(WOMENSENEWS)--When the television crews and newspaper reporters crowded around the Inova Fair Oaks Hospital maternity ward to capture a picture of the first baby of the New Year in the Washington, D.C. area with her mother, they were faced with an unusual question: Which mother did they want to photograph?
The 5 pound, 2 ounce girl was born to Helen Rubin, a lesbian who became pregnant through artificial insemination. She plans to complete asecond-parent adoption with her partner of 12 years, Joanna Bare.
Rubin's options were better than they were a decade ago, thanks to a small but growing number of service providers dedicated to helping lesbians and single women fulfill their dreams of parenthood. But in spite of their efforts--and the growing number of gay families and intentional single moms--women who want families without men still face significant social, financial and legal hurdles.
Law, Insurance behind Curve of 'Gaybie' Boom
"There's definitely been a gaybie boom in the past 10 years," says Stephanie Brill, co-author of "The Essential Guide to Lesbian Conception, Pregnancy, and Birth" and herself a lesbian mother of three children.
Brill was ahead of that curve. Twelve years ago, she founded Berkeley, Calif.-based Maia Midwifery and Preconception Services, which mostly serves lesbian couples and single women. Brill recently launched a training program for women's health professionals who want to do a better job of serving lesbians.
"The whole fertility system is hetero-based," says Brill, who teaches clinics how to be inclusive, from changing intake forms to including co-parents in prenatal care.
There are no laws in the United States that prohibit single women or lesbians from accessing fertility services. Just over 80 percent of fertility clinics in the United States serve single women, according to a 1998 survey conducted by the Centers for Disease Control and Prevention. Kate Kendell, executive director of the National Center for Lesbian Rights, says she rarely receives complaints about women being refused fertility services. More often, she hears from lesbian couples who feel they've been treated badly.
"Having gone through this myself, it is a very intimate, very stressful, very difficult and very rewarding experience. It requires you have confidence in the people taking care of you," Kendell says.
While she and her partner found supportive care, Kendell, a resident of San Francisco, says the situation is likely to be different for women not living in major metropolitan areas.
Brill agrees. Beyond the coasts, "a lot of women are not getting the care they need," she says. "They feel like they can't get pregnant in their state."
The High Price of Parenthood
Most lesbians and single women who manage to find a supportive sperm bank and physician will have to pay for services themselves. Only one-fourth of health plans offered at companies with 10 or more employees cover infertility treatment, according to RESOLVE: The National Infertility Association. In most cases, women are eligible for coverage only if they are infertile, usually defined as failure to conceive after a year or more of unprotected sexual intercourse--a requirement that leaves out single women and lesbians. Though 15 states have laws mandating that insurance policies cover some level of infertility, that coverage is dependent on medical necessity.
"Most states that have passed a requirement, and a majority of the clinics treating patients, feel that a woman does not have a fertility problem if she does not have a male partner," says Erin Kramer, government affairs director for RESOLVE, which advocates for comprehensive coverage for fertility treatment.
Women who undergo artificial insemination at a clinic can expect to pay $200 to $500 per attempt plus $200 to $400 per vial of donor sperm. Clinics and sperm banks levy additional fees for consultations, physical exams, and for preparing, storing and shipping frozen sperm samples. The overall chance of pregnancy using frozen sperm is about 8 percent to 15 percent each monthly cycle, which means it can take women many months of trying before they conceive. Expenses escalate steeply for women who require fertility medication or in vitro fertilization.
"I've seen the frustration of women who are not able to afford services," says Terry Boggis, director of the Center Kids program at The Lesbian and Gay Community Services Center, which advocates for more inclusive insurance policies and provides support for gay families. "What that means is they have to take greater risks with their health because they use fresh sperm from guys they know."
Whether the women inseminate themselves or have sex with men, they are taking a risk that the men involved may have sexually transmitted diseases.
A Choice between Low Cost or Caution
Besides the health hazards involved in using sperm that hasn't been screened for sexually transmitted diseases, women who use fresh sperm from known donors also expose themselves to greater legal risk. Though the laws vary from state to state, most donor-insemination statutes require physician performance or supervision of the insemination in order to rule out the possibility of successful donor paternity suits.
In those states where statutes are less restrictive, women can avoid the expense of physician-supervised insemination by self-inseminating using an anonymous donor through a sperm bank. Brill's Maia Midwifery and Preconception Services and a small number of other providers, including Fenway Community Health in Boston, offer counseling and information for women who choose this route.
Once a viable pregnancy has been achieved, lesbian couples face a crucial question: May the non-pregnant parent adopt the infant after birth?
One week before the birth of their daughter, Helen Rubin and Joanna Bare moved to Maryland from Virginia because the laws of their home state do not allow second-parent adoption. Without that option, the couple can't share full parental rights. Women who want to start families without men face hard choices. In spite of the growth in services, many lesbians and single women navigate the parenting obstacle course on their own.
Shauna Curphey is a freelance writer in Long Beach, Calif.
For more information:
Maia Midwifery and Preconception Services:
Single Mothers by Choice: