Infertility: The Unmet Need For Prevention And Care

WHO/Sex&Samfund Joint Concurrent session

Women Deliver Conference, Copenhagen

 

Objective:

To generate discussion among Sexual and Reproductive Health and Rights (SRHR) stakeholders on key human rights elements of infertility including access; mitigation of the negative effects of infertility (including violence) and first-person discussion on how critical economic and social effects of infertility can be managed

Participants:

• Siri Tellier, Special advisor, Sex&Sam Fund, opened the session
• Ian Askew, Director of the WHO Department of Reproductive Health and Research (RHR) touched on the size of the issue; human rights dimensions; negative impacts; access to services; links with the SDGs and the Global strategy and RHR short and medium term priorities (WHO Key messages below)
• Bjarne Christensen, Secretary General Sex&Samfund focused on the importance of prevention based on Sex &Sam Fund's experience leading comprehensive sexuality education in Denmark with an emphasis on why infertility is important for a rights based family planning NGO, and how critical approaches to prevention has developed over time
• Claudia Garcia-Moreno, Medical officer, WHO described evidence showing that: Infertility/subfertility is associated with an increased risk of experiencing partner/domestic violence in low- and middle-income countries and that violence among infertile women is a considerable, yet a poorly reported problem – and since women fear a diagnosis of infertility, it is hard to identify and capture this highly neglected population, who are women who are involuntarily "childless"
• Lilian Mbuya Sikoria from Uganda was absent due to visa issues- Siri Tellier spoke on her behalf stating that we must facilitate research on high quality treatment options, that public health basic service packages should include low-cost interventions and quality counselling, investment in capacity building of service providers and equip health facilities to handle infertility issues, that WHO must define clear guidelines to reduce expensive, ineffective treatments and support campaigns to mitigate stigma, social injustice and highlight infertility in broader SRHR agendas and finally national leaders must reinforce that childlessness should not be a social death penalty
• Vibhor Mukul Singh, from India, gave a first-person, male perspective on the infertility issue stating that medical conditions causing infertility can affect men and women individually or simultaneously, more education about preventable issues that can delay conception are needed, damilial/societal pressures for infertile couples are real, painful, and often worse for women and that these pressures can lead to desperate searches for solutions that might prove ineffective. Finally, pre & post-conception approach to beliefs, observations, mental health, will define the road ahead for infertile couples

 

Advocacy:

• All partners agreed that by focusing advocacy efforts around the message that "All couples should have the right to have children when they want to have them and the right to not have children when they do not want to not have them" neatly blends seemingly contradictory infertility and contraceptive messages.
• While Infertility is implicit in SDG 3.7 and the new Global Strategy, its importance in these broader global agendas is important and should be emphasized 
• Infertility advocacy must encourage a paradigm shift, away from viewing this as a private, individual issue, but as a widespread disability that affects both males and females of all sexual orientations. As such, it requires a broad public health response, on the same level as other health issues
• WHO should take the lead in developing guidelines and indicators, to help quantify the size of the problem and the best approaches to its management
• Vigilance against the "Demographic tyranny of the mean" is important- This is not an issue of the average total fertility rate, but of how many people have more, or fewer, children than they wish.
• Awareness campaigns on low cost, highly effective approaches should be encouraged.

Prevention

• Fertility awareness should be part of comprehensive sexuality education for adolescents for both boys and girls
• Fertility awareness should also be included in health educator curricula at all levels to allow medical practitioners to identify and address medical conditions (STIs, postnatal infections, complications from unsafe abortions, gynaecologic and/or andrologic factors etc.) which may cause either primary or secondary infertility

Service Delivery

• Effective treatments are more accessible, but much more needs to be done given distinct geographic inequities in infertility treatment options both within and between countries.
• Governments should integrate basic infertility investigations and simple forms of treatment (ovulation induction, artificial insemination) into existing basic health package within reproductive health settings
• Effective low-cost options and treatment algorithms (Affordable stimulation protocols, reduction in preprocedure investigations, natural cycles or ovulation induction with clomiphene citrate) should be prioritised as lower costs are critical in changing clinical approaches
• WHO should develop infertility treatment guidelines to help people navigate health services, and prevent reliance on high-priced, ineffective treatment options and expensive cross border infertility tourism

Harm reduction:

• Governments should address unjust treatment of the childless (e.g. abolish discriminatory inheritance laws)
• National opinion leaders should speak out to reduce stigma, stressing that childlessness is not seen as a social death sentence
• Health care providers dealing with infertility should be trained to identify those women experiencing violence and provide them a supportive response as per existing WHO clinical guidelines.
• Health care providers should help reduce intra family violence and conflict by involving both partners (males and females) in counselling and treatment.

 

Speaker Biographies:

Dr Ian Askew joined the Department of Reproductive Health and Research in January 2016 from the Population Council where he worked as Director of Reproductive Health Services and Research in Nairobi, Kenya. After joining the Population Council in 1990 as an associate in Senegal, he went on to become the Country Director for the Population Council office in Kenya in 2002 and the acting Country Director for Senegal between 2009 and 2012. During this time, Ian was closely involved in the Frontiers in Reproductive Health Operations Research Program (FRONTIERS) where he served as Associate Director from 1999 to 2006 and then as Director from 2006-2008. 

Bjarne B. Christensen, since 1998 Secretary General of Sex & Samfund, the Danish Member Association of the International Planned Parenthood Federation (IPPF). As a social anthropologist, he has led the Danish Refugee Council and Save the Children Denmark in areas such as human rights, development, as well as for communications and national programmes. As Secretary General, he has introduced the issue of infertility in Sex&Samfund’s national education programmes which reaches about 40% of Danish school children.

Dr Claudia Garcia-Moreno is a physician from Mexico with a Masters (MSc) in community medicine from the London School of Hygiene and Tropical Medicine. She has worked extensively in public health and global health policy, with a focus on women's health, including sexual and reproductive health and HIV/AIDS and leads WHO's work on violence against women. She coordinated the WHO Multi-Country Study on Women's Health and Domestic Violence, and and is a member of the FIGO Working Group on Gender-based Violence.

Lilian Mbuya Sikoria is a business woman from Kampala, Uganda. She has had difficulties in bearing a child, with the personal pain that entails. Despite the support of her husband, her stress has been augmented by the ruinously high cost, inconsistent advice, as well as strong social and familial pressures. She has some recommendations for solutions which she would like to share.

Vibhor Singh is a PhD trained architect from India who met difficulties in starting a family with his wife Natasha (Also a highly trained architect), particularly upon their return to India from their studies abroad. Dr Singh will provide a unique male insight to the question of infertility with all its frustrations, pressures, costs and stresses particularly in the context of busy dual professional lives.

Siri Tellier, representative from Sex&Samfund, the Danish member association of International Planned Parenthood Federation (IPPF). She is a public health demographer, with a MSc from Harvard School of Public Health and 40 years of working experience with UNFPA, UNDP, the Danish Red Cross, as well as Director of International Department, Danish Red Cross. She has 20 years of teaching experience, from Renmin University, China, University of Geneva, as well as Copenhagen University School of Global Health.