������Ƶ

This year, I turned 40, which happens to be the age at which I promised myself I would finally decide if I wanted to have kids. I wish I could say it’s an entirely artificial deadline, but it isn’t. Fertility age feels like the one inequality that women can never quite escape.

So, as we catapult toward 2024, my conversations often turn toward kids. Am I willing to change my lifestyle? Do I want to face the health risks of an advanced-age pregnancy? Is it the right time to slow down in my career? Will I regret it if I don’t?

It seems like there are endless things to consider, but regardless of the question, my answer is always the same. I wish I had more time. And I’m sure I’m not alone.

American women are having fewer children than in previous decades. Those who do have kids are having them later in life. According to a report by the , only 56.7% of women between 15-49 had at least one child. The same study showed that women over 35 were responsible for an increasing percentage of the nation’s birth rate.

Delayed childbearing is a with more women choosing to put their education, career and financial stability ahead of having a baby. In Hawaii, birth rates have fallen in every county with Hawaii County experiencing the largest decline (24%), according to the from the Centers for Disease Control and Prevention.

There are myriad reasons to delay pregnancy and put off motherhood, and in the last 10 years, I’ve used most of them. Yet this changing world that offers women more opportunities for independence, career advancement and personal growth hasn’t managed to stop time.

Your likelihood of a successful pregnancy still decreases with age. And, while the medical field has methods to increase your chances, high prices, sparse insurance coverage and a lack of government support make those options cost-prohibitive for most.

, one of the most effective fertility treatments, . That cost may or may not include necessary injectable medications that range between $3,000 and $5,000. , including Hawaii, require health insurance coverage for IVF under varying conditions.

requires insurers to cover one cycle of IVF, which is less than what’s covered in many other states. It also limits coverage to couples who can demonstrate a five-year history of infertility, which is problematic for women approaching the end of their fertility age. In contrast, requires coverage for up to three IVF cycles. Colorado, New Jersey and others have also that make women eligible for benefits after 12 months of infertility and only six months for women aged 35 or older. This language is much more suitable for today’s needs and should be adopted.

Similarly, is problematic in that it limits required coverage to women in heterosexual marriages by stipulating that the IVF process must use “the patient’s spouse’s sperm.” States like explicitly provide for donor insemination and/or require infertility services to be provided regardless of sexual orientation, gender identity or marital status. Hawaii’s current law needs this update too.

IVF and other fertility treatments are becoming more available as insurers and government expand coverage. While these services do provide care for women who have decided to conceive, they do not help women who want to proactively preserve their fertility through elective egg freezing.

The chances of a live birth from frozen eggs is approximately 39%, but despite the odds, it is still the for women who may face age-related or medically induced infertility. However, like IVF, the is unaffordable for most middle-to-low income earners.

As of 2022, offered coverage for egg freezing, a significant increase from 6% in 2015. In 2021, France became to pay for women to undergo elective egg freezing through their public health system. The United Kingdom’s National Health Service doesn’t pay for egg freezing, but its nationalized system tends to of the prescriptions that make up a significant portion of the cost.

While 17 states cover fertility preservation, it is limited to women who are at risk of infertility due to a medical procedures like cancer treatments. that requires insurance coverage for egg preservation regardless of the cause of infertility, but it still does not allow women to freeze their eggs proactively. However, elective egg freezing is undoubtedly going to become a bigger part of the conversation when it comes to women’s health and gender equality.

Hawaii can lead that discussion. Next session, in addition to expanding eligibility for IVF coverage, the Legislature should explore whether it would benefit our state to provide support to women who want to proactively preserve their fertility.

It doesn’t need to start with blanket coverage. France is currently limiting public support to women between 29-37 years of age. We could set age limits. Or, we could set income limits. We could create an insurance mandate or provide public funds. There are a lot of ways to approach it, and the idea deserves consideration.

I’m probably too old to make egg freezing worthwhile. I wish I had the option sooner. I wish that I had the $10,000 to do it when I priced it at 36. But, like most, my money went to rent, car payments and student loans.

Then, I was out of money. Now, I’m out of time. But lots of other women aren’t. Let’s help them.