Assisted reproduction: a comparative review of IVF policies in two pro-natalist countries

Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic 'challenge' created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with both-the state's and the market's involvements-carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are expected. For a range of reasons the two countries contrast sharply, however, in terms of their capacity to intervene in the health system, and also in terms of the political will to act on matters of reproduction. This paper examines how assisted reproduction, as reflected by present policies in both countries, influences women's welfare and considers whose interests the practices of assisted reproduction in these countries actually serve. By reviewing some of the present data on women's status in Bulgaria and Israel and assessing both states' policies and involvement in assisted reproduction this paper helps to identify some of the intended and unintended consequences of assisted reproduction policies in different countries.