Ethical issues of infertility treatment in developing countries
Open accessAbstract
The provision of infertility treatment in developing countries is controversial. Reports over the last decades have inculcated in people from Western countries the belief that overpopulation is the major problem of developing countries. This paper will analyse the different arguments advanced for and against providing infertility treatment to resource-poor countries. There are two arguments in favour: reproductive autonomy and the huge burden of infertility in these countries. Pronatalism, which reigns in almost all developing countries, is to a great extent responsible for the devastating effects of infertility. The five arguments against the application of infertility treatment are overpopulation, prioritization of limited resources, prevention rather than cure, justice and equal access and risk of abuse. The importance of a person's reproductive autonomy demands that efforts should be made to enable people to determine how many children to have. This is equally true in developing countries. However, given the enormous difficulties of resource-poor countries to provide even the most basic goods, the contribution by society should be directed mostly at prevention and should depend on a strong cost reduction for assisted reproductive technology.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
For the past half-century concerns regarding global overpopulation have frequently led to the contention that infertility treatments should have a low priority because they promote population growth.
“For the past half-century concerns regarding global overpopulation have frequently led to the contention that infertility treatments should have a low priority because they promote population growth and, as a result, support for fertility care has often been opposed.”
From Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature (2024) · cites this paper as Pennings, 2008
The Introduction (page unavailable) says that, over the last decades, concern about overpopulation has been a main barrier to considering infertility treatment in resource-poor countries. The Overpopulation section describes an argument for denying infertile people access to treatment because it would add children. The paper does not establish the more specific half-century timeframe, and its discussion concerns developing countries rather than infertility treatment generally. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSuch perspectives and actions give rise to inequality, injustice, and discrimination.
“Such perspectives and actions give rise to inequality, injustice, and discrimination (Pennings, 2008; Gerrits et al., 2017; Ombelet and Goossens, 2017).”
From Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature (2024) · cites this paper as Pennings, 2008
Support for fertility care has often been opposed as a result of concerns regarding global overpopulation.
“For the past half-century concerns regarding global overpopulation have frequently led to the contention that infertility treatments should have a low priority because they promote population growth and, as a result, support for fertility care has often been opposed.”
From Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature (2024) · cites this paper as Pennings, 2008
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Bulletin of the World Health Organization
van der Sande, M. A. B., Walraven, G. E. L., Milligan, P. J., BANYA, W. A. S., CEESAY, S. M., Nyan, O. A., & McAdam, K. P. W. J. (2001) · Bulletin of the World Health Organization · Cited by 7,097 · see citing works
International disparities in access to infertility services
Nachtigall, R. D. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.08.066 · Cited by 347 · see citing works
The value of DALY life: problems with ethics and validity of disability adjusted life years
Arnesen, T. M., & Nord, E. (1999) · BMJ · doi:10.1136/bmj.319.7222.1423 · Cited by 328 · see citing works
An international survey of the health economics of IVF and ICSI
Collins, J. A. (2002) · Human Reproduction Update · doi:10.1093/humupd/8.3.265 · Cited by 311 · see citing works
The value of children in African countries – insights from studies on infertility
Dyer, S. (2007) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/01674820701409959 · Cited by 235 · see citing works
Motherhood and Infertility: Viewing Motherhood through the Lens of Infertility
Ulrich, M., & Weatherall, A. (2000) · Feminism & Psychology · doi:10.1177/0959353500010003003 · Cited by 234 · see citing works
van Balen, F. (2001) · Human Reproduction · doi:10.1093/humrep/16.2.215 · Cited by 173 · see citing works
Eager for medicalisation: the social production of infertility as a disease
Becker, G., & Nachtigall, R. D. (1992) · Sociology of Health & Illness · doi:10.1111/1467-9566.ep10493093 · Cited by 133 · see citing works
Affordable IVF for developing countries
Ombelet, W., & Campo, R. (2007) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)60337-9 · Cited by 107 · see citing works
Gender Selection in China: Its Meanings and Implications
Chan, C., YIP, P. S. F., Ng, E. H. Y., Ho, P. C., Chan, C., & Au, J. S. K. (2002) · Journal of Assisted Reproduction and Genetics · doi:10.1023/a:1016815807703 · Cited by 94 · see citing works
The case against new reproductive technologies in developing countries
Okonofua, F. E. (1996) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1996.tb09542.x · Cited by 93 · see citing works
AbouZahr, C., & Vaughan, J. P. (2000) · PubMed · doi:10.1590/s0042-96862000000500010 · Cited by 82 · see citing works
Assisted reproductive technology in developing countries: why should we care?
