Barriers to Accessing Fertility Treatments in Ghana

In Ghana, having children is deeply valued. Families believe that children bring happiness, maintain family connections, and ensure stability in marriages. In a society where there are no formal support systems for the elderly, having children is seen as a way to secure social and economic support for parents as they age. Unfortunately, Infertility can create serious issues for couples. It's estimated that about 12% of women and 16% of men in Ghana face infertility.

The leading causes of infertility in Ghana are issues related to blocked fallopian tubes and severe male problems. Many couples are seeking medical help through assisted reproductive technology (Art) to achieve their dream of becoming parents. ART refers to medical procedures that help with conception by working with eggs, sperm, or embryos outside the body. The most common methods include in-vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI).

For Ghana's population of approximately 30 million, around 45,000 IVF cycles should be performed each year to meet the needs of couples requiring fertility Treatments. However, there are only a few ART centers in Ghana, and they are unable to provide the necessary number of treatments. For example, in 2020, just four of the 15 ART centers reported conducting 677 cycles. This indicates a significant gap between the demand for ART services and the supply available.

In developed countries, strict laws often limit access to infertility treatment. In Ghana, the reasons for limited access to ART services are not well understood. Research shows that high Costs of treatment, a lack of ART centers, socioeconomic challenges, and a shortage of trained professionals all contribute to the difficulty in accessing these services.

#Researching ART Access in Ghana

To understand the barriers to accessing ART services in Ghana, a study was conducted across 22 fertility centers from July 1 to July 31, 2024. Researchers gathered information from 61 ART professionals through a structured questionnaire sent via an online app. This questionnaire included questions about the professionals' demographics, training, work experiences, and the types of services they provided. Additionally, another questionnaire was given to patients who had stopped their treatment at a private fertility center called Hallmark Medicals in Kumasi.

Approvals for conducting the study were obtained ethically, and participants provided informed consent before participating. The data were analyzed using statistical software.

#Demographics of ART Professionals in Ghana

Most ART professionals surveyed were male. The age group of 30 to 49 years made up a significant portion of the participants. The professionals included embryologists, fertility nurses, and a very small number of psychologists specialized in fertility. Education levels varied, with many having achieved a clinical fellowship or postgraduate degrees.

Training for these professionals often came from mentorship, with some having attended clinical fellowship programs. A significant number had received their training in Ghana, while others had gone abroad, mainly to India and Europe, for further education in ART. The experience levels varied, with many professionals having less than five years of practice in ART.

#ART Services Offered and Challenges

Most ART professionals were involved in a wide range of services related to infertility, including IVF for single women and commercial surrogacy. However, a large number identified high costs as the main barrier to accessing ART services. Additionally, poor awareness of ART services among potential patients was also considered a significant issue. Very few professionals thought that religious beliefs affected access to ART.

#Characteristics of Women Who Stopped Treatment

A group of 104 women who had stopped their fertility treatments was studied to gather more insights. Many of these women were in their thirties or forties, with a considerable percentage being Christians and married. A small number had no partners.

Most women who sought treatment had experienced infertility for two to five years before visiting a center. Many of the couples lived together, but a notable portion were in long-distance relationships, with some partners residing abroad.

Women often learned about ART services through word-of-mouth recommendations rather than through traditional media or health professionals, which was the main source of information for ART services.

#Causes of Infertility and Treatments Received

Among those who defaulted on treatment, common diagnoses included fibroids, unexplained infertility, and blocked fallopian tubes. Fibroids were present in about a quarter of the cases. Treatment options offered included IVF, ovulation induction with timed intercourse, and intra-uterine insemination (IUI). However, many women had not undergone any previous treatment before seeking help from fertility centers.

#Reasons for Stopping Treatment

High costs of treatment were the most frequently mentioned reason for stopping ART services. Other reasons included lack of partner support and non-availability. This highlights the financial burden that couples face when seeking fertility treatments.

The high costs of ART services in Africa can be traced back to the expenses involved in setting up these facilities, the high operational costs, and the limited number of available clinics compared to the demand for services. Achieving access to affordable ART services remains a significant challenge, particularly in Ghana.

#Conclusion

The study of ART services in Ghana reveals significant barriers that individuals and couples encounter when trying to access infertility treatments. The high costs, lack of partner involvement, and insufficient awareness of available services contribute to the difficulties faced by those dreaming of parenthood. Although ART professionals in Ghana are well-trained and capable, the need for better access and equity in ART services remains.

By addressing financial, educational, and regulatory challenges, Ghana can create a more equitable environment for those seeking ART services. It is essential to advocate for policies that will help reduce costs and improve access, ensuring that all individuals have the opportunity to utilize reproductive technologies as they navigate their journeys through infertility.