Saturday, 28 January 2012

Infertility Treatment in the Developing World

Global demand for Assisted Reproductive Technology (ART) is undeniable however; the cost and difficulty of providing such interventions are highly debated. The high price of fertility treatment in the developing world means that these treatments are available only for a small minority of those who need and want them. Currently ARTs and expanded reproductive health care services targeting infertile couples are extremely limited in all developing nations. Furthermore, because infertility treatment is often synonymous with expensive
and controversial ARTs. It is unlikely that those services will become a public health priority for developing country governments or international health aid organizations.

Despite these challenges, many developing countries have been seen the introduction of new reproductive technologies through a global transfer of technology. The World Health Organisation (WHO) has recently received several requests for advice on the introduction of ARTs into resource-poor settings and the number of ART clinics in developing countries is rising. Additionally, infertility consumer groups are now established in several of these countries. By 2001 there were eight clinics offering ARTs in sub-Saharan Africa (located in Nigeria, Senegal, Zimbabwe, Cameroon, Togo and Ghana) and many others offering artificial insemination. African examples demonstrate that ARTs are feasible and can be successful in low-resource settings where staff are trained and equipment is available. The great social focus on family and children in Africa means that ARTs could not fail to generate interest and excitement. In most of all areas of the developing world, ART treatment, when available, will be eagerly sought despite negative physical, social, or financial consequences, because of infertile couple’s hopes of having a child.

Conversely, because treatment success rates are low and a majority of patients do not achieve a viable pregnancy, it is important to acknowledge that the Western standard of care many not be a worthy goal. New reproductive technologies are not a panacea for treatment of infertility; low “take-home baby rates” can be cruel and expensive chimera for infertile couples. Extensive media coverage of new infertility treatment has the negative side effect producing an unrealistic expectation of new technologies. Western physicians often encourage women to take physical, emotional and financial risk through repeated use of expensive and often unsuccessful reproductive technologies. The focus on high-tech treatment should not come at the expense of failure to acknowledge the importance of prevention, lower tech solutions, waiting, advocating for adoption or fostering, or the cessation of treatment and the acceptance of infertility.

In some parts of the world, infertile couples treat their childlessness with assistance from their social network instead of technology. Alternative routes to parenthood exist in many cultures. In Anglophone Africa, many ethnic groups treat male infertility through surrogate fatherhood whereby a woman whose husband is considered infertile is given permission by her husband’s family to have intercourse with her husband’s brother or another close relation in attempt to become pregnant. The matter is not discussed openly but any resulting child is raised by the woman and her infertile husband as their child. This process is similar to the modern medical treatment for infertility known as donor insemination where a sperm from a person besides a woman’s husband or partner is placed inside a woman’s cervix in attempts to achieve pregnancy. In some African cultures an infertile woman “marries” a younger wife to bear children for her husband when she is unable to. This is still practiced by the Ibos and Edos of Nigeria. The younger wife is often a relation, sometimes a cousin or sister, of the older infertile wife and the wives often live together with the husband and children. It is also possible that the younger wife lives separately while her children are brought up as the children of the older wife and the husband. Among these groups approaches to parenthood are fairly versatile and an interesting interplay of modern and traditional concept is used to solve problems posed by infertility.

While not a treatment for infertility per se, adoption or fostering is often recommended as a solution to involuntary childlessness. The degree to which this is culturally and individually acceptable varies. Studies show a widespread lack of adoptable children and social custom that resist both giving up and taking in children. Despite these barriers, with better information and counseling, adoption is being used increasing in developing countries. Formal adoption is an expensive option for resolving childlessness however, often significantly more expensive than treatment. As with medical therapies, most adoption expenses are paid out-of-pocket by the adopting individual or couple. When considering adoption or fostering as a solution to infertility it is important to remember that conditions that cause infertility can have other negative effects as well. Therefore, treatment may be necessary in some cases and should be explored.

In conclusion, many treatments for infertility exist but the degree to which they are available and acceptable to infertile couples varies considerably by geographical location and access to resources. Even with unlimited resources, not all infertile couples can be successfully treated. Prevention and socially-controlled options such as adoption or acceptance of childlessness are other important means of resolving the devastating consequences of involuntary childlessness. There is much work to be done in order to make treatment more accessible to those in need and the burdens of infertility less for all who struggle with them.

1 comment:

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