Faith Nyasuguta
Over 15 out of every 100 people in Africa are suffering from infertility, according to data released by the World Health Organisation (WHO) on Tuesday.
The new estimates show limited variation in the prevalence of infertility between regions, indicating that this is a major health challenge globally. Lifetime prevalence was 17.8 percent in high-income countries and 16.5 percent in low- and middle-income countries.
Around 17.5 percent of the adult population experience infertility, showing the urgent need to increase access to affordable high-quality fertility care.
The highest pooled estimate of period infertility prevalence was in the African region (16.4 percent), followed by the Western Pacific (13 percent), the Europe (12.4 percent), the Americas region (10.4 percent) and the Eastern Mediterranean (10.0 percent).
The available statistics indicate that estimated lifetime prevalence of infertility is highest in the WHO Western Pacific (23.2 percent) and lowest in the WHO Eastern Mediterranean (10.7 percent).
A review and meta-analysis of 52 studies in 2016 reported a mean infertility prevalence of 10 percent worldwide, with pooled prevalence lowest and highest in Australia and Africa respectively.
In Kenya, primary infertility is estimated to be two percent of the 15 to 45-year-olds in unions. There the secondary infertility is 42 percent.
In Uganda and Tanzania, the primary infertility prevalence was three percent and secondary 35 percent.
Primary infertility is described as a situation where a pregnancy has never been achieved by a person while secondary infertility is when at least one prior pregnancy has been achieved.
While primary infertility data may be useful for comparisons across time and settings, high rates of secondary infertility are associated with infection-related pathology resulting from postpartum infections, unsafe abortions and some sexually transmitted infections.
“The proportion of people affected shows the need to widen access to fertility care and ensure this is no longer side-lined in health research and policy, so that safe, effective, and affordable ways to attain parenthood are available for those in need,” WHO Director-General Dr Tedros Ghebreyesus said.
Corresponding new research by the UN Special Programme of Research, Development and Research Training in Human Reproduction and WHO and published in the journal Human Reproduction Open assessed the costs associated with infertility treatments in low and middle-income countries.
The prevalence of infertility among reproductive-aged couples ranges between 12.6 percent and 17.5 percent worldwide, with relatively higher prevalence rates in some regions such as the Americas, Western Pacific, African, and European regions.
Despite the existence of Assisted reproductive technologies (ART) for over four decades, it remains either unavailable or inaccessible to most people in resource-poor settings.
WHO hopes that these estimates of infertility are required to guide planning and coordination of infertility prevention, diagnosis and treatment.
“The data in this report emphasise the need to provide access to prevention, diagnosis and treatment of infertility. However, these services are inadequate in most countries,” said Tedros.
Infertility often abandoned
With direct medical costs paid by patients for ART including fertility-related treatments ranging from $2,109 to $18,592, the report raises concern over how affordable it is for patients in is low- and middle-income countries.
“In many resource-limited settings such as sub-Saharan Africa, infertility is often neglected due to many competing health need, as well as the relatively high fertility rates.”
“In many LMICs, government-funded infertility treatments are either limited or non-existent and are excluded from health insurance packages,” the researchers said.
“Millions of people face catastrophic healthcare costs after seeking treatment for infertility, making this a major equity issue and all too often a medical poverty trap for those affected for many couples,” WHO Sexual and Reproductive Health and Research Director Dr Pascale Allotey said.
“Better policies and public financing can significantly improve access to treatment and protect poorer households from falling into poverty as a result,” Allotey added.
The researchers note that the absence of ART policies and governments’ insufficient capacity or commitment to respond to infertility means that many couples pay for their treatment out of pocket making cost an important barrier to access, likely resulting in treatment inequalities.
The WHO is advocating ART regulatory frameworks in LMICs and the integration of infertility treatment as an essential service under universal health coverage.
“It is my hope that governments use this report to develop evidence-based policies and adopt proven solutions, as part of their efforts to strengthen health systems to help people fulfil their fertility intentions and live healthier lives,” concluded Tedros.
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