Is fertility a health issue or a lifestyle choice?
This month a health care refom advisory panel will mee
t to consider whether contraception should be offered free of charge as a form of preventative medicine, the AP reports. Healthcare reform of course poses many questions concerning how medical services are paid for and delivered. But, as the AP notes, social mores are at the heart of this latest question.
Contraception is a controversial tool for preventing pregnancy, with many religious movements banning it outright. At the heart of the argument against free contraception is that the use of contraception is a lifestyle choice, not a health issue. As the president of the National Catholic Bioethics Center notes, “there are other ways to avoid having children than by ingesting chemicals.”
All other things equal, should the use of contraception be thought of as a health issue or a lifestyle choice? And should it matter for whether it is provided free as a form of preventative care?
The most obvious way to avoid having children is of course to abstain from sex. In this sense, we can certainly think of fertility as a by and large voluntary decision. Moreover, parental preferences about family size do not exist in a vacuum. In poor societies, children bring income to their parents, perpetuate lineages (where they are important for economic reasons), and where property rights are poorly defined help the family take from “the commons.” In richer, more industrialized and more gender-equal societies, high opportunity costs to child-bearing turn children into more of a luxury good. This has been true even before chemical contraception. Fertility is indeed often a lifestyle choice.
But what can be said about other lifestyle choices? Many activities bring some kind of benefit to those who engage in them, but they are not risk-free or obviously enjoyable in excess. A person who is a little too fond of drink will harm his liver. Professional football players have life expectancies in the 50s owing largely to head trauma. Reading and studying hard can damage eyesight. A range of preventative, curative and palliative measures exist for all of these “lifestyle choices.”
Fertility is in some respects no different. Childbearing and childrearing are by no means risk-free or costless. And of course, fertility cannot happen without sex, which can lead to the transmission of disease.
and voluntary choices that improve some aspect of a person’s quality of life carry significant health risks. The one qualitative difference that clearly distinguishes fertility from all of the aforementioned activities is that fertility involves the creation of new life in addition to potential harm or injury to existing life. With respect to medicine, should the procreative aspect of fertility –and by extension sex- in any way outweigh its obvious similarities with other “lifestyle choices?” And if this difference is great enough, should we regulate medicine based on this distinction?
The answer has everything to do with sexual and family values and preferences. The Catholic Church provides one answer, but many alternatives are possible.
Image by Flickr user anqa used under a Creative Commons Attribution License.