Accessing medical care for infertility: a study of women in Mexico
Leslie V. Farland, Sc.D.,
Sana M. Khan, M.P.H.,
Stacey A. Missmer, Sc.D.,
Dalia Stern, Ph.D.,
Ruy Lopez-Ridaura, M.D., Sc.D.,
Jorge E. Chavarro, M.D., Sc.D.,
Andres Catzin-Kuhlmann, M.D.,
Ana Paola Sanchez-Serrano, M.D.,
Megan S. Rice, Sc.D.,
Martín Lajous, M.D., Sc.D.
Affiliations
Leslie V. Farland, Sc.D.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
Sana M. Khan, M.P.H.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
Stacey A. Missmer, Sc.D.
Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Dalia Stern, Ph.D.
Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
Ruy Lopez-Ridaura, M.D., Sc.D.
Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
Jorge E. Chavarro, M.D., Sc.D.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health
Andres Catzin-Kuhlmann, M.D.
Department of Medicine, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
Ana Paola Sanchez-Serrano, M.D.
Procrea, Centro de Reproducción Asistida, Mexico City, Mexico
Megan S. Rice, Sc.D.
Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
Martín Lajous, M.D., Sc.D.
Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Correspondence: Martín Lajous, M.D., Sc.D. Center for Population Health Research, National Institute of Public Health, Tlaplan, Ciudad de Mexico, CDMX, 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.
