Reframing the Debate Around State Responses to Infertility: Considering the Harms of Subfertility and Involuntary Childlessness
Open accessAbstract
Many countries are experiencing increasing levels of demand for access to assisted reproductive technologies (ART). Policies regarding who can access ART and with what (if any) support from a collective purse are highly contested, raising questions about what state responses are justified. Whilst much of this debate has focused on the status of infertility as a disease, we argue that this is something of a distraction, since disease framing does not provide the far-reaching, robust justification for state support that proponents of ART seem to suppose. Instead, we propose that debates about appropriate state responses should consider the various implications for health and broader well-being that may be associated with difficulties starting a family. We argue that the harms and disruption to valued life projects of subfertility-related suffering may provide a stronger basis for justifying state support in this context. Further, we suggest that, whilst ART may alleviate some of the harm resulting from subfertility, population-level considerations can indicate a broader range of interventions aimed at tackling different sources of subfertility-related harm, consistent with broader public health aims.
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Adoption of psychosocial interventions may remediate psychological stress associated with the diagnosis and management of infertility.
“Adoption of psychosocial interventions may remediate psychological stress associated with the diagnosis, and management, of infertility [16,55–61].”
From Psychosocial interventions for improving marital intimacy, sexual satisfaction, and quality of life of women and couples with infertility problems in low and middle-income countries: Systematic review protocol (2025) · cites this paper as [57]
The Population-Level Considerations section says that awareness and discussion of fertility can reduce stigma and the psychological harms of childlessness. It does not establish that psychosocial interventions relieve stress specifically associated with infertility diagnosis or management; searches for psychosocial interventions and counselling did not locate that claim in our copy. Page numbers were not available in the indexed passages. (LLM, conf=0.78)
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Cites
A Theory of Justice: Original Edition
Rawls, J. (1971) · doi:10.4159/9780674042605 · Cited by 9,496 · see citing works
SEN, A. (2009) · Harvard University Press eBooks · doi:10.2307/j.ctvjnrv7n · Cited by 3,431 · see citing works
Health as a Theoretical Concept
Boorse, C. (1977) · Philosophy of Science · doi:10.1086/288768 · Cited by 1,786 · see citing works
Population study of causes, treatment, and outcome of infertility.
Hull, M. G., Glazener, C. M., Kelly, N. J., Conway, D. I., Foster, P. A., Hinton, R. A., Coulson, C., Lambert, P. A., Watt, E. M., & Desai, K. M. (1985) · BMJ · doi:10.1136/bmj.291.6510.1693 · Cited by 1,141 · see citing works
Psychological impact of infertility
Cousineau, T. M., & Domar, A. D. (2007) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2006.12.003 · Cited by 997 · see citing works
Infertility and psychological distress: A critical review of the literature
Greil, A. L. (1997) · Social Science & Medicine · doi:10.1016/s0277-9536(97)00102-0 · Cited by 831 · see citing works
Social Justice: The Moral Foundations of Public Health and Health Policy
Powers, M., & Faden, R. (2006) · Cited by 743 · see citing works
Nordenfelt, L. (1987) · Philosophy and medicine · doi:10.1007/978-94-011-0241-4 · Cited by 569 · see citing works
Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE
Kupka, M. S., Ferraretti, A. P., de Mouzon, J., Erb, K., D’Hooghe, T. M., Castilla, J. A., Calhaz–Jorge, C., Geyter, C. D., Goossens, V., Strohmer, H., et al. (2014) · Human Reproduction · doi:10.1093/humrep/deu175 · Cited by 461 · see citing works
Sullivan, E., Zegers-Hochschild, F., Mansour, R. T., Ishihara, O., de Mouzon, J., Nygren, K. G., & Adamson, G. D. (2013) · Human Reproduction · doi:10.1093/humrep/det036 · Cited by 416 · see citing works
Children of choice: freedom and the new reproductive technologies
