"We are only looking at the tip of the iceberg in infertility": perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people

Emily Gilbert; Ruth Walker; David Simon; Ruth Derkenne; Alice Rumbold; Sandra Campbell; Jacqueline A Boyle

doi:10.1186/s12913-021-06714-8

"We are only looking at the tip of the iceberg in infertility": perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people

BMC Health Serv Res. 2021 Jul 17;21(1):704. doi: 10.1186/s12913-021-06714-8.

Authors

Emily Gilbert¹, Ruth Walker¹, David Simon², Ruth Derkenne², Alice Rumbold³, Sandra Campbell⁴, Jacqueline A Boyle⁵

Affiliations

¹ Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia.
² Top End Health Service, NT, Casuarina, Australia.
³ South Australian Health and Medical Research Institute, SA, Adelaide, Australia.
⁴ Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, QLD, Brisbane City, Australia.
⁵ Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia. Jacqueline.boyle@monash.edu.

Abstract

Introduction: Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group.

Method: Semi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package.

Results: Providers perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men's business and women's business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment.

Conclusion: The current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.

Keywords: Aboriginal and Torres Strait Islander; IVF; Indigenous; assisted reproductive technology; fertility; infertility; reproductive health.

MeSH terms

Australian Aboriginal and Torres Strait Islander Peoples
Female
Health Services, Indigenous*
Humans
Infertility* / therapy
Male
Northern Territory
Qualitative Research