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In August, Amazon announced that it would extend reproductive health care benefits to its full-time, part-time, and hourly employees. This means that more than 1 million Amazon employees in 50 countries beyond the US and Canada, including the UK, Spain, and Belgium, now have access to support for in vitro fertilization, adoption, egg freezing, and other family-building benefits. Through Amazon’s partnership with the New York City-born virtual platform Maven, workers can seek advice and guidance from a suite of fertility doctors, coaches, and other care providers in their own country and native language.
A move as wide-reaching as Amazon’s could be an inflection point in the employee benefits landscape. The concept of employer-sponsored egg freezing, which was first offered as part of a wider benefits package by Apple and Facebook in 2014, spread through Silicon Valley and slowly extended to Europe in the 2010s. Critics viewed the offering as a ploy to get women to delay having children and give their “best” years to the business instead. Progress has been made since then, however, and the number of companies offering reproductive benefits like fertility care is increasing each year. Some company policies have even begun to offer help in underserved areas of health care, like menopause, endometriosis, men’s health, and LGBTQ+ health. Amazon’s move marks an inflection point because of both its geographical reach and wide application.
In the UK, in particular, where fertility and reproductive health care is patchy and not covered by statutory insurance, workers welcome workplace support and sponsorship. Facilitated by private third-party fertility and family care providers, employees are able to access discreet expert advice, with some packages including reimbursement for up to £50,000 ($60,800) in lifetime costs. Such workplace benefits widen the already yawning privilege gap between corporate employees and other workers (such as freelancers, zero-hour workers, and migrant workers), but with NHS provisions rapidly crumbling, they might be the only way many in the UK can afford to have a family.
Since the pandemic, corporate interest and investment in reproductive health and family-planning support has grown rapidly. According to research by job platform Adzuna, since March 2022 there has been a 700 percent increase in job ads citing fertility benefits, while fertility clinic Apricity found that 61 percent of Britons expect their employer to cover the cost of their IVF treatment, either partially or in full. It’s not hard to see why. Adults in the UK, for many reasons, are waiting longer before exploring their fertility, which results in more problems conceiving. At the same time, state help in this area is declining.
In 2021, only 35 percent of IVF treatments were funded by the NHS, compared to 62 percent in Scotland, 50 percent in Northern Ireland, and 39 percent in Wales. Even if the support is available, navigating the system effectively alongside full-time work is hugely taxing. The waiting list for gynecology and fertility appointments is growing faster than for other areas of health care, averaging around four months, which causes significant emotional and physical stress for those trying to conceive.
For cancer patients and people with other medical conditions that affect their fertility, sperm and egg preservation options aren’t always widely accessible or adequately funded. Then there’s the hard truth that many patients, particularly those over 35, fall between the cracks, due to stringent eligibility criteria and limited funding for multiple IVF cycles. Going private simply isn’t affordable for many people, with the cost of just one round of IVF starting at £5,000.
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Intermediary telehealth companies like Peppy, Maven, and Fertifa have witnessed a profound shift, not just in the length of their client list, but in how companies approach reproductive health. “Before Covid-19, there was a clear separation between professional and personal welfare, but the pandemic changed that,” says Eileen Burbidge, director at Fertifa and founding partner at venture capital firm Passion Capital. “Employers and HR professionals recognized the importance of workers’ well-being and the commercial impact of health care on productivity,” Burbidge says. Burbidge believes that for employees at large tech firms, and even growth-stage companies, reproductive health care support is now table stakes. “If someone’s worked at one of the largest tech companies or a FAANG and goes on to join a scaling startup, the first thing they’ll ask is how the benefits compare to what they had before,” explains Burbidge. “I am convinced that it will become a nonnegotiable for every employer over time, even if it takes 20 years.”
Business has been booming for Fertifa. Burbidge says the company has processed more than £2 million worth of employer-funded reimbursements to employees for fertility procedures since May 2022. Its largest client is Meta UK and Ireland, with others including the investment company Bain Capital, pension insurance firm Rothesay, and law firm Osborne Clarke. Startups and SMEs are also represented on its client list, some with under 20 employees.
