title: The economic impact of infertility on women in developing countries ‑ a systematic review.
abstract: BACKGROUND
  It is the responsibility of health systems to provide quality health care and to protect consumers against impoverishing health costs. In the case of infertility in developing countries, quality care is often lacking and treatment costs are usually covered by patients. Additional financial hardship may be caused by various social consequences. The economic implications of infertility and its treatment have not been systematically explored.
  
  
  METHODS
  A systematic MEDLINE search was conducted to identify English language publications providing original data from developing countries on out-of-pocket payment (OoPP) for infertility treatment and on other economic consequences of involuntary childlessness.
  
  
  RESULTS
  Twenty one publications were included in this review. Information on OoPP was scant but suggests that infertility treatment is associated with a significant risk of catastrophic expenditure, even for basic or ineffective interventions. Other economic disadvantages, which may be profound, are caused by loss of access to child labour and support, divorce, as well as customary laws or negative attitudes which discriminate against infertile individuals. Women in particular are affected.
  
  
  CONCLUSIONS
  Pertinent data on OoPP and other economic disadvantages of infertility in developing countries are limited. According to the evidence available, infertility may cause impoverishing health costs as well as economic instability or deprivation secondary to social consequences. Health systems in developing countries do not appear to meet their responsibilities vis-à-vis infertile patients.
authors.affiliation: Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: S J
authors.initials: SJ
authors.lastname: Dyer
authors.affiliation: Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Patel
keywords: Catastrophic health cost; childlessness; developing countries; economics; infertility; out-of-pocket payment
references.citation: Reprod Health Matters. 2000 May;8(15):33-44
references.pmid: 11424266
references.citation: Anthropol Med. 2011 Dec;18(3):327-38
references.pmid: 22060126
references.citation: J Transl Med. 2006 Dec 27;4:54
references.pmid: 17192178
references.citation: Hum Reprod. 2011 Mar;26(3):623-9
references.pmid: 21216790
references.citation: Patient Educ Couns. 1997 May;31(1):29-37
references.pmid: 9197800
references.citation: Soc Sci Med. 2000 Jul;51(1):73-81
references.pmid: 10817470
references.citation: Cult Health Sex. 2008 Feb;10(2):159-73
references.pmid: 18247209
references.citation: Trop Med Int Health. 2004 Feb;9(2):273-80
references.pmid: 15040566
references.citation: Hum Reprod. 2001 Feb;16(2):215-9
references.pmid: 11157809
references.citation: Health Policy Plan. 1996 Sep;11(3):219-37
references.pmid: 10160370
references.citation: Soc Sci Med. 1994 Aug;39(4):463-74
references.pmid: 7973847
references.citation: Trop Med Int Health. 2001 Jul;6(7):563-9
references.pmid: 11469951
references.citation: Facts Views Vis Obgyn. 2009;1(2):106-21
references.pmid: 25478076
references.citation: J Psychosom Obstet Gynaecol. 2007 Jun;28(2):69-77
references.pmid: 17538814
references.citation: Health Care Women Int. 2002 Sep-Nov;23(6-7):540-9
references.pmid: 12418976
references.citation: Hum Reprod. 2009 May;24(5):1008-11
references.pmid: 19189993
references.citation: Bioethics. 1995 Jul;9(3-4):276-82
references.pmid: 11653043
references.citation: Int J Gynaecol Obstet. 2009 Aug;106(2):172-4
references.pmid: 19539927
references.citation: Facts Views Vis Obgyn. 2010;2(3):194-207
references.pmid: 25013712
references.citation: Patient Educ Couns. 1997 May;31(1):39-48
references.pmid: 9197801
references.citation: Patient Educ Couns. 2005 Dec;59(3):226-33
references.pmid: 16326264
references.citation: Med Law. 1994;13(3-4):297-306
references.pmid: 7968305
references.citation: Trop Med Int Health. 2007 May;12(5):673-86
references.pmid: 17445135
references.citation: Afr J Reprod Health. 2005 Aug;9(2):14-25
references.pmid: 16485583
references.citation: Fertil Steril. 2006 Apr;85(4):871-5
references.pmid: 16580367
references.citation: Hum Reprod Update. 2002 May-Jun;8(3):265-77
references.pmid: 12078837
references.citation: Bull World Health Organ. 2006 Jan;84(1):21-7
references.pmid: 16501711
references.citation: Hum Reprod. 2010 Aug;25(8):2024-30
references.pmid: 20573675
references.citation: Afr J Reprod Health. 2003 Aug;7(2):46-56
references.pmid: 14677300
references.citation: J Pak Med Assoc. 2006 Jan;56(1):19-22
references.pmid: 16454130
references.citation: Afr J Reprod Health. 2005 Aug;9(2):26-37
references.pmid: 16485584
references.citation: Hum Reprod Update. 2010 Nov-Dec;16(6):603-13
references.pmid: 20530804
references.citation: Health Aff (Millwood). 2007 Jul-Aug;26(4):972-83
references.pmid: 17630440
references.citation: Lancet. 2003 Jul 12;362(9378):111-7
references.pmid: 12867110
references.citation: BMC Public Health. 2006 Nov 15;6:283
references.pmid: 17107619
references.citation: Lancet. 2001 Sep 8;358(9284):833-6
references.pmid: 11564510
references.citation: Soc Sci Med. 2009 Jun;68(11):2061-8
references.pmid: 19356835