Agencies and challenged stakes involving ARTs in Mozambique: Local and transnational aspects of access, provision and use

Reproductive travel to, from and within sub-Saharan Africa: A scoping review

“…‘Outgoing reprotravel’ ( Inhorn, 2015: 58 ) by citizens of various SSA countries has been documented for treatments in the USA ( Bochow, 2015 ), Brazil ( Machin et al, 2018 ), France ( Duchesne, 2016a , Duchesne, 2016b , Epelboin, 2016 , Hörbst, 2012 , Hörbst, 2015 , Hörbst and Gerrits, 2016a , Hörbst and Gerrits, 2016b ), and destinations in the Middle East, including Dubai and Kuwait ( Inhorn, 2015 ). Travel by African citizens across borders also occurs within SSA, such as to Ghana ( Gerrits, 2018 ), South Africa ( Faria, 2018a , Faria, 2018b , Moll, 2020 ) and Uganda ( Hörbst and Gerrits, 2016a , Hörbst and Gerrits, 2016b ). Hörbst noted that in 2010, people from Chad, Burkina Faso, Ghana, Ivory Coast, Cameroon and the Democratic Republic of the Congo, as well as Malians living in Spain and France, travelled to Mali for ART, particularly after its first successful IVF/intracytoplasmic sperm injection ( Hörbst and Gerrits, 2016a , Hörbst and Gerrits, 2016b ).…”

“…Hörbst also pointed to a highly international ART clientele in Uganda, consisting of people from neighbouring countries, such as Rwanda, Congo, Tanzania and Sudan, as well as expatriates from India, Lebanon, Pakistan, Europe and the USA ( Hörbst and Gerrits, 2016a , Hörbst and Gerrits, 2016b ). Reproductive travellers have been studied in their country of origin ( Bochow, 2015 , Hörbst, 2015 , Hörbst and Gerrits, 2016a , Hörbst and Gerrits, 2016b ); at the CBRC destination ( Duchesne, 2016a , Duchesne, 2016b , Epelboin, 2016 , Gerrits, 2018 , Inhorn, 2015 , Hörbst and Gerrits, 2016a , Machin et al, 2018 ); and in both places by following reproductive travellers from their place of origin to the CBRC destination ( Faria, 2016 , Faria, 2018b , Pande, 2020 , Pande, 2021 ). People from SSA also ‘return home’ for treatments, as illustrated in research on diasporic Malians ( Hörbst, 2015 ), Ghanaian expatriates ( Gerrits, 2016 ), and South Africans living in Australia ( Rodino et al, 2014 ).…”

“…South Africa has at least 18 ART clinics (at time of writing), but the majority of these are in the private sector, and cost is a major barrier for local patients for whom attempts to access ART may result in ‘catastrophic’ costs ( Dyer et al, 2013 ). In Faria’s (2015) study, Mozambican couples travelled to South Africa because there was, at the time, no local clinic offering ART, whereas in South Africa, several public and private clinics provided IVF services ( Faria, 2018b ). Mozambique borders South Africa, and the country is a common destination for Mozambicans to shop, seek various medical and related treatments, and to holiday.…”

“…According to Tessa Moll, 2019 , Moll, 2020 , clinics in South Africa estimate that 20–40% of their patients are from other countries, and egg donor agencies report that approximately 50% of their clients are foreigners. This includes patients from central, east and southern Africa, including from Mozambique ( Faria, 2015 , Faria, 2016 , Faria, 2018a , Faria, 2018b ); Swaziland, Zimbabwe, Cameroon, Zambia, Uganda, Angola and Namibia ( Moll, 2020 ); the UK ( Culley et al, 2011 , Hudson et al, 2016 ); Germany ( Bergmann, 2011a , Bergmann, 2011b ); and Australia ( Moll, 2019 , Namberger, 2019 , Rodino et al, 2014 , Stuhmcke et al, 2020 ).…”

“…Access to ART is stratified by class and the capacity to pay for private services. The concept of stratified reproduction, originally coined by Colen (1995) , is used by several authors ( Faria, 2016 , Faria, 2018a , Faria, 2018b , Gerrits, 2018 , Inhorn, 2015 ). The lack of national health insurance schemes to cover ART reproduces and reinforces inequalities within African countries.…”