(1994) · Choice Reviews Online · doi:10.5860/choice.32-2172 · Cited by 365 · see citing works
Robertson, J. A. (1994) · Princeton University Press eBooks · doi:10.1515/9781400821204 · Cited by 355 · see citing works
Ryan, M. (1999) · Social Science & Medicine · doi:10.1016/s0277-9536(98)00374-8 · Cited by 342 · see citing works
On the Nature of Health: An Action-Theoretic Approach
Nordenfelt, L. (1988) · DigitalGeorgetown (Georgetown University Library) · Cited by 312 · see citing works
`Men leave me as I cannot have children': women's experiences with involuntary childlessness
Dyer, S., Abrahams, N., Hoffman, M., & van der Spuy, Z. M. (2002) · Human Reproduction · doi:10.1093/humrep/17.6.1663 · Cited by 289 · see citing works
The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception
Spar, D. L. (2006) · Cited by 242 · see citing works
Effect of female age on the diagnostic categories of infertility
Maheshwari, A., Hamilton, M., & Bhattacharya, S. (2008) · Human Reproduction · doi:10.1093/humrep/dem431 · Cited by 222 · see citing works
Self-citationBhattacharya, S., Harrild, K., Mollison, J., Wordsworth, S., Tay, C. C. K., Harrold, A., McQueen, D., Lyall, H., Johnston, L., Burrage, J., et al. (2008) · BMJ · doi:10.1136/bmj.a716 · Cited by 197 · see citing works
Self-citationHerrmann, D., Scherg, H., Verres, R., von Hagens, C., Strowitzki, T., & Wischmann, T. H. (2011) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-011-9637-2 · Cited by 183 · see citing works
Dyer, S., Lombard, C. J., & van der Spuy, Z. M. (2009) · Human Reproduction · doi:10.1093/humrep/dep278 · Cited by 179 · see citing works
Can child care policy encourage employment and fertility?
Haan, P., & Wrohlich, K. (2011) · Labour Economics · doi:10.1016/j.labeco.2010.12.008 · Cited by 175 · see citing works
Engelhardt, H. T., Jr. (1976) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/1.3.256 · Cited by 164 · see citing works
Disease in History: Frames and Framers
Rosenberg, C. E. (1989) · Milbank Quarterly · doi:10.2307/3350182 · Cited by 161 · see citing works
Global variations in the uptake of single embryo transfer
Maheshwari, A., Griffiths, S., & Bhattacharya, S. (2010) · Human Reproduction Update · doi:10.1093/humupd/dmq028 · Cited by 156 · see citing works
Self-citationIn vitro fertilisation for unexplained subfertility
Pandian, Z., Gibreel, A., & Bhattacharya, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003357.pub4 · Cited by 153 · see citing works
Self-citationDyer, S., Abrahams, N., Mokoena, N. E., Lombard, C. J., & van der Spuy, Z. M. (2005) · Human Reproduction · doi:10.1093/humrep/deh845 · Cited by 151 · see citing works
Vayena, E., Rowe, P. J., & Griffin, D. (2002) · World Health Organization eBooks · Cited by 138 · see citing works
Kamphuis, E., Bhattacharya, S., van der Veen, F., et al. (2014) · BMJ · doi:10.1136/bmj.g252 · Cited by 135 · see citing works
Self-citationCahill, D. J., & Wardle, P. G. (2002) · BMJ · doi:10.1136/bmj.325.7354.28 · Cited by 134 · see citing works
Eager for medicalisation: the social production of infertility as a disease
Becker, G., & Nachtigall, R. D. (1992) · Sociology of Health & Illness · doi:10.1111/1467-9566.ep10493093 · Cited by 133 · see citing works
Margolis, J. (1976) · The Journal of Medicine and Philosophy A Forum for Bioethics and Philosophy of Medicine · doi:10.1093/jmp/1.3.238 · Cited by 129 · see citing works
Mansour, R. T., Ishihara, O., Adamson, G. D., et al. (2014) · Human Reproduction · doi:10.1093/humrep/deu084 · Cited by 120 · see citing works
Psychiatric morbidity in couples attending a fertility service
Guerra, D., Llobera, A., Veiga, A., et al. (1998) · Human Reproduction · doi:10.1093/humrep/13.6.1733 · Cited by 119 · see citing works
Dyer, S. J., Sherwood, K., McIntyre, D., & Ataguba, J. E.-O. (2013) · Human Reproduction · doi:10.1093/humrep/det290 · Cited by 82 · see citing works
Sleepwalking Into Infertility: The Need for a Public Health Approach Toward Advanced Maternal Age
Lemoine, M., & Ravitsky, V. (2015) · The American Journal of Bioethics · doi:10.1080/15265161.2015.1088973 · Cited by 80 · see citing works
Powers, M., & Faden, R. (2008) · doi:10.1093/oso/9780195375138.001.0001 · Cited by 77 · see citing works
The psychiatric status of women presenting for infertility evaluation.
