Trading-Off Reproductive Technology and Adoption: Does Subsidizing in Vitro Fertilization Decrease Adoption Rates and Should it Matter?

I’ve just posted a new draft on SSRN of a paper I co-authored with Daniel Chen (Duke Law School), Trading-Off Reproductive Technology and Adoption: Does Subsidizing In Vitro Fertilization Decrease Adoption Rates and Should it Matter?, forthcoming in the Minnesota Law Review.  The paper is the first to examine a frequent claim in both the adoption and reproductive technology literatures that increased access to reproductive technologies will decrease domestic and international child adoptions, and that this counts as a good reason to oppose expanding reproductive technology access.  Using both econometric and normative methods, we find reason to be skeptical about both parts of the claim.  We still have a little time to make changes before it goes to print, so feedback is very much welcome.

Here is the full abstract:

For those facing infertility, using assisted reproductive technology to have genetically related children is a very expensive proposition. In particular, to produce a live birth through in vitro fertilization (IVF) will cost an individual (on average) between $66,667 and $114,286 in the U.S. If forced to pay these prices out of pocket, many would be unable to afford this technology. Given this reality, a number of states have attempted to improve access to reproductive technology through state-level insurance mandates that cover IVF. Several scholars, however, have worried that increasing access in this way will cause a diminution in adoptions and have argued against enactment of state mandates for that reason.

In this paper, which was selected for presentation at the 2010 Stanford-Yale Junior Faculty Forum, we push against that conclusion on two fronts.

First, we interrogate the normative premises of the argument and expose its contestable implicit assumptions about how the state should balance the interests of existing children waiting for adoption and those seeking access to reproductive technology in order to have genetically related children.

Second, we investigate the unexamined empirical question behind the conclusion: does state subsidization of reproductive technologies through insurance mandates actually reduce adoption; that is, is there a trade-off between helping individuals conceive and helping children waiting to be adopted? We call the claim that there is such an effect the “substitution theory.” Using the differential timing of introduction of state-level insurance mandates relating to IVF in some states and differences in the forms these mandates take, we employ several different econometric techniques (differences-in-differences, ordinary least squares, two-stage least squares) to examine the effect of these mandates on IVF utilization and adoption. Contrary to the assumption of the substitution theory, we find no strong evidence that state support of IVF through these mandates crowds out either domestic or international adoption.

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4 Responses

  1. Mirah Riben says:

    Exrta-familial child adoptions by infertiles are not all equal by any means. These adoptions encompasses three types which are very different and need to be looked at separately in terms of social value and deserving of encouragement and promotion via state funds:

    – Infant adoption
    – International adoption
    – Adoption of children from foster care

    We need to reevaluate how state and federal funds are used to support, encourage and promote “adoption” without making a distinction between adoption that serves the needs of our most vulnerable children and the needs of the states which are supporting them, and that which does not.

    “The Department of Health and Human Services reported on Sept. 30, 2006, the latest date for which figures are available, that 129,000 foster children could be adopted. Nearly forty percent of American adults, or 81.5 million people, have considered adopting a child. If just one in 500 of these adults adopt, all of the children in foster care waiting for adoption would have permanent, loving families, according to a National Adoption Attitudes Survey. Even using the much lower figure of an estimated 10 million American couples who “would likely attempt to adopt an infant domestically if they felt they had a realistic opportunity to do so,” according to pollster Richard B. Wirthlin all of the children in foster acre who could be adopted would find homes. This is the disparity of supply and demand that should be of most concern and the one for which solutions are sought.” The Stork Market, p. 39

    An August, 2008 survey by the National Center for Health Statistics based on more than 12,000 interviews, the most comprehensive measure available of the demand for adoption in the United States, found that nearly 600,000 women are seeking to adopt children they do not know. Astonishingly:
    • 521,400 survey respondents said they would adopt a black child. In fact, there were 41,591 black children in foster care waiting to be adopted — or, 12.5 pro-spective parents for each waiting child.
    • 351,600 respondents said they would adopt children ages 6 to 12. There were 46,136 children ages 6 to 12 in foster care — or, 7.6 prospective parents for each waiting child.
    • 185,400 said they would adopt a child age 13 or older. There were 30,654 children age 13 or older in foster care — or, six prospective parents for each waiting child.
    Additionally, 181,800 respondents said they would adopt children with severe disabilities, and 447,000 said they would adopt two or more siblings at once.
    How is it that if 600,000 women are seeking to adopt and many of them report a willingness to adopt older children, minorities, children with disabilities, why are fewer than 8,000 children adopted from foster by non-relatives?

    Attorneys, adoption businesses and facilitators, their and all who profit from the redistribution of children lobby fiercely and intentionally blur the differences and lump them all together, and in fact use the half millionchildren in foste rcare and intentionally exagerated numbers of world “orphans” (90% of whom have family) to garner public sympathy and increase promotion of all adoptions and thus increase their profits in arranging same, which ignoring the children in need the help is intended for.

    If the goal is to increase adoptions of waiting US children and relieve the burden of state support for same, it would seem logical to limit Federal tax benefits for adoption to those adoptions rather than using tax payers money to fund the importation of children to met a demand and encourage and support baby brokers. That is not the case however. In fact the majority of those tax incentive dollars defray transnational adoptions, often while exploiting impoverished nations who one by one are stopping or limiting such adoptions.

    We need to become more specific in our language and not simply speak of encouraging or promoting adoptions as if all were equal in terms of altruism, or proving for the overall good of society rather than filling a personal desire or market demand.

    Mirah Riben, author, “The Stork Market: America’s Multi-Billion Dollar Unregulated Adoption Industry”

  2. Glenn Cohen says:

    Thanks Mirah. As you will no doubt see from the paper, we do separate out international vs domestic, foster vs. non-foster, and infant vs. non-infant adoptions in both our normative and econometric analyses in the way you suggest.

  3. Ardea says:

    In vitro fertilization may also cause issues when determining parenthood status in posthumous birth situations (i.e., the father passed away after the child was conceived but before their birth). The question then becomes, is the child eligible for benefits under posthumous birth laws? See also:

  4. This is a technology where female eggs, sperms and embryos are handled,and grown outside the human body , in a very special controlled environment. The embryos are then replaced into the mother’s womb after a few days, to grow further into baby