Having grown up in the United Kingdom and now living in America, I have witnessed different approaches to growing a family, leaves of absence and support for parents. As we reflect on Celebrate Diversity Month and Infertility Awareness Week, I see both similarities and gaps worth exploring.
In 2020, the U.S. birthrate fell to its lowest point in more than a century. Many factors have contributed to this trend, like rising infertility rates and economic challenges, often causing younger generations to delay starting a family.
While that may be, the data still points to a majority of people wanting to start families. For many of them, the opportunity to grow their families is one of life’s most important journeys.
Diverse paths to forming a family
The journey to parenthood is increasingly diverse, and this should be recognized and supported by employers, providers, health plans and regulatory bodies.
Examples could look like:
- Individuals that haven’t found the right partner and want to become single parents by choice.
- Same-sex couples who are increasingly becoming parents and growing their families.
- And transgender or gender non-conforming people who also desire to pursue parenthood.
Regardless of the starting point, there are many ways people can go about forming a family, such as:
- Traditional or natural methods (basal body temperature, ovulation charting)
- Surrogacy
- Adoption
- Assisted reproductive technologies (ART), like egg and sperm donation/retrieval, intrauterine insemination (IUI), intracytoplasmic sperm injection (ICSI), in vitro fertilization (IVF) and frozen embryo transfer (FET).
However, I want to note that these options are not without their own challenges and costs that might influence one’s choices.
Barriers to growing a family
Having and raising a family in today’s world is an altogether different proposition—and there are a multitude of challenges for couples and individuals to overcome.
When I think about the barriers as a physician, they fall largely into three buckets: financial, physical and structural.
Socioeconomic status (SES): Rising costs are having a significant impact on if and when a person decides to have (more) children. Based on figures from the USDA, it is estimated that it now takes around $290,014 to raise a child from 0 to 18. Not including college.
Couple that with childcare costs nearly tripling what they were in 1990, it’s easy to see how basic economics serve as a major hurdle.
When SES is low, women are also less likely to receive prenatal care, leading to adverse outcomes. And, low SES in childhood can lead to worsened emotional, educational and physical health outcomes.
- Infertility: The consequences of infertility—both in terms of the emotional toll and the monetary cost—are significant. The average cost for a baby conceived through in vitro fertilization (IVF) is $40,000 to $60,000.
With just a handful of states mandating that insurers cover IVF, most people relying on the ART procedures discussed above must find a way to pay the expenses out of their own pocket. - Structural/systemic barriers: The LGBTQ+ segment of the population faces perhaps the greatest number of challenges while going through the family-building process.
Whether they are relying on assisted reproductive technologies, foster care or adoption, there are complex legal, physical, financial and socioemotional challenges that go beyond the initial decision to start a family.
Most pathways to parenthood require interacting with a range of professionals and institutions, including midwives, nurses, fertility specialists, social workers and possibly lawyers.
Unfortunately, many of these providers and professionals lack adequate training in addressing the unique needs of the LGBTQ+ community.
In addition, forms and computer systems are often not designed with LGBTQ+ families in mind.
There is also potential discrimination against LGBTQ+ prospective parents by agencies and providers, which only adds to the difficulty.
Finally, and critically, insurance policies are rarely tailored to support LGBTQ+ family building, leaving it up to employers and regulators to advocate in this area.
As employers are becoming more committed to diversity, equity and inclusion (DEI), they must be mindful to support all segments of the workforce as they strive to build their families.
Thoughtful benefits design can help ensure LGBTQ+ employees receive equitable access to services and support.
Outreach campaigns can also help everyone feel comfortable utilizing these benefits without fear of stigma or discrimination at work.
Employee support doesn’t end with a child’s arrival
I vividly remember the infamous “Baby on Board” car signs of the 1980s. It was around that time employers started stepping up to support parents in the workforce, establishing onsite childcare centers and other family-friendly benefits.
After a child comes into their parent’s life, the journey of support should continue—not just through those first few months but beyond to encompass early development, critical attachment and more.
Here’s how employers can help support the day-to-day care that every parent struggles to manage:
- Onsite childcare centers to help as people return to work.
- Back-up daycare and babysitting services from qualified caregivers, as employers recognize the difficulties their people face when things fall through at the last minute.
- Assistance with finding vetted providers by providing memberships to hiring sites where background-checked childcare professionals can be found.
- Parenting apps that can help across many dimensions, from health and safety concerns to tracking developmental milestones, receiving trusted advice and resources, establishing routines and helping with educational activities.
Let’s also not forget about creating an environment that supports the overall wellbeing of working parents. Flexible work arrangements and family-friendly cultures attract and retain talent.
The return on such investments is significant.
According to Ovia Health’s 2023 Future of Family Friendly Benefits survey, 91 percent of employees also say they would consider a lateral move to another company with better family-friendly benefits and a family-friendly culture.
Such initiatives have been shown to increase loyalty, improve engagement and enhance productivity, while bolstering recruitment and retention.
Reflections from across the pond
In the UK, maternity leave can last up to 52 weeks. Statutory Maternity Pay is paid for the first 6 weeks at 90% of average weekly earnings. Then, for the remaining 33 weeks, it is £172.48 or 90% of their average weekly earnings, whichever is lower.
If the employee takes the full maternity leave, the final 13 weeks will be unpaid.
For fathers, it’s interesting to note they are entitled to two weeks leave with some level of statutory pay—compared to up to 12 weeks of unpaid leave fathers can qualify for here under the Family and Medical Leave Act (FMLA).
However, in the UK, parents do have the option to share leaves, which makes caring for a child more flexible.
In terms of daycare, the costs are similar, but the UK government does offer subsidies to working parents to help cover costs.
Starting in 2025, the UK government plans to offer 30 hours of childcare per week, for eligible children between nine months and three years old. This will be an improvement on the current 30 hours childcare per week that is only available to three and four year olds.
In the realm of paid vs. unpaid leaves, some U.S. states are ensuring paid leaves for new parents, alongside progressive employers who carry these policies nationwide. I am proud to say Alight is one.
We must applaud and shine a light on these efforts, rallying others to join in with what I see as a win-win for society.
In closing, when we look to other parts of the world, where studies show children are healthier and better adjusted, I believe the U.S. needs to do more to protect vulnerable families and fill the gaps in our safety net when it comes to children and families.
We still have much to learn as we seek to support the health and welfare of those individuals who want to create and grow families—but I am encouraged by the momentum I see.