Downey, J., & McKinney, M. (1992) · American Journal of Orthopsychiatry · doi:10.1037/h0079335 · Cited by 74 · see citing works
Public Financing of IVF: A Review of Policy Rationales
Mladovsky, P., & Sorenson, C. (2009) · Health Care Analysis · doi:10.1007/s10728-009-0114-3 · Cited by 70 · see citing works
Medical Progress and National Health Care
Lomasky, L. Ε. (1982) · Princeton University Press eBooks · doi:10.1515/9781400853564.115 · Cited by 69 · see citing works
In vitro fertilisation for unexplained subfertility
Pandian, Z., Gibreel, A., & Bhattacharya, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003357.pub3 · Cited by 53 · see citing works
Self-citationPractical Reason and Incompletely Theorized Agreements
Sunstein, C. R. (1998) · Current Legal Problems · doi:10.1093/clp/51.1.267 · Cited by 44 · see citing works
Falling fertility rates: new challenges to the European welfare state
Vos, A. E. (2009) · Socio-Economic Review · doi:10.1093/ser/mwp007 · Cited by 37 · see citing works
Infertility and moral luck: The politics of women blaming themselves for infertility
McLeod, C., & Ponesse, J. E. (2008) · International Journal of Feminist Approaches to Bioethics · doi:10.2979/fab.2008.1.1.126 · Cited by 37 · see citing works
Should Fertility Treatment be State Funded?
McTernan, E. (2014) · Journal of Applied Philosophy · doi:10.1111/japp.12091 · Cited by 37 · see citing works
REGULATING REPRODUCTIVE TECHNOLOGIES
Andrews, L. B. (2000) · Journal of Legal Medicine · doi:10.1080/019476400272792 · Cited by 33 · see citing works
Policies, Institutions and Fertility Rates
D'addio, A. C., & d’Ercole, M. M. (2006) · OECD Economic Studies · doi:10.1787/eco_studies-v2005-art9-en · Cited by 32 · see citing works
McLernon, D. J., Velde, E. R. T., Steyerberg, E. W., Mol, B. W., & Bhattacharya, S. (2014) · Human Reproduction · doi:10.1093/humrep/deu173 · Cited by 31 · see citing works
Self-citation1. Introduction. Interpreting Infertility: A View from the Social Sciences
van Balen, F., & Inhorn, M. C. (2019) · University of California Press eBooks · doi:10.1525/9780520927810-001 · Cited by 31 · see citing works
Assisted reproductive technological blunders (ARTBs)
Harris, J. (2003) · Journal of Medical Ethics · doi:10.1136/jme.29.4.205 · Cited by 28 · see citing works
Establishing a middle-range position in the theory of health: A reply to my critics
Nordenfelt, L. (2006) · Medicine Health Care and Philosophy · doi:10.1007/s11019-006-9018-2 · Cited by 26 · see citing works
The Right to Health Care and The State
Jones, G. E. (1983) · The Philosophical Quarterly · doi:10.2307/2219226 · Cited by 26 · see citing works
Friedrich, D. (2013) · Journal of Applied Philosophy · doi:10.1111/japp.12003 · Cited by 25 · see citing works
Incomplete and inconsistent reporting of maternal and fetal outcomes in infertility treatment trials
Dapuzzo, L., Seitz, F. E., Dodson, W. C., et al. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.02.040 · Cited by 23 · see citing works
Cost of fertility treatment and live birth outcome in women of different ages and BMI
Pandey, S., McLernon, D. J., Scotland, G., Mollison, J., Wordsworth, S., & Bhattacharya, S. (2014) · Human Reproduction · doi:10.1093/humrep/deu184 · Cited by 23 · see citing works