“The UK is still behind the US, but of all the countries in the European continent, it’s head and shoulders above in terms of progressiveness around employee well-being and reproductive health benefits,” says Burbidge. “There’s been a sense of comfort that these matters are covered by the NHS, but that’s eroding fast, leaving space and the need for employers to step in.” Even so, companies like Fertifa have to play an educational role, as many aren’t aware how little is covered by the NHS and how few people have access. Burbidge says sales prospects often discover that the task is bigger than they ever imagined.
Krystal Wilkinson, an associate professor at Manchester Metropolitan University’s Centre for Decent Work and Productivity, notes that fertility treatment, including IVF, is often wrongly seen as a simple matter of personal choice. “This historical stigma has limited advocacy and campaigning efforts,” she says. The World Health Organization recognizes infertility as a reproductive health disease that impacts one in six individuals worldwide. It’s far from a niche problem, and it affects both genders almost equally.
LGBTQ+ people face an even bigger web of complexities when trying to conceive. A survey of LBTQ+ women and nonbinary people trying to have children in the UK found that 36 percent of respondents with children had experienced barriers or challenges when starting their family, particularly through the lottery of IVF access. “It’s a lot more of a process in their path to parenthood, not necessarily because workplaces don’t want to offer support and care for them, but businesses just aren’t aware of it and don’t know how to do it,” says Francesca Steyn, chair of the Royal College of Nursing Fertility Forum and clinical director of fertility at Peppy, a digital health platform that provides staff at companies like Adobe, Disney, Accenture, Clifford Chance, and Santander access to human clinical support, medical resources, and medication. These challenges are why third-party experts like Peppy often play such a pivotal role in advising companies.
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“Reproductive health benefits aren’t just for people who want to reproduce—every single one of us has some degree of vulnerability to breast cancer, ovarian cancer, prostate cancer, or testicular cancer, for example,” says Burbidge. “It isn’t just about putting things off or choosing family over work, it’s about being your best, or at least getting answers you need to feel at your best.” Now that companies are waking up to this notion, there’s no doubt that policies are becoming more holistic and wide-ranging.
Broader acceptance of flexible work arrangements since the pandemic has been helpful for anyone pursuing a fertility journey. “More policies now allow time off for reproductive health appointments and treatments,” says Steyn. “Not long ago, I was writing sick notes from clinical patients so that they could ask for time off—and I had to be careful in word choice because they didn’t want their employer knowing it was for a fertility-related procedure.” Now, some organizations even offer paid leave for fertility treatment, like fintech bank Monzo, which gives employees six days of annual leave for this purpose.
“Going through fertility treatment includes logistical challenges of getting to the clinic, often at very short notice—you might have to travel overseas even,” says Wilkinson. “Having to deal with cycles of hope and grief means there are lots of physical and emotional challenges, and if an employee chooses to disclose, it’s luck of the draw whether managers will be understanding.”
When the Chartered Institute of Personnel Development surveyed senior HR professionals and decision-makers earlier this year, it found that around half (49 percent) of employers provide some kind of support for employees pursuing fertility treatment. However, employee experience tells a different story. According to research by Totaljobs and the Fawcett Society, over half (59 percent) of women going through fertility treatment have kept it secret from senior colleagues, despite 92 percent needing to take time off for treatment. And one in five workers even quit their jobs because of the way they were treated during their fertility journey.
Wilkinson highlights that there’s currently no specific protection from discrimination for people undergoing fertility procedures, or for their partners. “Everybody should be able to access the treatment they need, as well as being protected from discrimination for utilizing that ability to have treatment,” says Wilkinson. She notes the recent positive legislative developments around flexible working, neonatal leave, and menopause. Hopefully, fertility will be next on the agenda.
As the average age of first-time parents increases, reproductive issues will be a growing problem, exacerbated by a public health service that is being squeezed into oblivion. “I’d love it if the NHS offered fertility treatment to everyone who needs it, but I think we’ll get to a point where none whatsoever will be available,” says Steyn. “I hope employers do step up and more people take them up, because otherwise lots of people won’t ever have a family.”
This article was originally published by WIRED UK
