Infertility in Africa and resource ‐ constrained settings

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The central difficulty associated with infertility in developing countries is that infertility transforms from an acute, private agony into a harsh, public stigma with complex and devastating consequences.
Although male factors contribute to about half of all cases of infertility, women are also overwhelmingly perceived as being the party responsible for a couple’s infertility, and subsequently the social suffering associated with infertility tends to be greater for them than their husbands.
Discrimination against the infertile woman may include that a girl will never pass into womanhood (regardless of age) if she never becomes pregnant, are no longer marriageable and become viewed as a burden on families, communities or societies.

Violence: Intimate Partner Violence (IVP), gender ‐ based violence (GBV) and domestic violence have shown to have significant association with individuals and couples suffering from infertility.
to have significant associations with individuals and couples suffering from infertility.

Mental health: High rates of clinically significant symptoms of depression and anxiety, suicidal tendencies, and a strong conceptualization of grief affects infertile individuals.

Prevention: Lower levels of development are thought to be associated with higher levels of non‐genetic and preventable causes of infertility such as poor nutrition, untreated sexually transmitted infections (STIs), unsafe abortion, consequence of infections caused by the practice of female genital mutilation , exposure to smoking and exposure to leaded petrol and other environmental pollutants.

Reproductive Rights: Addressing &ldsquo;reproduction&rdsquo; within the public health sphere of reproductive health is important in order to fully address reproductive rights. &ldsquo;People have the capability to reproduce and the freedom to decide if, when and how often to do so.&rdsquo; As defined by the International Committee on Population and Development, ICPD.

Stigma: An inability to have a child or to become pregnant can result in being greatly ostracized, feared or shunned, may be used as grounds for divorce and will often justify a denial to access any family traditions.

Motivations for parenthood and the perceived meaning of children vary among cultures: In broad terms, in high‐income countries the desire for parenthood is expressed as a wish for personal happiness and fulfilment and children are said to be valued as they enhance the relationship and are enjoyable.

In resource‐poor settings, additional reasons are identified for the wish to have children: The continuation of the family line, compliance with religious and societal expectations, and assurance of security in old age. Replacement fertility and demographics changing reproductive health needs: No single country in the European Union and, few transitional and developed Asian countries had a total fertility rate above replacement level in 2009. Many of these countries are coming close to or already defined as, low ‐ or very low‐fertility countries

The lack of ART: regulation implies that the full responsibility for these aspects of care rests on the shoulders of the professionals running the private clinics, The costs of a single IVF treatment varies greatly across the various countries.

Geographic barriers: as in all countries infertility services are available only in the capital city or in a few big cities, expenses for travel and accommodation. Increase the total burden associated with infertility treatments. Thus, as with many areas of health care, geographical distance to clinics is an additional barrier to fertility treatment, increasing access inequity.

Private investment and self‐development:
Setting up a private fertility clinic demands a huge investment, in financial terms, in order to establish a clinic location and to buy medical instruments, materials and medicines, but also in self‐development, in order to acquire and maintain updated knowledge and skills required to provide the services of a fertility clinic. At the same time, though, there is no guarantee that the clinic will be successful, in the sense of achieving pregnancies, attracting sufficient clients and being profitable.