OUT-OF-POCKET EXPENDITURE FOR ASSISTED REPRODUCTIVE TECHNOLOGY RELATIVE TO WOMEN'S PERSONAL INCOME: A CROSS-SECTIONAL STUDY OF SALARIED WOMEN IN COIMBATORE, INDIA

Abstract

Assisted Reproductive Technology (ART) in India is delivered predominantly   through the private sector and is largely excluded from publicly funded insurance, so households meet its cost from their own resources. Indian cost evidence reports expenditure at the couple or household level, which cannot show what treatment costs a woman relative to her own earnings. To quantify ART-related out-of-pocket expenditure (OOPE) among salaried women as a multiple of personal income, and to describe the financing strategies used to meet it. Cross-sectional survey of 47 employed women undergoing infertility treatment in Coimbatore, Tamil Nadu, recruited purposively through fertility clinics. A structured interviewer-administered schedule captured personal monthly income, cumulative treatment expenditure, financing behaviour (asset sale, borrowing, source, amount, repayment), awareness of government schemes and treatment pathway. Income and expenditure were recorded in bands; burden was expressed as the ratio of cumulative expenditure to personal monthly income using band midpoints. In this sample, ART expenditure was large relative to women's personal income and was met substantially through asset sale and borrowing. Near-universal unawareness of existing schemes indicates that a communication gap compounds the coverage gap. Findings describe the sampled group only and are not generalizable.