Assessing Child Welfare under the Human Fertilisation and Embryology Act 2008: A Case Study in Medicalization?

This article reports findings from a study of interviews with 66 members of staff working in assisted conception clinics in the UK about their experience of making ‘welfare of the child’ (WOC) assessments pre-conception. This aspect of the provision of infertility treatment services is obligatory under section 13(5) of the Human Fertilisation and Embryology Act. This provision was amended in 2008 and the primary aim of the study was to find out how this change had impacted on practice. In describing what we found, we also make a contribution to scholarship about the medicalization of reproduction. Section 13(5) has often been discussed as a prime example of medicalization, as it gives clinics power to grant or deny access to infertility treatment on wide ranging ‘child welfare’ grounds, encompassing far more than purely clinical considerations. Yet while such medicalization may be entrenched in the law, our findings suggest this power is used in a very ‘light touch’ way, with clinics explicitly directed by the Human Fertilisation and Embryology Authority that they should operate with a presumption to treat. Further, while our interviewees offered near-universal support for the need to consider child welfare before offering treatment, this is now justified by concerns which focus not on family form (e.g. the need for a father figure) but more on the quality of interactions and relationships between parents and children. In this light, and by virtue of the fact that a wide variety of clinic staff share the gatekeeping role with doctors, we suggest that the concept of medicalization may offer a rather blunt tool for understanding a far more complex reality.