Hungary recently made international headlines by announcing that the state would soon cover the cost of IVF treatments. Along with financial incentives for Hungarian women who produce four children, IVF will form part of Prime Minister’s Orban’s strategy for increasing the Hungarian birthrate. The announcement attracted international attention in part because Orban connected his support for fertility treatments to his long-standing, vocal opposition to immigration. Yet, this announcement also sparked interest internationally because it touches on questions about access to IVF and other forms of reproductive technologies. In many countries, such procedures are expensive and limited to patients of significant financial means.
Hungary’s government is not the first to pledge to help citizens conceive through IVF (and other forms of reproductive technologies) as part of a larger bid to promote childbearing. Within the last twenty years, a number of Eastern European countries, including Romania and Bulgaria, have attempted similar programs with limited success.1 As for Western Europe, France’s Social Security covers the cost of IVF for heterosexual couples and is expected to soon cover such services for single women and same-sex couples. In fact, the French state’s commitment to covering the cost of reproductive technologies has a long history predating the availability of IVF. Beginning in the 1970s, the state mandated full coverage of fertility treatments, diagnostic testing, and reproductive technologies such as artificial insemination. The state’s decision reflected both its longstanding determination to raise the national birthrate and its policy of supporting French families.
French demographic concerns stretch back to the nineteenth century when demographers and other analysts revealed data showing that France’s birthrate was in a state of decline and the sluggish rate of population growth would likely continue.2 In an era marked by intense nationalism, the specter of depopulation produced intense calls for government intervention into the private realm of the family. As the demographic question became a national obsession, the French state began actively promoting childbearing through a mixture of financial incentives, propaganda, and punitive measures. While reformers offered a variety of explanations for the causes of the low birthrate, including such diverse factors as tax law and urbanization, the issue was primarily understood in moral and gendered terms.3 Reformers claimed that many women chose a life of independence or leisure, unencumbered by the demands of a large family. To counter this perceived trend of “voluntary sterility,” propaganda presented such women as selfish and celebrated the virtues of motherhood and large families.The fact that an estimated ten percent of French couples experienced “involuntary sterility” or infertility was a reality frequently overlooked in the intense pronatalism of the day.
Beginning in the 1920s, however, some influential gynecologists, including Dr. Louis Devraigne, connected the issue of involuntary sterility to the depopulation crisis.4 Advocating that medical treatment of infertility could position France to “recuperate” thousands of births, Devraigne had convinced the state by 1937 that fertility medicine should form part of the state’s larger demographic policy.5 Early efforts focused mainly on facilitating access to medical treatments aimed at curing, when possible, the medical causes of infertility. As for reproductive technologies, specifically artificial insemination by donor (AID), some physicians quietly carried out the procedure during the interwar period. Yet, at this time, as well as in the decades immediately following the Second World War, the procedure remained controversial due to the legal and ethical questions it raised about kinship and marriage.6
By the 1970s, the French state had largely embraced AID as a solution to involuntary childlessness and began taking steps towards removing the financial barriers to producing a baby this way. This position was partly a consequence of the continuing commitment to encouraging childbearing. France’s post-war Baby Boom was over and, following the 1967 Neuwirth Law, contraception was more readily available. Yet, despite the acceptance of legalized contraception, and the idea of couples choosing to plan and space births according to their individual needs, the state still presented the three-child family as the ideal model. It was in this context that health minister Simone Veil mandated that social security cover most of the costs of AID. In 1975, the health ministry approved subsidies for CECOS, the French network of sperm banks. This was followed by a 1976 law mandating that most diagnostic testing and procedures, such as the act of insemination, be fully reimbursed by Social Security. In 1978, the state passed a law mandating full coverage of the remaining fees associated with the diagnosis and treatment of sterility. Finally, in 1979, the law covered the cost of the paillettes (vials) of donor semen required for artificial insemination.
