Living with infertility – World Health Organization (WHO)

Report on Infertility Care and its Alignment with Sustainable Development Goals

Executive Summary: The Global Challenge of Infertility

Infertility is a significant global health issue, affecting approximately one in six people worldwide. This condition presents profound challenges that extend beyond medical diagnoses, impacting emotional well-being, social standing, and economic stability. A recent United Nations study in Morocco highlights systemic barriers to care that undermine progress toward several Sustainable Development Goals (SDGs). This report analyzes these challenges and the corresponding need for integrated health policies that align with SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).

Findings from the Moroccan Case Study: Barriers to SDGs

The study, “Experiences of infertility among couples in Morocco,” reveals critical obstacles faced by individuals seeking fertility care. These challenges represent significant barriers to achieving universal health and gender equality objectives.

• Systemic Gaps in Healthcare (SDG 3): Couples reported fragmented care pathways, long diagnostic delays, and a lack of clear information. One participant noted seeing 13 specialists on a “long journey of suffering,” indicating a failure to provide accessible and comprehensive healthcare services as mandated by SDG 3.
• Social Stigma and Gender Inequality (SDG 5): The research documents severe social stigmatization, which disproportionately targets women. Participants stated, “The society always makes women feel guilty,” highlighting a critical challenge to SDG 5. This gender-based blame persists even when male factors contribute to infertility, reinforcing harmful gender stereotypes and inequality.
• Economic Barriers and Inequality (SDG 10): Access to care is severely limited by high costs and the exclusion of infertility treatments from national health benefit packages. This financial burden exacerbates inequalities, preventing equitable access to health services and contravening the core principle of SDG 10 to reduce inequality within and among countries.
• Health and Well-being Risks (SDG 3): In desperation, many couples resort to traditional medicine, sometimes with dangerous consequences. One account of an herbal treatment leaving a couple unconscious for 12 hours underscores the urgent need for safe, regulated, and accessible medical alternatives to protect public health.

Progress and Recommendations for Achieving Universal Health Coverage

In response to these challenges, Moroccan health experts and officials are advocating for systemic reforms aimed at integrating fertility care into the national health framework, directly supporting the achievement of SDG 3.8 (Universal Health Coverage).

1. Establishment of Public Sector Solutions: The creation of the first public Assisted Reproductive Technology (ART) centre at the Reproductive Health Hospital of Ibn Sina University is a foundational step toward providing equitable access to care.
2. Advocacy for Universal Fertility Care Coverage: Experts like Professor Rachid Bezad emphasize that including fertility care in the national health insurance system is a crucial strategy to “promote equity and ensure couples receive comprehensive care.”
3. Government Commitment to Policy Change: The Ministry of Health and Social Protection has formally supported this vision. Ms. Hanane Rassimi stated that including infertility management in the “reimbursable care basket” is essential to “reduce financial barriers and provide patients with appropriate and timely care.”

Global Directives and the Role of WHO in Advancing SDGs

The challenges identified in Morocco are reflective of global patterns. The forthcoming World Health Organization (WHO) and HRP global guideline on infertility represents a pivotal opportunity to standardize care and accelerate progress on related SDGs worldwide.

• Evidence-Based Recommendations: The guideline will provide evidence-based recommendations to improve access to quality infertility care, helping nations build health systems that leave no one behind.
• Promoting Gender Equality (SDG 5): By addressing male, female, and unexplained infertility equally, the guidelines will directly combat gender inequality. As noted in the WHO Fact Sheet, encouraging men to seek fertility care and ensuring women are not unfairly blamed for infertility are critical actions for mitigating social stigma and relationship problems.
• Ensuring Equitable Access (SDG 3 & SDG 10): The recommendations will support the development of inclusive health policies that address the financial and systemic barriers to care, ensuring that access is not determined by economic status. This aligns directly with the goals of achieving universal health coverage and reducing inequalities.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on infertility in Morocco addresses and connects to several Sustainable Development Goals (SDGs) by highlighting challenges in health, gender equality, and socioeconomic equity. The primary SDGs identified are:

• SDG 3: Good Health and Well-being: The core subject of the article is infertility, a health condition affecting one in six people globally. The text details the struggles of couples in accessing quality healthcare, the need for proper diagnosis, and the importance of integrating fertility care into national health systems.
• SDG 5: Gender Equality: The article explicitly discusses the gendered impact of infertility, noting that women disproportionately bear the social burden. It points out the “stigmatization, especially for the woman,” and how society “always makes women feel guilty.” Addressing infertility is presented as a way to mitigate gender inequality.
• SDG 10: Reduced Inequalities: The article highlights significant inequalities in access to care. The high cost of treatment, the “lack of inclusion of infertility in national health benefit packages,” and the call for “universal fertility care coverage” to “promote equity” directly relate to reducing health and economic inequalities.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets can be identified:

1. SDG 3: Good Health and Well-being

   • Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes. The article’s focus on infertility care falls under the umbrella of reproductive health services. The described “fragmented fertility care” and “long journey to find out the exact diagnosis” point to a lack of universal access.
   • Target 3.8: Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The call from Moroccan officials to “expand universal health coverage and include all medications and techniques used in managing infertility in the reimbursable care basket” is a direct reference to achieving UHC for this specific health issue.

2. SDG 5: Gender Equality

   • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article highlights the severe social discrimination faced by women, who are often blamed for infertility. One participant states, “Being an infertile couple in Morocco means being the victim of all kinds of stigmatization, especially for the woman.” Tackling this stigma is essential to ending this form of discrimination.
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights. While related to Target 3.7, this target emphasizes the rights aspect. The article underscores that women often bear the consequences, including “divorce or polygamy,” which infringes upon their rights. Ensuring women are not “unfairly blamed” and have equal access to care is a matter of reproductive rights.

3. SDG 10: Reduced Inequalities

   • Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality. The proposal to include infertility treatments in the “national health insurance system” is a clear example of a social protection policy aimed at reducing financial barriers and promoting equity, as stated by Professor Rachid Bezad.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article mentions or implies several indicators that can be used to measure progress:

1. For SDG 3 (Good Health and Well-being)

   • Indicator for Target 3.8: The article directly implies an indicator: the inclusion of infertility services, medications, and techniques in the national health insurance’s “reimbursable care basket.” Progress can be measured by whether this policy is adopted and the proportion of the population whose infertility treatments are covered.
   • Indicator for Target 3.7: An implied indicator is the number and accessibility of public-sector Assisted Reproductive Technology (ART) centres. The article mentions the establishment of the “first public ART centre” as a key step, suggesting that an increase in such facilities would indicate improved access.

2. For SDG 5 (Gender Equality)

   • Indicator for Target 5.1: While difficult to quantify, the article points to a qualitative indicator: a reduction in the reported social stigma and guilt associated with infertility, particularly for women. This could be measured through follow-up qualitative studies, similar to the one cited, or population surveys on attitudes towards infertility.
   • Indicator for Target 5.6: The WHO’s goal to encourage “men to seek fertility care” implies an indicator: the ratio of men to women seeking and receiving fertility care. An increase in men participating in diagnosis and treatment would signify a shift away from unfairly blaming women and a move towards shared responsibility and rights.

3. For SDG 10 (Reduced Inequalities)

   • Indicator for Target 10.4: The primary indicator is the existence and implementation of a national policy for universal fertility care coverage. The statements from the Moroccan Ministry of Health and Social Protection provide a clear benchmark; progress would be the official adoption and rollout of this policy to “reduce financial barriers.”

4. Summary Table of SDGs, Targets, and Indicators

Source: who.int