Changes to NICE fertility guideline for same-sex couples

As Britain's
leading lesbian, gay and bisexual equality charity, Stonewall welcome the
decision by the National Institute for Health and Clinical Excellence (NICE) to
update its fertility guidance to recognise recent changes in the law that will
affect lesbian and bisexual women. The guidance, out to consultation,
explicitly includes same-sex couples as an eligible group for fertility treatment.

Unfortunately,
the NHS has a poor record in dealing with lesbian and bisexual women's health,
often failing to acknowledge their specific needs. This was most apparent in
the unfair 'need for a father' provision, which was interpreted by many clinics
and healthcare professionals as an outright ban on same-sex couples accessing
fertility treatment. Stonewall successfully lobbied to have these removed in the
Human Fertilisation and Embryology Act 2008, putting gay people on an equal
footing with straight people.

Now lesbians
and bisexual women seeking fertility treatment on the NHS are entitled to
exactly the same assessment as heterosexual women - the NHS is not allowed to
refuse access to fertility treatment simply on the basis of sexual orientation.
To support lesbians, bisexual women, and healthcare professionals on understanding
these legal changes, Stonewall produced 'Pregnant Pause' (1), a guide for
lesbian and bisexual women on getting pregnant.

However, at
Stonewall we still hear of lesbian couples who have been denied treatment
simply because of who they are: our research into the
health of lesbians and bisexual women, 'Prescription for Change' (2), found one in two has
had a negative experience of healthcare in the past year. Lesbians have told us
common responses from healthcare professionals include: 'A couple is defined as
a man and woman' and 'Civil partners are not entitled to the same rights on the
NHS as married spouses'. These are examples of outright discrimination towards lesbians
looking to start a family.

So does the
NICE draft guidance on fertility resolve some of these issues? Yes and no. The
document explicitly refers to same-sex couples for the first time, recognising
the changes in the law and growing number of lesbians accessing fertility
treatment. However, the guidance recommends lesbians fund six cycles of intrauterine
insemination themselves, after which the NHS will fund a further six if they
are unsuccessful. NICE has come to the conclusion that six self-funded cycles
(with a potential cost of £6,000) is the equivalent to a heterosexual couple
failing to conceive after 12 months of unprotected vaginal intercourse.

So while we
welcome the recognition of same-sex couples, and the issues they face in the
draft guidance, lesbian couples are expected to pay up to £6,000 before being
considered by the NHS for treatment. This is unfair.

We are acutely
aware that some lesbians conceive at home, which exposes them to a number of potential
risks. This is precisely why we lobbied to lift the ban on lesbians accessing
fertility treatment. Unfortunately, we are concerned that making lesbians pay
for treatment will dissuade them from accessing safe clinical services.

Stonewall will
continue to work with clinics, NICE and the NHS to ensure lesbians can access safe
fertility treatment, and that healthcare professionals treat them with dignity
and respect.