The importance of being fertile. A call for a more balanced approach towards reproductive health

UNLABELLED The core business of reproductive health care in developing countries is HIV/AIDS, contraception and maternal care and not one single reproductive health care program is dealing with couples unable to reproduce. How strange to have on the one hand the reproductive medicine clinics in the resource rich countries focusing mainly on infertility care and on the other hand reproductive health care programs in resource poor countries not giving one single penny to infertility care. In this paper I am exploring the reasons for this unbalanced situation. It is clear from the facts and figures that infertility affects - often with devastating consequences - the lives of roughly one tenth of couples in developing countries. I argue that the neglect of infertility in the public health debate is caused by a mixture of ignorance (mainly by the international aid community) and tunnel vision, opportunism and a non--enlightened attitude of contempt for individual human rights. The prohibitive cost of IVF is contributing to this neglect as well. At present promising low cost IVF techniques are being developed and could potentially make IVF available at a cost accessible for a much larger part of the world population. With the latter becoming available, there should be no impediment for infertility care to become integrated into mainstream reproductive health care in developing nations. Reproductive rights advocates can no longer justify the systematic exclusion of one tenth of couples from the right to decide freely if, when and how to reproduce. KEY WORDS Reproductive health, reproductive rights, infertility care, developing countries, public health, simplified IVF.