Vayena, E., Rowe, P. J., & Peterson, H. B. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03177-1 · Cited by 78 · see citing works
Coming soon to your clinic: patient-friendly ART
Pennings, G., & Ombelet, W. U. A. M. (2007) · Human Reproduction · doi:10.1093/humrep/dem158 · Cited by 77 · see citing works
Self-citationKapiriri, L., & Norheim, O. F. (2002) · Health Expectations · doi:10.1046/j.1369-6513.2002.00161.x · Cited by 54 · see citing works
Taming the Brain Drain: A Challenge for Public Health Systems in Southern Africa
Schrecker, T., & Labonté, R. (2004) · International Journal of Occupational and Environmental Health · doi:10.1179/oeh.2004.10.4.409 · Cited by 47 · see citing works
From population control to 'reproductive rights': Ideological influences in population policy
Grimes, S. (1998) · Third World Quarterly · doi:10.1080/01436599814307 · Cited by 37 · see citing works
Zandvoort, H. V., de Koning, K. A., & Gerrits, T. (2001) · Tropical Medicine & International Health · doi:10.1046/j.1365-3156.2001.00756.x · Cited by 23 · see citing works
Masculinity, Reproduction, and Male Infertility Surgery in the Middle East
Inhorn, M. C. (2007) · Journal of Middle East Women s Studies · doi:10.1215/15525864-2007-4001 · Cited by 17 · see citing works
REPRODUCTIVE TECHNOLOGIES IN DEVELOPING COUNTRIES
Macklin, R. (1995) · Bioethics · doi:10.1111/j.1467-8519.1995.tb00362.x · Cited by 14 · see citing works
Ethical aspects and regulation of assisted reproduction in the Arabic-speaking world
Aboulghar, M. A., Serour, G. I., & Mansour, R. (2007) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)60749-3 · Cited by 11 · see citing works
(2006) · Nature · doi:10.1038/442958a · Cited by 9 · see citing works
Ranking Reproductive Health Problems to Define Service Priorities
Vos, T. (2001) · African Journal of Reproductive Health · doi:10.2307/3583195 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 7
- sandelowsky M, de Lacey s. The uses of a 'disease': infertility as rhetorical vehicle. in: inhorn MC, Van balen F (eds). infertility around the Globe. berkeley, Los angeles, London: University of California press, 2002, 33-51.
- shah i. Treatment of infertility: an integral part of reproductive health and a necessity. reprod health Matters 1994;4:96-97.
- sundby J. infertility and health care in countries with less resources: case studies from sub-saharan africa. in: inhorn MC, Van balen F (eds). infertility around the Globe. berkeley, Los angeles, London: University of California press, 2002, 247-259.
- Toubia nF. social pressure is not the only reason people want children. reprod health Matters 1994;4:94-95.
- United nations. programme of action adopted at the interna- tional Conference on population and Development, Cairo, 1994.
- Van balen F, inhorn MC. introduction. interpreting infertility: a view from the social sciences. in: inhorn MC, Van balen F (eds). infertility around the globe. berkeley, Los angeles, London: University of California press, 2002, 3-32.
- Verweij M. preventing disease. in: ashcroft re, Dawson a, Draper h, McMillan Jr (eds). principles of health Care ethics, 2nd edn. Chichester: John Wiley & sons, 2007, 557- 562.
Cited by
Sorted by citations
Fauser, B. C. J. M., Adamson, G. D., Boivin, J., Chambers, G. M., de Geyter, C., Dyer, S., Inhorn, M. C., Schmidt, L., Serour, G. I., Tarlatzis, B., et al. (2024) · Human Reproduction Update · doi:10.1093/humupd/dmad028 · Cited by 224 · see citing works
“Such perspectives and actions give rise to inequality, in-justice, and discrimination (Pennings, 2008; Gerrits et al. , 2017; Ombelet and Goossens, 2017).”
