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. 2021 Aug 3;18(1):165.
doi: 10.1186/s12978-021-01212-w.

Household income and medical help-seeking for fertility problems among a representative population in Japan

Arisa Iba  1 , Eri Maeda  2 , Seung Chik Jwa  3 , Ayako Yanagisawa-Sugita  1 , Kazuki Saito  4 , Akira Kuwahara  5 , Hidekazu Saito  6 , Yukihiro Terada  7 , Osamu Ishihara  3 , Yasuki Kobayashi  8
Affiliations

Household income and medical help-seeking for fertility problems among a representative population in Japan

Arisa Iba et al. Reprod Health. .

Abstract

Background: Fertility treatments help many infertile couples to have children. However, disparities exist in access to fertility tests and treatments. We investigated the association between household income and medical help-seeking for fertility in Japan.

Methods: We conducted a cross-sectional study using nationally representative data from the National Fertility Survey 2015. Respondents were 6598 married women younger than 50 years old. The primary outcome was medical help-seeking for fertility among those who experienced fertility problems. Multiple logistic regression models were used to assess the association between household income and medical help-seeking, adjusting for age, length of marriage, educational level, employment status, number of children, childbearing desires, living with parents, and region of residence.

Results: Among 2253 (34%) women who experienced fertility problems, 1154 (51%) sought medical help. The proportion of help-seekers increased linearly from 43% in the low-income group (< 4 million Japanese yen [JPY]) to 59% in the high-income group (≥ 8 million JPY) (P for trend < 0.001). Respondents with upper-middle (6-8 million JPY) or high household income were more likely to seek medical help, compared to those with low household income: adjusted odds ratio [aOR] 1.37 (95% confidence interval [CI]: 1.00-1.86) and aOR 1.78 (95% CI: 1.29-2.47), respectively.

Conclusions: We found that higher household income was associated with a higher probability of seeking medical help among Japanese women who experienced fertility problem. Along with policy discussion about additional financial support, further studies from societal, cultural, or psychological views are required.

Keywords: Care-seeking; Healthcare disparities; Infertility; Japan; Socioeconomic status.

Plain language summary

Fertility treatments have helped millions of people to have a child. Although financial factors are known to play an important role in the decision to use fertility treatments, no previous studies have investigated how socioeconomic factors affect medical help-seeking for fertility in Japan. Therefore, we assessed the association between household income and medical help-seeking among couples with fertility problems in Japan, using nationally representative data from the National Fertility Survey 2015. Of the 6598 respondents (married women under 50 years old), one-third (2253) reported worrying about fertility problems, and half of those women (1154) sought medical help for fertility-related issues. The proportion of help-seekers was highest (59%) among those with high household income and lowest (43%) among those with low household income with a significant linear trend. Even after accounting for age, length of marriage, educational level, employment status, and other possibly related factors, those with higher household income were more likely to seek medical help for fertility tests and treatments. Japan provides various sources of financial support for fertility-related care, such as health insurance coverage for tests and early-stage treatments and partial subsidies for assisted reproductive technology treatments. However, the results indicate that further policy discussion about additional financial support and further studies focusing on barriers to care in Japan could help improve the situations for those with fertility problems.

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Conflict of interest statement

The authors declare that they have no competing interests with respect to this research study and paper.

Figures

Fig. 1
Fig. 1
Proportions of medical help-seekers for fertility problems among subfertile couples in each income group
See this image and copyright information in PMC

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