The decision to cover these expenses was inspired in part by the large volume of letters that ordinary French citizens sent to the health ministry detailing their struggles with infertility and asking the state to help them produce the child they very much hoped to have. One woman expressed her sense of injustice that the possibility of having a child should be a “luxury” reserved only for the rich.7 Many of the people writing to the health ministry echoed the sentiment that every French citizen should have an equal right to produce biological children; access to AID should not just be reserved for those who could afford such services.
Letters to the health ministry subsequently urged officials to incorporate state-funded reproductive technologies into the existing demographic policy. In this way, ordinary French citizens adopted the pronatalist rhetoric of the state and presented access to reproductive technologies as intrinsic to larger efforts to support population growth. One woman stated that, with the birthrate down, the government needed to do more to help childless couples.8 This sentiment was echoed by another woman who saw a contradiction in the state’s “aggressive preaching” that families needed to have at least three children. Given all this talk about the birthrate, she continued, “has anyone thought about couples like us? One talks about those couples who are already parents, but does anyone think about the others? I have often likened our case to that of disabled people.”9 Another such letter, this one written by a man, likewise criticized the state’s emphasis on the three-child family, arguing that it made little sense to push established families to produce a third child when many such families did not want more children. He concluded that it would be a better use of the state’s resources to assist infertile couples to produce the one child that they would cherish above all else.10
Most citizens who wrote to the health ministry in the 1970s with their stories of infertility wanted to bring to the ministry’s attention the obstacles they faced in producing a much-desired biological child. Given the pronatalist basis of the state’s family policy, these individuals argued the state should cover the cost of fertility medicine and AID so that all citizens could access these services equally. They asserted that, for the birthrate to increase, the state had an obligation to do more than provide financial incentives to convince people to produce children; the state had to also acknowledge the reality of infertility. These letters, along with the lobbying of leading OB-GYNs, had a strong influence on the ministry of health. Though the state removed many of the financial barriers to accessing reproductive technologies, these services were nevertheless restricted to heterosexual couples. Like Orban’s plans to provide IVF to Hungarian women, France’s decision to improve access to reproductive technologies in the 1970s reflected established ideas about which individuals should produce children this way. But as the recent French Senate vote illustrates, France is nevertheless poised to break, however controversially, with earlier such restrictions by allowing single women and same-sex couples to access to reproductive technologies.
- Costica Dumbrava, “Reproducing the Nation: Reproduction, Citizenship and Ethno-Demographic Survival in Post-Communist Romania.” Journal of Ethnic and Migration Studies 43, no. 9 (2017), 1498. Return to text.
- See Joshua Cole, The Power of Large Numbers: Population, Politics, and Gender in Nineteenth-Century France (Ithaca: Cornell University Press, 2000). Return to text.
- See Mary Louise Roberts, Civilization Without Sexes: Reconstructing Gender in Postwar France, 1917–1927 (Chicago: University of Chicago Press, 1994). Return to text.
- Louis Devraigne, Puériculture Sociale: Puériculture, Stérilité, Dénatalité (Paris: G. Doin et Cie. 1936). Return to text.
- “La Stérilité Involontaire sera combattue méthodiquement.” Revue de l’Alliance Nationale Contre la Dépopulation, no. 305 (1938): 17–19. Return to text.
- For Devraigne’s position on this, see Devraigne, Puériculture Sociale, 209. Return to text.
- Archives Nationales (AN): 19850019/6: Santé: Direction Générale de la santé: sous-direction de la maternité et de l’enfance et des actions spécifiques de santé: maternité: Stérilité, Correspondence: Letter dated 29 March 1979 from madame P. Return to text.
- AN: 19850019/6: Letter dated 29 March 1979 from madame P. Return to text.
- AN: 19850019/6: Letter dated 19 January 1976 from madame G. Return to text.
- AN: 19850019/6:Letter dated 18 May 1975 from monsieur G. Return to text.