BackgroundSelf-citationMumtaz, Z., Shahid, U., & Levay, A. (2013) · Reproductive Health · doi:10.1186/1742-4755-10-3 · Cited by 117 · see citing works
Bennett, L. R., Wiweko, B., Bell, L., Shafira, N., Pangestu, M., Adayana, I. B. P., Hinting, A., & Armstrong, G. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.11.016 · Cited by 60 · see citing works
Bennett, L. R., Wiweko, B., Hinting, A., Adnyana, I. P., & Pangestu, M. (2012) · Reproductive Health · doi:10.1186/1742-4755-9-24 · Cited by 51 · see citing works
Iran’s experience with surrogate motherhood: an Islamic view and ethical concerns
Aramesh, K. (2009) · Journal of Medical Ethics · doi:10.1136/jme.2008.027763 · Cited by 46 · see citing works
The market for reproductive tourism: an analysis with special reference to Greece
Paraskou, A., & GEORGE, B. P. (2017) · Global Health Research and Policy · doi:10.1186/s41256-017-0037-8 · Cited by 39 · see citing works
The Walking Egg Project: Universal access to infertility care - from dream to reality.
Ombelet, W. U. A. M. (2013) · Europe PMC (PubMed Central) · Cited by 36 · see citing works
Okafor, N. I., Joe‐Ikechebelu, N. N., & Ikechebelu, J. I. (2017) · African Journal of Reproductive Health · doi:10.29063/ajrh2017/v21i4.6 · Cited by 28 · see citing works
Poor recovery of households from out-of-pocket payment for assisted reproductive technology
Dyer, S., Vinoos, L., & Ataguba, J. E.-O. (2017) · Human Reproduction · doi:10.1093/humrep/dex315 · Cited by 26 · see citing works
“A Child is as important as Life”: Reflections on the Value of Children from Infertile Couples
Iwelumor, O. S., Jamaludin, S. S. S., George, T. O., Babatunde, S. K., & Olonade, O. Y. (2020) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2020.3752 · Cited by 16 · see citing works
Adenike, O.-B. (2014) · Gynecology & Obstetrics · doi:10.4172/2161-0932.1000210 · Cited by 15 · see citing works
Promoting reproductive options for HIV ‐affected couples in sub‐Saharan Africa
Mmeje, O. O., Cohen, C., Murage, A., Ong'ech, J. O., Kiarie, J. N., & van der Poel, S. Z. (2014) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12876 · Cited by 15 · see citing works
Robert G Edwards and the Roman Catholic Church
Benagiano, G., Carrara, S., & Filippi, V. (2011) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2011.03.004 · Cited by 13 · see citing works
Dual-Use and Infectious Disease Research
Evans, N. G. (2020) · International library of ethics, law, and the new medicine/The international library of ethics, law, and the new medicine · doi:10.1007/978-3-030-39819-4_9 · Cited by 8 · see citing works
Infertility treatment financing in Nigeria
Adewumi, E. (2017) · Nigerian Journal of Health Sciences · doi:10.4103/njhs.njhs_28_16 · Cited by 7 · see citing works
What drives grand multiparous women in rural Nigeria to seek treatment for infertility
Nzerem, U., Umeora, O., & Eze, J. (2013) · African Journal of Medical and Health Sciences · doi:10.4103/2384-5589.129917 · Cited by 7 · see citing works
Olorunfemi, O., Osian, E., Oahimijie, F. O., Osunde, N. R., & Oduyemi, R. O. (2020) · CHRISMED Journal of Health and Research · doi:10.4103/cjhr.cjhr_110_19 · Cited by 5 · see citing works
Dyer, S., & Pennings, G. (2010) · Ghent University Academic Bibliography (Ghent University) · Cited by 4 · see citing works
Self-citationIn Vitro Fertilisation: Tinjauan Medis, Bioetik, Humaniora Dan Profesionalisme
Putra, B. P., & Abrar, H. K. (2022) · Jurnal Ilmiah Ecosystem · doi:10.35965/eco.v22i2.1527 · Cited by 4 · see citing works
Male subfertility and the role of micronutrient supplementation: clinical and economic issues.
