assisted reproduction remains a hot topic, polarising opinions. This paper examines some of the dominant discourses and the underlying assumptions and philosophies.

1. Pandora's eggs
Social Darwinism v Economic Rationalism in access to IVF
IVF technologies continue to raise ethical issues for policy makers. In addition to
existential questions about creating life, society can now control who can reproduce,
in what circumstance and for what purpose, at least for that growing portion of the
population who require reproductive assistance. Since the first IVF birth in 1978,
reproductive technologies have provided hope to many infertile women and couples.
Funding structures and legislation create barriers to regulate access to IVF to those
who meets to society’s norms.
Infertility – the new epidemic
The IVF industry defines infertility as the inability to get pregnant after one year of
trying,1 2, although the World Health Organisation expands the period to two years,3
acknowledging that many couples take more than one year but still conceive without
medical assistance.4 Fertility, conversely is related to actual births, not potential to
conceive.
Infertility prevalence data is based on numbers of couples who seek treatment, or a
population-based estimate of married women of reproductive age.5 Approximately
10% of Australians are estimated to be infertile6, with 40% of the cause lying with the
male, 40% with the female and 20% unknown cause7. The narrow focus of study
misses other women who may wish to access IVF procedures such as single women,
lesbians and post-menopausal women. Although both males and females may be
infertile, infertility as it relates to IVF generally considers only the female as potential
recipient of the treatment ‘product’ – the embryo. Homosexual male couples may also
wish to be parents, but would not be considered in infertility statistics.
Demographic data on Australian infertility seems unavailable, however international
data shows a link to lower socio-economic status8 through occupational and
environmental exposure to chemicals and radiation9, shift-work and working long
hours10 11, and higher incidence of infections.
1
US Department of Health and Human Services Centres for Disease Control and Prevention.
http://www.cdc.gov/reproductivehealth/ART/index.htm
2
Ross R. The McBaby Business. http://searchsa.com.au/Diary/Diary_my23.asp
3
World Health Organisation. Consultation on the place of in vitro fertilisation in infertility care.
Summary Report, Copenhagen 18-22 June 1990.
4
Fuentes A, Devoto L. Infertility after 8 years of marriage: a pilot study. Human Reproduction. 1994.
9(2):273-78.
5
Thonneau P, Spira A. Prevalence of infertility: international data and problems of measurement.
European Journal of Obstetrics and Gynaecology and Reproductive Biology. 38:43-52. 1990.
6
Ratcliffe J. The economics of the IVF Programme: A Critical Review. Centre for Health Program
Evaluation. February 1992.
7
Victorian Department of Health. http://ofw.facs.gov.au/publications/wia/chapter3.html#f54
8
Leke JI et al. Regional and geographic variations in infertility: effects of environmental, cultural and
socioeconomic factors. Environmental Health Perspectives Supplements 101 (Supplement 2):S73-80.
1993
9
Shahara F et al. Environmental toxicants and female reproduction. Fertility and Sterility. 70 (4):
613-622. 1998
10
Dawson D, McCulloch K, Baker A. Extended working hours in Australia: Counting the Costs.
(2001) The Centre for Seep Research. University of SA.
11
Tntiseranee P et al Are long working hours and shiftwork risk factors for subfecundity? A study
among couples from Southern Thailand. Occupationa ad environmetnal Medicine. 55:99-10. 1998.

2. Australian women are also increasingly delaying motherhood12 13 14. The fertility rate
of women over 40 doubled between 1982 and 2002 and highest fertility in the 30-34
age range in 200415. Social and biological causations16 reflect the changing role of
women in society, ‘changing attitudes about relationships, families and careers”17,
financial or employment insecurity18, delayed interest in having children and lack of
awareness of the effect of age on fertility19 - delaying motherhood beyond biological
reproductive ability. These women are often of high education and career attainment,
able to pay for IVF treatment. Hence increased consumer demand for reproductive
assistance.
