Assisted Reproductive Technologies (Art) Equity, Justice and Autonomy in Ghana

Background: Restrictive legislation, which is the main barrier to some assisted reproductive technology services in many countries, is non-existent in Ghana. However, these services are available only in the burgeoning capital cities of only four out of the sixteen regions of the country, patronised mainly by the middle or upper class of the society. There is a dearth of evidence on the factors that limit access to ART services to most Ghanaians. This study aims to document these barriers to ART in Ghana. Materials and methods: A cross-sectional survey was conducted across all twenty-two fertility centres in Ghana in July 2022 using two structured questionnaires administered separately via Google App to sensor ART personnel in these centres and treatment defaulters at Hallmark Medicals, Kumasi. Results: Sixty-one ART professionals and 104 ART clinic defaulters responded to the questionnaires. Mentorship/observership from more experienced senior colleagues locally (65.57%) was the most common mode of acquiring knowledge and clinical skills in ART. Almost all (91.80%) ART professionals offered all ART procedures available globally, but 86.89% yearned for a regulated practice. They identified high treatment costs (70.49%) and lack of awareness (16.39%) as the main barriers to ART services in Ghana. Most women who defaulted to ART clinic attendance or treatment (88.47%) had visited the fertility centre based on word-of-mouth recommendations, compared to 4.8% who did so following traditional and social media information. More than half (50.96%) were in their thirties, and only 30.77% were in their forties. Almost half (48.08%) of them required IVF. A good number (58.65%) sought treatment within five years of Infertility, but 70.2% defaulted because of prohibitive treatment costs and 35.57% for partner non-availability. Conclusion: Even though there is complete autonomy to all ART services in Ghana, access is limited by prohibitive treatment costs, partner non-availability and lack of awareness. Meanwhile, the ART professionals advocated a regulated practice.