Abstract
In recent years, there has been an increase in women obtaining donor sperm via unregulated websites and social media. In this article, we bring together the disparate evidence in this emerging field to consider whether restrictive UK policies and practices for regulated clinical donor insemination (DI) are a potential explanation for the growing use of the currently unregulated, online route to donor insemination. To this end, we examine the nature of the National Institute for Health and Care Excellence (NICE) guidelines, recent data provided by the Human Fertilisation and Embryology Authority (HFEA), and prior research on who uses online sperm donation and their reasons for doing so. In addition, we highlight why this issue is important by outlining some of the benefits and drawbacks of the unregulated route. We argue that, whilst there are many factors driving the unregulated route to DI, restrictive UK policies and practices for regulated DI might be one of these. We conclude that turning our attention to structural barriers, such as regulated DI policies and practices, is necessary to produce more definitive evidence of this potential issue, and that adopting a Reproductive Justice framework could lead to more equitable provision of regulated DI services.
Highlights
In the United Kingdom (UK) and other countries with advanced healthcare systems, if an individual needs access to donor sperm to have a baby, they can do so via a regulated or unregulated route
In this article we have considered whether restrictive policies and practices for clinical, regulated donor insemination (DI) are a potential driver for the growing online sperm donation market
From an exploration of the National Institute for Health and Care Excellence (NICE) criteria for treatment, coupled with evidence of reduced NHS funding and inequity in its distribution, we can conclude that poor, single, LGBT+ and Black and minority ethnic women are at a significant disadvantage when attempting to access regulated DI, and even more so if they are positioned at the intersection of any number of these identities
Summary
In the United Kingdom (UK) and other countries with advanced healthcare systems, if an individual needs access to donor sperm to have a baby, they can do so via a regulated or unregulated route. As a consequence, increasing numbers of single women and women in same-sex couples from low-income households and proportionally more from ethnic minority backgrounds, are looking for unregulated sperm donors online We highlight why this issue is deserving of attention by outlining some of the benefits and drawbacks of the online route, concluding by proposing potential solutions to address the inequity in provision of regulated DI services in the UK. The stringent NICE guidelines (Table 1), coupled with the localized CCG and Health Board criteria for DI, mean that fewer and fewer women—and same-sex couples and single women in particular— in England, Wales and Northern Ireland are eligible for NHSfunded treatment, that is, if DI is funded at all in their region [17, 25]. During the same period as the results from the aforementioned report were being finalized, in July 2019, the UK Health Secretary
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