IVF
In vitro fertilisation (IVF) refers to fertilisation outside the womb, with the resulting
embryo/s being placed in a womb for development. Treatments may use the couple’s
own genetic material, or donor material/s. In 2002, 32,958 cycles were attempted in
Australia resulting in 6675 pregnancies and 5953 babies20 representing 3%21 of all
births in Australia, (30,00022 children in the past five years). In the US a typical cycle
will cost $US12,400 and may be partly covered by medical insurance.23 In Australia
IVF treatment is ~50% funded by Medicare24, with a gap payment of around $408925
per cycle. The IVF industry is worth $170 million p.a. in Australia.26
IVF is not strictly speaking a health 'treatment'. Infertility is not a sickness, although
it may result from disease or injury. IVF does not cure infertility, rather circumvents
12
Australian Bureau of Statistics. Australian Demographic Statistics 2000. Population. Special Article
– Lifetime Childlessness. September 1999.
13
Rowland D. Cross-National Trends in Childlessness. Working Papers in Demography, No 73.
Australian National University Research School of Social Sciences. 1998.
14
Australian Bureau of Statistics. Demography, Australia
http://www.abs.gov.au/Ausstats/abs@.nsf/1020492cfcd63696ca2568a1002477b5/3c467e74c23239ffca
256e8a0077add9!OpenDocument#BIRTHS%20AND%20CONFINEMENTS
15
Australian Bureau of Statistics. Australian Social Trends. Population. Echoes of the Baby Boom.
2004. http://www.abs.gov.au/Ausstats/abs@.nsf/0/47F151C90ADE4C73CA256E9E001F8973?Open
16
Baum F. Choosing not to have children. 1994. Vol 2, No 3. p22-25
17
Australian Bureau of Statistics. Year Book Australia 2002: Population. Special Article -
Confinements resulting in multiple births.
http://www.abs.gov.au/Ausstats/abs@.nsf/0/729445EA93DFE747CA256B20007EB589?Open
18
Australian Institute of Family Studies, cited in Cronin R. Birth rate linked to fear of losing job. The
Canberra Times. 29 January 2005. http://canberra.yourguide.com.au/detail.asp?
class=news&subclass=national&category=general%20news&story_id=367294&y=2005&m=1
19
Hammarberg K, Clarke VE. Reasons for delaying child-bearing – a survey of women aged over 35
years seeking assisted reproductive technology. Australian Family Physician. March 2005; 34 (3):
187-8, 206
20
Bryant J, Sullivan EA, Dean JH. Assisted reproductive technology in Australia and New Zealand
2002. Australian Institute of Health and Welfare. National Perinatal Statistics Unit.
21
Robotham J. Pregnancy rate fall forces clinic into U-turn. Sydney Morning Herald. 19 January 2005
22
ABC Online. Govt warned against IVF Medicare changes. 20 April 2005.
23
American Society of Reproductive Medicine. Frequently Asked Questions.
http://www.asrm.org/Patients/faqs.html
24
ABC News Online. Govt warned against IVF Medicare changes. 20 April 2005.
http://www.abc.net.au/news/newsitems/200504/s1349690.htm
25
Meatherall M. IVF fee rises no Medicare rort: clinics. Sydney Morning Herald. 23 April 2005. http://
www.smh.com.au/news/Health/IVF-fee-rises-no-Medicare-rort-
clinics/2005/04/22/1114152325941.html?oneclick=true#
26
Ross R. The McBaby Business. Http://www.searchsa.com.au/diary/diary_my23.asp

3. it.27 Whether having children is 'essential' depends on beliefs, but with the exception
of children genetically matched to save ill siblings, not having a child does not
directly endanger life.
Evidence-based Medicine : defining success
"Clinical decisions must respect, primarily, the interests and welfare of the persons
who may be born, as well as the long-term health and psychosocial welfare of all
participants"28
IVF is invasive, expensive and emotionally taxing – usually a treatment of last resort
for the infertile and carriers of heritable diseases. Maximum success with the
minimum number of cycles is an advantage for clinics competing for the Medicare
dollar and research dollars. More than 30% of all IVF babies take at least three
cycles.29
Definitions of success vary. In the US, the cycles begun to pregnancy rate is between
33-55%30, but data on live births show a live delivery rate of 29.1% per retrieval in
199831. Comparatively, a fertile couple has a 20% chance of pregnancy leading to
live birth in any month.32 33 To further confuse the statistics, many couples (estimated
as high as 38%) who register at fertility clinics achieve pregnancies independent of
treatment,34 reflecting on the appropriateness of the infertility definition.
In Australia, IVF statistics are collected on pregnancy, live births and neonatal
survival compared to number of cycles attempted. Information such as gestation
length and birth weight is recorded but no further information on the health of the
baby, infant mortality, development or health outcomes of the older child. 2002
statistics show 61.7% of IVF pregnancies resulted in a live singleton birth and 14.2
resulted in a live multiple birth.35 (The remaining 24.1% are miscarriages or
stillbirths.) A recent study showed IVF babies had over double the rate of birth
defects by age one36 and other studies have shown higher incidence of ADD and
autism, neurological impairments and cerebral palsy and developmental delays.37
27
Ratcliffe J The economics of the IVF Programme: A Critical Review. Centre fr Health program
evaluation. February 1992.
28
Australian Health Ethics Committee. Section 4. Ethical guidelines on the use of assisted reproductive
technology in clinical practice and research. National Health and Medical Research Council. Australian
Government. 2004.
29
McBain J (Melbourne IVF Group) quoted in ABC Online. Govt Warned against IVF Medicare
Changes. 20 April 2005. http://www.abc.net.au/news/newsitems/200504/s1349690.htm
30
Ratcliffe J The economics of the IVF Programme: A Critical Review. Centre fr Health program
evaluation. February 1992. Section 2.
31
US Department of Health and Human Services Centres for Disease Control and Prevention.
Frequently Asked Questions. http://www.cdc.gov/reproductivehealth/ART02/faq.htm#4
32
American Society of Reproductive Medicine http://www.asrm.org/Patients/faqs.html
33
Victorian Department of Health, http://www.ofw.facs.gov.au/publications/wia/chater3.html#f54
34
Ratcliffe J The economics of the IVF Programme: A Critical Review. Centre fr Health program
evaluation. February 1992. Section 2
35
Table W, Bryant J, Sullivan EA, Dean JH. Supplement to Assisted reproductive technology in
Australia and New Zealand 2002. Australian institute of Health an Welfare National Perinatal Statistics
Unit and the Fertility Society of Australia
36
Ross R. The McBaby Business. http://searchsa.com.au/Diary/Diary_my23.asp
37
ibid

4. While parents may feel live multiple births are a success, they are not the ideal
outcome. Twins account for 20% of IVF births p.a. in Australia,38 an increase of 71%
since 1980, a trend predicted to continue.39 (Triplet births have increased 257% in the
same period.) Multiple births are associated with higher rates of stillbirth and
miscarriage, a higher risk of prematurity associated with higher infant morbidity and
mortality,40 and higher costs to the health system for both mother and babies. Due to
the health risks and considering higher embryo transplant success rates, Australian
clinics now limit the number of embryos transferred per cycle to one or two -
although transferring only one embryo does not eliminate the possibility of a multiple
birth as IVF babies also have a higher rate of monozygotic twinning.41 42 When
success is defined as the live birth of a singleton at term gestation the rate is 11.1%
per cycle begun.43
One of the most successful fertility options is surrogacy. Commercial surrogacy is
illegal. Non-commercial surrogacy is legal in some states although the National
Health and Medical Research Council (NHMRC)’s guidelines warn of ethical, social
and legal implications44 (including the potential for exploitation). Surrogacy has few
intrinsic barriers except cost and hence is potentially open to all including post-
hysterectomy women and men. The Medicare rebate for IVF does not apply to
surrogate pregnancies.
