October 14, 2021
There are many paths to parenthood, and each comes with unique challenges. Offering inclusive benefits that support the variety of ways employees choose to form and grow their families is a critical step toward health equity. This section shares best practices and opportunities in employer-sponsored birth parent/maternity benefits and benefits for fertility, adoption and foster care.
Birth Parent/Maternity Benefits: Preconception to Postpartum Care
Benefits that promote healthy pregnancies and deliveries decrease risks associated with preterm births and low birth weight, mitigate complications for birth parents and reduce claims costs. According to Business Group on Health’s 2022 Large Employers’ Health Care Strategy and Plan Design Survey, high-risk maternity/NICU (neonatal intensive care unit) is a top condition driving health care costs and trend, with 17% of employers indicating it is one of the top three conditions driving costs at their company. Moreover, respondents to Ovia Health’s The Future of Family Friendly Benefits said digital prenatal and parenting classes (64%), high-risk pregnancy care management (60%) and pregnancy loss leave (48%) were important benefits to employees.
Table 1.1: Benefits for Prenatal Care, Delivery and Postpartum Care
|BENEFIT||LARGE EMPLOYER BENCHMARK|
|Preventive care, immunizations and screenings, as defined by the Affordable Care Act (ACA), without cost-sharing for the employee||100%|
|Preconception and prenatal health coaching and/or counseling (including counseling for tobacco cessation and weight management/maintenance)||64%|
|Maternity Center of Excellence (COE)||23%|
|Steerage to higher quality maternity care||22%|
|"Hard stop" utilization management requirements to determine whether early elective delivery or non-medically indicated C-sections are appropriate||4%|
|Efforts to lower C-section rates among under-resources populations||18%|
|Pregnancy assessment/risk survey||33%|
|Identification of high-risk pregnancies through maternity programs/services among under-resourced populations||47%|
|Digital tool/app on prenatal care and labor and delivery||44%|
|Healthy pregnancy/maternity management program||73%|
|Virtual prenatal care management/coaching||50%|
|BENEFIT||LARGE EMPLOYER BENCHMARK|
|Group-based prenatal care||26%|
|Birthing/parenting classes (free or affordable access)||15%|
|Maternity navigators/advocates/coordinators forbenefits education and assistance||53%|
|Access to specially trained nurses for high-risk mothers-to-be (including follow-up calls after delivery and screenings for depression)||64%|
|Goodie bag for expectant mothers (including prenatal vitamins, diapers, books, etc.)||20%|
|On-site health clinic||44%|
|Leave for pregnancy loss, miscarriages and/or stillbirths (not including regular sick, vacation or PTO)||20%|
|Short-term disability for medical-maternity leave (fully paid by employer, not voluntary benefit)||93%|
|Postpartum depression (PPD) treatment||47%|
|Telehealth options for counseling and therapy for postpartum mental health||60%|
Sources: 2021 Family Benefits Quick Survey, 2022 Large Employers’ Health Care Strategy and Plan Design Survey, 12th Annual Employer-Sponsored Health & Well-being Survey, 2021 Large Employers’ Leave Strategy and Transformation Survey, 2020 Large Employers’ Leave Strategy and Transformation Survey, 2020 Supporting Employees with School-Aged Children During the Pandemic Quick Survey, 2018 Parental Benefits, Supports & Perks Quick Survey
Ending Disparities in Maternal Health and Mortality
Like other disparities, the COVID-19 pandemic exacerbated maternal health inequities. A 2021 Ovia Health study found that more women, especially BIPOC mothers, experienced postnatal depression during the pandemic than pre-pandemic. BIPOC mothers had a 10% increase in severe symptoms of depression and a 26% increase in reports of suicidal ideation, compared to only a 10% increase in moderate symptoms of depression and no change in suicidal ideation for White women.1 Investing in benefits to alleviate the pressures expecting and new parents are experiencing during the pandemic and beyond can address these distressing findings, positively impact employee well-being and support health equity.
