The sixth and final installment in a series authored by Memorial University faculty members on the value and importance of diversity, equity and inclusion policies to build a more just society.

Infertility can affect anyone, but the ability to access reproductive care is anything but equal.

From a controversial Supreme Court decision classifying frozen embryos as children to President Trump’s surprising executive order aimed at expanding medically assisted conception access, recent events in the United States have thrust fertility treatment into the spotlight.

These developments highlight an undeniable truth: infertility is a growing issue that demands attention on both sides of the border.

The American contradiction

Trump’s sudden interest in fertility access stands in stark contrast to his administration’s broader record on reproductive rights.

This contradiction reveals the inherent tension in American reproductive policy: acknowledging fertility treatments as essential medical care while simultaneously undermining the broader reproductive health-care infrastructure.

“This lack of accessible care has allowed concerning rhetoric to emerge unchallenged.”

The U.S. remains one of the only high-income countries without universal health care, leaving fertility treatment access largely determined by employment-based insurance or personal wealth.

Canada’s troubling silence

While it’s tempting to critique American failings, Canada’s approach to fertility care also deserves scrutiny.

Our universal health-care system contains a glaring blind spot when it comes to reproductive medicine. Unlike other medical treatments, assisted reproductive technology (e.g., in-vitro fertilization; IVF) is largely relegated to private clinics, with many patients paying out of pocket for treatment that can cost upwards of $20,000 per cycle.

This lack of accessible care has allowed concerning rhetoric to emerge unchallenged.

When Conservative Party of Canada leader Pierre Poilievre recently made statements about women’s “biological clocks”, he ignored the systemic barriers that prevent many Canadians from starting families when they choose, including the prohibitive costs of fertility treatments. Such comments shift responsibility onto individuals while ignoring the structural inequities in our health-care system.

If an American administration historically hostile to reproductive rights can acknowledge affordability as a key issue in fertility care, how can Canada, with its publicly funded health-care system, continue to neglect this growing problem?

Medical necessity, not luxury

For too long, infertility has been framed as a private struggle rather than a legitimate medical condition deserving of equitable health-care access.

The World Health Organization formally recognizes infertility as a disease, yet the patchwork of provincial support across Canada reveals our inconsistent approach.

“True equity in reproductive care means acknowledging that different communities have different needs.”

While some provinces provide limited public funding, recent developments like Newfoundland and Labrador’s still leave significant gaps that ignore the clinical reality that multiple cycles can be necessary.

Countries like Denmark offer a stark contrast, where publicly funded fertility treatments are widely accessible as part of their health-care system.

The equity crisis in fertility care

The intersection of infertility and equity issues receives insufficient attention in Canadian health care.

While affluent couples may have means to pursue IVF, lower-income individuals, single parents, and LGBTQ+ families face insurmountable financial and systemic barriers. Many provincial health systems operate under outdated frameworks based on heteronormative principles (e.g., requiring couples to try to conceive through intercourse for a number of months before undergoing medically assisted reproduction), effectively ignoring many who need fertility care.

Individuals whose infertility results from their partnership (e.g., same-sex couples, single parents), also known as social infertility, face additional barriers to becoming parents. These include financial constraints, medical bias, and inadequate culturally competent care.

True equity in reproductive care means acknowledging that different communities have different needs.

For LGBTQ+ individuals, fertility treatments aren’t always a response to medical infertility but a necessary pathway to family formation. For individuals with disabilities or chronic health conditions that affect fertility, reproductive care is an essential component of comprehensive health care.

Moving forward

Canada cannot afford to continue to wait to address these disparities. We must proactively ensure fertility care is accessible to all Canadians through expansion of provincial health-care coverage for fertility treatments, with particular attention to underserved populations.

Fertility care access is not merely a health-care issue — it’s a profound equity issue that reveals our societal values. A just society ensures that reproductive autonomy isn’t limited by income, sexual orientation, gender identity, race or postal code.

Universal health care means little if it excludes reproductive health. Creating truly inclusive fertility care isn’t just about expanding medical services — it’s about building a more just society where reproductive autonomy is recognized as fundamental to human dignity and equality.