Abstract
IntroductionAboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group.MethodSemi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package.ResultsProviders perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men’s business and women’s business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment.ConclusionThe current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.
Highlights
Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility
Increased assisted reproductive technology (ART) utilisation is being driven by a multitude of factors such as the rise of infertility owing to the impact of lifestyle factors, [4] improved accessibility in terms the number and location of clinics, and the availability of low-cost fertility options [5]
Barriers associated with treatment costs occur in part because treatment is partially funded by the Commonwealth Government under the Medicare Benefits Scheme, [11] most treatments require co-payments, and costs vary across clinics and jurisdictions [12, 13]
Summary
Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. Remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group. Across Africa, 33 out of 54 countries (61 %) have no registered IVF unit, [6] despite elevated levels of secondary infertility in most countries [7] This contrasts with Europe where nearly half (42.7 %) of all the world’s fertility centres are based [2]. To reduce out of pocket costs, some services offer bulk-billed IVF services, lower cost treatment strategies and discounts to concession card holders, it is unclear how widespread these practices are and even with these measures the cost can remain prohibitive for some
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