"Queer tax" creates extra fertility barriers for 2SLGBTQ+ BIPOC families
Queer Tax: Examining 2SLGBTQ+ Black, Indigenous, and People of Colour's Experiences of Accessing Assisted Reproductive Technologies (Tam, 2025)
Tam, M.W., Brumer, A.-P., & Ross, L.E. (2025). Queer Tax: Examining 2SLGBTQ+ Black, Indigenous, and People of Colour's Experiences of Accessing Assisted Reproductive Technologies. Social Science & Medicine. https://doi.org/10.1016/j.socscimed.2025.118053
Geographic Region: Canada
Research Question: What are the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) Black, Indigenous, and People of Colour (BIPOC) accessing ART in Ontario, Canada?
Design: Data were collected through semi-structured interviews conducted from November 2021 to July 2022 with participants, their partners, and medical/legal professionals involved in the ART process. The researchers employed modified constructivist grounded theory coding using MAXQDA software, combined with situational analysis mapping to understand power structures and relationships within the reproductive access context.
Sample: 32 participants (26 principal service users and 6 partners) comprising 2SLGBTQ+ BIPOC individuals in family units. Inclusion criteria required participants to self-identify as or be the partner of someone who is Black, Indigenous, and/or person of colour; identify as 2SLGBTQ+; be over 18 years old; and have accessed, considered, or chosen not to access ART since 2015. Demographics showed 47% identified as genderqueer/non-binary and 44% as cisgender women; 59% identified as queer and 31% as lesbian; with 81% of participants being racialized.
Key Findings
Participants identified four major barriers termed "queer tax" - additional financial, time, and emotional burdens faced by 2SLGBTQ+ BIPOC when accessing ART services.
Mandatory fertility counseling serves as gatekeeping and disciplining mechanism, requiring "correct" answers about personal history, education, and family support to determine parental "fitness."
Known donor sperm regulations create significant barriers, particularly for Indigenous donors who face discriminatory screening questions about family medical history without consideration of colonial trauma impacts. Participants chose known donors for various reasons, including unavailability of racially similar sperm, desire to know donor identity, wanting ongoing connections, and enabling both parents to have biological connections through family member donation.
Severe shortage of Black, Indigenous, and People of Colour donor sperm forces families to purchase expensive international donors or compromise desired cultural/genetic connections. Canada has only 19 registered sperm donors (mostly white) with an additional 17 restricted to families with existing children from the same donor, leading to reliance on US and Danish sperm banks at 1.5 times the cost.
Clinic policies charge double storage fees for same-sex couples using reciprocal IVF and restrict embryo transfers between partners, creating financial and procedural barriers.
Participants described "performative allyship" where clinics display inclusive symbols but maintain discriminatory practices in actual service delivery.
Many participants preferred open-identity donors who agreed to be contacted when children reach 18, viewing this as integral to effective parenting and fostering children's connections to cultural and genetic roots.
The limited availability of BIPOC donor sperm impacts not only conception but also participants' ability to parent children who share their racial background, with concerns about navigating different political experiences and being misidentified as babysitters rather than parents.
Limitations: Convenience and snowball sampling methods may introduce bias toward more engaged, resourced community members. Study focuses on specific time period (2015-2022) and may not reflect more recent policy changes.
Applications: Urgent need to examine and reform heteronormative, cisnormative policies and provide genuine inclusive care beyond performative displays. Specific recommendations include: eliminate double storage fees for same-sex couples; allow embryo transfers between partners; train staff on 2SLGBTQ+ competency; update intake forms to be inclusive; implement policies supporting known donor processes.
Funding Source: Social Sciences and Humanities Council of Canada (grant number: 752-2021-2171) and the Lesbian Health Fund from GLMA: Health Professionals Advancing LGBTQ+ Equality
Lead Author: Michelle Tam is a researcher focused on reproductive justice and health equity at Harvard T.H. Chan School of Public Health (formerly University of Toronto). No personal connection to donor conception was disclosed.
Regulatory Context
In 2004, Canada passed the Assisted Human Reproduction Act (AHRA), one of the most comprehensive pieces of legislation in the world concerning reproductive technologies and related research. In 2010, the Supreme Court of Canada struck down parts of the AHRA, leaving responsibility to provinces, which have largely not acted.
Currently, there is no central system for storing donor information accessible to donor-conceived persons and no legislation protecting their right to know donor identity.
Industry guidelines suggest limits of 25 people per population of 800,000; however, there is no national registry to track the number of births by individual egg and sperm donors.
In 2024, Canada removed restrictions on gay and bisexual sperm donors.
Commercial payment to donors is prohibited - donations must be altruistic. Donors can receive reimbursement for legitimate expenses but not payment for gametes themselves.
Single people, same-sex couples, and heterosexual couples all have equal legal rights to access assisted reproduction treatments.
Gamete and embryo donation can be known or anonymous. When a child is born using anonymously donated gametes, that child does not have a right to know the identity of their donor.
In 2024, Quebec became the first province to recognize the right to know one's origins. They launched a provincial donor registry, allowing donor-conceived people over 14 to access certain donor information if available.
Over 90% of donor sperm used in Canada comes from the United States due to regulatory burden and lack of donor incentives.
Related Posts
Navigating complex biological connections through reciprocal IVF (Bower-Brown, 2024)
A look at key priorities in family building for gay men (Hanson, 2022)
Unique experiences of transgender and cisgender fathers who use donor sperm (Mendes, 2024)
I’m someone who should appreciate this article, in theory (we’re an interracial gay couple who used a known donor and found the fertility clinic annoying) but I just found myself groaning over and over. It’s a great example of how people who are overly concerned with queer rights end up centering themselves at the expense of DCP. The article barely considered the impact of any of these practices on the children who will be created. It was all about adult desires.
Some of this “gatekeeping” is to protect the clinics from getting sued, but counseling and genetic screening is also for the benefit of the future children.
We also need to acknowledge that reality is homophobic. A lot of these complaints are about it being harder for gay people, but in my experience, the people who think it’s “not fair” and that everyone should bend over backwards to make gay people feel just like a straight couple, are the same people who are adult-centered not child-centered. Part of being a responsible RP is wrestling with all of the ways you are doing something unusual.
If you’re obsessed with making everyone prop up your fantasy that you’re having babies just like any straight couple, how will that make the child feel when he/she wants a relationship with the donor?
All of this academic language about heteronormativity and colonialism is trying to reframe biological reality as oppression. But that doesn’t serve our children.
There’s also the egg donor issue (at least for Confucianist cultures). Slowly changing, I think, as cultures become more integrated, but it takes time (everyone says it takes three generations).
Note: some people think term “BIPOC” others certain groups (including yours truly)