Legislative Barriers to IVF
The Australian Government acknowledges the right of Australians to define their own
family through choice45, a principle upheld in law.46 However access to IVF to fulfill
this right is governed by a range of state and Commonwealth legislations.47 Some
states have specific legislation regarding IVF, while others rely on the NHMRC
ethical guidelines for the clinical practice of ART,48 which state that the clinic needs
38
Perinatal Statistics Unit. Quoted in: Robotham J. Pregnancy rate fall forces clinic into U-turn. Sydney
Morning Herald, 19 January 2005
39
Australian Bureau of Statistics. Year Book Australia 2002: Population. Special Article -
Confinements resulting in multiple births.
http://www.abs.gov.au/Ausstats/abs@.nsf/0/729445EA93DFE747CA256B20007EB589?Open
40
MMWR, June 23, 2000/ 49(24); 535-8.
41
National Organisation of Mothers of twins Clubs Inc. Twinning Facts.
http://www.nomotc.org/library/twinning_facts.html
42
Robotham J. Pregnancy rate fall forces clinic into U-turn. Sydney Morning Herald. 19 January 2005
43
Min JK. Breheny SA. MacLachlan V. Healy DL. What is the most relevant standard of success in
assisted reproduction? The singleton, live birth rate per cycle initiated: the BESST endpoint for assisted
reproduction. Human Reproduction. Vol 19 No 1, 3-7 January 2004.
44
National Health and Medical Research Council. Ethical Guidelines for the clinical practice of ART.
Part B, p42.
45
Retreating from the full realisation of economic, social and cultural right in Australia: A gendered
analysis shadow report to Australia’s third periodic report to the Committee on Economic, Social and
Cultural Rights. Article 10. http://home.vicnet.au/~wrana/advocacyfiles/escr.pdf
46
Cannold L, Cica N, The Law. The Price of Parenthood. 28 July 2003. Posting on Australian policy
online website. www.apo.org.au
47
SA Department of Health. Reproductive Technology. Legislation Around Australia.
http://dh.sa.gov.au/reproductive-technology/other.asp
48
Australian Health Ethics Committee. Ethical Guidelines for the clinical practice of ART. Part B, p42.
National Health and Medical Research Council. Australian Government. 2004.

5. documented practices and procedures, and specific protocols regarding access to IVF
treatment49, but do not specify a framework for decision making.
Legislative barriers centre around two factors: medical need (clinical infertility) and
the nature of the parental relationship (married or heterosexual de facto). While all
Australians have access Commonwealth funded Medicare rebates, States regulate the
clinics and have the power to close them and de-register doctors if they do not
comply. The clinics and doctors must do the policing.
Women who access IVF in the US tend to be older, of higher education attainment
and higher socio-economic status50 whereas infertility is more prevalent amongst
those of lower socio-economic status. The out-of-pocket costs of IVF along with the
disruption to paid employment form barriers to access51 and will affect people
differently across the socio-economic stratum. Australia’s Medicare subsidising of
costs may dampen this effect, but the demographics could be expected to look similar.
The use of public funding for IVF has brought a private matter into the public arena
and given the tax-paying public an arguable right to comment on access issues52, but if
a woman is willing to pay for the procedure privately, this argument is baseless. States
would still be liable for antenatal and post-natal hospital care.
Health for all or babies for all?
Is it an inalienable right for human beings to reproduce?
"...the original motherhood issue is motherhood itself. Everyone's for it (if not for
oneself, then at least in principle). No one would be caught dead opposing it (not
publicly anyway). It is, unambiguously, a 'good thing'. End of story."53
The concept of reproduction is tied to many fundamental beliefs about society. The
book of Genesis says "Go forth and be fruitful54". Darwinists believe the drive to
reproduce is a biological urge to ensure the perpetuation of the species. The
International Covenant on Civil and Political Rights proclaims the right of "men and
women of marriageable age to marry and found a family"55.