Even before the pandemic, appalling racial and ethnic disparities in maternal mortality existed in the U.S. In 2019, the maternal mortality rate for Black people was 3.5 times higher than for White people and 2.5 times higher than for Hispanic people.2 To understand disparities in maternal (or carrier) mortality, why they exist and what employers can do to be part of the solution, review the Business Group’s Ending Disparities in Maternal Mortality.
Walmart's Doula Benefit
In 2021, Walmart announced upcoming expansion of benefits under its medical plan to include coverage for doulas, up to $1,000 per pregnancy, to employees in Georgia. Lisa Woods, Walmart’s Vice President of Physical and Emotional Well-being, said the company is starting in Georgia because that’s where “we believe we can leverage our network of health care resources to create immediate positive impact in supporting healthy pregnancies.” The doula benefit was added to Walmart’s Life with Baby Program, which provides other resources like one-on-one nurse coaching, special baby gifts and more.
Fertility, Adoption and Foster Care Benefits
Fertility, adoption and foster care benefits are essential for many families, including LGBTQ+ couples and single individuals who are ready to start or grow their family, as well as the 50 million couples across the globe who experience infertility. Unfortunately, significant disparities exist in access to fertility care across race, ethnicity, income level, sexual orientation, gender identity, insurance plan and state of residence.3
Large employers are leading the way in eliminating existing issues. In 2021, nearly 800 large companies introduced or improved their family-building benefits, including fertility treatments.4 And, a large majority (79%) of large employers offer some form of adoption and/or foster care benefit. While only 2% of American adults adopt or foster children, there’s a ripple effect for many other employees who do not use these benefits but see them as a sign of a caring company culture.5
Table 1.2: Benefits for Fertility, Adoption and Foster Care
|BENEFIT||LARGE EMPLOYER BENCHMARK|
|Steerage to high quality fertility/family forming care||38%|
|Equitable coverage of fertility benefits for all employees regardless of gender identity status or marital status (e.g. transgender and nonbinary employees have the same access to fertility benefits as other employees)||80%|
|Evidence-based medical evaluation for infertility||78%|
|Virtual fertility care||35%|
|Fertility/family-forming Center of Excellence (COE)||40%|
|Fertility medication(s) coverage||84%|
|Assisted reproductive technology (ART), including in vitro fertilization (IVF)||78%|
|Single-embryo transfer policy||27%|
|Cryopreservation (e.g., egg/embryo freezing)||51%|
|No dollar limit for medications and/or medical services||29%|
|Financial support for gestational carriers (surrogacy)||39%|
|Paid time off for fertility appointments (including PTO, unlimited/permissive or sick leave)||100%|
|Flexible scheduling for fertility appointments||78%|
|Educational materials, communications and/or campaigns to address the stigma of infertility||18%|
|BENEFIT||LARGE EMPLOYER BENCHMARK|
|Financial assistance for adoption||85%|
|Agency fees financial assistance||78%|
|Legal fees financial assistance||80%|
|Court fees financial assistance||80%|
|Travel fees financial assistance||49%|
|Medical fees financial assistance||49%|
|Counseling fees financial assistance||51%|
|Equitable access to financial assistance for adoption for all employees regardless of gender identity, marital status or age||84%|
|Parental leave for adoptive parents to bond with new child||98%|
|Leave for foster parents to bond with new child||62%|
|Paid time off for employees going through the adoption or foster process (including PTO, unlimited/permissive and vacation leave)||100%|
|Flexile scheduling to support adoptive/foster parents||78%|
|Digital cognitive behavioral therapy programs||36%|
Sources: 2021 Family Benefits Quick Survey, 2022 Large Employers’ Health Care Strategy and Plan Design Survey, 12th Annual Employer-Sponsored Health & Well-being Survey, 2020 Large Employers’ Leave Strategy and Transformation Survey, 2020 Supporting Employees with School-Aged Children During the Pandemic Quick Survey
Fertility Care: The Impact on Well-being, Equity and Work
Global Reproductive Justice and Access to Fertility Care
Access to safe, affordable and effective fertility care is fundamental to reproductive health. Unfortunately, even in countries where fertility treatments are legal and culturally accepted, many individuals are unable to access services.