Salma, U., Gill, H. K., Keith, L. G., Tilmon, S. J., Jones, C. A., Sobti, A., & Patel, A. A. (2011) · PubMed Central · Cited by 2 · see citing works
Infertility – an unfinished reproductive rights agenda in India
Ramanathan, M., & Thomas, S. C. (2021) · Indian Journal of Medical Ethics · doi:10.20529/ijme.2021.072 · Cited by 2 · see citing works
Farquhar, C. M., Bhattacharya, S., Repping, S., Mastenbroek, S., Kamath, M. S., Marjoribanks, J., & Boivin, J. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0062-7 · Cited by 2 · see citing works
The patient from the developing world
Ombelet, W., & Nargund, G. (2008) · CRC Press eBooks · doi:10.3109/9780203092200-28 · Cited by 1 · see citing works
Ragab, A. (2016) · Springer eBooks · doi:10.1007/978-3-319-09483-0_243 · Cited by 1 · see citing works
Sexuality and Gender: Psychosocial Implications in Cancer Patients: A Multicultural Perspective
Costantini, A., Navarra, C. M., Ashing‐Giwa, K. T., & Yeung, S. (2012) · doi:10.1002/9781119941101.ch4
CHRISTIANITY AND REPRODUCTION: A BRIEF DISCUSSION
Benagiano, G., Carrara, S., & Filippi, V. (2011) · American Journal of Social Issues and Humanities
Deonandan, R. (2014) · Journal of Advances in Medicine and Medical Research · doi:10.9734/bjmmr/2014/7394
Accessible Infertility Care: From Dream to Reality
Ombelet, W. U. A. M. (2017) · Springer eBooks · doi:10.1007/978-3-319-53454-1_20
Modeling the Superovulation stage in IVF
Yenkie, K. M., Diwekar, U. M., & Bhalerao, V. (2012) · Computer-aided chemical engineering/Computer aided chemical engineering · doi:10.1016/b978-0-444-59507-2.50160-8
Saravanan, S. (2018) · Springer eBooks · doi:10.1007/978-981-10-6869-0_2
THE ROLE OF SCIENCE AND TECHNOLOGY IN REPRODUCTIVE BIOLOGY FOR SUSTAINABLE ENVIRONMENT
Bowolaksono, A. (2022) · Journal of Environmental Science for Sustainable Society · doi:10.3107/jesss.11.mr01
Ragab, A. (2015) · Springer eBooks · doi:10.1007/978-3-319-05544-2_243-1
The patient from the developing world
Ombelet, W., & Nargund, G. (2008) · Reproductive medicine and assisted reproductive techniques series · doi:10.3109/9780203092200.025
Renzo, G. C. D., Tosto, V., Tsibizova, V., & Benagiano, G. (2022) · Cambridge University Press eBooks · doi:10.1017/9781009025034
Koigi, P. K., Kamau, R., Wanjala, S. H. M., & Maranga, I. S. O. (2016) · Journal of Obstetrics and Gynaecology of Eastern and Central Africa · doi:10.59692/jogeca.v28i2.337
Suryanarayanan, S. (2025) · Springer eBooks · doi:10.1007/978-981-97-7944-4_2
Acharya, A., Talukdar, R., Rout, P. C., & Pradhan, S. K. (2026) · Health Care Analysis · doi:10.1007/s10728-026-00583-0
Mukasa, M. N. (2022) · Digital Archive @ GSU · doi:10.57709/4372029
- Authors
- Pennings, G.
- Affiliations
- Ghent University (BE)
- Corresponding author
- Pennings, G.
- ORCID
- Pennings, G.
- Venue
- ESHRE Monographs
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-07-01
- Volume
- 2008
- Issue
- 1
- Pages
- 15-20
- ISSN
- 1477-741X (ISSN-L)
- 1477-8378
- OpenAlex
- W2112248228
- Cited by
- 38
- References
- 23
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 4 · 2013: 3 · 2012: 3
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- ESHRE Monographs (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Facts Views and Vision in ObGyn
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- infertility treatment, assisted reproduction, developing countries, reproductive autonomy, pronatalism, overpopulation, resource allocation, infertility prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
