Disparate provincial funding and lack of cohesive federal oversight result in a "patchwork" of ART access in Canada, says Carolynn Dubé of Fertility Matters Canada (FMC).
Dubé discusses how infertility impacts mental health and career progression, urging employers to recognize the ROI of inclusive family-building benefits for talent retention.
FMC's advocacy is yielding policy momentum, including a federal campaign promise for IVF support, but sustained efforts are critical for equitable access via public policy and proactive workplace accommodations.
For many Canadians navigating their reproductive journeys, accessing fertility care and ART is a complex calculus of financial, emotional, and logistical hurdles. Within a healthcare framework ostensibly rooted in universality via the Canada Health Act, access often diverges significantly by province, employer benefits, and geographical realities.
Carolynn Dubé is the Executive Director of Fertility Matters Canada (FMC), an organization at the forefront of advocating for systemic change. She joined us to discuss the critical gaps in current public policy in Canada and beyond.
A patchwork system: "The biggest gap in access to fertility care on the policy side stems from having a patchwork of programs," Dubé explains. "Not one of the programs across the country are the same. Fertility care is healthcare. But unfortunately it does not fall under the CHA's protective umbrella, undermining principles of universal, equitable, and accessible healthcare."
This lack of a national standard means a patient's access to ART services can vary dramatically. "If you are in the GTA, you can have the choice of 21 IVF centers," she notes. "If you are in Newfoundland, you have to fly to another province because there is no IVF offered in Newfoundland." This creates an "increased barrier to accessing specialists and care, plus the disruption to life in terms of extra cost, time off work, time away from your family."
An economic imperative: Dubé stresses that the implications of low fertility rates extend beyond individual well-being into the economic health of the nation. "We have just come through our second year in a row of recording the lowest birth rate in the history of Canada," she says. "The country's fertility rate is highly correlated, as per the data, to its economic health. So public policymakers need to be considering alternative ways to help support the population growth." Publicly funding ART and comprehensive fertility care, she argues, is a vital piece of this puzzle.
The silent toll: "When someone's diagnosed with infertility, it has the same impact on someone's mental health as any other significant health diagnosis, like cancer or heart disease. And yet we don't treat it the same," Dubé says. This struggle often happens in silence, particularly in the workplace.
"It's a challenging topic for employees to talk about publicly," she adds, noting that women, in particular, worry about how it will impact their career trajectory. "I think something for employers to understand is the significant toll this takes on employees silently."
Progress and untapped potential: While some progress is being made, particularly among large corporations, Dubé points out that "51% of employers still were not offering any type of fertility benefit". For those that do, it's often limited to drug coverage with caps. "Where the challenge comes in is in the SMEs because it's hard to determine, like, what is the benefit, what do I implement... It's unpredictable." But the upside for employers is significant as a means of retention for young talent. "In many cases, over 70% of people surveyed said that they would stay longer with an employer if fertility and family-building benefits were offered."
The path forward: Looking ahead, Dubé is hopeful, but stresses the urgency for continued action. Fertility Matters Canada has been advocating at the federal level, and a recent campaign promise from the Liberal Party for $20,000 of support per IVF cycle is a "fantastic step forward."
Beyond federal funding, she calls on employers of all sizes to consider their role. "Maybe you have a small company and you don't have the ability to put forward funding for fertility benefits per se, but you can still have policies in place for someone in your workplace on a fertility journey. Just like any other health journey, an employer should always consider, 'How can we help accommodate?'"
