PRISTINA -- Placard in hand on the front steps of Kosovo's national assembly here late last month, Blende Asllani and her fellow activists wanted to send a clear message.
"Secular state, where?" one of the signs read, signaling the demonstrators' fear that public policy is falling prey to outsized religious influence in the Balkans' newest state. "Does IVF in private hospitals destroy the family?" read another at the February 29 protest in front of Kosovo's parliament, organized by the We March, We Don't Celebrate collective and joined by other groups.
The protest was part of an emerging legislative and regulatory battle over in vitro fertilization (IVF) -- a medical procedure where an egg is fertilized by sperm outside the body, typically in a laboratory dish -- and other fertility treatments in Kosovo, a male-dominated, mostly Muslim country of around 2.2 million people.
The argument in Kosovo has been simmering on and off since a proposed law on reproductive health began making the rounds in March 2023. In the draft bill , women are granted access to IVF treatment regardless of whether they are single, in a same-sex or any other type of relationship.
But a smattering of lawmakers, including those from Prime Minister Albin Kurti's ruling Self-Determination party, are leading opposition to the bill in its current form. They want IVF and other assisted pregnancies restricted to couples in order to safeguard the institutions of marriage and family. They say they fear "accidental incest" -- where people who were conceived with the assistance of sperm or egg donors unintentionally enter into sexual relationships with their biological relatives -- and have argued that children conceived outside the womb should have the right to know their father.
The opponents of the reproductive-health bill, in its more inclusive wording, have so far successfully fended off a plenary vote that would likely result in passage. Long-running efforts at passage failed again last week and once more on March 7, when parliament failed to muster a quorum each time.
Since the first "test-tube baby" was born in England in 1978, IVF has advanced and expanded dramatically throughout the world as a response to infertility and other obstacles to natural conception. The procedure has accounted for around 12 million children since then and nearly 1 million births around the world every year, according to an international NGO.
It has sometimes come under fire on ethical grounds, including by critics who insist conception should be left to nature. Others object on religious grounds or because they believe IVF threatens traditional family values.
Kosovo has regulated IVF since 2013 through an administrative instruction that grants access for individuals or couples but does not envisage the storage of reproductive tissue or so-called embryo banking, in which multiple eggs are fertilized and some of the resulting embryos are frozen for future use rather than being implanted in a uterus.
Kosovar Health Minister Arben Vitia, a former general practitioner, has complained that the administrative instruction cannot adequately regulate the IVF sector. "So far, reproductive health and medically assisted fertilization have been affected by a lack of adequate legislation, a lack of human resources and equipment, and a lack of funding in the public sector," Vitia told a session of the Kosovar parliament on February 22. He said the draft law would permit the state-run University Clinical Center to provide IVF services and allow for the launch of a public bank for reproductive tissue. Such facilities typically store frozen sperm and eggs but also embryos.
A fully equipped IVF center at the University Clinical Center's OB-GYN department stands mostly idle despite a promise by Vitia's ministry to offer IVF services to the public by the end of 2023.
One mother who spoke to RFE/RL's Balkan Service said she had paid around 4,000 euros ($4,375) for a licensed private clinic to perform the procedure, or around two-thirds of the average annual salary. The Health Ministry says patients are forking out a combined 5 million euros each year for IVF in Kosovo.
What Makes A Family?
But some lawmakers inside and outside the governing coalition disagree with Vitia's inclusive approach and say the proposed bill would unleash a whole new set of problems.
Albena Reshitaj, a deputy for the national conservative opposition Alliance for the Future of Kosovo (AAK), said she agreed in principle with a new law on IVF, but the second draft included "many defects." Patients, she said, and possibly the wider public, should have access to sperm or egg donors' details. Reshitaj said that children should have the right to know the identity of their biological father once they reach adulthood and is seeking tighter sanctions for noncompliance. "My desire is for this draft law to be put into operation once we vote on it," Reshitaj told RFE/RL's Balkan Service, rather than it being struck down in the country's Constitutional Court.
Self-Determination lawmakers Eman Rahmani and Visar Korenica have openly opposed the bill's extension of IVF services to individuals, instead of just couples, calling it a threat to the institution of the family. Korenica has suggested he has the support of at least 10 more deputies.
In 2023, the U.S.-based analytics giant Gallup ranked Kosovo 108th out of 123 countries or regions on a list of "good places" for gay and lesbian people to live. Although Kosovo's constitution has been interpreted as allowing same-sex marriage, the country's Law on the Family defines marriage as a union between "spouses of different sexes." Kosovo also does not recognize adoption rights for unmarried or transgender people.
Kosovar Bosniak lawmaker Duda Balje, who has chaired a parliamentary commission on human rights and gender equality but has publicly opposed same-sex couples, told RFE/RL that she opposed the draft law on IVF because "a woman who gives birth to a child without a father…gives birth to an orphaned child."
Balje came under fire last week after she held a meeting with representatives of the Islamic Community of Kosovo (BIK). The BIK said its representatives had discussed the draft legislation on assisted pregnancies with Balje, which it believed "contributes directly to the destruction of the institution of the family." Balje later denied that they had discussed the IVF bill at the meeting.
Contacted by RFE/RL, most representatives of religious communities declined to comment on the draft law. Only Beth Israel Kosovo, a group which represents the country's Jewish community, responded by stressing that "the institution of the family must be protected." "We are not [against] supporting a mother who wants to have children. We, as a community, are very supportive of the family," the community's chairman, Hysen Hyseni, said. "We want a law to be approved regarding artificial fertilization, but the ethical and moral part must be respected."
The office of Kosovo's ombudsperson has also expressed concerns about the current draft bill. It cited "ambiguities" in the current wording "that make it difficult to implement the law and…prevents citizens from enjoying legal protection in this area" but declined to identify the objectionable passages.
With parliament hindered by the opposition's pledge to vote only on international agreements, the bill has languished for a full year since it was first introduced on March 9, 2023.
Activist Asllani said that "besides feeling underrepresented, I think this is profoundly unfair." She said she is convinced that, if passed, the bill wouldn't encourage more single women to have children, but she said it is vital that they be given the right to decide for themselves.
"The debate has been very dehumanizing, especially toward single women," she told RFE/RL's Balkan Service. "There has been a tendency to demonize them and present them as being able to make decisions about their bodies only if they are married or in a relationship with a man."
