Basic Tool 3: How To Overcome Societal Barriers To Fertility Care

Tool 3

Action 10. Strengthen Public and Private Networks to Provide High Complexity Treatments Action 8. Identify Organizations that Can Encourage Infertility Awareness and Influence Decision Makers Action 9. Provide Training to Diagnose and Treat Low and Middle Complexity Infertility at PHC Setting Action 1. Identify and Reduce Socioeconomic, Demographic, Religious and Cultural Barriers Action 2. Identify and Manage Competition of Infertility with Other Sexual and Reproductive Health Conditions Action 3. Identify and Improve Inadequate Health Care Networks and Untrained Personnel Action 4. Identify and Improve Inadequate Infertility Risk Factor Education and Insufficient Male Partner Involvement Action 5. Identify Primary Health Providers (PCP) and Primary Health Care (PHC) Clinics to Develop Community Educational Programs Action 6. Identify the Infertile and Develop Protocols to Transition to Appropriate Care in the Health Network Action 7. Evaluate the Psychosocial Impact of Infertility in the Family
Tool 3

Action 7. Evaluate the Psychosocial Impact of Infertility in the Family Action 6. Identify the Infertile and Develop Protocols to Transition to Appropriate Care in the Health Network Action 5. Identify Primary Health Providers (PCP) and Primary Health Care (PHC) Clinics to Develop Community Educational Programs Action 4. Identify and Improve Inadequate Infertility Risk Factor Education and Insufficient Male Partner Involvement Action 3. Identify and Improve Inadequate Health Care Networks and Untrained Personnel Action 2. Identify and Manage Competition of Infertility with Other Sexual and Reproductive Health Conditions Action 1. Identify and Reduce Socioeconomic, Demographic, Religious and Cultural Barriers Action 9. Provide Training to Diagnose and Treat Low and Middle Complexity Infertility at PHC Setting Action 8. Identify Organizations that Can Encourage Infertility Awareness and Influence Decision Makers Action 10. Strengthen Public and Private Networks to Provide High Complexity Treatments
  1. Identify and reduce socioeconomic, demographic, religious and cultural barriers: In most countries infertility is not considered a disease and treatment costs must be paid by the individual, usually making them unaffordable and therefore not accessible. Frequently religious and cultural barriers also limit access to care. When these socioeconomic, religious and cultural barriers are identified it is often possible to take some steps to reduce their impact on limiting access to infertility care. Whenever possible, adapt the provision of health care to the best options considering these barriers.
  2. Identify and manage competition of infertility with other sexual and reproductive health conditions: Infertility has to compete with other reproductive health problems considered as being more important. Nevertheless, it is usually possible to share physical resources if healthcare personnel can be trained in simple infertility care.
  3. Identify and improve inadequate health care networks and untrained personnel: In general, there is little communication between Primary Health Care (PHC) clinics and referring hospitals where infertility is diagnosed and treatments provided. Potential lines of communication from the PHC to Tertiary Health Care (THC) centres and resources should be identified and used to refer patients.
  4. Identify and improve inadequate infertility risk factor education and insufficient male partner involvement: The implementation of sex education in schools can reduce the incidence of sexually transmitted infections (STIs) and unwanted pregnancy. Involving males in education and the male partner in infertility treatment can reduce STIs and unwanted pregnancy and improve the quality of family life and the outcomes of fertility treatment.
  5. Identify Primary Care Providers (PCPs) and Primary Healthcare Clinics (PHC) to develop community educational programs: PCPs should be trained to educate the community regarding reproductive health and prevention and treatment of infertility, including the role of social factors such as local/religious beliefs and impact of age on fertility. The interconnection of infertility with general health, reproductive health and quality of life should be emphasized.
  6. Identify infertile couples and develop protocols to transition to appropriate care in the health network, especially between PHC and upper level of care: Identify those with infertility; and further educate them on the effect of age of the female partner, years of infertility, recurrent gynecologic infection, unsafe termination of pregnancies, and other risk factors. Those with expected normal fertility can be educated and advised to wait in order to avoid unnecessary interventions. Those with identified severe problems should be referred as appropriate.
  7. Evaluate the psychosocial impact of infertility in the family: The large impact of infertility on the patient, her partner and their families should be assessed and used to help the patients and other affected/involved individuals.
  8. Identify organizations that can encourage infertility awareness and influence decision makers: Since infertility does not constitute a priority in the health agenda of most countries, it is necessary to identify (women) leaders, law makers and others who are sensitive to those suffering from infertility. These organization leaders should be educated about infertility and solutions they could help implement to improve access to quality infertility care.
  9. Provide training to diagnose and treat low and middle complexity infertility at the PHC setting: In order to restrict the referrals to only high complexity treatments, it is important to develop the capacity to deal with low or middle complexity treatments at the PHC level by training health providers such as nurses and midwives.
  10. Strengthen public and private networks to provide high complexity treatments: Strengthening and cooperation of both public and private networks to bring more cost-effective simple treatments in the public clinics and less expensive complex treatments in the tertiary care hospitals will enable more patients to access the care they need.