Re-examining reproductive rights, 25 years after Cairo: Legal determinants of reproductive health in The Gambia and beyond
David Benbow, Julie Balen, Fiona Campbell
Infertility is a universal but neglected global reproductive health issue and it has been estimated that 8 to 12% of the couples worldwide are infertile (Boivin et al 2007) Estimates suggest that half of these couples are living in Sub-Saharan Africa (SSA) and South Asia (Rutstein and Shah 2004, Mascarenhas et al 2012).
Consequences of involuntary childlessness are usually more dramatic in LMICs when compared to Western societies, particularly for women (Ombelet 2011, Inhorn and Patrizio 2015). Childless women are frequently stigmatised, isolated, disinherited and neglected by the entire family and the local community (Dierickx et al XXX). This may result in physical and psychological violence, polygamy, even suicide. Because many families in LMIC completely depend on children for economic survival, childlessness has to be regarded as a social and public health issue and not only as an individual medical problem (Dyer et al 2012).
Despite its relatively high prevalence and the cultural values associated with childbearing, infertility care remains a low priority area for local health care providers and community leaders, not only on a national but also on an international level. This can be explained by two commonly used arguments; the “limited resources” and the “overpopulation” argument. The lack of infertility treatment services is mostly justified as a form of population control, particularly in high-fertility settings such as SSA and Asia. This argument therefore denies equitable access to effective and safe infertility treatment to those in LMICs.
International statements drawing upon the 1948 UN Universal Declaration of Human Rights challenge such a view. In 2020 the WHO published a fact sheet on infertility. The WHO recognises that the provision of high-quality services for family-planning, including fertility care services, is one of the core elements of reproductive health. This very important message includes the wish to do research on global etiological and epidemiological research, facilitating policy dialogue with countries worldwide on infertility care, developing guidelines on the prevention, diagnosis and treatment of male and female infertility, collaborating with relevant stakeholders to deliver fertility care globally and providing country-level technical support to develop or strengthen implementation of national fertility policies and services.
A team of researchers and practitioners from The University of Sheffield, with partners in Belgium and The Gambia, has been exploring laws, policies and access to infertility care and services in The Gambia, funded by the GCRF Pump Priming Partnership Award. This includes in-person and digital dialogues and workshops on infertility care in The Gambia, bringing together campaigners, researchers, clinicians, community leaders, policy makers and critically women for whom infertility is their lived experience, to improve awareness, guide policy and inform research. These activities have had significant impact in that infertility is now, for the first time, being integrated into the Gambian 10-year National Health Policy (2021-2030). This work is ongoing, a review paper is in draft form and we will report future progress in due course.
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