More on the Quebec election campaign

(as I posted earlier this week)

QUEBEC CAMPAIGN: REVENGE OF THE CRADLE REDUX
Kissing babies isn't enough
Sure, it's politics, Ingrid Peritz explains, but Jean Charest's sudden support for IVF also rights a wrong

INGRID PERITZ
November 22, 2008

MONTREAL -- Annie Martel enjoys family perks that would be the envy of mothers anywhere. When she became a foster parent two years ago, she took advantage of Quebec's generous parental leave. And when her girl started daycare, Quebec subsidies ensured that the service would cost her just $7 a day.

Now that Ms. Martel has adopted the child and dreams of giving birth to a sibling for her, Quebec once again is poised to deliver.

With a provincial election campaign in full throttle, Liberal Leader Jean Charest has pledged to introduce a benefit that would be unique in Canada: full coverage of in-vitro fertilization (IVF) treatments.

"To have the government pay is an enormous step - maybe we will still be able to have a biological child of our own," says Ms. Martel, a 41-year-old Montreal Web designer who estimates that she and her husband have spent $35,000 on fertility treatments. "This gives us a lot of hope."

The promise brings a measure of comfort to women like Ms. Martel. And it may be a winner on the campaign trail.

No politician has ever gone wrong by promising pro-baby policies in Quebec, where increasing the province's low birth rate has been a near-obsession since it plunged from one of the world's highest to one of its lowest.

Even so, as recently as June, Philippe Couillard, then Mr. Charest's health minister, opposed extending medical coverage to IVF, putting the Liberals at odds with both the Parti Québécois and Action démocratique du Québec, whose leader, Mario Dumont, had championed the cause.

Now, while campaigning for a third term as premier, Mr. Charest seems to have seen the light. This week, he announced that under a Liberal government, Quebec's health-insurance plan would cover two IVF treatments and the existing 50-per-cent tax credit would still apply if further attempts are required.

"A couple that wants children must get all the help possible," he declared.

Total cost of the promise: $35-million a year. Estimated boost to the population: 1,500 babies.

The pledge helps to secure Quebec's status as the most baby-conscious and aggressively pro-family province in the land. The provincial government has been coaxing the stork into Quebeckers' homes ever since it brought in baby bonuses in 1988. Since then, Quebec has trail-blazed with universal daycare and unparalleled parental leave.

The incentives are credited with helping to produce a modest baby boom, although the fertility rate of 1.6 babies per woman is still below replacement levels. Quebec has long tied a robust population to its collective survival in an English-speaking continent, a concern that once led the Catholic Church to advocate the "revenge of the cradle." But the secularism of the 1960s Quiet Revolution brought a steep drop in the birth rate that policy-makers have struggled to reverse since.

Today, the province's family-friendly ethos trickles down to small towns such as St-Lin-Laurentides, which has been encouraging residents to have large broods for 20 years.
To this day, the community of 15,000 north of Montreal gives new parents T-shirts and bibs emblazoned with the municipal crest, along with a $500 bonus for a third child. Mayor André Auger admits the money won't go far, but he wants to get the message across.

"I'm a good Québécois, I'm a nationalist," Mr. Auger says, "and I say a people that respects itself has to reproduce."

Still, with Mr. Charest's latest pledge, Quebec is shifting the focus from new parents to would-be parents.

HIGH-PROFILE STRUGGLE

Infertile couples have battled for years to have costly IVF treatments covered. They found a mighty advocate in TV personality Julie Snyder, wife of media magnate Pierre-Karl Péladeau, chief executive officer of Quebecor Inc.

Ms. Snyder's crusade on behalf of infertile couples led to a high-profile confrontation with Dr. Couillard during parliamentary hearings in June.

At a time when Quebec was struggling with a low birth rate, she asked, why was the province paying for "life-prevention" procedures such as abortions and vasectomies but not something "that creates life?"

Ms. Snyder recently gave birth to her second child. Meanwhile, Dr. Couillard has retired from politics.

Quebec offers a tax credit for IVF, but couples still find themselves taking out loans to pay upward of $10,000 for each series of treatment. For some, the cost puts the dream of parenthood out of reach.

"Do I borrow the money to try it once? Do I have to borrow again for a second try? Then I'll really be in the hole," says Mélanie Pétrin, a Montreal school-board employee whose husband, Benoit Adams, studies while working part-time.

She has been trying to conceive for nearly two years and feels frustrated that other women can afford fertility treatments that she cannot.

"It's true, I'm not sick, I'm not coughing or stuck in bed, but my state of health isn't normal," says Ms. Pétrin, who turns 29 today.

"You feel you could be a good mother, you could give your time and invest in a child. But you're unable to do it. At least if I can try, I will say that I've tried everything."

If the Liberals win the election - they are leading in the polls - and stick to the promise, Quebec will be the only province to cover IVF fully. Ontario pays only for women who have complete blockages in both Fallopian tubes.

As it stands, Canada lags behind most developed countries. Nations such as Australia, France, Israel, Norway and Germany all offer various kinds of coverage, as do some health-maintenance organizations (HMOs) in the United States.

"Canada is a huge anomaly. It's an embarrassment," says Jeff Nisker, a medical ethicist at the University of Western Ontario who has written about the issue. "I applaud Quebec. It's about time someone had the courage to do this."

According to Dr. Nisker, also a professor of obstetrics and gynecology, Canada sees IVF as "something for the rich, like cosmetic surgery. Elsewhere in the world, it's seen as a serious problem and it deprives women of being mothers.

"Canadian women are discriminated against more than any other women in the world."

He says that granting coverage is not only fair, it also makes sound medical sense. Women who can't afford IVF may turn to high-powered fertility drugs that result in multiple births, which often require costly neonatal care.

Mr. Charest's promise - and his reference to infertility as a "medical condition" - was seen as a significant step toward victory for the couples and doctors who have been seeking public financing.

"This promise is profoundly symbolic," says obstetrician and gynecologist Pierre Miron, director of the fertility clinic at Montreal's Maisonneuve-Rosemont hospital. "It may not increase the birth rate that much, but it gives a social signal that the state supports births even more.

"We are the Gaulois, resisting," he adds, comparing Quebeckers to the ancient Gauls who stood up to the Romans. "With this, we're coming up with an incentive for infertile couples."

Dr. Miron, who has been helping couples conceive since the 1980s, predicts that whoever wins the vote on Dec. 8 will now find it difficult to back down from the IVF promise.

After all, it's a true motherhood issue.

Ingrid Peritz is a reporter in The Globe and Mail's Montreal bureau.

***
Child-friendly

$1,207
The after-tax annual cost per child of daycare for a Quebec family with two children and an income of $75,000 a year

$6,974
The figure for Saskatchewan, with the next cheapest child care.

$7,145
The Canadian average, excluding Quebec.

Source: Le Québec, un paradis pour les familles? by Luc Godbout and Suzie St-Cerny (Laval University Press, 2008).