Geographies of Fertility Treatment: A Study of Availability, Accessibility, Awareness and Experience in England and Ireland
Lead Research Organisation:
King's College London
Department Name: Geography
Abstract
This research is proposed at a time when access to fertility
treatment is becoming increasingly rationed and the barriers
faced by people wishing to access these services are
becoming more diverse and severe (Marsh, 2018). Free
access to NHS IVF-related treatment in England is being
significantly reduced, creating a postcode lottery and forcing
some people to relocate (Khan, 2017; Marsh, 2018). In
Ireland, by contrast, IVF is not publicly funded at all and
accessing treatments can prove costly (Holland, 2018). NonIVF forms of treatment are available including Restorative
Reproductive Medicine (RRM) which can still be expensive.
RRM aims to restore the natural reproductive function rather
than bypass it as is the case with IVF-related treatments
(Neo Fertility, 2018; IIRRM, 2018). However, these services
remain largely unknown to people and academic research
concerning access appears scarce. The aim of this research
is to examine and compare the availability, accessibility and
awareness of all forms of fertility treatment in England and
Ireland and analyse how people experience accessing these
services. Two key objectives will be addressed in order to
answer this overarching research question:
1. Examine, compare and contrast the aspatial and spatial
factors affecting inequities of availability and access in
relation to all forms of fertility treatment services in England
and Ireland.
2. Analyse approaches to fertility treatment provision and
awareness in each country and examine how people
experience the process of accessing these services.
This research sits at the conceptual and empirical
intersections of critical social scientific approaches to health
- spanning geography, sociology and anthropology - and
public health. The proposed research will, in the first
instance, inform health geography by identifying how fertility
treatment access, awareness and experience is affected by
aspatial and spatial factors across different geographical
scales. Medical anthropology will be addressed by examining
the relationships between local, regional and national politics
and cultural, social and religious norms, and how this affects
health service provision and accessibility. This research will
contribute to medical sociology by determining how social
factors, including behaviours of people seeking treatment,
medical institutions, healthcare providers and governments,
affect accessibility, awareness and access experience. This
work will inform debates in public health, social policy and
politics by analysing equity of access to fertility treatment
and examining how treatment is accessed and funded.
treatment is becoming increasingly rationed and the barriers
faced by people wishing to access these services are
becoming more diverse and severe (Marsh, 2018). Free
access to NHS IVF-related treatment in England is being
significantly reduced, creating a postcode lottery and forcing
some people to relocate (Khan, 2017; Marsh, 2018). In
Ireland, by contrast, IVF is not publicly funded at all and
accessing treatments can prove costly (Holland, 2018). NonIVF forms of treatment are available including Restorative
Reproductive Medicine (RRM) which can still be expensive.
RRM aims to restore the natural reproductive function rather
than bypass it as is the case with IVF-related treatments
(Neo Fertility, 2018; IIRRM, 2018). However, these services
remain largely unknown to people and academic research
concerning access appears scarce. The aim of this research
is to examine and compare the availability, accessibility and
awareness of all forms of fertility treatment in England and
Ireland and analyse how people experience accessing these
services. Two key objectives will be addressed in order to
answer this overarching research question:
1. Examine, compare and contrast the aspatial and spatial
factors affecting inequities of availability and access in
relation to all forms of fertility treatment services in England
and Ireland.
2. Analyse approaches to fertility treatment provision and
awareness in each country and examine how people
experience the process of accessing these services.
This research sits at the conceptual and empirical
intersections of critical social scientific approaches to health
- spanning geography, sociology and anthropology - and
public health. The proposed research will, in the first
instance, inform health geography by identifying how fertility
treatment access, awareness and experience is affected by
aspatial and spatial factors across different geographical
scales. Medical anthropology will be addressed by examining
the relationships between local, regional and national politics
and cultural, social and religious norms, and how this affects
health service provision and accessibility. This research will
contribute to medical sociology by determining how social
factors, including behaviours of people seeking treatment,
medical institutions, healthcare providers and governments,
affect accessibility, awareness and access experience. This
work will inform debates in public health, social policy and
politics by analysing equity of access to fertility treatment
and examining how treatment is accessed and funded.
Organisations
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| ES/P000703/1 | 01/10/2017 | 30/09/2027 | |||
| 2287499 | Studentship | ES/P000703/1 | 01/10/2019 | 30/12/2022 | Neil Marshall |
| Description | This study examined how people access, negotiate and experience fertility treatment in Ireland. The key themes and knowledge identified from this research included; negotiating costs, time and travel costs, workplace relationships, access during the Covid-19 pandemic, knowledge and communication actors and sources, support networks, emotions and emotional geographies whilst accessing treatment, clinic atmosphere and environment, relationships with healthcare professionals, and free treatment and policy. It was found that participants' life goals and decisions were either delayed or cancelled due to the significant cost of treatment in Ireland, and that participants utilised multiple different types of sources in order to finance treatment. The majority of employers were found to accommodate and facilitate the path of access for participants, however, the time costs associated with travel to city-centric services were detrimental to access and negotiation. It was also found that Covid-19 pandemic restrictions which prevented partners or close support actors to attend appointments contributed to a negative emotional experience for those attending treatment. However, the clinic also acted as a place of evasion and circumvention as pandemic restrictions in relation to eating out at restaurants did not apply to fertility clinic premises. Although a number of participants found clinic nurses to be valuable sources of information, the majority of participants felt that clinics offered little communication and information, and that a lack of patient-centredness contributed negatively to participants' emotional wellbeing and treatment-related decision-making. Whilst power was found to lie with the private healthcare providers, it was found that people carried out acts of resistance against this medical power. The processes of biosociality and biosolidarity were seen to occur amongst people who sought, or who had previously experienced, treatment through the formation of and communication within online communities in the form of infertility and treatment-related forums. Emotional geographies and the attachments to and detachments from place and actors was found to be central to accessing, negotiating and experiencing treatment. The fertility clinic waiting room, and the actors within this place, was found to exacerbate negative emotional geographies as the environment contributed to the formation of a chain of negative emotional geographies. However, acupuncturists were seen to empower those people attending these professionals for complementary acupuncture alongside fertility treatment. Acupuncturists were seen to contribute positively to decision-making, knowledge accumulation and transfer, and emotional wellbeing, whilst it was found that the acupuncture treatment room forms a therapeutic landscape which contributes positively to emotional geographies and the overarching treatment experience. This research contributes knowledge in relation to the social, financial, political, logistical and emotional factors affecting how people access, negotiate and experience fertility treatment in Ireland. The research contributes empirical and conceptual knowledge concerning healthcare accessibility and affordability, knowledge accumulation and transfer, awareness creation, biosociality, biosolidarity, power and resistance, emotional geographies, and therapeutic landscapes. Furthermore, this work examines the issues surrounding the dominating private fertility treatment landscape in Ireland, analyses how people access, navigate and experience this system and its treatments, services and actors, and informs healthcare policymakers. |
| Exploitation Route | Significant potential exists for further academic research to build upon this research. Future academic research could conduct a wider geographical study across the across the country as although certain participants recruited were located in the South of Ireland, these people were all residents of one city, Cork. Participants were predominantly located in the Eastern & Midland region, thus, a geographically broader study could contribute key additional findings. Furthermore, this research predominantly examines how women access, negotiate and experience fertility treatment in Ireland. Thus, a broader focus addressing how men access, negotiate and experience treatment could contribute important additional knowledge which would build upon this research. |
| Sectors | Healthcare |