Experts’ Account of Socio-Cultural and Environmental Factors Affecting Utilization of Assisted Reproductive Technology (ART) in Enugu State

Background: Infertility is one of the major health challenges confronting married couple in Nigeria generally, with recent studies reporting 26.8% prevalence (Oguejio for et al, 2023), and 55.6% secondary infertility in Enugu State (Ndubusis et al, 2021). Compared to global infertility rate of 17.8% (WHO, 2023a), Enugu state has high case of infertility, despite advancements in assisted reproductive technology (ART). The prevalence of infertility globally rose from 7.3 million in 2002, to around 186 million worldwide (The Lancet Global Health, 2022). The increase could be indication of poor utilization of ART and other fertility treatment options, or an increase in failure rate of the procedure. But considering growing evidence on improved outcomes ofART procedures; this study focused on utilization to investigate socio-cultural and environmental factors associated with ART utilization in Enugu State, Nigeria. Method: The study adopted case study design to investigate fertility experts’ account of socio-cultural and environmental factors identified by couple’s during consultations as affecting their utilization of ART. The study made use of in-depth interview to obtain data from 18 fertility experts, most of whom are Obstetrics and gynecology consultants in 10 private fertility clinics, and two tertiary hospitals in Enugu State, Nigeria. The result was thematically presented and analyzed within the discursive analysis tradition. Findings: The study found that in spite of the increase in ART clinics within the state, utilization remains hampered by poor conception of the procedure, and socio-cultural factors that are tied to individuals’ commitment to traditional practices. Environmental factors like rural-urban differences, and proximity to fertility clinics were also identified as affecting utilization, but couples’ ability to afford the financial requirements of ART was majorly identified as affecting utilization of ART.