In subsistence cultures women’s identity, role and value in society is defined by their
ability to bear children. An infertile woman may be abandoned by her husband.56
Children support their parents in old age. Australia parallels this with baby-boomers
49
Australian Health Ethics Committee. Section 5.3 Ethical guidelines on the use of assisted
reproductive technology in clinical practice and research. National Health and Medical Research
Council. Australian Government. 2004.
50
Stephen EH, Chandra A. use of infertility services in the United States: 1995. Family planning
Perspectives. Vol 32. No 3. May/June 2000. http://guttmacher.org/pbs/journals/3213200.html
51
Phelps K. Informed debate on IVF costs must still go ahead. Medical Observer. 20 May 2005. p24
52
ibid
53
Maushart S. The Mask of Motherhood. How mothering changes everything and why we pretend it
doesn't. 1997. Random House Australia Ltd. P1
54
Genesis 1:27-28
55
International Covenant on Civil and Political Rights. Article 23.2 . New York, 16 December 1966
http://www.austlii.edu.au/au/other/dfat/treaties/1980/23.html
56
Dyer SJ, Abrahams N. Hoffman M. van der Spuy ZM. ‘Men leave me as I cannot have children’:
women’s experiences with involuntary childlessness. Human Reproduction Vol 17, No 6, p1663-1668.
June 2002. http://humrep.oxfordjournals.org/cgi/cntent/fll/17/6/1663

6. needing a younger generation of taxpayers to support their welfare and health in
retirement.
The American Society of Reproductive Medicine website states “[t]he desire to have
children and be parents is one of the most fundamental aspects of being human” 57 in
arguing for health insurance for treatment costs. This argument is self-serving and
fails to consider the increasing number of people who choose not to have children. 58 59
In 2000, the ABS estimated that 25% of women who had not yet ended their
reproductive lives would remain childless60 by choice or circumstance, up from 9%
for women born between 1930 and 1946. These people give the lie to the argument
for parenthood as a fundamental aspect of humanity on an individual level.
However, if we accept that the drive for parenthood is 'natural', part of being human,
valued in society, perhaps genetically programmed into us, then do we have the right
to decide who can reproduce and who cannot? The economic rationalists argue that
we have the right to say how our taxes are spent when it comes to publicly funded
reproductive treatments61 but it could equally be argued that dominant social norms
are not necessarily the best standards for forming legislation. Conservatives and some
religious groups say we do not have the right to over-ride the will of God (sometimes
this relates to IVF generally, sometimes to access for lesbians and single women).
Darwinists argue that IVF over-rides evolutionary mechanisms of survival of the
fittest by reproducing those genes that would not naturally have survived in the wild
to reproduce, and the result will be a weakened human race. There is evidence that
IVF children may have poorer developmental and health outcomes than the general
community, whether because of genetics or damage done by the IVF procedures.62
How do we value a live baby compared to some notional concept of perfection in
these days of wrongful life cases?
Arguments about limiting access to IVF fall on both sides of the nature v nurture
debate. On the nature side, can we value-judge genes on their positive or negative
values? Few would choose to have the genes for predisposition to breast cancer, lower
than average IQ or other factors affecting length or quality of life. But does this give
us the right to eliminate these genes from the population either by limiting people’s
access to reproduction or by genetic screening of embryos? Maybe their value is in
what they can offer to genetic variation.
Taking the nature debate a step further, is it ethical or fiscally responsible to
reproduce people inherently unable to survive by themselves (in the case of
genetically inherited disorders) and hence destined to be a burden on the welfare and
health systems, and society in general? Does it differ if we are talking about someone
whose body is physically unable to sustain life without medical assistance compared
to someone who might be able to survive quite happily in society but be unable to
57
American Society of Reproductive Medicine http://www.asrm.org/Patients/faqs.html
58
Baum F. 1994. Choosing not to have children. Vol 2, No 3. p22-25
59
Australian Demographic Statistics 2002. Population. Special Articles- Lifetime Childlessness (Sep
1999). Australian Bureau of Statistics.
