After five years of trying to become pregnant, Laxmi (name changed), who lives in a low-income neighborhood of a lower-middle income country, remains childless. She has been on an exhausting journey. Years of failed consultations with doctors, visits to clinics, temples, and religious leaders, has left her feeling distraught and ostracized.
“I have given up on medical treatment. It is up to God now,” said Laxmi.
Her husband has not undergone any testing to assess if he was contributing to their inability to achieve pregnancy. The couple’s infertility, has led to Laxmi being labelled as ‘inauspicious’ by her own family. This has also taken a toll on her physical, mental, emotional, and social well-being.
Laxmi’s story is not an isolated one; it is shared by millions in all world regions. Across countries and cultures, a lack of accurate evidence-based information, together with socio-cultural pressures to have a child, and the subsequent stigma associated with the inability to have one, causes serious mental health and well-being issues, that are often not discussed, let alone addressed.
Furthermore, as in Laxmi’s case, the burden and the blame for infertility often falls on women alone, adding to the complexity, even though infertility can be caused by male, female, or unexplained factors.
With advances in medicine, there are well-known and effective interventions for the prevention, diagnosis and treatment of infertility, but the reality is that fertility care is not universally available or accessible. In many countries, treatment for infertility is not included in health insurance schemes or benefit packages, making it very expensive.
A recently published scientific article shows that cost of a single cycle of in vitro fertilization (IVF), in many low and middle-income countries, is more than the average annual per capita income.
To generate evidence that substantiates these lived experiences and make a data-driven case to include infertility in the global reproductive health agenda, the World Health Organization (WHO) released the Infertility Estimates, from 1990 to 2021. The findings of the report show that 1 in 6 people globally are affected by infertility in their lifetime.
“Given the global magnitude of infertility, and its negative impact on people’s lives and wellbeing, there is a clear need to make fertility care services widely available, accessible and affordable,” said Dr Gitau Mburu, a Scientist within the Contraception and Fertility Care Unit at WHO. “Efforts to address infertility should be part of universal health coverage. This should include financial risk protection to prevent households incurring catastrophic health expenditure on medically assisted reproduction.”
“We need to destigmatize infertility and change it from something that makes people feel unwanted in society,” noted a social scientist who is part of a team of researchers collaborating with the WHO to conduct a study on the impact of delayed conception.
To leave no one behind, we need to break the silence on infertility. There is a critical need for all stakeholders to acknowledge that infertility is a serious health issue, experts say.
“Evidence is noticeably clear that infertility is a significant problem, yet it has been neglected in the global sexual and reproductive health and rights agenda,” said Professor Marie Thoma, a researcher based at the University of Maryland, who has been part of the team that gathered data for the infertility estimates.
The infertility prevalence report is the first of its kind from WHO in more than a decade, and points toward an important public health problem, that is affecting people in all countries and all parts of the world.
WHO is calling on all governments and stakeholders to recognize infertility as an issue that requires attention and collaboration to provide evidence-based medical, clinical, and psychosocial interventions. Accordingly, countries need to focus on enhancing availability, accessibility, affordability, and quality of interventions, without stigmatizing the prevention, diagnosis, or treatment of infertility.