Accessing medical care for infertility: a study of women in Mexico

OBJECTIVE: To investigate barriers in accessing care for infertility in Mexico, because little is known about this issue for low and middle-income countries, which comprise 80% of the world’s population. DESIGN: Cross-sectional analysis. SETTING: Mexcian Teachers’ Cohort. PATIENT(S): A total of 115,315 female public school teachers from 12 states in Mexico. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The participants were asked detailed questions about their demographics, lifestyle characteristics, access to the health care system, and infertility history via a self-reported questionnaire. Log-binomial models, adjusted a priori for potential confounding factors, were used to estimate the prevalence ratios (PRs) and 95% confidence intervals ( CIs) of accessing medical care for infertility among women reporting a history of infertility. RESULT(S): A total of 19,580 (17%) participants reported a history of infertility. Of those who experienced infertility, 12,470 (63.7%) reported seeking medical care for infertility, among whom 8,467 (67.9%) reported undergoing fertility treatments. Among women who reported a history of infertility, women who taught in a rural school (PR, 0.95; 95% CI, 0.92–0.97), spoke an indigenous language (PR, 0.88; 95% CI, 0.84–0.92), or had less than a university degree (PR, 0.93; 95% CI, 0.90–0.97) were less likely to access medical care for fertility. Women who had ever had a mammogram (PR, 1.07; 95% CI, 1.05–1.10), had a pap smear in the past year (PR, 1.08; 95% CI, 1.06–1.10), or who had used private health care regularly or in times of illness were more likely to access medical care for fertility. CONCLUSION(S): The usage of infertility care varied by demographic, lifestyle, and access characteristics, including speaking an indigenous language, teaching in a rural school, and having a private health care provider.