60
Australian Bureau of Statistics. Australian Social Trends 2002, Trends in childlessness, pp. 37-40.
Quoted in Australian Social Trends Population. Echoes of the baby boom.
http://www.abs.gov.au/Ausstats/abs@.nsf/0/47F151C90ADE4C73CA256E9E001F8973?Open
61
Phelps K. Informed debate on IVF costs must still go ahead. Medical Observer. 20 May 2005. p24
62
Ross R. The McBaby Business. http://searchsa.com.au/Diary/Diary_my23.asp

7. compete for resources and hence reliant on welfare? While sterilisation without
consent of the intellectually disabled was only outlawed in 199263 there is now no
legal barrier to an intellectually disabled infertile woman in a relationship seeking IVF
using her own (or donated) genetic material.
Lesbian access to IVF illustrates the nature v. nurture debate in its two central issues:
replication of “gay genes” and gay parenthood. Some Australian states have
specifically legislated against IVF access for women outside a male-female
relationship (marriage or de facto), or only to the clinically infertile64 (and their
partners) in order to exclude those whose infertility is seen by the state as being by
choice.
While these policies do limit gay parenthood, the limits do not apply to donors of
genetic material. There is no requirement on sperm or egg donors that they be
heterosexual, although recipients have brief information about the donor and can
choose between donors. Hence it would appear that either policy-makers, correctly or
incorrectly, do not believe that homosexuality has a genetic basis or perhaps nurture
theory is the rationale for the policies.
The Commonwealth Sex Discrimination Amendment Bill 200265 was drafted to
exempt state reproductive technology legislation from the Commonwealth Sex
Discrimination Act following two legal challenges where Commonwealth legislation
over-rode the state legislation regarding access to IVF66 for a single woman in
Victoria (McBain v State of Victoria) and a woman separated from her husband in SA
(Pearce v SA Health Commission67). While the Amendment does not mandate
exclusion of homosexual or single women from access to IVF, it specifically enables
the states to do so. The Amendment does prevent discrimination between married and
de facto couples (defined as "of the opposite sex"), and removes the time-based
criteria on relationships. While there is no evidence that parental marital status affects
the wellbeing of the child68, access can also be restricted to those clinically infertile,
effectively excluding single and lesbian women without risking accusations of
discrimination.
The International Covenant on Civil and Political Rights (1966) declares that the
family is "the natural and fundamental group unit of society and is entitled to
protection by society and the State"69 and proclaims the right of "men and women of
marriageable age to marry and found a family"70. The preamble to the United Nations
Convention on the Rights of the Child state that “the family, [is] the fundamental
63
Grover SR. Menstrual and contraceptive management in women with an intellectual disability.
Medical Journal of Australia . February 2002. 176 :108-110.
64
SA Department of Health. Reproductive Technology. Legislation Around Australia.
http://dh.sa.gov.au/reproductive-technology/other.asp
65
Sex Discrimination Bill 2002: Explanatory Memorandum. www.scaleplus.law.gov.au/cgi-
bin/topicSrch.pl?action=View&VdkVgwKey=%2Fscale
66
Del Villar K. McBain v State of Victoria: Access to IVF for all Women. 15 August 2000.
http://www.aph.gov.au/library/pubs/rn/2000-01/01RN03.htm
67
Pearce v SA Health Commission
68
Victorian Law Reform Commission. IVF access changes in air. Media release. 11 May 2005.
