Uneven reproduction: regional cross-border fertility patients in South Africa

Increasing numbers of people travel from elsewhere in sub-Saharan Africa (SSA) to South Africa for assisted reproduction. Travel to South Africa for medical care and access to allied health professionals is longstanding from countries in the region as well as from high-income countries elsewhere, but few researchers have considered this in relation to assisted reproduction. Across the continent, reproductive decision-making is embedded in social and economic inequality, and how this translates into local realities and lived experiences. These social factors influence the importance of bearing one's own children and the experiences of intending parents as they seek to conceive. Cross-border fertility care can be complicated and expensive, including for travel, visas, and payment systems between countries, and in South Africa, for local living costs. People must also adjust to different systems of care and sometimes different languages. This paper highlights the challenges intended parents face as they juggle their disappointment with failed attempts to conceive and the economics of continuing with treatment. We draw on the concept of uneven reproduction to attend to how family formation is shaped by long-standing inequalities within and between countries, and by the uneven organisation and limited availability of reproductive health services.