Australia: Fertility treatment is partially subsidized with public funding. Nonetheless, couples pay a significant amount toward treatment. In fact, when the costs to couples went up in 2010, the number of in vitro fertilization (IVF) cycles went down by nearly 25% across all socioeconomic groups.6
Brazil: Overall, fertility treatment in Brazil is accepted, accessible and affordable. Success rates of treatments are comparable with the best in the world while costs tends to be more affordable than in the U.S. and western Europe.7
Britain: While infertile women under 40 can get three cycles of IVF through the National Health Service, local clinical commissioning groups can set standards, such as stricter rules on ages, weight requirements and having no children from previous relationships. These standards limit and create differences in access within the country.6
China: While Beijing wants women to have more babies, they’re not making it easy. Currently, eggfreezing and IVF are not available to “single women and couples who aren’t in line with the nation’s population and family planning regulations;” conversely, China allows single men to freeze their sperm. A small number of wealthy women who have the means can travel outside the country to freeze their eggs. In fact, about one third of a Hong Kong egg-freezing clinic’s clients come from China.8
France: In 2021, France passed legislation that, for the first time, gave lesbian couples and single women access to fertility treatment. France’s health care system will cover the cost of fertility procedures for all women under 43.9
Russia: While Russia does not allow fertility treatments for same-sex couples, in all other regards it’s considered to have liberal laws on reproductive rights (e.g., no age limits, open to single and unmarried couples, legal surrogacy). In fact, fertility treatment is part of the country’s strategy to boost population figures, and Russia hopes to reach 90,000 state-financed IVF procedures per year in 2024.10
Singapore: As of January 2020, the cap on the number of IVF cycles and age limits for IVF in Singapore were removed. However, IVF is still only available to married couples.11 To minimize the financial burden, couples in Singapore may withdraw from Medisave for the first ($6,000), second ($5,000) and third ($4,000) treatment cycles. The lifetime Medisave withdrawal limit per patient is $15,000 for assisted conception procedures.12
Sub-Saharan Africa: Fewer than one-third of countries have an IVF clinic.6 The lack of access can have devastating impacts. Women who can't have children may be subject to isolation and can suffer economically.
United States: 40% of women of reproductive age have limited or no access to nearby fertility treatments.6 Furthermore, the cost of fertility treatment, which is often paid out-of-pocket, makes it out of reach for many people. In the U.S., the average cost of IVF is $10,000-$15,000, intrauterine insemination is $500 to $4,000, egg freezing is $8,000 to $10,000 and surrogacy is $75,000 or more.13
Employer Recommendations for Designing and Administering Fertility and Adoption Benefits
- 1 | Reassess eligibility determinations for fertility treatments and adoption benefits to reflect the diverse needs of their workforce.
- 2 | Ensure that all programs include appropriate benefits that focus on supporting mental health needs of employees experiencing changes in family status, including screening for post-partum depression.
- 3 | Steer employees toward high-quality providers who follow evidence-based protocols and deliver superior clinical outcomes. Also, suggest that employees discuss with their health plans the availability of new programs and value-based payment models, such as maternity bundles and any other programs that emphasize quality in maternal health and fertility benefits.
- 4 | Ensure that there are adequate connections between fertility benefits, maternity programs and other supplemental services and supports for new parents.
- 5 | Educate employees about available fertility, adoption and foster care benefits and programs, including related leaves. Provide clear, concise information about fertility benefits, use employee scenarios to illustrate coverage options and consider a targeted approach by tailoring communications to different cohorts.
