A new study at the University of Oxford in England finds that the use of assisted reproductive technologies (ART) — e.g., fertility medication, in vitro fertilization, and surrogacy — varies significantly across Europe and that moral and social acceptance of the treatments, rather than economic issues, is the biggest driver of its popularity in each area.
‘When people think of infertility treatments, they usually expect biological or economic aspects to be the most important drivers. Our findings however make a compelling case that cultural factors play a key role,” said lead author Patrick Präg.
Fertility issues are quite common (about one in eight couples), and while many couples turn to ART to help conceive a child, many others decide to pass on such procedures.
Previous research has focused primarily on the economic issues that may hinder ART usage, such as a country’s wealth and health insurance costs. In the new study, however, scientists from the Oxford University Department of Sociology and Nuffield College, have for the first time assessed several factors that may play a role, including economics, demographics, and cultural norms.
The researchers looked at ART usage, or cycles, per million women of reproductive age (15-44 years), and compared the findings across 35 European countries since 2010. They found that although economic factors and national wealth are important, it is not merely affordability that determines ART use.
In fact, ART treatments were most common in countries where it was considered culturally and morally acceptable. For example, the Czech Republic, which ranks 51st in a poll of the world’s wealthiest countries, reported 10,473 cycles per million women of reproductive age — which is a usage level almost identical to the comparatively wealthier (37th) Denmark.
On the other hand, high income nations such as Italy (eighth) and the United Kingdom (fifth) reported only 5,480 and 4,918 cycles per million women of reproductive age, respectively.
The researchers also calculated an ART accessibility scorecard for each country. They found that there was no direct relationship between the availability of the treatment on the scorecard and the actual number of people using it.
For instance, the United Kingdom and Kazakhstan score higher on available treatment but have comparatively low numbers of usage. This gap between availability and actual usage points to other underlying factors driving country differences, suggesting that normative cultural values play a role.
Religion was found to be a key factor, with a strong correlation between the size of religious Protestant, Catholic, Orthodox, and Muslim groups in a country and the ART usage. Having a higher proportion of Protestants in a country explained a large part (25 percent) of higher ART usage.
The findings also show a link between cultural attitudes in countries where ART was considered to be socially acceptable, with the number of people using the treatment. In Scandinavia for example, where ART usage is high, it is seen as a public good and justified, and the government has taken a key role in making services widely available to singles, those on low income and LGBTQIA groups.
However in other countries, such as Italy — where the Catholic Church is openly against ART and heavily influences the policy agenda — ART is not widely used or available. In these cases, individuals often travel for cross-border care outside of their own country.
“With the increased postponement of having children at later ages, access to ART treatments has growing relevance,” said Melinda Mills, co-author and professor of sociology at Nuffield College.
”The standout finding from our research is that policy-makers, governments, medical bodies and ART providers should more openly acknowledge the strong role that attitudes and acceptability of ART plays on shaping accessibility, availability and usage. Our hope is that these findings will be used to shape ART policy and improve access across Europe.”
The findings are published in the journal Human Reproduction.
Source: University of Oxford