Center for Research in Reproductive Health of Campinas (CEMICAMP), Caixa Postal 6181, 13084-971 Campinas, Brazil.
Hum Reprod. 2010 Feb;25(2):430-5. doi: 10.1093/humrep/dep405. Epub 2009 Nov 17.
In view of the lack of information on availability of public sector infertility services and in order to contribute to the debate on access to these services, we assessed the availability of public sector infertility services, including assisted reproduction technology (ART), in Brazil.
We conducted a cross-sectional study with telephone interviews using a semi-structured questionnaire with Health Secretariats' authorities from the 26 States, the Federal District, 26 Municipal state capitals and another 16 cities with more than 500 000 inhabitants. Also, directors of 26 referral centres and teaching hospitals provide ART procedures supported by the state or university teaching hospitals.
Authorities from 24/26 State Secretariats and the Federal District, from 39/42 cities and 26 directors of referral centres and teaching hospitals offering government-funded infertility care and ART were interviewed. In 19/25 states (76%) and 26/39 cities (66.7%), no infertility treatment was available free of charge. The most common reason for lack of services at the state and municipal levels was 'lack of any political decision to implement them', followed by 'lack of human and financial resources'. When ART was available, barriers to access included the fact that patients needed to purchase medication and the more than 1-year waiting list for treatment.
Lack of political commitment results in inequity in the access of low-income couples in Brazil to infertility treatment, including ART.
鉴于公共部门不孕服务的提供情况信息匮乏，为了促进对这些服务获取途径的讨论，我们评估了巴西公共部门不孕服务（包括辅助生殖技术）的提供情况。
我们进行了一项横断面研究，通过电话访谈，使用半结构化问卷对 26 个州、联邦区、26 个州首府和另外 16 个拥有 50 多万居民的城市的卫生部门当局进行了调查。此外，26 个转诊中心和教学医院的主任提供了由州或大学教学医院支持的辅助生殖技术程序。
采访了 24/26 个州卫生部门和联邦区、39/42 个城市以及 26 个提供政府资助的不孕治疗和辅助生殖技术的转诊中心和教学医院主任。在 19/25 个州（76%）和 26/39 个城市（66.7%）中，没有免费的不孕治疗。州和市级服务缺乏的最常见原因是“缺乏实施这些服务的任何政治决策”，其次是“缺乏人力和财力资源”。当提供辅助生殖技术时，获得服务的障碍包括患者需要购买药物和治疗需要等待 1 年以上。
缺乏政治承诺导致巴西低收入夫妇在获得不孕治疗，包括辅助生殖技术方面存在不平等。
