GHIC 2020: Global Health & Innovation Conference
April 4-5, 2020
Yale University, New Haven, CT

Unite For Sight's 2011 Global Health & Innovation Conference

Blog Report by Daniel Ting, Unite For Sight Global Health Leadership Intern Alumnus

"Global Infertility and the Millennial Challenge of Reproductive 'Tourism,'" Marcia Inhorn, MPH, PhD, William K. Lanman Jr. Professor of Anthropology and International Affairs Chair, Council on Middle East Studies

Marcia Inhorn’s talk delved into the world of infertility and reproductive tourism. Both are global concerns. Around the world, a staggering 15 % of couples suffer from infertility problems. In Sub-Saharan Africa, an “infertility belt” stretches from Gabon to Tanzania. There, infertility afflicts 30 % of couples. The infertility belt is influenced by an uncontrolled amount of reproductive tract infections, which indirectly cause infertility.  

Infertility is a social problem because it is associated with increased divorce rates. According to a WHO study, infertile couples have a 14 % greater chance of undergoing divorce or separation. Women in these relationships are more likely to suffer from domestic violence and to see their husbands engage in extramarital affairs.

Women carry an unfair, gendered burden of the blame for infertility. The uncorroborated notion that women are responsible for the majority of fertility problems dates from antiquity and remains pervasive today—leading a disproportionate amount of women into social stigma and economic impoverishment. Men are actually responsible for half of infertility problems. Moreover, male reproductive problems are often genetic and require assisted reproductive technologies (ARTs). Female infertility, conversely, is often hormonally or age-related.

ARTs have spread around the world in response to infertility and include technologies such as in vitro fertilization and a related technology called intracytoplasmic sperm injection (ICSI). Clinics offering these technologies have become ubiquitous in the Middle East. Notably, both Sunni and Shia Islam have been fairly open to ARTs. A key Shia leader, Ayatollah Ali Husayn al-Khamene’i, issued in 1999 a fatwa permitting third-party reproductive technologies, including surrogacy. His rationale was rooted in an attempt to preserve the marriages of infertile couples. 

Unfortunately, the introduction of ARTs has not been uniform and has led to disparity. Only 48 out of 191 WHO member states have ARTs available. The African infertility belt does not have ARTs, and there are vast undersupplies in China, India, Pakistan, and Indonesia. Disparity, coupled with powerful social forces, has driven many would-be mothers to engage in a form of medical tourism called cross-border reproductive care (CBRC). Different commodities are found in different countries. Eggs are commonly from Spain, sperm from Denmark, and surrogate mothers from India. Prohibitively expensive, these commodities and technologies have led to a stratification of their use with social class. Does this disparity represent a health—or even human right—inequity?

Various groups have attempted to reduce “stratified reproduction.” One strategy to reduce preventable infertility has been an increased vigilance to reduce infections such as Chlamydia that lead to female reproductive tract damage. Other groups, such as Low-Cost IVF (LCIVF) and the European Society of Human Reproduction and Embryology (ESHRE) have made efforts to try and decrease the cost of ART technology to the poor. Their goals are lofty, but parallel the drive to decrease costs of anti-retroviral HIV treatment in the developing world, which has been remarkably successful over the past few decades.  

Take-away messages