Health Equity: WHO Global Fertility Care Guidelines

Context

The World Health Organization (WHO) has released global guidelines on the prevention, diagnosis, and treatment of infertility for the first time. Their aim is to make fertility care safer, more affordable, and accessible to all worldwide.

Infertility: A Global Crisis

Infertility is increasing rapidly worldwide, but access to diagnosis and treatment remains limited. In many countries, techniques like IVF are prohibitively expensive, leaving people vulnerable to financial hardship. The WHO has identified this as a major health equity issue.

Background

• According to the WHO, 1 in 6 people of reproductive age faces infertility at some point in their lives.
• Infertility is defined as the failure to conceive despite 12 months of regular unprotected sexual intercourse (without contraception).
• Currently, in many countries, infertility treatment relies on the private sector, and patients bear the cost themselves.
• WHO Director Tedros has described infertility as "one of the most neglected global public health challenges."

Key Points

• For the first time, WHO released 40 recommendations on the prevention, diagnosis, and treatment of infertility.
• The guidelines emphasize promoting cost-effective options and incorporating fertility care into national health strategies.
• WHO recommends timely treatment of sexually transmitted infections (STIs), reducing tobacco use and unhealthy lifestyles, improving diet, physical activity, and tobacco cessation.
• The guidelines call for increasing fertility awareness in schools, primary health centers, and reproductive health facilities.
• Clinical pathways have been outlined to diagnose common biological causes of male and female infertility.
• Treatment is recommended to progress progressively from simple counseling (fertile window awareness) to more complex treatments like IUI and IVF.
• WHO emphasizes the importance of providing psychosocial support, considering the psychological impact of infertility, such as depression, anxiety, and social isolation.

Challenges

• In many countries, the cost of treatments like IVF exceeds a family's annual income by several times.
• Demand for infertility services is growing, but infrastructure is limited.
• Social taboos, psychological stress, and stigmatization of women remain issues.
• Lack of fertility care in health systems and inadequate inclusion in government programs.
• Access to diagnosis and treatment is extremely limited for people in rural areas and low-income groups.

Way Forward

• Increasing government support: Incorporate fertility testing and treatment into health insurance and government schemes.
• Providing affordable services: Develop affordable models for techniques like IVF/IUI in public hospitals.
• Awareness campaigns: Educate on fertility literacy, STI prevention, and healthy lifestyles from the school level.
• Mental health support: Ensure counseling and support services in fertility clinics.
• Equitable access: Mobile clinics, telemedicine, and training programs to increase access to fertility services for rural and marginalized communities.
• Data and research: Promote national infertility data collection and research.