“We are only looking at the tip of the iceberg in infertility”: perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people

Abstract

Introduction Aboriginal 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. Method Semi-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. Results Providers 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. Conclusion The 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.

Inequity of Access: Scoping the Barriers to Assisted Reproductive Technologies

“…The studies published ranged in date from 2009 to 2021. While many of the studies were published in the United States (11), studies were also based in Australia (3), Canada (2), Indonesia (1), Germany (1), and Ghana (1) [ 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

“…The studies investigated barriers to people either initiating or continuing infertility treatment or both. Fourteen of the studies focused on barriers to initiating ART, with barriers to continuing treatment being the focus of 4 studies [ 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. One study discussed both initiating and continuing fertility treatment [ 29 ].…”

“…However, there are other barriers that exist which prevent patients from initially accessing and/or continuing ART. As ART is a specialist medical service, facilities are generally only located in metropolitan and large regional areas, with greater populated cities providing more choice of service [ 7 , 8 , 9 , 10 ]. ART comprises complex treatments and stressful procedures, including daily self-administered injections, blood samples, ultrasound, and laparoscopic surgery, and involves a multidisciplinary team of medical specialists, midwives, registered nurses, laboratory staff, sonographers, administrative staff, psychologists, and pharmacists [ 11 , 12 ].…”

School-Based Education: An Opportunity to Promote Equitable Access to Sexual and Reproductive Health Knowledge

“…6 7 8 9 These groups experience higher rates of maternal mortality and morbidity, unsafe abortions, teenage pregnancies, STIs, undiagnosed infertility, and limited access to health care. 6 9 10 Progress has been slow in addressing disparities in sexual and reproductive health with social, economic, and environmental determinants of health still requiring attention. 6…”

“…6-9 These groups experience higher rates of maternal mortality and morbidity, unsafe abortions, teenage pregnancies, STIs, undiagnosed infertility, and limited access to health care. 6,9,10 Progress has been…”