29 Jun 2022 LGBTQ Intended Parents Face Higher Costs, Extra Hurdles to Creating Families
Even as some states and a growing number of corporations offer support for family-building expenses such as adoption or IVF, LGBTQ intended parents are still likely to face higher medical and legal costs than their heterosexual peers.
As I told reporter Contessa Brewer for CNBC earlier this month, a handful of states have mandates requiring insurers and employers to offer coverage for fertility treatments such as egg or sperm donation or in vitro fertilization (IVF). The expansion of insurance coverage to fertility services has helped make assisted reproductive technology (ART) accessible and affordable for thousands of would-be parents. However, often those state requirements are very gender-specific and not inclusive of LGBT intended parents in general.
High Cost of Parenthood
Parenthood is expensive, regardless of how a family is created. According to advocacy organization Family Equality’s 2019 report, “Building LGBTQ+ Families: The Price of Parenthood,” the average cost of raising a child to age 18 in the United States is $230,000. Intended parents who create families by adopting or using egg or sperm donation, IVF and/or surrogacy undertake extra legal and medical costs. In addition to those extra costs of conception, LGBTQ individuals and same-sex couples, even those who are legally married, often must take legal steps to establish their parental relationships.
According to the report, adoption fees and legal costs can range as high as $45,000 for domestic adoption and $70,000 for international adoption. The cost of surrogacy in the United States can total $200,000 including medical procedures, legal services and surrogate expenses, according to CNBC.
In addition to the added expense that comes with alternative ways of family-building, LGBTQ intended parents must also be aware that the laws of some states and countries restrict assisted reproduction, surrogacy or adoption to married or heterosexual couples only. As NBC News reported in December 2019, several states allow state-licensed child welfare agencies to refuse to place children with LGBTQ families on the basis of religious belief. And even though same-sex marriage has been legal since 2015, some U.S. states have (and continue to enact) laws that limit assisted reproduction or surrogacy for LGBTQ individuals.
As the Family Equality report concludes:
“For those struggling with fertility challenges or without the anatomy necessary to create a child within the context of their relationships, the initial cost of becoming a parent can be significant. For single parents, those in same-sex relationships, those living with HIV/AIDS, and the transgender community thinking about gender affirmation surgery or medical transition, the cost of bringing a child into the family ranges from a few hundred dollars to hundreds of thousands of dollars, depending on the specific path chosen".
“Many of these options are financially inaccessible to the majority of LGBTQ+ people.”
According to the 2018 Family Building Survey, which sampled 500 LGBTQ adults and 1,004 non-LGBTQ adults, nearly a third of LGBTQ families surveyed reported household incomes below $25,000 per year. A 2019 analysis of Gallup poll data by the Williams Institute reported that 25 percent of all LGBTQ people surveyed have annual incomes below $24,000.
Fertility Insurance Helps Offset Expense of Assisted Reproduction
For intended parents lucky enough to live in a state or work for a corporation that provides fertility insurance, the benefits can knock tens of thousands of dollars off the cost of assisted reproduction—the difference for some people between becoming a parent or not.
But here LGBTQ people often face an additional burden as well: in a bizarre Catch 22, the definitions of “infertility” used in many state laws and insurance policies, developed generations before assisted reproduction technology became widely available, automatically exclude LGBTQ couples as well as single heterosexual people. That’s because, as we wrote earlier, fertility often is defined as the inability to conceive a pregnancy or to carry a pregnancy to live birth after a year or more of regular sexual relations without contraception or similar language. As we wrote earlier, “Obviously, for gay or lesbian couples, that definition doesn’t work.”
While fertility medical professionals and advocates are working incrementally, state-by-state and insurer-by insurer, to modernize and expand definitions of infertility, today LGBTQ people who need the financial support of insurance benefits to offset the high cost of family-building often find they don’t qualify.
With all the challenges faced by LGBTQ would-be parents, you’d think a lot of them would simply give up and go home. But the numbers tell a different story. Despite all the obstacles in their paths, including the high cost of medical and legal services and discriminatory policies, LGBTQ people still want to create families. What’s more, LGBTQ people living on less than $25,000 a year want to become parents at similar rates to LGBTQ people making over $100,000 a year. Some 40 percent of LGBTQ people are considering assisted reproduction as a path to parenthood, NBC News reports.
Many LGBTQ People Want Families
Our team here at International Fertility Law Group could have told you how many people have a strong desire to become parents. Every year we work with hundreds of people who have undergone great difficulty, spent years of their lives and thousands of dollars to create the families of their dreams. The advance of assisted reproductive technology has made and is making those dreams possible for more people than ever before.
Our team was shaken and disappointed, along with most of our fellow Americans, with the U.S. Supreme Court’s June 24 decision to overturn Roe v. Wade, stripping American women of a right they have held for 50 years. As shocking and dangerous to women’s health as this decision is, the June 24 ruling basically states that the U.S. Constitution doesn’t provide a right to abortion—and therefore it should be left to the legislatures (federal and states). Certainly, there are states that have trigger laws. About 13 will go into effect soon, and perhaps another 10-13 more will follow with restrictive laws and/or laws to criminalize all abortion and attempt to go even further. Despite this, today abortion remains legal in most parts of the country.
Supreme Court precedent on the 14th Amendment makes it clear that every person has a constitutional right to travel (in this case, to seek abortion care in states where it is allowed). Surrogates will continue to be able to travel to another state for a procedure if they live in one of the restrictive states. Supreme Court precedent also makes it crystal clear that one state cannot regulate that which is permitted in another state. While one might wonder about the current court’s appetite to overturn established precedent, there is no countervailing interest on the other side of the equation of these two issues, as there is in the potential life in the abortion analysis. I think the right to abortion is truly unique because of this and that the court will uphold well-established precedent, especially precedents that benefit from broad support and consensus, such as the right to travel and the freedom of the states to regulate themselves without interference from another state.
Additionally, while the Supreme Court’s ruling carries the implicit threat that increasingly draconian state abortion bans might also spell the end of life-affirming fertility treatments such as in vitro fertilization, some 8 million babies have come into the world as a result of assisted reproductive technology. The fact that, despite financial hardship and discriminatory laws, LGBTQ people continue to fight for the right and ability to create families is a testament to the strength of the human desire to parent. I do not believe the majority of Americans are ready or willing to reject and criminalize the miracle of assisted reproductive technology that makes that parenthood and the dream of family possible for so many of us.
