title: Low priority level for infertility services within the public health sector: a Brazilian case study.
abstract: BACKGROUND
  In view of the lack of information on availability of public sector infertility services and in order to contribute to the debate on access to these services, we assessed the availability of public sector infertility services, including assisted reproduction technology (ART), in Brazil.
  
  
  METHODS
  We conducted a cross-sectional study with telephone interviews using a semi-structured questionnaire with Health Secretariats' authorities from the 26 States, the Federal District, 26 Municipal state capitals and another 16 cities with more than 500 000 inhabitants. Also, directors of 26 referral centres and teaching hospitals provide ART procedures supported by the state or university teaching hospitals.
  
  
  RESULTS
  Authorities from 24/26 State Secretariats and the Federal District, from 39/42 cities and 26 directors of referral centres and teaching hospitals offering government-funded infertility care and ART were interviewed. In 19/25 states (76%) and 26/39 cities (66.7%), no infertility treatment was available free of charge. The most common reason for lack of services at the state and municipal levels was 'lack of any political decision to implement them', followed by 'lack of human and financial resources'. When ART was available, barriers to access included the fact that patients needed to purchase medication and the more than 1-year waiting list for treatment.
  
  
  CONCLUSIONS
  Lack of political commitment results in inequity in the access of low-income couples in Brazil to infertility treatment, including ART.
authors.affiliation: Center for Research in Reproductive Health of Campinas (CEMICAMP), Caixa Postal 6181, 13084-971 Campinas, Brazil. mmakuch@cemicamp.org.br
authors.forename: María Y
authors.initials: MY
authors.lastname: Makuch
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Petta
authors.forename: Maria José Duarte
authors.initials: MJ
authors.lastname: Osis
authors.forename: Luis
authors.initials: L
authors.lastname: Bahamondes
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006291:Health Policy / Q000639:trends; D006297:Health Services Accessibility; D006801:Humans; D007246:Infertility / Q000453:epidemiology / Q000628:therapy*; D008427:Maternal Health Services / Q000600:supply & distribution*; D011057:Politics; D011634:Public Health; D017150:Public Sector; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*