infertility and involuntary childlessness can have a devastating impact on the life and well-being of the women and men involved. in the last two decades the manifold consequences of infertility, most significant within developing countries, at personal, conjugal, family and community levels, and finan- cially, have been well documented (inhorn and Van balen, 2002; schuster and hörbst, 2006; Van balen and bos, 2009; Van balen and Gerrits, 2001). These studies have also shown that the way people experi- ence, explain and deal with infertility is strongly related with their socio-cultural and economic life circumstances as well with the availability and non- availability of health care options.

Since the early nineties of the previous century various declarations and policy documents of inter- national organizations and meetings, including the international Conference on population and Devel- opment (iCpD) in Cairo, 1994, the World health assembly 2004 and the World summit 2005, have underlined the importance of the prevention and appropriate treatment of fertility problems by recog- nizing the right to found a family, in high and low resource settings alike (Ombelet, 2009). however, in practice sexual and reproductive health care pro- grams often neglect infertility and it is generally not viewed as a public health issue. This lack of attention for infertility care, including assisted reproductive technologies (arTs), from the public health sector in developing countries is generally explained by referring to concerns about overpopulation, the heavy burden of life-threatening conditions (such as maternal mortality and hiV/aiDs) and the scarcity of health resources. Despite this lack of public policy attention for infertility care, a rapid globalization of arTs has taken place in the past few decades. Worldwide the number of (primarily) private fertility clinics is steadily increasing, including within developing countries.

Limited information is available pertaining to the ways biomedical infertility care is supplied and used in different developing countries and within low re- source contexts, though the number of studies in this area has increased over the last decade (Gerrits and shaw, 2010; hörbst, 2010; inhorn, 2003; inhorn and Tremayne, 2012; sundby, 2002; Widge and Cleland 2009). These and other studies have provided insight into financial, political, socio-cultural, ethical and religious issues regarding access to infertility care, specifically with regard to arTs. The aim of this Monograph is to bring together insights from various local realities in order to increase our understanding of factors and circumstances that are constraining, complicating and/or facilitating the provision and use of infertility services in different contexts. in addition, this Monograph addresses some of the challenges that the high prevalence of hiV/aiDs in many low resource areas can present within the delivery of infertility services.

This Monograph is the outcome of a two day expert Workshop on ‘socio-cultural and ethical aspects of biomedical infertility care in poor resource  countries’, when the contributors presented earlier versions of their articles. The expert Workshop, which was held in Genk, belgium, in november 2012, was organized by the social science study Group of the eshre special Task Force on ‘Devel- oping countries and infertility’ ( 1 ), in cooperation with the Walking egg Foundation, the World health Organization and the amsterdam institute of social science research (aissr) of the University of amsterdam. besides making an inventory of the current state of the provision of infertility care in various low resource contexts, the expert Workshop also aimed to reflect on further studies needed to examine and address barriers to access to infertility care, and to support, assess and track the introduction of accessible and affordable infertility care in developing countries.

The articles included in this Monograph give insight into the current day situation regarding the provision and use of arTs in 11 countries on four continents. The 11 countries include three Low income Countries (LiC) ( 2 ): Mali, rwanda and bangladesh; three Lower-Middle income Countries (LMiC): egypt, sudan and Vietnam; and five Upper-Middle income Countries (UMiC): botswana, brazil, iran, south africa ( 3 ) and Turkey. in the LMiC and UMiC vast disparities in income per capita exist, which appears to have significant im- plications for their access to arT services.

The articles show the manifold barriers that the provision and use of these technologies confront. yet, they also provide us with insights into how some of these barriers have been, albeit partially, addressed. it should be noted that some of the articles present new insights, not previously published else- where; others are a digest of fuller papers about country situations that have already been published elsewhere but updated for the expert Meeting and this Monograph. This introduction highlights major themes addressed in the contributions of this Monograph.

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