Practicing at the margins-fertility care in sub-Saharan Africa: Understanding the Assisted Reproductive Technology (ART) landscape in South Africa and Zimbabwe a medical professional perspective

Despite the growing demand for assisted reproductive technologies (ART), access across Sub-Saharan Africa, remains limited, with only 21 countries offering such services. This qualitative study explores the perspectives of 20 healthcare practitioners in Zimbabwe and South Africa on the systemic barriers to effective ART provision. South Africa emerges as a regional leader with advanced facilities and strong training capacity, whereas Zimbabwe faces significant challenges, including limited infrastructure and inadequate professional development. Both countries, grapple with restricted funding and minimal government investment in infertility care, despite South Africa hosting three publicly funded ART clinics within its university hospital system. Four key themes were identified: (1) The Financial Burden of ART and Clinician Efforts to Facilitate Access for disadvantaged couples; (2) Lack of Government Investment and the Need for Fertility Training Infrastructure (3) Fertility Treatment: A Privilege of Urban Access and (4) Absence of Policy and Regulation in ART Practices. Public health-policies in Africa must prioritise infertility, ensuring equitable access to treatment. This requires government investment in health systems, local expertise, and regulatory frameworks. Framing infertility care within a public health and human rights agenda is crucial for dismantling stigma, addressing structural biases, and promoting reproductive justice through universal access to treatment.