69
International Covenant on Civil and Political Rights. Article 23.1 . New York, 16 December 1966
http://www.austlii.edu.au/au/other/dfat/treaties/1980/23.html
70
International Covenant on Civil and Political Rights. Article 23.2 New York, 16 December 1966
http://www.austlii.edu.au/au/other/dfat/treaties/1980/23.html

8. group of society and the natural environment for the growth and well-being of ….
children” and “the child, for the full and harmonious development of his or her
personality, should grow up in a family environment, in an atmosphere of happiness,
love and understanding.”71 These statements do not define what makes a family in
numeric or gender specific terms. Arguments that it is ‘natural’ and best for a child to
have a mother and a father as opposed to two parents of the same gender prioritise
gender over other factors perhaps more germane to parental quality.
Perhaps this policy reflects environmental causation belief – that sexuality is a social
construct and the homosexual parents may influence their child to be homosexual. Is
it intrinsically bad if the child does turn out to be homosexual? The International
Covenant on Civil and Political Rights states signatories “undertake to have respect
for the liberty of parents and, when applicable, legal guardians to ensure the religious
and moral education of their children in conformity with their own convictions,”72 and
if the parent is homosexual they would presumably consider their behaviour to be
morally acceptable.
A less contentious use of environmental causation in policy-formation is SA
legislation preventing access to IVF for anyone with a child protection order, found
guilty of a sexual or violent offence, or suffering from an illness, disease or disability
that may hinder their care for the child.73 74 While this aims to provide a safe
environment for the child the argument does not hold true of the convicted person is
sentenced to prison for a long period and hence poses no environmental threat to the
child. In the end, the nature/nurture arguments are insoluble as the expression of
genetic potential is influenced by environmental factors, and policy must reflect this
dichotomy.
Another contentious access to IVF issue relates to posthumous use of gametes. This
covers both the harvesting of gametes posthumously and the use of gametes harvested
with consent during the person’s life but used posthumously. State legislation is
mixed, some allowing for use of existing embryos, or use of embryos/gametes only
with prior consent, but NSW also requires clinics to contact (presumably consented)
donors to ensure they are still alive75. No states allow for posthumous harvesting,
which, while potentially traumatic for bereaved partners, does prevent children being
created for the purpose of financial inheritance.
Valuing lives - economic rationalism
The economic rationalism of allocating the health budget funds between competing
needs must consider health priorities, size of demand, relative costs and likelihood of
success. Recent debate has centred around whether there should be a cap on funding
IVF treatments, particularly for older mothers, who have a statistically lower chance
of achieving IVF success.
71
Preamble. United Nations Convention on the Rights of the Child. 1990.
http://www.unicef.org/crc/crc.htm
72
ibid
73
Victorian Law Reform Commission. Legislative background. 11 May 2005.
74
Ratcliffe J The economics of the IVF Programme: A Critical Review. Centre fr Health program
evaluation. February 1992. Section 2
75
Victorian Law Reform Commission. Legislative background. 11 May 2005.

9. "Nothing in life is free, nor should it be." Prime Minister John Howard
"There needs to be some restraint when it comes to the availability of taxpayer funds
for non-essential procedures." Federal Health Minister Tony Abbott
"taxpayer funding [of health] needs to be based on the likelihood of success of
medical treatments." Federal Treasurer Peter Costello.76
Balanced against these arguments for economic rationalism, we have the perceived
need for future taxpayers to support the population bulge of baby-boomers in their
retirement.77 Australia’s population profile is ageing, the birth rate is in decline78, and
many women are choosing to remain childless.
“health budgets have to address priorities for a nation79”
While the financial burden is disputed,80 the predictions appear to be driving Federal
policy. The 2004 Federal Budget had financial incentives to have children and the
2005 Budget contained efforts to increase the workforce by getting the disabled and
single mothers to work. Federal Treasurer Peter Costello urged Australians to have
one baby for the mother, one for the father and "one for the country".81
Perhaps current taxpayers, considering the population profile and the increasing
number of women remaining childless, should finance IVF for all women who ask for
it, even those of whose lifestyles they may disapprove and those who have a low
likelihood of success as a societal investment. Those who choose to remain childless
may not share in the experience of being a parent, but they will benefit from the taxes
(hopefully) paid by these child-products of IVF procedures when they (the childless)
are past their financially productive days.
