Reproducing Oppression: A Discourse Analysis of OFP Funding for IVF Through the Lens of Reproductive Justice

Canada has long been viewed as a beacon of progressive universal healthcare. However, a closer look into reproductive healthcare services at the provincial level reveals some services are not as accessible as they are portrayed to be. The existing literature demonstrates the ways in which the bodily autonomy of marginalized groups has been restricted through reproductive oppression, as well as how the discourses surrounding infertility have influenced health policy. Using Reproductive Justice (RJ) theory, this research contributes to this literature by examining what discourses are employed in relation to the Ontario Fertility Program (OFP) funding model for IVF in the province, and the implications of these discourses for the accessibility of reproductive health care services in Ontario. The OFP is a government-run program that funds IVF treatment in the province.\nThe primary question this research sought to address is as follows: Through the lens of reproductive justice, who does the state support in becoming parents via in vitro fertilization? To answer this question, a critical discourse analysis informed by Foucauldian and feminist methodological approaches was conducted on a foundational report on infertility and IVF in Ontario and current OFP policy documents. The themes that emerged from this analysis were: (1) the use of gendered language and (2) IVF policy shifting accountability for services away from the Ontario government. In terms of the first theme, this discourse analysis finds that the foundational report used to inform Ontario’s IVF policy viewed fertility services as a means to achieve the goal of building a family through conceiving children with government assistance. The lack of gender-inclusive language and conflation of sex and gender in the report resulted in the erasure of those outside the gender binary as well as reinforced gendered assumptions that bodies assigned female are passive towards their fertility. This culminated in the report emphasizing the need for women to “protect” their fertility from the dangers of infertility, and the need for the state to fund IVF for the betterment of Ontarians.\nThe second theme focuses on shifting accountability. Within various documents that communicated how OFP funding and IVF delivery operate, this study finds that the Ontario government presented the OFP as a progressive government-run, state sponsored program that is similar to other forms of healthcare in the province. However, documents about the IVF program were often unclear regarding how IVF funding actually operates, which includes a significant reliance on private fertility clinics, creating the impression that the funding for fertility treatment was being increased through OHIP rather than a separate program known as the OFP. The use of language within these documents also emphasized the government’s contributions to the OFP and allowed it to present itself as progressive for increasing support for fertility services while obfuscating how and how much support is provided. The lack of clarity within these documents is significant because it plays into assumptions that IVF is covered under universal healthcare. In actuality, fertility clinics must deliver IVF services while not having to meet the standards set by the Canada Health Act (CHA).\nThis paper concludes with a discussion on IVF and the right to have a child, and employs the principles of RJ to further interrogate how OFP funding actually restricts the right to have a child for those seeking to get pregnant through assisted reproduction rather than fully supporting it. The report used to inform IVF policy in Ontario also used a singular view of identity that did not take into account the barriers to IVF for those with intersecting identities. As a result, the OFP was not designed with these considerations in mind, and therefore, primarily supports white, cisgender, heterosexual couples with financial privilege in becoming parents through IVF.

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