be honest, most people don’t fit into one box), those difficulties get just that little bit harder.
So, what are we missing here?
The most obvious answer that comes to mind, as always, is representation. Research finds that LGBTQ+ stem professionals are more likely to experience career limitation, harassment and professional devaluation than their non-LGBTQ+ employees. They are also more likely to suffer with mental health difficulties and to leave the profession. As with any industry, lack of diversity leads to a lack of innovation both creatively and scientifically. People create products and services reflecting themselves and their own life experiences, meaning a lack of LGBTQ+ representation in the medical field leads directly to that community being missed out on in treatment. This is also seen in how the policy change was implemented, coming from outside rather than within.
I think cultural context is also important. In the UK, it’s been less than 10 years since marriage equality, and in the last couple of years we have seen a wave of anti-LGBTQ rhetoric globally. It hangs in the balance as to whether our society becomes more open to the LGBTQ+ community and decisions we make in our sector will have huge implications, positive or negative, on people's lives. More data, research and support for queer people seeking fertility treatment feels like the next logical step, but that decision lies with the medical community.
Regardless of social narratives, LGBTQ+ people will continue to have children, and the numbers are growing. Creating better mental health support, collating more research and implementing equal parental policies in the workplace can only be positive – for patients, parents and the new generation of queer-raised children. I hope that in the future, LGBTQ+ people will be more involved in the conversation of fertility, embryology and andrology services. Stonewall suggests two actions we can take to help:
1. Make access to IVF equal – email your MP (https://www.stonewall.org.uk/our-work/campaigns/make-access-ivf-equal-lgbtq-people)
2. Donate to support the campaign for fertility equality (https://donorbox.org/support-stonewall)
Happy Pride to all, and remember – support for the queer community must exist all year round, not just in June.