Restricted access to assisted reproductive technology and fertility preservation: legal and ethical issues

• Published in: Reproductive biomedicine online 2021-09, Vol.43 (3), p.571-576
• Main Authors: Oliveira, Brenda LC, Ataman, Lauren M., Rodrigues, Jhenifer K., Birchal, Telma S., Reis, Fernando M.
• Format: Article
• Language: English
• Subjects: Assisted reproductive technology; Brazil; Family Planning Services - economics; Family Planning Services - ethics; Family Planning Services - legislation & jurisprudence; Female; Fertility preservation; Fertility Preservation - ethics; Fertility Preservation - legislation & jurisprudence; Health Services Accessibility - ethics; Health Services Accessibility - legislation & jurisprudence; Healthcare Disparities - ethics; Healthcare Disparities - legislation & jurisprudence; Humans; Infant, Newborn; Infertility - economics; Infertility - epidemiology; Infertility - therapy; Male; Pregnancy; Public health system; Reproductive health; Reproductive Rights - ethics; Reproductive Rights - legislation & jurisprudence; Reproductive Techniques, Assisted - economics; Reproductive Techniques, Assisted - ethics; Reproductive Techniques, Assisted - legislation & jurisprudence; Social disparities
• ISSN: 1472-6483; 1472-6491
• DOI: 10.1016/j.rbmo.2021.06.018

Access to assisted reproductive technology (ART) and fertility preservation remains restricted in middle and low income countries. We sought to review the status of ART and fertility preservation in Brazil, considering social indicators and legislative issues that may hinder the universal access to these services. Although the Brazilian Constitution expressly provides the right to health, and ordinary law ensures the state is obliged to support family planning, access to services related to ART and fertility preservation is neither easy nor egalitarian in Brazil. Only a handful of public hospitals provide free ART, and their capacity far from meets demand. Health insurance does not cover ART, and the cost of private care is unaffordable to most people. Brazilian law supports, but does not command, the state provision of ART and fertility preservation to guarantee the right to family planning; therefore, the availability of state-funded treatments is still scarce, reinforcing social disparities. Economic projections suggest that including ART in the Brazilian health system is affordable and may actually become profitable to the state in the long term, not to mention the ethical imperative of recognizing infertility as a disease, with no reason to be excluded from a health system that claims to be ‘universal’.