Self-citationToward a Public Health Approach to Infertility: The Ethical Dimensions of Infertility Prevention
Lemoine, M., & Ravitsky, V. (2013) · Public Health Ethics · doi:10.1093/phe/pht026 · Cited by 20 · see citing works
IN WHOSE INTEREST? POLICY AND POLITICS IN ASSISTED REPRODUCTION
Donchin, A. (2010) · Bioethics · doi:10.1111/j.1467-8519.2010.01869.x · Cited by 14 · see citing works
Should There Be a Female Age Limit on Public Funding for Assisted Reproductive Technology?
The ASTUTE Health study group, Carter, D., Watt, A. M., Braunack‐Mayer, A., Elshaug, A. G., Moss, J. R., & Hiller, J. E. (2013) · Journal of Bioethical Inquiry · doi:10.1007/s11673-012-9415-6 · Cited by 12 · see citing works
Fair Rationing is Essentially Local: An Argument for Postcode Prescribing
Ashcroft, R. E. (2006) · Health Care Analysis · doi:10.1007/s10728-006-0021-9 · Cited by 12 · see citing works
NICE, the draft fertility guideline and dodging the big question
McMillan, J. R. (2003) · Journal of Medical Ethics · doi:10.1136/jme.29.6.313 · Cited by 8 · see citing works
Is IVF becoming a band aid for social infertility?
Weston, G. C., & Vollenhoven, B. J. (2002) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.0004-8666.2002.00476.x · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 5
- In Vayena, E., Rowe, P. J. and Griffin, P. D. (eds), Current Practices and Controversies in Assisted Reproduction. Geneva: World Health Organisation, pp. 15-21.
- May, E. T. (1995). Barren in the Land of Promise: Childless Americans and the Pursuit of Happiness. Cambridge, MA: Harvard University Press.
- Meniru, G. I., Brinsden, P. R. and Craft, I. L. (1997). A Handbook of Intrauterine Insemination. Cambridge: Cambridge University Press.
- NICE. (2004). Fertility: Assessment and Treatment for People with Fertility Problems. London: RCOG Press.
- Rawls, J. (1971). A Theory of Justice. Oxford: Oxford University Press.
Cited by
Sorted by citations
Oppong, S. S., Naab, F., Duah, I. O., Ankamah, S., Owiredu, D., Ametor, F. H., Imakando, M. M., Kyei, J. M., & Danso-Appiah, A. (2025) · PLOS ONE · doi:10.1371/journal.pone.0335068
- Authors
- Brown, R. C. H., Rogers, W. A., Entwistle, V. A., & Bhattacharya, S.
- Affiliations
- University of Aberdeen (GB)
- Macquarie University (AU)
- Corresponding author
- Brown, Rebecca C. H.
- Venue
- Public Health Ethics
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-03-08
- Volume
- 9
- Issue
- 3
- Pages
- 290-300
- ISSN
- 1754-9973 (ISSN-L)
- 1754-9981
- OpenAlex
- W2305126855
- Cited by
- 15
- References
- 60
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 2 · 2019: 3 · 2017: 1
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- green
- philpapers.org
- Locations
- Public Health Ethics (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- PhilPapers (PhilPapers Foundation) (submittedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- infertility, assisted reproduction, subfertility, involuntary childlessness, family formation, public health policy, population-level interventions, well-being
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