Global access to infertility care in developing countries: a case of human rights, equity and social justice

Abstract

According to WHO data more than 180 million couples in developing countries suffer from primary or secondary infertility. The social stigma of childlessness still leads to isolation and abandonment in many developing countries. Differences between the developed and developing world are emerging because of the different availability in infertility care and different socio-cultural value surrounding procreation and childlessness. Although reproductive health education and prevention of infertility are number one priorities, the need for accessible diagnostic procedures and new reproductive technologies (ART) is very high. The success and sustainability of ART in resource-poor settings will depend to a large extend on our ability to optimise these techniques in terms of availability, affordability and effectiveness. Accessible infertility treatment can only be successfully introduced in developing countries if socio-cultural and economic prerequisites are fulfilled and governments can be persuaded to support their introduction. We have to liaise with the relevant authorities to discuss the strengthening of infertility services, at the core of which lies the integration of infertility, contraceptive and maternal health services within public health care structures. After a fascinating period of more than 30 years of IVF, only a small part of the world population benefits from these new technologies. Time has come to give equitable access to effective and safe infertility care in resource-poor countries as well.

Keywords: Developing countries; equity; government; human rights; infertility treatment; involuntary childlessness; low cost ART; social justice.

Fig. 1. Total fertility trajectories for the world and the major development groups, 1950-2050 (World Population Prospects: The 2006 Revision, page 6).

Fig. 2. Life expectancy at birth for the world and the major development groups, 1950-2050. (World Population Prospects: The 2006 Revision, page 12)

Fig. 3. Some of the most important foundations, NGOs and international societies linked to reproductive health. In none of these organisations “infertility care in developing countries” is mentioned as an issue they support.

Fig. 4. Differentials in total fertility by women’s education, circa 2000, for selected regions. (replacement level = 2.1). Source: Adapted from Lutz W, Goujon A. The world’s changing human capital stock: multi-state population projections by educational attainment. Population and Development Review 2001;27:323-9.