Expanding access to assisted reproductive technology in a developing country: getting more for less.

Abstract

Background: Infertility is a universal health burden with profound consequences in low/middle-income countries (LMIC). The global prevalence of infertility is between 8-12 % with values as high as 32 % in Central and Southern Africa, often referred to as the “infertility belt” [1]. In Nigeria, a prevalence rate of between 20-30% has been estimated due to the high prevalence of sexually transmitted infections [2]. The consequences of involuntary childlessness in a low/middle-income country can be devastating, leading to economic deprivation and impoverishing medical costs [3]. There is a high premium placed on childbearing in developing countries due to the socio-cultural beliefs and practices, yet there exists a high disparity between urban and rural dwellers with respect to accessing health care [4].

Challenge(s): There is an unmet need for assisted conception in sub-Saharan Africa as published data suggest less than 1.5% of the African population have access to assisted conception services [3]. This is further compounded by the high tubal factor infertility requiring in-vitro fertilization. Assisted conception requires significant investment in manpower and infrastructure, the cost of which is borne by the patients seeking care. Invariably, assisted conception is strenuous, time consuming, expensive, and often inaccessible to the financially vulnerable. Out-of- pocket payment for services is a major limiting factor in developing countries as insurance coverage and government support are lacking. In the absence of financial protection, out-of-pocket payments can ultimately lead to household poverty [5].

Opportunities: Expanding access to Assisted Reproductive Technology in developing countries will alleviate the impact of infertility which has been declared an issue of Public Health importance by the World Health Organization [6]. Embracing low-cost treatment protocols and partnerships via the hub-and-spoke organization design with relevant stakeholders may be the panacea in developing countries, as resources are far from equitable.

Conclusion: A paradigm shifts by government towards prioritizing infertility management against the background of a delicate balance between overpopulation and paucity of resources will provide succor to the financially vulnerable and often forgotten infertile couples.

Keywords: Access, Assisted Reproductive Technology, Developing Country.

Résumé
Contexte: L’infertilité est un fardeau de santé universel avec des conséquences profondes dans les pays à revenu faible ou intermédiaire (PRFI). La prévalence mondiale de l’infertilité se situe entre 8 et 12% avec des valeurs aussi élevées que 32% en Afrique centrale et australe, souvent appelée «ceinture d’infertilité» [1]. Au Nigéria, un taux de prévalence compris entre 20 et 30% a été estimé en raison de la forte prévalence des infections sexuellement transmissibles [2]. Les conséquences de l’absence d’enfant involontaire dans un pays à revenu faible ou intermédiaire peuvent être dévastatrices, entraînant une privation économique et une diminution des frais médicaux [3]. Les croyances et pratiques socioculturelles accordent une grande importance à la procréation dans les pays en développement, mais il existe une forte disparité entre les citadins et les ruraux en ce qui concerne l’accès aux soins de santé [4].

Défi (s): Il existe un besoin non satisfait de procréation assistée en Afrique subsaharienne car les données publiées suggèrent que moins de 1,5% de la population africaine a accès à des services de procréation assistée [3]. Ceci est encore aggravé par l’infertilité tubaire élevée nécessitant une fécondation in vitro. La conception assistée nécessite un investissement important en main-d’œuvre et en infrastructure, dont le coût est supporté par les patients qui recherchent des soins. Invariablement, la conception assistée est ardue, longue, coûteuse et souvent inaccessible aux personnes financièrement vulnérables. Le paiement direct des services est un facteur limitant majeur dans les pays en développement, car la couverture d’assurance et le soutien gouvernemental font défaut. En l’absence de protection financière, les paiements directs peuvent en fin de compte conduire à la pauvreté des ménages [5].Opportunités: L’élargissement de l’accès aux technologies de procréation assistée dans les pays en développement atténuera l’impact de l’infertilité, qui a été déclarée problème de santé publique par l’Organisation mondiale de la santé [6]. Adopter des protocoles de traitement à faible coût et des partenariats via la conception d’organisation en étoile avec les parties prenantes concernées peut être la panacée dans les pays en développement, car les ressources sont loin d’être équitables.

Conclusion: Un changement de paradigme du gouvernement vers la priorité à la gestion de l’infertilité dans le contexte d’un équilibre délicat entre la surpopulation et la rareté des ressources apportera une aide aux couples infertiles financièrement vulnérables et souvent oubliés.

Mots clés: Accès, technologie de procréation assistée, pays en développement.

Correspondence: Dr G.O. Obajimi, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: gbolahanobajimi@gmail.com

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