Perspectives on access to in vitro fertilization in Portugal

Abstract

OBJECTIVE:To analyze users' reasons for choosing in vitro fertilization treatment in public or private services and to identify their suggestions for improving fertility treatment. METHODS:A qualitative study using an interpretative approach was conducted. Fifteen semi-structured interviews were conducted with patients undergoing in vitro fertilization treatment (nine women, one man and fi ve couples) at home or at their workplace in the districts of Viana do Castelo, Braga, Porto and Lisbon, Portugal, between July 2005 and February 2006. RESULTS:Users evaluated access to in vitro fertilization treatment in public and private services based mainly on their individual experiences and called for more access to less costly, faster and friendlier care with suitable facilities, appropriate time management and caring medical providers. These perceptions were also associated with views on the need for fi ghting stigmatization of infertility, protecting children's rights and guaranteeing sustainability of health care system. Interviewees sought to balance reduced waiting time and more attentive care with costs involved. The choice of services depended on the users' purchase power and place of residence and availability of attentive care. CONCLUSIONS:Current national policies on in vitro fertilization treatment meet user's demands of promoting access to, and quality, availability and affordability of in vitro fertilization treatment. However, their focus on legal regulation and technical-scientifi c aspects contrasts with the users' emphasis on reimbursement, insurance coverage and focus on emotional aspects of the treatment. The study showed these policies should ensure insurance coverage, participation of user representatives in the National Council for Assisted Reproductive Technology, promotion of infertility research and certifi cation of fertility laboratories. The World Health Organization (WHO) established as a global goal for the new millennium to improve women's access to infertility treatment, and availability and affordability of infertility services, 6 which can contribute to the delivery of optimal infertility care. Portugal has taken this directive to task and medically assisted reproduction is a major issue in the recent structural reforms of the Portuguese health sector. MÉTODOS:Estudo qualitativo e interpretativo, baseado em 15 entrevistas semiestruturadas com pessoas que tentaram conceber por meio de técnicas de procriação medicamente assistida em Portugal (nove mulheres, um homem e cinco casais). As entrevistas foram realizadas entre julho de 2005 e fevereiro de 2006 nos distritos de Viana do Castelo, Braga, Porto e Lisboa, em casa ou no local de trabalho dos entrevistados. RESULTADOS:Os usuários avaliaram o acesso aos tratamentos de fertilidade no serviço público ou privado sobretudo com base nas suas experiências individuais, reclamando acesso mais barato, rápido e amigável, em espaços adequados, com gestão apropriada dos tempos de espera e serviços médicos atenciosos. Tais percepções fora...

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