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

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.

Symptom Experiences before Medical Help-Seeking and Psychosocial Responses of Patients with Esophageal Cancer: A Qualitative Study

“…Unsar et al [36] showed that esophageal cancer not only imposes physical and psychological burdens on patients but also gradually increases family caregivers' anxiety and depression as the caregiving burden increases. Moreover, income levels are considered a crucial infuencing factor for patients to actively seek medical care [37][38][39]. In the case of esophageal cancer as a chronic disease, expensive follow-up treatment can place a heavy fnancial burden on families, leading to delays in seeking medical help or poor treatment adherence [40,41].…”

Out-of-pocket payment and patients’ treatment choice for assisted reproductive technology by household income: a conjoint analysis using an online social research panel in Japan

“…Among the various factors affecting fertility care utilisation (e.g. sociocultural acceptability, availability), financial accessibility is a dominant one [ 6 , 11 ]. Our findings corroborate that patients consider their out-of-pocket payment to be the most important attribute in their fertility decisions (Fig.…”

“…In response to prolonged low fertility rates in Japan, ART treatments have been covered since April 2022 [ 9 ]. Prior to that date, only eligible couples received partial subsidies for ART treatment [ 10 , 11 ]. Specifically, at the time of this survey in 2020, ART subsidies were available only to low- or middle-income patients.…”

“…Specifically, at the time of this survey in 2020, ART subsidies were available only to low- or middle-income patients. For high-income couples, the out-of-pocket payment for ART was approximately 400,000 − 500,000 JPY per cycle, or 3,300 − 4,200 euros using the 2020 exchange rate of 1 euro = 120 JPY [ 10 , 11 ].…”

Education, socioeconomic status, leisure sedentary behaviours and female infertility: Mendelian randomization study

“…For instance, recent causative analyses show an association between education level and infertility 12,13 . A largescale cross-sectional study by Iba Arisa et al found a correlation between household income and infertility clinic attendance 14 .…”