Absences: Resource Shortages and Waiting Lists

The global metrics of infertility point to a cruel paradox: Namely, the highest rates of infertility occur in parts of the world with the lowest access to IVF. This is especially true in sub-Saharan Africa, which is a continent relatively devoid of IVF clinics, despite high levels of unmet need. A low-cost IVF (LCIVF) movement has emerged in the past decade to make IVF available in resource-poor nations of the global South. Meanwhile, elites from countries lacking IVF services are making their way to Dubai, especially from the Horn of Africa. Once these travelers reach Dubai, they encounter a high-end IVF market consisting of mostly private clinics operating under a British neocolonial pricing structure. This is because the once-generous Emirati state has retracted its publically financed IVF services over time. Thus, many reprotravelers to Dubai end up engaging in “catastrophic expenditure,” namely, depleting all of their financial resources in order to pay for IVF and the related reprotravel. This is especially true of poor migrant couples, who can ill afford the high costs in private IVF clinics. At the same time, Dubai also receives many “NHS refugees,” or British couples seeking high-end IVF services after spending years on government waiting lists in Britain’s publicly financed IVF sector. This chapter addresses these various resource constraints, all of which restrict infertile couples’ access to affordable IVF.