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The National Health Insurance (NHI), for which membership will be compulsory, is a funding scheme that aims to address healthcare inequity in South Africa. The scheme will do this by creating a fund that the government will use to buy healthcare services at set fees from accredited public and private health providers. The NHI Bill was passed in the National Assembly in June 2023. It has to go to the National Council of Provinces for approval.

HomeArticlesShould government health schemes pay for infertility treatment?

Should government health schemes pay for infertility treatment?

“Women are blamed for infertility when, in fact, as we know from research, it is quite often on the man’s side.”

Infertility affects up to 180-million couples worldwide, shows new research released today. The study argues that infertility treatment should become part of basic health services offered under national health insurance schemes.

Launched in Johannesburg on Wednesday, and published in The Lancet medical journal, the report outlines two years of global research into areas of reproductive health such as access to safe abortions, antenatal care and gender-based violence. 

The 59-page study found that although many countries have focused on expanding access to, for instance, contraception and HIV treatment, infertility treatment is absent from most national agendas.

“Issues of infertility treatment have been ignored around sexual and reproductive health rights”, says Alex Ezah, former executive director of Kenya’s African Population and Health Research Center. Ezah was also a co-chair of the commission that compiled the new report.

“The treatment and therapy are very expensive. Only a few people, especially the rich, can afford it. If we can adopt a programme that can expand access, it can help bring the cost down and make it affordable for many more couples to access treatment,” he says.

Despite the fact that infertility issues can affect both men and women, women often shoulder the bulk of stigma or blame when a couple is unable to conceive. This is especially true in societies in which women’s identities and positions are highly dependent on having children, the research argues.

The commission suggests that countries can combat this stigma through education.

“In many cultures, women are blamed for infertility when, in fact, as we know from research, it is quite often on the man’s side.

“Greater understanding of the causes of infertility and better counselling is needed around these issues”, explains commission co-chair and Guttmacher Institute president Ann Starrs.

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Nations can also begin to look at new, cheaper forms of infertility treatment being piloted around the world. In Belgium, researchers at The Walking Egg project are working to develop a cheaper test to diagnose infertility. The project is also looking into lower priced treatments. 

In South Africa, Head of the Reproductive Medicine Unit at Stellenbosch University Thabo Matsaseng has pioneered new ways to offer in vitro fertilisation (IVF) to treat infertility at less than a quarter of what it would cost at most private clinics.

Working out of Tygerberg Hospital, his team has managed to bring the cost of IVF down to about R7 000, according to 2014 research published in the South African Journal of Obstetrics and Gynaecology.

As part of IVF, women are given hormones to stimulate the release of multiple eggs from their ovaries. Doctors collect these eggs from the ovaries before placing them in a lab to be fertilised by sperm, explains the US research organisation the Mayo Clinic. 

Matsaseng and his team were able to cut costs by slashing clinic and administration fees, lowering the hormone doses needed to stimulate ovulation and removing eggs under local, instead of more expensive and complicated general anaesthetic, the study explains.

The Lancet study recommends that countries looking to move towards universal healthcare in the form of, for instance, national health insurances, including infertility as part of a basic package of funded services.

South Africa is in the process of introducing a National Health Insurance scheme, the benefits members will receive have not yet been announced.

But experts admit that fertility specialists remain rare in rich countries and even scarcer in poorer parts of the world. — Additional reporting by Laura Lopez Gonzalez

Nelisiwe Msomi was a health reporter at Bhekisisa.