In low-resource settings such as Nigeria, accessing basic assisted reproductive technology treatments can be challenging or impossible for many couples who want to conceive. Many fear the negative consequences of childlessness resulting from societal pressure. Couples who cannot conceive often experience emotional and psychological trauma. Sadly, societal norms dictate that the woman is the cause of the infertility, ignoring male infertility. Infertility comes at a high price financially, emotionally and physically for many couples in Nigeria.
The prevalence of infertility is generally higher in sub-Saharan Africa compared to most other regions. Given the poverty that exists in Nigeria, where 92.4% of the population live on less than 2 USD a day, the high cost of infertility treatments is associated with a significant risk of catastrophic health expenditure. For example, tubal disease, which is the most common cause of infertility in Nigeria, is best treated with in-vitro fertilization (IVF), and one cycle of IVF in Nigeria costs an average of 3,289 USD. This out-of-pocket payment has the potential to create or exacerbate poverty.
Evidence suggests that many women discontinue treatment for financial reasons. In desperation, some have sought cheaper care from traditional healers such as “mamas that rub.” Mamas that rub are generally untrained providers who use herbal medicines and abdominal massage, a technique that is not supported by scientific evidence for infertility treatment, exploiting and deceiving their patients. This type of care can be dangerous for a woman’s health: Some researchers have suggested a link between abdominal massage and maternal mortality in Nigeria. Further evidence suggests that male traditional healers have sexually exploited women seeking infertility treatments.
Universal access to health care has been shown to offer protection against the financial hardship that results from ill health, as illustrated by its inclusion in the Sustainable Development Goals. Unfortunately, the absence of functional health insurance schemes in many states of Nigeria is a major barrier for couples trying to conceive continue to face challenges. Infertility care is excluded from the list of services offered in the states where health insurance schemes are currently operating and in the National Health Insurance Scheme. Thus, many couples who are struggling financially are forced to pay out-of-pocket.
Data from Quebec, Canada have demonstrated that universal coverage of IVF resulted in increased access to IVF treatments and reduced costs. Similar results were obtained in Belgium, where patients benefited from financial reimbursement for six cycles of assisted reproductive technology treatments. Insurance mandates have been found to significantly improve the utilization of effective and safe infertility treatments in some parts of the United States as well.
There is a need to raise the visibility of infertility within the maternal health care field. People in Nigeria, other low-resource settings and all over the world deserve equitable access to infertility care. Everyone has a right to enjoy the highest attainable standard of physical and mental health—and this right extends to the ability to make reproductive choices for oneself and one’s family.
By: Kingsley Agholor, Consultant Gynecologist, Central Hospital, Warri, Nigeria
Source: MHTF Blog