Fertility treatment is a right, not a luxury
Infertility is a medical disease, not a lifestyle choice.Classified by the World Health Organisation under the ICD-10 – alongside cancer, diabetes and HIV/AIDS – it affects millions globally. Yet in Namibia, couples struggling with infertility are left to fend for themselves: public healthcare and private medical insurance exclude fertility treatment. This is not only unjust but also discriminatory.
Globally, one in six couples face infertility, and in Africa, the figure is as high as one in four. For many, the inability to conceive carries devastating emotional, social and psychological consequences. In societies where childbearing is central to cultural identity and marital stability, infertility can cause stigma, isolation and mental health struggles. While we recognise infertility as a disease, access to treatment is still denied.
The real cost of exclusion
A common argument is that fertility care is too expensive for government or insurance providers to fund. But the numbers tell a different story. A typical IVF cycle in Namibia costs between N$60 000 and N$100 000, with most couples needing 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, often exceeding N$200 000 over a lifetime.
These conditions rightly receive support, yet infertility does not. The government outsources cancer care and funds HIV/AIDS programmes, but does not assist in fertility treatment. Private insurance also excludes infertility services. Couples are therefore doubly disadvantaged – denied by both the state and the private sector, 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 shoulder the full financial and emotional burden alone. This is not equitable healthcare; it is systemic discrimination.
Equal disease, equal treatment
Infertility has profound effects on mental health, relationships and self-worth. Goal 3 of the Sustainable Development Goals, specifically target 3.7, calls for universal access to sexual and reproductive health services, which must include infertility care. Equity requires recognising all conditions that affect reproductive capacity and ensuring access to treatments that enable parenthood. Denying infertility care is a violation of reproductive rights.
What can be done?
• Recognise infertility as a public health priority. Include infertility care in national health strategies and insurance benefits packages.
• Outsource fertility services to private clinics, as is done with cancer care. This offers an immediate solution while public services are developed.
• Establish a public fertility unit at Windhoek Central Hospital. A national Assisted Reproductive Technology (ART) centre would improve access and affordability.
• Invest in training. Build the capacity of fertility specialists, embryologists, and nurses to ensure sustainable, high-quality care.
• Implement fair screening criteria. Like cancer care, access to public fertility support should be guided by clinical assessment to ensure resources are used effectively.
The bottom line
Infertility is a disease. It deserves treatment. Namibia cannot claim to provide equitable healthcare while ignoring couples who long for children. Fertility treatment is not a luxury – it is a medical necessity. If lifelong HIV/AIDS care, diabetes management, and half-a-million-dollar cancer treatments can be funded, then supporting people to build families is equally achievable. 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 Emvula is a Specialist Obstetrician & Gynaecologist at OB-GYN Practice and Head: Department of Obstetrics and Gynaecology, Windhoek Central Hospital.