Free IVF? Technoprogressive policy and reproductive rights

The technoprogressive perspective emerges when people with Enlightenment values of secularism, individual rights, democracy, and egalitarianism address emerging technologies. The Technoprogressive Declaration of 2014 argued that technoprogressives should build solidarity with "The movement for reproductive rights, around access to contraception, abortion, assisted reproduction, and genomic choice." For technoprogressives, rights to technological enablement are implicit in every human rights issue. The right to control our bodies and brains requires access to safe, effective technologies. The right to freedom of speech requires the protection of civil liberties and the right to use communication technologies. The right to control our reproduction requires social reforms like the freedom to marry and divorce, but also access to technologies that determine whether, when, and what kind of children we will have.

In the U.S. Presidential race, the right to abortion is a central issue. The Christian Right's fifty-year campaign to put anti-abortion judges on the Supreme Court resulted in the overturning of the Roe v. Wade decision in 2022, and many states are trying to ban abortion. The misogyny of MAGA has even further radicalized American women, and many are turning out to vote for abortion protections and against anti-choice candidates. The electoral unpopularity of the abortion bans being proposed in red states has spooked Trump. This week, Trump briefly supported a constitutional amendment on the ballot in Florida that would enshrine abortion access until his pro-life base forced him to reverse his position and support the state's ban on abortions after six weeks of gestation.

In-vitro fertilization (IVF) has also now entered the electoral debate. In the last decade, the use of assisted reproduction has more than doubled in the U.S., resulting now in more than 2% of births. One in ten American women of childbearing age have accessed fertility services. For the hardest Right, pro-life ideologues, who believe all embryos should have a right to life, both contraception that blocks implantation and fertility treatments that destroy embryos are equivalent to abortion. Earlier this year, the Alabama Supreme Court ruled that frozen embryos have a right to life and that IVF providers who routinely dispose of excess embryos should be held liable for murder. Both the Republican Platform and the Project 2025 policy agenda prepared for a Trump 2.0 administration advocate enshrining "fetal personhood" into law, which would lead to a national ban on IVF. (Technoprogressives, by contrast, generally believe moral standing derives from consciousness, not from mere biological life.) Trump's running mate, JD Vance, a pro-life Catholic who has compared abortion to slavery and has advocated a national abortion ban, voted with fellow Republicans against the Right to IVF Act in the U.S. Senate in June.

Pro-life voters are more divided, however, on the permissibility of fertility treatments since they are intended to help produce life. According to Pew survey research, only 8% of Americans and only 20% of pro-life Americans who want abortion to be illegal under all circumstances are opposed to IVF. Most (61%) Americans think IVF should be covered by health insurance. Now, after the Harris-Walz campaign attacked Vance and Trump for opposing IVF, and Governor Tim Walz has spoken passionately about his family's use of fertility assistance therapies, Trump has suddenly promised free, universal access to IVF. While this angers the fetal personhood ideologues and health insurance lobby, it pleases the pronatalists and most of the pro-life base. In the U.S., this proposal would require forcing private health insurers and state legislatures providing Medicaid for people experiencing poverty to spend $12,000 to $100,000 per patient (given an average of six attempts before success) on a non-medically necessary treatment with rapidly expanding demand.

Trump explained his new IVF policy proposal: "Because we want more babies." As I argued in a recent piece on pronatalism, economic policies like expanding child subsidies, free childcare, and free university education would do more to encourage people who want children to have them. However, expanding access to fertility assistance as a part of reproductive health services is another logical, if secondary, pronatal policy. I don't know where most technoprogressives land on pronatalism or what they think are the best pronatalist policies; unlike reproductive rights, I haven't surveyed them on this yet. But for technoprogressives, universal free access to fertility treatments is a matter of social justice since only the affluent and lucky in the U.S. are currently able to afford them or have them covered. None of the insurance programs for people with low incomes (Medicaid) in the United States cover artificial insemination or in-vitro fertilization.

Of course, a social justice claim to fertility treatment is just a tiny piece of the more considerable demand for expanding coverage for all healthcare. Although it is inconceivable that a Trump 2.0 administration would focus any effort on universal free IVF, at least in the campaign season, it could be very productive to take advantage of this opening to discuss the benefits of mandating universal healthcare coverage, such as proposals for Medicare4All.

Technoprogressives should also be alert to the wide-ranging implications of expanding access to fertility therapies, given our new genetic testing and editing capabilities. Many potentially beneficial therapies that technoprogressives anticipate will, like IVF, not be treatments for specific diseases, but still candidates for universal access given their beneficial risk-cost-benefit calculus. Infertility is a condition that causes psychological distress that can be ameliorated with technology, like most psychiatric disorders, breast reconstruction after mastectomy, and gender dysphoria. A rational healthcare system should take account of the cost, risks, and social and individual benefits of covering such conditions in deciding which should be universal and accessible, permitted but out-of-pocket, or discouraged due to a poor risk-benefit calculus. If IVF warrants universal free coverage, why shouldn't gender-affirming therapies for a diagnosis of gender dysphoria? As our capacities expand, there will be many more technologies that do not exactly treat diseases but have a beneficial risk-cost-benefit calculus.

IVF coverage also opens the question of parents' rights to make genomic decisions about their offspring. The obligation to make embryo implantation choices in IVF spurred bioethicist Julian Savulescu to propose the "procreative beneficence" principle, that we should choose embryos with the best chances in life. The children produced by IVF have a higher risk of congenital anomalies, primarily due to the conditions limiting their parents' fertility. If the state is paying for IVF, it should also pay for pre-implantation genetic screening to determine which embryos have the best chances in life and the lowest risk of congenital anomalies. People paying out-of-pocket for IVF in the U.S. largely already have access to a wide range of pre-implantation genetic screening tests and choices.

Technoprogressives largely affirm parents' right to test embryos for, and select for, anything they prefer, so long as there are no tangible harms to children or society from specific choices. In the case of sex selection in the West, for instance, which is primarily pursued to have at least one child of each gender, there is no harm to the child, and there is no significant impact on the proportion of the sexes (if that should be a policy concern at all). Eventually, we will also have the option of using pre-conceptive or pre-implantation gene editing.

In conclusion, the debate over access to IVF and fertility treatment intersects with broader technoprogressive commitments to reproductive rights, healthcare access, and genomic choice. Trump's proposal for universal IVF coverage, while likely insincere, opens a crucial dialogue on reproductive technologies and their place in healthcare policy. As technoprogressives, we must seize this opportunity to advocate for a more comprehensive approach to reproductive rights that includes not only contraception and abortion access but also fertility treatments, genetic screening, and future genomic technologies. These technologies, like all healthcare, must be accessible to all, and rationally evaluated based on their overall benefits to individuals and society rather than narrow definitions of medical necessity. The technoprogressive vision of reproductive rights is not just about preserving existing freedoms but also embracing the possibilities emerging technologies offer for shaping our future.