title: Barriers to access to infertility care and assisted reproductive technology within the public health sector in Brazil.
abstract: BACKGROUND
  In Brazil, access to infertility care, including assisted reproductive technologies (ARTs), is restricted. This is the third report of a study on access to infertility care and ARTs within the public sector, focusing on the barriers to these services.
  
  
  METHODS
  The study was anchored on quantitative and qualitative methods. For the quantitative study interviews were conducted with health authorities in each of the 26 states, the Federal District, the state capitals and 16 cities with ≥ 500,000 inhabitants and directors of infertility referral centres within the public sector. Qualitative case studies-- were conducted in five ART centres.
  
  
  RESULTS
  Overall, 63.5% of the authorities reported that complex infertility treatments were unavailable. Barriers identified consisted of "lack of political decision to implement them", and "lack of financial resources". In addition, 75% reported to have "no plans to implement them over the next 12 months". At the facilities offering ART, the barriers to these procedures were the high costs, long waiting times, complex scheduling processes and lack of initiative to implement low cost ARTs.
  
  
  CONCLUSIONS
  Infertile couples' access to ART procedures is restricted due to the insufficient services and lack of political commitment to support existing and new services..
authors.affiliation: Centre for Research in Reproductive Health of Campinas (CEMICAMP).
authors.forename: M Y
authors.initials: MY
authors.lastname: Makuch
authors.affiliation: Human Reproduction Unit, Department of Obstetrics and Gynaecology, Medical School, University of Campinas (UNICAMP), Campinas, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Bahamondes
keywords: Barriers; IVF; inequity; infertility care; low-income populations; public health
references.citation: J Psychosom Obstet Gynaecol. 1998 Dec;19(4):218-28
references.pmid: 9929848
references.citation: Fertil Steril. 2001 Apr;75(4):749-53
references.pmid: 11287030
references.citation: Soc Sci Med. 1997 Dec;45(11):1679-704
references.pmid: 9428088
references.citation: Br J Obstet Gynaecol. 1996 Oct;103(10):957-62
references.pmid: 8863690
references.citation: Reprod Biomed Online. 2007 Sep;15(3):257-65
references.pmid: 17854519
references.citation: Hum Reprod. 2010 Feb;25(2):430-5
references.pmid: 19920065
references.citation: Lancet. 2007 Apr 21;369(9570):1373-1378
references.pmid: 17448824
references.citation: Fertil Steril. 2009 Jun;91(6):2295-7
references.pmid: 18440518
references.citation: Cien Saude Colet. 2008 Sep-Oct;13(5):1431-40
references.pmid: 18813646
references.citation: Patient Educ Couns. 1996 Aug;28(3):247-52
references.pmid: 8852100
references.citation: Hum Reprod Update. 2008 Nov-Dec;14(6):605-21
references.pmid: 18820005
references.citation: Hum Reprod. 2007 Jun;22(6):1506-12
references.pmid: 17376819
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: Hum Reprod. 2011 Mar;26(3):623-9
references.pmid: 21216790
references.citation: Int J Gynaecol Obstet. 1997 Jul;58(1):149-58
references.pmid: 9253677
references.citation: Facts Views Vis Obgyn. 2011;3(4):257-66
references.pmid: 24753875
references.citation: Hum Reprod. 2011 Dec;26(12):3312-8
references.pmid: 21987524
references.citation: Int J Gynaecol Obstet. 2009 Aug;106(2):172-4
references.pmid: 19539927
references.citation: Hum Reprod. 1992 Jan;7(1):49-50
references.pmid: 1551957
references.citation: Hum Reprod. 2011 Aug;26(8):2054-60
references.pmid: 21613314
references.citation: Fertil Steril. 2006 Apr;85(4):871-5
references.pmid: 16580367
references.citation: Hum Reprod. 2002 Jun;17(6):1663-8
references.pmid: 12042295