- 6 | Encourage third-party vendors to use available claim and demographic data to engage those who may be planning or starting a pregnancy in choosing a quality provider and enrolling them in applicable programs offered. While communicating to or engaging with employees on sensitive issues related to the reproductive health, vendors should emphasize confidentiality of such services.
- 7 | Educate supervisors regarding appropriate support and creating a supportive culture in the workplace for parents experiencing family change, especially in less common situations, such as interracial adoption, pregnancy difficulties and return to work for parents of children requiring special care.
To better understand infertility and its the impact on employers and treatments, review the Business Group’s Evidence-Based Fertility Treatments.
- 1 | Bradley D. What digital depression screener data are telling us about the impact of COVID-19 on parents’ mental health. Ovia Health. April 22, 2021. https://www.oviahealth.com/blog/digital-depression-screener-data/. Accessed August 6, 2021.
- 2 | Hoyert, DL. Maternal mortality rates in the United States, 2019. CDC. April 2021. https://www.cdc.gov/nchs/data/hestat/maternal-mortality-2021/E-Stat-Maternal-Mortality-Rates-H.pdf. Accessed June 16, 2021.
- 3 |Weigel G, Ranji U, Long M and Salganicoff A. Coverage and use of fertility services in the U.S. KFF, September 15, 2020. https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/. Accessed July 20, 2021.
- 4 | FertilityIQ. 2021 FertilityIQ Workplace Index. 2021. https://www.fertilityiq.com/topics/fertilityiq-data-and-notes/fertilityiq-workplace-index. Accessed June 1, 2021.
- 5 | Adoption Network. US adoption statistics. October 13, 2020. https://adoptionnetwork.com/adoption-myths-facts/domestic-us-statistics/. Accessed July 28, 2021.
- 6 | Grose J. When it comes to fertility, access is everything. New York Times. April 17, 2020. https://www.nytimes.com/2020/04/17/parenting/fertility/fertility-treatment-cost-access.html/. Access August 19, 2021.
- 7 |Fertility Treatment Abroad. Fertility treatment in Brazil. https://fertility.treatmentabroad.com/countries/brazil. Accessed October 5, 2021.
- 8 |CNN staff. Beijing wants women to have more babies. So why isn’t it loosening the rules on egg freezing? CNN. August 21, 2021. https://www.cnn.com/2021/08/21/china/egg-freezing-fertility-intl-hnk-dst/index.html. Accessed August 30, 2021.
- 9 | Agence France-Presse. French parliament votes to extend IVF rights to lesbians and single women. The Guardian. June 29, 2021. https://www.theguardian.com/world/2021/jun/29/french-parliament-votes-to-extend-ivf-rights-to-lesbians-and-single-women. Accessed August 19, 2021.
- 10 | France 24. Russia funds IVF baby boom to battle population slump. January 30, 2020. https://www.france24.com/en/20200130-russia-funds-ivf-baby-boom-to-battle-population-slump. Accessed August 19, 2021.
- 11 | Ling J. Protected: 10 IVF clinics in Singapore for couples trying to conceive. Yahoo News. September 15, 2020. https://sg.news.yahoo.com/protected-top-10-ivf-clinics-042426163.html. Accessed August 30, 2021.
- 12 | Ministry of Health Singapore. Marriage and parenthood schemes. 2021. https://www.moh.gov.sg/cost-financing/healthcare-schemes-subsidies/marriage-and-parenthood-schemes. Accessed August 30, 2021.
- 13 | Snider S. How to compare fertility treatment options. U.S. News & World Report Money. October 21, 2020. https://money.usnews.com/money/personal-finance/family-finance/articles/how-to-compare-fertility-treatment-options. Accessed August 19, 2021.
Full GuideThe Family Benefits Bundle: Full Guide
Part 1The Family Benefits Bundle: Introduction
Part 2The Family Benefits Bundle: Family Building
Part 3The Family Benefits Bundle: Family Transitions
Part 4The Family Benefits Bundle: Parenting and Childcare
Part 5The Family Benefits Bundle: Caregiving