Navigating the social, ethical and legal challenges in the provision of in-vitro fertilization care services in Ghana: a qualitative study

Background In-vitro fertilization (IVF) presents complex ethical challenges, particularly in settings like Ghana, where cultural diversity and limited regulation complicate care. With no formal legal framework guiding IVF practices, understanding how healthcare providers navigate ethical dilemmas is critical for improving reproductive health services. This study explored the lived experiences of healthcare professionals and the strategies they use to manage the social, ethical and legal issues arising in the provision of IVF services at the University of Ghana Medical Centre (UGMC). Methods A qualitative phenomenological study was conducted to gain deep insights into participants’ ethical decision-making processes. Ten (10) healthcare providers (including doctors, nurses, midwives, an embryologist, a laboratory technician, and a counsellor) were purposively selected from UGMC Assisted Reproductive Technology (ART) unit using a maximum variation sampling strategy. In-depth interviews were conducted using an open-ended interview guide, with each session lasting between 30 and 60 minutes. All interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis to identify key patterns and themes. Results The study revealed that healthcare providers primarily addressed ethical challenges in IVF through comprehensive counselling offered before, during, and after treatment. They relied on collaborative decision-making, often involving multidisciplinary teams, to navigate complex dilemmas. They adapted international guidelines to develop internal policies. A strong emphasis was placed on values-based care and patient education to support shared ethical decision-making. Additionally, continuous professional development including ethics training, mentorship, and reflective practices was cited as essential for enhancing ethical competence. Conclusion IVF providers at UGMC employ proactive, multi-layered strategies to address ethical challenges, helping reduce conflicts and improve care. However, these efforts remain largely context-specific and may not be enforceable across facilities. To strengthen ethical practice nationwide, mandatory ethics education and collaborative policy development are essential.