RESUMO
BACKGROUND: The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family. METHODS: This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost. RESULTS: There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child. CONCLUSIONS: It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.
Assuntos
Infertilidade Feminina/terapia , Infertilidade Masculina/terapia , Técnicas de Reprodução Assistida , Adulto , Países em Desenvolvimento , Características da Família , Feminino , Custos de Cuidados de Saúde , Política de Saúde , Recursos em Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Humanos , Infertilidade Feminina/economia , Infertilidade Masculina/economia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Áreas de Pobreza , Técnicas de Reprodução Assistida/economiaRESUMO
Public health hazards from the use of agricultural pesticides have received increasing attention in developing as well as industrial nations. This article examines a remarkable case of massive sterilization of approximately 1,500 workers in Costa Rica, due to exposure to a toxic nematicide called DBCP 1,2-dibromo-3-chloropropane), applied in large commercial banana plantations. Although the product was used during the 1970s, sterile victims have continued to be diagnosed through the 1980s. The effects include psychological trauma as well as permanent infertility. The case has international repercussions because several hundred workers have filed law suits against the U.S.-based transnational DBCP manufacturers, and because DBCP use was continued during the 1980s in other developing nations. The author analyzes the causes behind this serious impairment. It is argued that the contributing factors include not only biomedical processes and technical dimensions (i.e., how DBCP was used), but most importantly, political-economic factors that explain how and why DBCP was used despite the severe hazard. The crucial determinants pertain to the dominance of short-term profit motives, and the control over information and technology by the manufacturers (who concealed early toxicological research evidence of the reproductive hazards) and by the managers of the banana producer-companies. This case well illustrates problems and injustices from labor exploitation and resource extraction from transnational agro-industries. The article concludes with a brief summary of policy implications from the case.