Politics in IVF care strains patient-provider relationships


I chose to get a Master in Public Health and Physician Assistant degree because I wanted to understand and work with the circumstances that place communities in vulnerable health situations. But my vision of returning to my home state of Missouri to work with women, mothers, children and families has faced the brutal reality that providing care to this population requires a political stance.

The extreme politicizing of reproductive care is impeding the provider-patient relationship in places that need care the most.

The aftermath of the Alabama Supreme Court’s ruling last month, which found that embryos created through in vitro fertilization (IVF) are to be legally considered children, has shocked families, mothers and the medical community. States pursuing embryonic personhood, such as Alabama, are the very states that most need comprehensive reproductive care.

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As a current MPH and PA student building a career to go into hormonal and reproductive health, I turn a concerned eye to the state that raised me with fear of how far we are willing to go on reproductive restrictions.

Missouri is one of multiple states moving toward granting full personhood to fertilized embryos since the overturn of Roe v. Wade in 2022. Given Missouri’s track record against women’s autonomy over their own bodies, there’s a fear of further restrictions on reproductive care. Several Alabama IVF providers temporarily suspended services due to the recent ruling in fear of facing civil lawsuits or prosecution.

As an aspiring provider and public health advocate, I recognize the need for representation of care in these states, now more than ever. However, the legal implications that threaten the provider-patient relationship challenge the goal of caring for a community.

Missouri courts in the past have declared embryos as “marital property,” requiring consent from both parties for use after a divorce or other changes in circumstances. Pending legislation now would mandate courts to reconsider the “best interests of the embryo” when determining custody in such cases. The legislation would specifically tilt that decision toward the parent who “intends to develop the embryo to birth.”

In this political climate, we must take a pulse check on the repercussions these cases and bills have on families, communities and providers.

Other states, such as Florida, have paused their embryonic personhood pursuit in the name of protecting IVF care. If Missouri continues to pursue new restrictions, especially in light of emerging embryo custody issues, it raises profound concerns on undermining medical decision-making autonomy. It also threatens civil lawsuit action against health care providers.

The broader context of these decisions underscores the urgent need for states that grapple with the complexities of reproductive health care, such as Missouri, to avoid passing more legislation that limits reproductive autonomy.

The exodus of reproductive care professionals in Missouri has already worsened in the aftermath of the 2022 decision overturning Roe. To further this disparity of care with additional restrictions on how we define “life” through the embryonic development severely limits the lives that families are entitled to build and the care that providers are entitled to offer.

My journey into public health and medicine is founded in values instilled in me from my upbringing in St. Louis, where the community reflected the need for social justice. Navigating my educational and professional aspirations remains rooted in defining community.

St. Louis, and Missouri at large, urgently require reproductive care providers. However, the challenges that our community face extends beyond access to health care. Intricate legal and ethical dilemmas surrounding embryonic care, amidst advancing reproductive technologies and shifting political climates, jeopardize the essence of patient-provider relationships.

How can I aspire to care for a community that may not fully support its caregivers? To be the provider I strive to be, it is no longer solely about identifying areas in need of care, but also navigating the complex landscape of patient advocacy and ethical practice within communities. We must think of each other, the weight of our decisions, the consequences of our beliefs, as we redefine what community means to us all.

Acker, raised in St. Louis County, is currently a graduate student at the George Washington University Milken Institute of Public Health in Washington, D.C., and a Physician Assistant student concentrating in child and maternal health.


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