Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies

Abstract

Infertility impacts millions of people of reproductive age worldwide, with approximately 10–15% of couples affected. When infertility is present, there are many potential barriers to treatment, leading to inequity of access. Assisted reproductive technologies (ART) are the mainstay of medical treatment for infertility and include procedures such as in vitro fertilisation. This scoping review aims to explore the barriers to accessing assisted reproductive technologies to highlight a potential role for the pharmacist in addressing these barriers. Five databases, including CINAHL, Emcare, Medline, Scopus, and Web of Science, were searched using keywords that resulted in 19 studies that explored barriers to initially accessing or continuing ART. Studies identified more than one barrier to accessing ART, with the most mentioned barrier being the geographic location of the patient, with others themed as psychological, financial, minority groups, educational level, and the age of the patient. Recommendations were made to address barriers to accessing ART, which included changes to government regulations to increase health education and promotion of infertility. Pharmacists' accessibility, even in geographically remote locations, places them in an ideal position to address many of the challenges experienced by people accessing infertility treatment to improve outcomes for these people.

Ten years of in vitro fertilization in Indonesia: Access to infertility care in a developing country

“…5,11 Studies by Brodeur et al and Mackay et al also showed that socioeconomic and ethnic factors as infertility services access barriers. 13,14 IVF policy in Indonesia is different from other countries, in which the Indonesian legal policy prohibits gamete donor, surrogacy, and gestational carrier. 8,16 This could encourage Indonesian people to seek IVF procedures in other countries in order to undertake the methods that are prohibited in Indonesia.…”

“…On Kalimantan island, which is around 539 460 km 13,14 Geographical aspect becomes an infertility services barrier due to more time and more money that patients must spend for this service, and thus more inconvenience and social-psychological burden for the patients. 12,14 Most of the treatment cycles, however, were performed in centers located in larger metropolitan cities.…”

“…On Kalimantan island, which is around 539 460 km 13,14 Geographical aspect becomes an infertility services barrier due to more time and more money that patients must spend for this service, and thus more inconvenience and social-psychological burden for the patients. 12,14 Most of the treatment cycles, however, were performed in centers located in larger metropolitan cities. The disparity in the number of cycles performed in metropolitan cities compared to other areas in Indonesia can be attributed to the relatively high costs of IVF, fear of infertility diagnosis and its social burden, and lack of a proper referral system regarding the use of IVF.…”

“…and Mackay et al. studies 13,14 . Geographical aspect becomes an infertility services barrier due to more time and more money that patients must spend for this service, and thus more inconvenience and social‐psychological burden for the patients 12,14 …”

“…and Mackay et al. also showed that socioeconomic and ethnic factors as infertility services access barriers 13,14 . IVF policy in Indonesia is different from other countries, in which the Indonesian legal policy prohibits gamete donor, surrogacy, and gestational carrier 8,16…”