A blog post written by Andrea Sprockett, Chief Operating Officer at Metrics for Management and published on SRHM. She is also passionate about equitable health service delivery.
Despite widespread recognition that reproductive health should embrace the full range of choices including contraception, antenatal and postnatal care, and safe abortion, we, as a community, too often fail to include the other side of the coin. Full reproductive choice should encompass both the ability to prevent, delay, or stop a pregnancy, but also the ability to start it. Yet prevention, diagnosis, and treatment of infertility are conspicuously absent from the reproductive health conversation.
For example, the 2030 Sustainable Development Goals fail to include infertility, despite Health Goal 3’s aim to achieve universal access to sexual and reproductive health care. This neglect for supporting fertility services persists despite data that show it affects an estimated 49 to 186 million people worldwide, or approximately 15% of all couples. For the sake of comparison, the United Nations estimates 142 million individuals have an unmet need for contraception. Despite huge advances in medical technology, its prevalence has not budged, or has even increased slightly, since 1990. Although new techniques are available to prevent, diagnose, and treat infertility, access remains low, and global attention to and concern for infertility has changed little from its low level 20 years ago. Infertility remains a devastating social, psychological, economical, and personal burden, and, for many, results in decreased quality of life. In many cases, we know how to address infertility, and yet it remains an overlooked and neglected disease.
Ethically, individuals and couples dealing with infertility have as much right to choose the timing and spacing of their families as those seeking to limit family size. The two are not antithetical, and should work together as part of a human right to healthcare. As Dr. Mahmoud Fathalla from the World Health Organization (WHO) stated in a 2010 WHO Bulletin, “In a world that needs vigorous control of population growth, concerns about infertility may seem odd, but the adoption of a small family norm makes the issue of involuntary infertility more pressing. If couples are urged to postpone or widely space pregnancies, it is imperative that they should be helped to achieve pregnancy when they so decide, in the more limited time they will have available.” Beyond addressing this human right, we also need to recognize the reproductive injustice that the wealthy are able to access and afford care, while the poor are not, effectively giving wealthy individuals more reproductive agency to address their disease.
While underserved, infertility is not entirely absent from the global development landscape. A few global initiatives, such as the 2012 United Nations Committee on Population & Development resolution or the 2016-2030 Maputo Plan of Action for comprehensive sexual and reproductive health services in Africa include mention of infertility prevention and treatment. In addition, the WHO’s Human Reproduction Programme includes work on infertility. Yet, comparatively little funding is available for infertility services. In 2017, we saw US$11.3 billion committed to sexual and reproductive health, where the vast majority (70%) is allocated to HIV treatment and prevention. Only 16% of this funding went to supporting other critical global health services, including prenatal care, delivery, postnatal care, prevention and management of abortion complications, and safe motherhood activities. Prevention and management of infertility was included within this “other” category, receiving just a fraction of that funding.
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