Barriers To Accessing Assisted Reproductive Technology in LowAnd Middle- Income Countries: A Systematic Review

ABSTRACT : Background: The advent of assisted reproductive technology (ART) has significantly aided addressing fertility issues. However, equitable access to this intervention in low- and middle- income countries (LMICs) has been shown to be a major challenge due to several barriers. Socio-economic determinants including, but not limited to financing, cultural connotations and literacy have been shown to affect health service utilisation in low resource countries. Aim: The present study aimed to systematically review relevant literature on various barriers to accessing ART services in LMICs and interventions in overcoming them. Method: A comprehensive search was conducted in 5 electronic databases (Web of Science, PubMed, Science Direct, CINAHL Ultimate, MEDLINE), with MeSH terms using the SPIDER framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2020) guideline was employed for this review. 10 articles were included in the systematic review using the eligibility criteria and critical appraisal based on the Critical Appraisal Skill Programme (CASP) and Joanna Briggs Institute (JBI). Data was synthesised using thematic analysis. Results: The results demonstrated that cost of infertility treatment, situation of fertility centers as well as residential area of patients, poor knowledge, wrong perception, beliefs and social influences are barriers to accessing and utilising ART. The distribution of these wider determinants of health were shown to result in inequities and inequalities in accessing assisted reproductive technology. Some of these barriers were mutual with high income countries but the absence of funding and policies have made the consequences of infertility more impactful in low- and middle- income countries. Conclusion: The impact of these barriers will continually be felt in low- and middle- income countries unless there are significant strides in supporting sustainable access to ART. The presence of policies to regulate ART, subsidising of fertility treatments, proper sensitisation of the public with the inclusion of leaders of the society are some of the actions which may enhance access to ART.

KEYWORDS : Assisted reproductive technology, low- and middle- income countries, health inequalities, barriers to accessing infertility treatment.