Abstract

BACKGROUND

Infertility affects over 50 million couples worldwide and impacts people’s social and emotional wellbeing. In low- and middle-income countries, particularly across Africa, the inclusion of fertility care into reproductive health (RH) policies remains fragmented or non-existent.

OBJECTIVE AND RATIONALE

This review aims to provide a framework for understanding the inclusion (or lack thereof) of fertility care in RH policies in African settings. It synthesizes the barriers and facilitators to such inclusion, with a view to uncovering the positioning of fertility care in broader health systems and on the agendas of key stakeholders such as health policymakers and practitioners.

SEARCH METHODS

A qualitative evidence synthesis was performed, systematically searching papers and grey literature. Searches were conducted in MEDLINE, EMBASE, CINAHL, Web of Science and Scopus between February and April 2020. No date restrictions were applied. Language was limited to publications written in English and French. Two reviewers independently screened titles and abstracts, and extracted data, applying thematic coding. The quality of the included papers was evaluated using The Joanna Briggs Institute Checklist for Text and Opinion Papers.

OUTCOMES

The search identified 744 papers, of which 20 were included. Findings were organized under four cross-cutting categories, namely: perceived importance of infertility; influence of policy context; resource availability and access; and perceived quality of care. Across these categories, key barriers to the inclusion of fertility care in RH policies were limited political commitment, under-recognition of the burden of infertility and high costs associated with ART. Conversely, facilitators comprised specialized training on infertility for healthcare providers, standard procedures for ART safety and guidelines and North–South/South–South collaborations.

WIDER IMPLICATIONS

The inclusion of fertility care in African RH policies depends upon factors that include the recognition of infertility as a disease, strong political engagement and proactivity and affordability of ART through opportunities for partnership with the private sector, which ease costs on the public health system. Further qualitative and quantitative research, including context-specific analysis and in-depth comparative approaches across diverse African countries, will help to delineate differential impacts of local and global factors on fertility care to address this neglected RH issue.

中文翻译：

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非洲将生育保健纳入生殖健康政策的障碍和促进因素：定性证据综合

摘要

背景

不孕症影响全球超过 5000 万对夫妇，并影响人们的社会和情感健康。在低收入和中等收入国家，特别是在整个非洲，将生育保健纳入生殖健康 (RH) 政策的做法仍然支离破碎或根本不存在。

目标和理由

本综述旨在提供一个框架，以了解在非洲环境中将生育保健纳入（或缺乏）生殖健康政策。它综合了这种包容的障碍和促进因素，以期揭示生育保健在更广泛的卫生系统中的定位以及卫生政策制定者和从业人员等主要利益相关者的议程。

搜索方法

进行了定性证据综合，系统地搜索论文和灰色文献。在 2020 年 2 月至 2020 年 4 月期间，在 MEDLINE、EMBASE、CINAHL、Web of Science 和 Scopus 中进行了搜索。没有应用日期限制。语言仅限于用英语和法语编写的出版物。两名审稿人独立筛选标题和摘要，提取数据，应用主题编码。使用 Joanna Briggs Institute Checklist for Text and Opinion Papers 评估纳入论文的质量。

结果

搜索确定了 744 篇论文，其中 20 篇被收录。调查结果分为四个交叉类别，即：不孕症的重要性；政策背景的影响；资源可用性和访问；和感知的护理质量。在这些类别中，将生育保健纳入 RH 政策的主要障碍是有限的政治承诺、对不孕症负担的认识不足以及与 ART 相关的高成本。相反，促进者包括针对医疗保健提供者的不孕症专业培训、ART 安全和指南的标准程序以及南北/南南合作。

更广泛的影响

将生育保健纳入非洲 RH 政策取决于以下因素，包括将不孕症视为一种疾病、强有力的政治参与和积极性以及通过与私营部门合作的机会来负担 ART，从而减轻公共卫生系统的成本。进一步的定性和定量研究，包括针对不同非洲国家的具体情况分析和深入比较方法，将有助于描绘当地和全球因素对生育保健的不同影响，以解决这一被忽视的生殖健康问题。