Saturday, April 01, 2006

Health Disparities in Infertility Treatment

The April issue of the journal Fertility and Sterility has a special section on disparities in infertility treatment, which looks at barriers to care, disparities in treatment-seeking, the impact of insurance, socioeconomic and racial disparities, and related issues. I thought it was interesting that the authors chose to look at this issue; when people talk about health disparities, it tends to be about access to routine healthcare, cancer screening, preventive services, nutrition, and other basic health needs - it doesn't tend to be about issues that can be perceived as a luxury, that most people would not consider a fundamental need. However, the editorial author states,
"...very few studies have looked at the prevalence and receipt of infertility services by minority and low-income populations. In the United States, the costs of infertility treatments are borne primarily by couples, including an estimated 85% of the cost of IVF. Emerging evidence also suggests that there might be variation in treatment response to assisted reproductive technologies and that causes of infertility might vary by racial or ethnic group...nfertility-related disparities are likely to exist at multiple levels. First, disparities in the likelihood of facing infertility problems might be generated by disparities in age patterns of childbearing, number of children desired, and lifetime history of sexually transmitted infection acquisition and treatment. Second, disparities by income and race or ethnicity might exist in diagnosis (subfecund vs. sterile). Third, disparities might be generated by differences in access to health insurance with relevant benefits and income with which to purchase treatment services. Fourth, disparities might exist in the types of treatment available and in the response to and outcome of that treatment."
One study in the set looked at barriers to infertility treatment for Arab and African Americans in Detroit, and found income/economics to be an important factor. Another survey-based piece in the issue looked at socioeconomic and racial disparities, and again found income to be an overriding factor, but also found racial differences in the causes of infertility. Throughout the issue, the income factor arises over and over as the main disparity in access to infertility treatment.

The question is, how important is this? Should anyone have access to infertility treatment, regardless of income? Should resources be used to address this issue when other disparities may have much broader effect (such as lack of access to insurance or routine care)? Understanding differing causes of infertility in different populations may be important, but how does that relate to the importance of access to treatment? Is the ability to bear children a basic healthcare need and right, or is infertility treatment an elective luxury akin to cosmetic surgery? I think this is a touchy issue, and would be interested in your thoughts.

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MeSH Tags: Infertility; Reproductive Techniques, Assisted; Socioeconomic Factors

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