doi:10.1093/humrep/den204
Human Reproduction 2008
False perceptions and common misunderstandings surrounding the subject of infertility in developing countries Willem Ombelet1,† Genk Institute for Fertility Technologies, Schiepse Bos 2, 3600 Genk, Belgium 1
Correspondence address. E-mail: willem.ombelet@telenet.be
Although the consequences of the problem of childlessness are more pronounced in developing countries when compared with Western societies, local health care providers and international organizations pay little attention on this issue. The limited budgets for reproductive health care are mostly restricted to family planning and mother care. The most common misunderstanding is the ‘overpopulation-issue’. It is generally believed that the expected growth of the world population puts a real burden on the issue of infertility treatment in resource-poor countries, although recent UN reports clearly show that in most developing countries the fertility rate is dropping significantly and will fall below the threshold of 2.0 by 2050. It seems that the expected population growth in developing countries in the next decades is rather due to population ageing and not to high fertility rates. Another important issue surrounding infertility in developing countries is the so-called ‘limited resources argument’. Because the problem of childlessness is a major health problem in most developing countries, a re-arrangement of the global reproductive health care budget should be requested from local governments and international organizations taking into account the urgent need for a go-together of more successful family-planning policies and affordable simplified ART methods. Keywords: affordable; assisted reproduction; developing countries; limited resources; population growth
Introduction In developing countries, unwanted childlessness creates a more profound problem when compared with Western societies. This is related to the fact that having children in developing countries has an important influence not only on the personal wellbeing of a couple, but also and even more pronounced on the women’s status within the couple, within the extended family and the community at large (van Balen and Gerrits, 2001). Children are highly valued for socio-cultural and economic reasons and childlessness often leads to psychological, social and economical burden, especially for women (Dyer et al., 2002, 2004, 2005). The social stigma of childlessness still leads to isolation and abandonment in many developing countries (Ebomoyi and Adetoro, 1990; Leke et al., 1993; van Balen and Gerrits, 2001; Giwa-Osagie, 2002; Daar and Merali, 2002), but the magnitude of the problem differs between different geographic areas because of different †
Chairman of the scientific committee of the Flemish Society of Obstetrics and Gynaecology. Coordinator of the ESHRE Special Task Force on ‘Developing countries and infertility’
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religious, ethical and sociocultural influences (Leke et al., 1993; Serour, 2002, 2006). Although the United Nations International Conference on Population and Development in Cairo in 1994 agreed on making reproductive health care universally available no later than 2015 (Table I), the progress that was made since than has fallen a long way short of the original goal (Fathalla, 2007). Until very recently the problem of infertility in developing countries has been ignored at all levels of health care management, not only in the developing countries themselves but also from an international viewpoint. This attitude of local governments in developing countries can be explained by a serious underestimation of the problem of childlessness and a lack of facilities and affordable treatment options. Even more important is the observation that in almost all resource-poor countries infertility is not a priority for the health authorities and the only destination of the limited resources spent on reproductive health is primary health care with two main objectives: to promote family planning services and to reduce maternal mortality and morbidity. This is easy understandable by the fact that the most common underlying
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