The Draft Law on Infertility Treatment with Bio-Medically Assisted Fertilization in the Federation BiH established: improvements needed

After several attempts and draft laws from many sides in the previous years – attempts to regulate this area in the Federation BiH and harmonize the practice of Bio-Medically Assisted Fertilization in all its cantons, the Federation BiH Government, in March 2018, established the Draft Law on Infertility Treatment with Bio-Medically Assisted Fertilization. The Law regulates the pre-conditions and ways/procedures of infertility treatment, all according to regulation on health care, health insurance, patients’ rights, duties and responsibilities. Adoption of this law would enable equal opportunity for all couples, no matter the material status, creditworthiness or the canton they live in.

Bosnia and Herzegovina is still the only country in the Region of Western Balkans that does not have this law on the entity nor state level, and this issue is partially and unequally regulated on the cantonal level. The patients are currently left to the mercy of the private clinics whose prices are extremely high (like those in EU countries’ private clinics), and the public sector is not able to compete with the private one, not in terms of the necessary equipment, nor in terms of the number of procedures that resulted in pregnancy. Not adopting this law has often been justified by the insufficient amount of money that would finance the treatment, which is unfounded if we take into account the fact that the BiH entity Republika Srpska enables its citizens, since 2007, two procedures of bio-medically assisted fertilization at the expense of the compulsory health insurance.

The significance of adopting this Law lays in the fact that the issues that have so far existed in the so called “grey area” of the legal system (exploiting the uninhabited status of infertile persons with the aim to gain material benefits), that were not allowed nor prohibited, can be regulated with this Law. This is the way to better protect the Bosnia and Herzegovina citizens, thus improve their position and access to health care/treatment. Citizens do not have adequate access to treatment, they cannot get the treatment for free because of the compulsory health insurance that they exercise via cantonal healthcare institutions or Federation BiH Healthcare Institution, and the participation of the institution varies from canton to canton, which creates the unharmonized picture. The bio-medically assisted fertilization procedures are expensive, financially exhausting for couples and the couples’ existence is often in question. So, this is why the support of the community is important in order to facilitate the process and adopting this law for the level of the Federation BiH makes it possible, having in mind the benefits for and welfare of the patients, not political or religious convictions.

In January 2018, Sarajevo Open Centre published the Comparative Analysis (author: Indiana Husić Šabanović) of the previous draft laws on Infertility Treatment with Bio-Medically Assisted Fertilization in the Federation of Bosnia and Herzegovina (the ones existing since 2013) – the ones proposed by Social-Democratic Party and the Government.

According to the comments to both draft laws solutions made in the analysis, many of the comments/improvements we emphasised should be included in this latest Government Draft Law (2018) are not there. These include:

  • The pre-conditions that the health institutions should have in order to organise the procedure of bio-medically assisted fertilization: The Draft Law does not recognize the situation in which the domestic health institutions are not able to provide the services of heterologous fertilization because there is no cells bank in the country, so there should be a provision that the patients chould be directed to treatments outside BiH.
  • Homologous/heterologous fertilization: The Draft Law does not recognize the case when in the process of bio-medically assisted fertilization it is not possible to use the partners’ cells, or when the fertilization is done for preventing transmission of severe hereditary disease to the child, so in the process the cells acquired from the authorized EU cell banks can be used
  • Usage of the frozen embryos and cells: The Draft Law regulates that all the frozen embryos and cells should be used from the partners before starting the ovaries stimulation for the cause of acquiring egg cells. This article does not recognize the patients who produce a small number of egg cells, or the patients who have to go through the pre-implant genetic diagnostics.
  • Donating cells, tissues and embryos: The heterologous fertilization is forbidden, donating cells, tissues and embryos that is not made between marital/extra-marital partners. This does not solve the disadvantages related to heterologous fertilization, but deepens the discriminatory relation to the patients who need this kind of assistance.
  • Pre-implant genetic diagnostics: In the Draft Law, it is allowed only in the case of the risk of transmission of hereditary disease. Its usage should be spread to not only detect the possible genetic disease or sex of the future child, but also for detecting genetic mutations in the embryo, which helps with treating the repetitive spontaneous abortions that women face.

We hope that the Federation BiH Parliament will, in the following period, adopt this Law and ensure that having a baby/child is should not be a privilege of the rich and creditworthy, but a human right of all the people who want it.

Sarajevo Open Centre will keep advocating for the inclusion of these improvements in the existing Draft Law.