Insurance cover in the United States for contraception, abortion, and transgender procedures is controversial, especially if private insurers are responsible. Cases have gone all the way to the Supreme Court. What is the chance that insurers will pay for uterus transplants for transwomen or men who want to experience pregnancy?

An article in the AMA Journal of Ethics discusses some of the ethical complications and concludes that insurers should probably cover uterus transplants, provided that they are safe and effective. Timothy F. Murphy and Kelsey Mumford contend that several classes of people could be interested in this operation:

“Among those likely to be interested in UTx are transwomen who want to gestate their own children, transwomen who want uterus transplants to consolidate their identities but not to gestate children, some transmen who want to gestate their own children, and cismen wanting to gestate children of their own. Transwomen and cisgender men will not have been born with a uterus, and transmen might have had female-typical bodies in the past but lacked a uterus for reasons of disease or disorder.”

At the moment, uterus transplants are in their infancy, so to speak. There have been some births to women with a borrowed womb, none to biological men. However, in principle it is possible – although it will be mighty expensive. In the United States, it would cost between US$100,000 and $300,000. Should such procedures be subsidised?

The authors say that “The strength of claims for subsidy of UTx [uterus transplant] will vary according to ethical rationales for covering costs in the first place.”

They analyse several scenarios. The most relevant, perhaps, is transwomen (i.e., biological males) who want to become pregnant. Is it ethical for them to have a uterus transplant? Absolutely, because if a transwoman is really a woman, she has a right to all the experiences which characterise a woman:

“Transwomen lack a trait (the ability to bear children) that may cause them to experience psychological dissonance in a way that undermines their health and well-being. The lack of a uterus also closes off the prospect of gestating a child in a way that is available to women as a class. It follows that lack of a uterus is an obstacle to full participation in the social goods attached to women’s identity.”

This argument did not go unnoticed by Wesley J. Smith, bioethics columnist for the National Review. He commented:

“Ow, my head! The prospect of enabling such utter solipsism is more than I can stand. Why should society be required to support — much less subsidize — sophisticated surgeries and aftercare to enable the emotional obsessions of a male who feels female? No: Childbearing is not “attached to a women’s identity.” It is the biological reproductive function of women. Such opinions could make a Salvador Dalí painting look realistic.”