Assisted reproduction and justice: Threats to a new model in a low- and middle-income country

Infertility is an unpredictable but widespread condition. While high-income countries grapple with when, or how to cover the costs of assisted reproductive technology (ART), such as in-vitro fertilisation (IVF), these services are generally only available to wealthy persons at private facilities in low- and middle-income countries (LMICs). Although the principle of non-interference with normal individual reproductive rights is robust, whether it is also the responsibility of collective society to provide the means (when ART applies) to achieve pregnancy, is controversial. Recently, a low-cost model was developed at a South African public institution. The target population for this model was "helpless and marginalised, childless couples", but a new threat has arisen, namely, infertile couples who could conceivably afford private care. In the allocation of this scarce resource, we argue for a prioritarian response that first addresses the worst-off, in order to even out unequal access imposed by sharp differences in income.