Baroness Barker
Deputy Chair, APPG on Global LGBT+ RightsBelow, Baroness Liz Barker, one of the strongest advocates of LGBT equality in Parliament, tackles the fundamental inequality of access to fertility treatment that same-sex female couples face and how this results in a cruel postcode lottery.
Take any strategic plan for the NHS published in the last three decades and search for the words “lesbian” or “bisexual women” … nothing. For years, LGBT organisations, including the LGBT Foundation and Opening Doors, have produced reports showing how the health needs of lesbians and bi women are ignored, especially by primary care. They have catalogued the comparatively poor health outcomes for lesbians and bi women across a range of physical and mental conditions. Every time, the NHS response was a combination of incomprehension and indifference.
In England, current NICE guidelines state that NHS-funded access to IVF in England is only available to couples “who have not conceived after two years of regular unprotected intercourse or 12 cycles of artificial insemination (where six or more are by intrauterine insemination or IUI)”, the latter of which is required by female same-sex couples. According to the Human Embryology and Fertility Authority in 2020, one cycle of IUI using donor sperm costs between £2000 and £3500. So, a female same-sex couple would have had to find between £24k and £42k just to get to the same starting point as a heterosexual couple. For many lesbians, their hopes of forming their own family are dashed right there.
What Wegan Did Next
Any couple who wants to start a family but are unable to do so face difficulties, heartache even. Many same-sex female couples have suffered that bitter disappointment in silence. Many have gone on to become brilliant adoptive parents. But it took one couple, Whitney and Megan Bacon-Evans, social media influencers and campaigners known as Wegan, to get through to the NHS by proposing a judicial review of their local commissioning group policy on fertility treatment. The policy required same-sex couples and single women to self-fund 12 rounds of artificial insemination, 6 of which must take place in a clinic. However heterosexual couples need only demonstrate that they had tried and failed to conceive for two years. Campaigns by DIVA magazine illustrated that this policy was not only unfair, but it also created health risks by pushing same-sex couples to use unregulated services. The judicial review application was withdrawn after several statements from NHS England that there would be a new policy based on greater transparency.
In July 2022, the Government published its first-ever women’s health strategy for England. In the preceding years, the APPG on Global LGBT+ Rights, the APPG on Sex and Reproductive Health, and Stonewall spoke at events, and in debates in parliament, pointing out how the NHS was consistently treating lesbians and bisexual women badly.
So when the strategy included commitments to “address the current geographical variation in access to NHS funded fertility services across England to ensure all NHS fertility services are commissioned in a clinically justifiable way”, “explore mechanisms to publish data nationally on provision and availability of IVF”, “improve information provision regarding fertility over the next two years” and “ensure there is no requirement for self-funding and that the NHS treatment pathway for female same-sex couples will start with six cycles of artificial insemination, prior to accessing IVF services if necessary”, there was a sense that the NHS had finally got the message.
We Should Have Known Better. Policy vs Implementation
The commissioning of IVF services is covered by the National Institute for Health and Care Excellence (NICE) Fertility Guidelines. These Guidelines, which are due for revision in 2024, have never been fully implemented. Policies have been determined by local commissioning bodies. Some, notably in Oldham (birthplace of Louise Brown, the first in-vitro baby), have until recently funded three full cycles, others have not only reduced the number of cycles they will fund but also changed the definition of treatment to one episode of ovarian stimulation and the transfer any resultant embryo.
In July 2023, a quarter of integrated care boards (ICBs) had not made their policies public and of the 40 ICBs who do have a policy, only 15 follow the NICE guidelines. So, two couples living in the same constituency but within different ICB areas can find themselves either having to pay nothing or find £25k before they become eligible for NHS-funded treatment. Only 14 per cent of females in same-sex couples have received NHS-funded IVF, compared to 39 per cent in different-sex couples. In Wales, not all health boards fund IUI. In Scotland, artificial insemination is NHS-funded, so female couples do not have to self-fund.
Inequality, Baked Into the System
Instead of an equal chance to form a family, same-sex couples are buying a ticket in a postcode lottery. One in which the odds are growing worse for everyone.
At a time when LGBT people face a concerted attack coordinated by conservative nationalists, the NHS, which loves to cloak itself with rainbows, needs to realise the disservice it has done to lesbians and same-sex female couples and for once, give us a fair go.
The revised NICE fertility guidelines in 2024 must accurately reflect the commitments made by ministers to remove discrimination against female same-sex couples. And the Secretary of State must set out a clear timeline for full implementation of those commitments in the Women’s Health Strategy.
