Reproductive justice for the invisible infertile: A critical examination of reproductive surveillance and stratification

The ability to decide if, when, and how often to reproduce is a human right and a biomedical and sociopolitical goal. Infertility impinges upon this right by restricting the ability of individuals and couples to meet their reproductive desires. While biomedical interventions to address infertility have proliferated recently, their distribution has been inequitable; inequalities in rates of infertility, infertility-specific distress, and access to reproductive healthcare to address infertility abound. Using a reproductive justice framework, and focusing on the United States, we examine the collection and utilization of the Integrated Fertility Survey Series, the inception and provisions of Title X, and the structural limitations of the private healthcare system. This analysis highlights systematic and linked exclusions of marginalized groups from reproductive health surveillance and the public and private provision of reproductive healthcare, including older, non-white, working class, LGBTQ, geographically remote, less educated, HIV-positive, institutionalized, and disabled individuals. Individuals who are excluded from infertility tracking, services, and treatment-the invisible infertile-are limited in their ability to realize their human right to reproductive health. Utilizing existing resources in public and private clinical spaces may be a useful starting point for addressing these disparities, but a broader commitment to equitable and inclusive surveillance and healthcare provision is also needed.