Access to assisted reproductive technologies in sub-Saharan Africa: fertility professionals’ views

Figures & data

Table 1. Characteristics of informants interviewed

Fertility specialist	Embryologist	Clinic manager	Sector	Country
14	4		Private	South Africa
2	2		Public	South Africa
1	1		Private	Zimbabwe
1	2		Private	Namibia/South Africa
	1		Private	Ethiopia
1			Private	Namibia Kenya
	1		Private	Uganda
		1	Private	Uganda
19	11	1		TOTALS

Table 2. Means of improving access suggested by fertility specialists and embryologists in interviews

Human resources	Laboratory	Medications
Public employees/public funded clinics Academic centres employ staff Fertility specialists/embryologists travel 3-month trained embryologists	Mobile low-tech incubators ‘Standard’ IVF Wealthy patients subsidise poorer patients Mobile full lab on truck ‘Batching’ Develop intra-uterine incubation device	Sufficient volume of patients to reduce wastage Low stimulation cycles Conscious sedation for removals Reduce costs

Table

	Elements	This study
Domain 1: Research team and reflexivity	1. Interviewer/facilitator	1. Majority of Interviews undertaken by AW & TG. Some additional interviews undertaken by KH and RA staff member.
	2. Credentials	2. AW, LM and TG have PhDs in Anthropology, KH has a PhD in Public Health.
	3. Occupation	3. All researchers in academic positions; KH is also in a regulatory position
	4. Gender	4. All middle-aged, white women
	5. Experience and training	5. All senior experienced researchers
	6. Relationship established	6. In some cases participants were known to researchers before the study commencement but in other cases not.
	7. Participant knowledge of the interviewer	7. Prior to participation, informants received written information and informed consent material about the researchers and study.
	8. Interviewer characteristics	8. Reasons and interests in the research topic were included in information informants received prior to study.
Domain 2: study design	9. Methodological orientation and theory	9. Grounded theory and critical medical anthropology
	10. Sampling	10. Participants selected through a combination of purposive sampling and snowball sampling when other potential informants suggested
	11. Method of approach	11. Participants approached through emails and telephone calls to respective clinics. In a few cases, face-to-face requests were made.
	12. Sample size	12. 19 Fertility specialists, 11 embryologists, 1 clinic manager
	13. Non-participation	13. 27 fertility specialists and embryologists were approached to participate, 19 agreed to be interviewed; 2 declined to be interviewed and 6 did not respond to our requests. 13 embryologists were approached for an interview of which 11 agreed and 2 declined. Of the 2 who declined, 1 could not participate as her clinic manager declined for anyone in the clinic to participate and 1 did not respond.
	14. Setting of data collection	14. Interviews took place in workplaces or via Zoom
	15. Presence of non-participants	15. Only researchers and participants present at interviews.
	16. Description of sample	16. See Table 1.
	17. Interview guide	17. Interviews largely unstructured, prompt questions were used for particular themes. These were modified as the study progressed.
	18. Repeat interviews	18. In 1 case a fertility specialist was interviewed twice by this is not counted as a repeat interview.
	19. Audio/visual recording	19. All interviews audio recorded and transcribed expect one when notes taken.
	20. Field notes	20 Fieldnotes also undertaken by researchers.
	21. Duration	21. Interviews took approx. 1 hour
	22. Data saturation	22. Data saturation considered to have occurred when repeated issues emerging from interview data however it is recognised that additional issues likely to emerge if the sample could have extended to more specialists across the region.
	23. Transcripts returned	23. Transcripts of interviews were offered and given to participants when requested.
Domain 3: analysis and findings	24. Number of data coders	24. Research team of 5 participated in coding and discussion of analysis
	25. Description of the coding tree	25. Coding was thematic and generally first order codes. Not analysed for relationship between codes.
	26. Derivation of themes	26. Themes were derived from the data.
	27. Software	27. NVivo 4.0 used for data management.
	28. Participant checking Reporting	28. Feedback to participants is occurring through presentations at some clinics as requested and a professional organisation meeting.
	29. Quotations presented	29. Quotations are presented to illustrate the themes and are identified through participants.
	30. Data and findings consistent	30. Findings are drawn from the data.
	31. Clarity of major themes	31. Major themes are presented
	32. Clarity of minor themes	32. Discussion of diverse cases and minor themes is also presented.