Socio-economic disparities in access to assisted reproductive technologies in Australia.
Women from disadvantaged socio-economic groups access assisted reproductive technology treatment less than women from more advantaged groups. However, women from disadvantaged groups tend to start families younger, making them less likely to suffer from age-related subfertility and potentially have less need for fertility treatment. Whether socio-economic disparities in access to assisted reproductive technology treatment persist after controlling for the need for treatment, has not been previously explored. This population based study demonstrates that socio-economic disparities in access to assisted reproductive technology treatment persist after adjusting for several confounding factors, including age at first birth (used as a measure of delayed childbearing, hence a proxy for need for fertility treatment), geographic remoteness and Australian jurisdiction. Assisted reproductive technology access progressively decreased as socio-economic quintiles became more disadvantaged, with a 15.8% decrease in access in the most disadvantaged quintile compared with the most advantaged quintile after controlling for confounding factors. The adjusted rate of access to assisted reproductive technology treatment also decreased by 12.3% for women living in regional and remote areas compared with those in major cities. These findings indicate that financial and sociocultural barriers to assisted reproductive technology treatment remain in disadvantaged groups after adjusting for need.
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia. Electronic address: Katie.harris@unsw.edu.au.
Katie
K
Harris
School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO), CSIRO Land and Water, Canberra, ACT, Australia.
Hugh
H
Burley
Hudson Institute of Medical Research, Australia; Department of Endocrinology, Monash Medical Centre, Clayton, Australia; Andrology Australia, Alfred Hospital, Monash University School of Public Health, Prahran, Australia.
Robert
R
McLachlan
Genea, Sydney, NSW, Australia; Department of Obstetrics and Gynaecology, University of Sydney, Australia.
Mark
M
Bowman
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia.
Alan
A
Macaldowie
Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia; Australian Fertility Medicine Foundation, Sydney, New South Wales, Australia.
Kate
K
Taylor
School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia; St George Private Hospital, IVF Australia, Pty Ltd, Sydney, Australia.
Michael
M
Chapman
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health UNSW, University of New South Wales, Sydney, Australia.
Georgina Mary
GM
Chambers
D001315:Australia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008423:Maternal Age; D016012:Poisson Distribution; D012044:Regression Analysis; D027724:Reproductive Techniques, Assisted; D012959:Socioeconomic Factors
IVF; assisted reproductive technology; epidemiology; socio-economic disparities