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March 20, 2014 | Posted By Lisa Campo-Engelstein, PhD

While assisted reproductive technologies (ART) are common in most “developed” countries (the global North), in the global South (“developing” countries), ART is generally not available for a variety of reasons, most of which center around money. These resource-poor countries typically lack both qualified health-care professionals and facilities necessary for ART. Although some countries do have ART centers, the cost of ART is prohibitive for all but the extremely wealthy. Indeed, infertility is usually seen as a treatable problem only for the upper class primarily because the poor cannot afford basic health care let alone expensive treatment like ART. The fact that the majority of people in the global South cannot afford basic health care, which is typically seen as the top priority in health-care allocation, is another reason why ART are not readily available in the global South. Most public and private health-care funding goes toward primary care and not treatments that are often seen as elective and cosmetic, like ART.

Yet, infertility can be considered a health problem according to the World Health Organization's broad definition of health – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Infertility in the global South can have severe and interrelated social, economic, and health-related consequences for women. This is still the case when the woman is physiologically fertile but her partner has male factor infertility; she is the one who is generally blamed for the couple’s inability to have a biological child.

For instance, infertility adversely affects women socially by leading to lower social status and ostracism. The way women are treated by their husbands, families, and communities (e.g., how much food they eat, whether they suffer physical abuse, and whether other community members trade with them and help them) heavily depends on their social status. At the extreme, infertility can lead to social death: being expelled from the community. In countries where women are not permitted to have jobs outside the home and/or are financially dependent upon men, expulsion from the community, or even just divorce, can be socially and economically devastating.

Infertility can also negatively affect women's economic stability in other ways. For many families in the global South, the ability to reproduce is necessary for economic survival, particularly later in life. From early ages, children contribute to the family's workload and even work in the public realm to help make ends meet. Furthermore, children are often the means by which the elderly acquire basic necessities.

Some of the economic consequences of infertility, like lack of food, can lead to health-related problems, such as malnutrition. But there are health-related problems due to infertility that are independent of economic problems. For example, infertile women are more likely to be the victims of physical and emotional abuse. Also, infertile women may be denied basic necessities or forced to do extra labor.

Given the serious social, economic, and health-related consequences infertile women face in the global South, it is worth rethinking the priority placed on ART. While price is clearly a barrier, there are clinics in Africa who provide IVF for under $300 (in the US, one cycle of IVF typically costs $10,000 to $15,000). As the price of ART decreases and the number of health care professionals and clinics specializing in ART increases, ART will hopefully become more affordable and accessible to women in the global South.

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The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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