Dr. David N. Emvula

Infertility is a medical condition, not a lifestyle choice. Categorised by the World Health Organisation under the ICD-10, alongside cancer, diabetes, and HIV/AIDS, it affects millions worldwide.

However, in Namibia, couples facing infertility are left to manage on their own: public healthcare and private insurance do not cover infertility treatments. This is not only unfair; it is discriminatory.

Globally, one in six couples face infertility, and in Africa, it’s as high as one in four. For many, the inability to conceive results in devastating emotional, social, and psychological effects.

In a society where childbearing is central to cultural identity and marital stability, infertility can lead to stigma, isolation, and mental health issues. Yet, even though we recognise it as a disease, access to treatment is often denied.

The real cost of exclusion

One common argument is that fertility care is too costly for the government or insurance to cover. However, upon examining the data, this argument doesn’t hold up.

A typical IVF cycle in Namibia costs between N$60 000 and N$100 000, usually requiring only one or two cycles. Compare this to:

• Cancer treatment, where chemotherapy and radiation can cost N$150 000 to N$500 000+ per patient, depending on the diagnosis.

• HIV/AIDS care, fully funded by state and private insurance, with lifelong antiretroviral therapy costing N$4 000 to N$8 000 per year, reaching over N$200 000 depending on age at diagnosis.

These conditions rightly receive support, yet infertility does not. The government outsources cancer care and funds HIV/AIDS but provides no support for fertility treatment. Private insurance also excludes infertility services. Couples are therefore doubly discriminated against, denied help by both the state and private sector, leaving them with nowhere to turn.

No patient chooses to have endometriosis, polycystic ovary syndrome, blocked tubes, or other medical causes of infertility. Yet, patients with infertility are expected to bear the full financial and emotional burden alone. This is not equitable healthcare; it is systemic discrimination.

Equal disease, equal treatment

Infertility is a serious issue with significant effects on mental health, relationships, and self-esteem. Women often face the most stigma. Achieving Sustainable Development Goal 3, especially target 3.7 on reproductive health, depends on universal access to sexual and reproductive health services, including infertility treatment. Equity involves recognizing all conditions that affect reproductive ability and ensuring access to treatments that support parenthood.

Denying infertility care violates reproductive rights.

Solutions

1. Recognise infertility as a public health priority. Include infertility care in national health strategies and insurance benefits packages.

2. The government is to outsource fertility services to existing private clinics, just as we do with cancer. This provides an immediate solution while public services are being developed.

3. Establish a public fertility unit at the referral centre, Windhoek Central Hospital. A public Assisted Reproductive Technology (ART) centre would improve access and affordability.

4. Invest in training. Build the capacity of fertility specialists, embryologists, and nurses to deliver sustainable, high-quality care.

5. Implement fair screening criteria. Like cancer treatment, access to public fertility support should be guided by clinical assessments to ensure efficient use of resources.

Infertility is a disease. It deserves treatment. Namibia cannot claim equitable healthcare while ignoring couples who long for children. Fertility treatment is not a luxury; it is a medical necessity. If we can fund lifelong HIV/AIDS care, diabetes management, and half-a-million-dollar cancer treatments, we can afford to help people build families. Achieving SDG 3.7 means ensuring reproductive health services include infertility care. What is needed is political will, compassionate policy, and a commitment to reproductive health for all.

Disclaimer

Diseases such as cancer, diabetes, and HIV/AIDS are mentioned only to illustrate healthcare priorities and costs. The intention is not to diminish these conditions, but to highlight the unfair disparity in how infertility, an equally recognised disease, is treated.

*Dr. David N. Emvula is a Specialist Obstetrician & Gynecologist at OB-GYN Practice and Head of the Department of Obstetrics and Gynecology at Windhoek Central Hospital