A reason to be proud

Stefania Zaccari is no stranger to recruiting payers and physicians to our ever-growing stakeholder network. However, this Pride month, Lightning Health is flipping the discussion guide on our Director of Stakeholder Engagement and taking the rare opportunity to interview her. In conversation with her, Nick Stringfellow Senior Analyst at Lightning Health, explores the immense struggle Stef underwent to achieve US citizenship for her children, impacted by the fact that her and her US-born wife were in a same-sex marriage.

When Stefania Zaccari and her wife (at the time), Allison, went to the U.S. Embassy, London, in 2015 to register their new-born baby as a U.S. citizen, they had no idea of the struggle they were about to embark on.

Having entered into a civil partnership in 2009 which was subsequently converted to a marriage in 2015, following the Marriage (Same Sex Couples) Act, the couple had long been planning their future family. Living in London at the time, Italian-born Stef and US-born Allison had no expectation that the ease at which their child would receive US citizenship would hinge on which parent decided to carry the child. They decided to take it in turns, with Stef carrying their first child, a boy, born in 2015. The terminology of the birth certificate stated Stef as the mother with Allison as his other parent. Shortly after the birth, the couple travelled to the U.S. embassy to register their son as a US citizen, based on Allison being both a parent, and legally Stef’s wife.

However, when there, the couple were told they were unable to register him on this basis. They were subjected to an intrusive line of questioning regarding who the donor had been, which they felt was irrelevant with Allison clearly labelled as the other parent on the birth certificate. The couple left the embassy disheartened.

Stef said, "It was frustrating, upsetting and gave me the feeling of injustice. It felt like we were being penalised for being a same-sex couple because, if we were an opposite-sex couple, these questions wouldn’t have been asked. It seemed that if the donor had been American, it may have been easier to get the citizenship rather than through Allison who’s my son’s other mother.”

In 2017, Stef and Allison welcomed their second son, this time carried by Allison and using the same donor as their first born. The couple returned to the U.S. Embassy and tried to register their children as US citizens. Their newborn son’s birth certificate named Allison as his mother, and he was granted citizenship. However their older son was denied for a second time.

Instead of dissuading the couple, the experience gave them the strength to say that enough was enough, and out of principle, decided it was time to fight for justice. They got in touch with the nonprofit organisation, Immigration Equality, who specialise in advocating for LQBTQ+ people in the US immigration system. Immigration Equality took on their fight and partnered with law firm Sullivan & Cromwell who agreed to represent the couple on a pro-bono basis, to file a lawsuit against the US government over their decision to deny the couple’s first child US citizenship.

Part of Stef and Allison’s confidence to go ahead with the process, came from the fact that Allison was a lawyer. Unlike many other couples in a similar position, she was able to navigate the options available to her from the perspective of a lawyer, understanding the US courts, processes and the legal language used. The couple were not discouraged by the complexity and potential expense involved, allowing them to take on what others had not felt able to before.

The case hinged on the fact that the antiquated law pertaining to hereditary citizenship in the US only acknowledged married parents, regardless of that being same-sex or not. Therefore, as Stef and Allison had been married at the time of birth, both children should be considered US citizens. The State Department, however, had a policy not to recognise the US citizenship of children born to same-sex couples, unless the US parent was the genetic or gestational parent.

Shortly before the case was set to go to court, the Biden administration came into power, bringing with it a new Secretary of State, which was the office that the couple had been litigating against. The new administration decided to change their policy and allowed US citizenship to be recognised for the couple’s oldest son. The case impacted not only their son, but all other children in the same position, whose US citizenship would be recognised both retrospectively and in the future.

The process was a huge undertaking for Stef and Allison, beginning in 2018 and not being completed until July 2021. When the case was finally dismissed, Stef was shocked by the speed at which the citizenship documentation was processed, arriving at her house only a week later. The delivery was accompanied by an immense feeling of happiness and justice for the couple.

“It was an amazing feeling, especially due to the fact that it solved the same issue for other people in the same position”, said Stef.

Due to the Covid restrictions at the time, the couple, who had relocated to New Jersey during the process, celebrated with a party in their backyard, joined by not only friends and family, but also the lawyers that had represented them during the case.

On a personal note, this story acts as a fantastic example of how the fight for equal rights is far from over. During my discussion with my colleague and good friend Stef, I was shocked to understand just how recently this had happened. As an LGBTQ+ person living in the progressive city of London, you can easily take for granted the level of acceptance such places offer, forgetting that these views are not always so widely shared.

We must use Pride month in part to remind ourselves that the world is not perfect, the fight is far from over and nor is likely to be in the next 20 years. However, when we look back over the past 20 years, it is clear that significant progress has been made, and much like Stef did after finally receiving US citizenship for her son, we must also use Pride as a time to celebrate these achievements.