On the other hand, as health spending continues to consume an increasingly large
portion of the budget, can we afford such big ticket, low success, 'non-essential' items
as IVF? In 2003 the total IVF bill funded by Medicare was $50 million. Following
the introduction of the Safety Net in 2004, costs leapt to $78.6 million year.82 This is
approximately $15,720 of taxpayer funding per live baby born - arguably still not a
huge commitment in times of falling birth rates and less than the costs the parent/s
will incur in raising the child.83
76
quoted in Glasson B. Beware the IVF trojan horse. Medical Observer 13 May 2005 p24
77
Australian Bureau of Statistics. The Health of Older People, Australia. 2004. http://www.abs.gov.au/
Ausstats/abs@.nsf/0/5B3A04650641EF75CA256F4700715847?Open
78
Australian Bureau of Statistics. Year Book Australia. 2005. Population. Births.
http://www.abs.gov.au/Ausstats/abs@.nsf/0/B9D7BE2CDD8D623FCA256F7200833029?Open
79
Phelps K. Informed debate on IVF costs must still go ahead. Medical Observer. 20 May 2005 p24
80
Lie back and think of Australia. Sydney Morning Herald. 5 June 2004. Fairfax Digital Website.
http://www.smh.com.au/articles/2004/06/04/1086203630799.html?oneclick=true
81
Australian Institute of Family Studies, cited in Cronin R. Birth rate linked to fear of losing job. The
Canberra Times. 29 January 2005. http://canberra.yourguide.com.au/detail.asp?
class=news&subclass=national&category=general%20news&story_id=367294&y=2005&m=1
82
Meatherall M. IVF fee rises no Medicare rort: clinics. Sydney Morning Herald. 23 April 2005. http://
www.smh.com.au/news/Health/IVF-fee-rises-no-Medicare-rort-
clinics/2005/04/22/1114152325941.html?oneclick=true#
83
Henman P. (Macquarie University sociologist) quoted in The Cost of Kids. Macquarie University
News. October 2002. http://www.pr.mq.edu.au/macnews/ShowItem.asp?ItemID=137

10. Where the costs of IVF should be borne depends on whether we consider
reproduction to be a personal or population issue. If we having children is a personal
issue with personal benefits then the costs should also be borne on a personal level. If
we believe that benefits will accrue to the population as a whole (through the creation
of a new generation of tax payers) then there exists an argument for public funding.
The Federal Government consideration of restricting women under age 42 to a
maximum three Medicare funded cycles p.a. and limiting funding for women aged
over 42 to a total of three IVF cycles84 was seen as hypocritical in the context of the
recent funding to boost the birth rate. The limit for older women was related to the
success rates for implantation. Perhaps smokers and those living with smokers should
also be limited as a recent study linked smoking and passive smoking with lower
implantation success85.
Conclusion
Whether we consider the state has the right to restrict access to IVF from any
Australian woman, and on what grounds we consider this acceptable involves a
number of inter-related factors including our beliefs about ‘human-ness’, society,
parenthood and what we consider to be the best interests of the child. Who we choose
to prevent from reproducing either genetically or in terms of parenting, depends on
our values and whether we believe the ‘unacceptable’ factors are determined by
nature or nurture.
While Medicare funds are involved this argument will remain in the public arena,
whether we consider it to be a public or personal issue. Deciding how much society is
prepared to pay for children, and in what circumstances, involves existential questions
such as whether we should be valuing children in financial terms, in terms of what
they can contribute to society, for their genetic variation or some other basis.
84
ABC Online. Govt warned against IVF Medicare changes. 20 April 2005. http://www.abc.net.au/
news/newsitems/200504/s1349690.htm
85
Passive smoking affects IVF. Australian Doctor. 10 June 2005. P19