Global Parity for Fertility Benefits: the Challenges and Opportunities

BY Emily Nonko | January 02, 2023

Over the past 30 years, the share of U.S.-based multinational companies working outside the country has increased significantly. By 2017, 35% of those companies’ employees worked outside the U.S.–and with the growth of remote work, the number has likely gotten higher.

One challenge that comes with that growth–and that is often left out of benefits discussions–is achieving global parity for fertility benefits when employees live in countries with different rules and regulations around fertility care and family forming. 

“There’s a lot that employers should know about differences in fertility care around the world and how companies can assess whether a fertility benefit is truly global,” said Kirsten Ferro, VP of sales at Carrot, a fertility-benefits provider. 

In a From Day One webinar titled, “Global Parity for Fertility Benefits: Challenges and Opportunities,” Ferro broke down differences in fertility and family-forming access across Latin America, Asia, Europe, and the U.S. She also detailed what employers should know about cross-border care and offered strategies so employees have access to high-quality care wherever they’re located.

There are many challenges to achieving this inclusivity, Ferro says. “For one, every country handles rules and regulations around fertility care differently, or in many cases, very differently,” she said. “What’s accessible in one country might be illegal in another country or might have strict regulations that make it more difficult to access care.” 

One case she highlighted was gestational carrier (GC) services, commonly known as surrogacy, which is subject to drastically varying regulations in different countries. For example, although compensated GC services are allowed in the U.S., they’re illegal in Sweden. Countries including the UK and Canada similarly only allow for uncompensated GC services. And, from other countries, it’s possible to access cross-border care–meaning you’re working with a surrogate in a different country. 

Navigating a GC journey with support means step-by-step guidance, help connecting with vetted agencies, including options for cross-border care, and access to legal resources. “It’s so important that the guidance is all staying in line with the laws and regulations,” Ferro said.

She also highlighted global challenges related to assisted reproduction (IVF) and fertility preservation (egg freezing). In Italy, for example, assisted reproduction is limited to heterosexual couples. In Austria and Norway, fertility preservation for non-medical reasons is banned. And in the Philippines, there are restrictions on the use of donor materials. “Many restrictions are related to the sexual orientation and the relationship or marital status of the intended parents,” Ferro said.

Kirsten Ferro, VP of sales at Carrot (Company photo)

Resources that are needed to navigate this include care navigation to help create a step-by-step plan for a complex journey, support finding high-quality clinics, and guidance on cross-border care. “You want to make sure your vendor is vetting for safety and clinical standards, to make sure your employees are well taken care of,” Ferro said. 

A final example Ferro offered is global adoption, which is regulated by strict laws. Once again, every country has different requirements for adoptive parents, including age, length of marriage, number of children, and income. Parents will need support in finding an accredited adoption agency, guidance on country-by-country requirements, and emotional support on what is often a long and demanding process. 

Finances are another major factor to consider. “It’s no secret that fertility and family forming care can be wildly expensive,” said Ferro. “Figuring out how to manage the financial side of global fertility benefits is so tough, but employers can work with fertility vendors to ensure your offerings are as equitable as possible across geographic locations.” 

Questions to ask when it comes to financial parity include: If providing employer-sponsored funds, how will you account for potential exchange rates? How is cost of care in different countries factored in? How will employees pay for care?

Tackling all these questions and challenges will benefit your entire workforce. “Fertility care impacts nearly everyone in your organization,” Ferro said. For example, egg preservation has become mainstream. Approximately 1 in 8 different-sex couples face infertility challenges, and 1 in 20 men face reduced fertility. (Forty percent of Carrot members identify as male, according to Ferro.) 

A solution that fits everyone, wherever they’re located, should include global coverage and parity, localized experience and insight, care navigation tools, and rigorous clinical, financial, and regulatory expertise. 

“Not all vendors are created equal,” Ferro said, especially when it comes to global inclusivity. “When we talk about important inclusions for this type of coverage, we take it really seriously at Carrot.” 

Editor’s note: From Day One thanks our partner, Carrot, who sponsored this webinar.

Emily Nonko is a freelance journalist based in Brooklyn, NY. In addition to writing for From Day One, her work has been published in Next City, the Wall Street Journal, the Guardian and other publications. 

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