article · Sexual and Reproductive Health Matters
Access to assisted reproductive technologies across sub-Saharan Africa faces significant challenges, with local healthcare experts offering diverse perspectives on how to address them. Qualitative interviews conducted between 2021 and 2023 with fertility specialists, embryologists, and clinic management across six countries highlighted multiple barriers. These obstacles include high treatment costs, an absence of public funding, limited policy prioritisation, few facilities, long travel distances for patients, and over-servicing in private clinics. All interviewed specialists agreed that government funding for public sector assisted reproduction is necessary to expand access. Proposed clinical strategies to lower costs included adopting mild stimulation protocols and performing oocyte retrieval under sedation rather than general anaesthetic. However, experts noted that a lack of clinical data on low-cost options and a severe shortage of skilled embryologists hinder implementation, while few proposed reducing clinic or pharmaceutical profit margins.
Infertility affects many individuals across sub-Saharan Africa, yet assisted reproductive services remain largely out of reach. Understanding the operational, clinical, and financial barriers identified by regional practitioners is vital. This knowledge can help health authorities, policymakers, and service providers design more affordable, publicly supported treatments and expand specialised medical training programmes to meet pressing patient needs.
The findings outline practical opportunities for developing lower-cost treatment protocols, such as simplified mild stimulation regimens and reduced-anaesthesia procedures, as well as targeted training programmes for embryologists. The primary users would be public and private fertility clinics and healthcare providers. Because experts cite a lack of data on low-cost interventions as a key barrier, these approaches remain at an early, exploratory stage requiring further clinical validation before wider rollout.
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Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.
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DOI: 10.1080/26410397.2024.2355790
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