Assisted Reproductive Technology: The Aotearoa/New Zealand Policy Context: A thesis submitted in fulfilment of the requirements for the degree of Master of Arts in Sociology in the University of Canterbury (2002)
AuthorsBatty, Lynne Patriciashow all
The focus of this thesis is the current policy situation in relation to assisted reproductive technologies (ART) in Aotearoa/New Zealand. I explore how government policies (and lack of policy) have shaped access to ART. I also explore the policy initiatives of funding agencies, the National Ethics Committee on Assisted Human Reproduction (NECAHR), managers, healthcare professionals, and interest groups. My investigation into ART policy issues critically examines the various formal mechanisms and policies used to regulate and control ART in Aotearoa/New Zealand. Drawing on my analysis of policy-focused documents and material from in-depth interviews with key actors in the policy debate, I demonstrate how the ad hoc and contingent approach to ART developments, practices, funding, and access has contributed to inconsistent and inequitable access to ART services. I argue that the lack of an ART-specific policy organisation contributes to fragmented, and possibly discriminatory, policy decisions. I examine how the use of restrictive access criteria to manage the increasing demand for publicly funded ART services disadvantages certain groups wishing to use these services. By investigating the influence of rationing strategies on the allocation of resources and regulation of access, I provide some appreciation of the 'messy reality' of policy creation, interpretation, and implementation. I argue that the criteria used to limit access to public ART services obscure the use of social judgements and provider discretion. Likewise, they succeed in limiting publicly funded ART treatments to those who conform most effectively to the normative definition of family. My analysis of the ART policy discourse identifies silences and gaps in relation to specific ART practices, particularly the use of ART by Maori. I highlight the invisibility and marginalisation of Maori within the ART policy debate. After examining the broader issues concerning Maori access to health services, I explore how these may affect Maori using ART services to overcome infertility. I argue that the gathering of information about the utilisation of ART services is crucial for the accurate identification of the needs of Maori. It is also fundamental for effective monitoring of state health policy decisions and outcomes.