Abstract
Research questionWe analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth.DesignWe applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services.ResultsThe first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general.ConclusionsLong waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
Highlights
Since 2008, the volume of Assisted Reproductive Technologies (ART) in Spain has increased by nearly 50%, reaching 149,337 In-Vitro Fertilization (IVF) and 34,100 Intrauterine Insemination (IUI) cycles in 2018 [51, 53].Alon and Pinilla International Journal for Equity in Health (2021) 20:156Spain is the largest European ART provider and fourth globally [7, 14, 21, 33].Given that 10–15% of the entire population may suffer from infertility [1, 5], the rise in ART practices can be explained by several factors
The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics
The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service
Summary
Since 2008, the volume of Assisted Reproductive Technologies (ART) in Spain has increased by nearly 50%, reaching 149,337 In-Vitro Fertilization (IVF) and 34,100 Intrauterine Insemination (IUI) cycles in 2018 [51, 53].Alon and Pinilla International Journal for Equity in Health (2021) 20:156Spain is the largest European ART provider and fourth globally [7, 14, 21, 33].Given that 10–15% of the entire population may suffer from infertility [1, 5], the rise in ART practices can be explained by several factors. Spain enjoyed a sharp increase in the number and quality of ART clinics [51, 53], of which some have become world-leading ART corporations. Spain has the OECD’s second-highest average maternal age at childbirth (32.1 years in 2017) [43], and 1.3 children per woman, among the lowest in the world. Spaniards are among the oldest in Europe to leave parents’ home [38, 43]. These conditions have ongoingly contributed to marriage and pregnancy delay [2, 11, 18, 38]. In 2018, patients older than 40 years received more than 30% of ART cycles, while 57% of these included egg donations. Spain produces more than half the continent’s egg donations [21, 53]
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