Barriers to assisted reproductive technology (ART) services in Ghana: a countrywide cross-sectional quantitative survey of fertility health workers and women with infertility.

backgroundFor many couples with infertility, assisted reproductive technology (ART), which involves the manipulation of both eggs and sperm or embryos outside the human body to facilitate conception, offers the only path to childbearing. While restrictive legislation is the main barrier to some ART services in many countries, a liberal regulatory environment in Ghana allows unfettered patient autonomy for all. However, these services are available only in the burgeoning capital cities of only three out of the sixteen regions of the country, patronised mainly by the middle or upper class of society. There is a dearth of evidence on the factors that limit access to ART services for most Ghanaians. This study aims to document these barriers to ART services in Ghana. MATERIALS AND

methodsA cross-sectional survey was conducted across all twenty-two (22) fertility centres in Ghana in July 2022 using two structured questionnaires administered via Google Forms and telephone interviews to censor fertility health workers (ART professionals) in these centres on their training and experience, and women with infertility who withdrew from ART treatment at Hallmark Medicals, Kumasi, on their awareness and reasons for dropping out.

resultsSixty-one ART professionals and 104 women who withdrew from ART treatment responded to the questionnaires. Mentorship from more experienced senior colleagues was the most common mode employed by 20 (32.79%) of ART professionals for acquiring knowledge and clinical skills in ART. Two out of three (65.7%) did so locally. These professionals offered all ART procedures available in Ghana, but the majority, 53 (86.89%), yearned for regulated practice. Forty-three (70.49%) identified high treatment costs and 10 (16.39%), lack of awareness, as the main barriers to ART services among couples with infertility in Ghana. Most, 92 (88.47%) of women with infertility had visited the fertility centre based on word-of-mouth recommendations, compared to 5 (4.8%), who did so following traditional and social media information. More than half, 53 (50.96%), were in their thirties, and only 32 (30.77%) were in their forties. Almost half 50 (48.08%) of them required in vitro fertilisation (IVF). A good number, 61 (58.65%), sought treatment within five years of infertility, but 73 (70.2%) withdrew from treatment because of prohibitive treatment costs and 37 (35.57%) due to partner unavailability.

conclusionEven though there is complete autonomy for all ART services in Ghana, access is limited by prohibitive treatment costs, partner unavailability, and lack of awareness. Meanwhile, the ART professionals strongly advocated regulated practice.