Wednesday, 22 February 2012

Why Infertility Should Be Considered a Public Health Issue

I would now like to examine reasons for including infertility as an issue of public health concern. It is important to again emphasize that childlessness is only problematic when it is undesired; many people freely choose to not have children. While those who voluntarily do not have children are often regarded as atypical, parenthood should be an individual choice, made privately, free from coercion. My arguments therefore
pertain to those who desire to have children, but are biologically unable to do so, not to those who choose not to have a family.

In light of the prevalence, causes and consequences of infertility, a significant case for naming the condition as a public health issue can be made. While the population-level focus of public health suggests that issues which affect only a limited number of individuals would not likely be considered public health concerns, infertility is common, with an average of one in ten couples of reproductive age experiencing difficulty in becoming pregnant and a portion of every population on the globe affected. Furthermore, the high prevalence is actually an underestimate, with the real percentage of the population affected likely to be greater.

Public health concerns itself with the protection, promotion and restoration of the
people's health; if a health condition cannot be prevented or treated, the role of public health in dealing with it is limited. While there is a core prevalence of infertility which unfortunately cannot be prevented; the majority of cases in the developing world and a portion of the cases in the developed world are due to preventable causes. The field of public health therefore has a role to play in educating the public and preventing infertility caused by preventable factors such as infection, environmental and occupational toxicant exposure, and human behaviors. Additionally, many cases of infertility can be successfully treated, and other means to resolving infertility also exist.

The consequences of infertility vary dramatically depending on many factors. At the very minimum, unwanted infertility causes decreased levels of well-being, with more severe social, economic, and health consequences extremely common in the developing world. (1) The negative physical, emotional, and psychological health effects may not be easily seen or widely known, however they are widespread. The failure to recognize infertility as an issue with severe negative health effects exacerbates the pain of affected individuals and couples. Infertility is a complex disease and difficulties arise in preventing, diagnosing, and treating it. However, the large numbers of people affected, the devastating consequences, and the ability to prevent or treat its effects are strong arguments for naming infertility as a public health issue. Other arguments for recognizing unwanted childlessness as an issue of public concern include: the dual personal and social nature of infertility, the unique relationship between infertility and HIV/AIDS, the potential to improve the suffering caused by infertility with public health tools, and human rights demands to provide comprehensive reproductive health care.

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