JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):234
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263847

P-222. The Brazilian Paradox in Access to Assisted Reproduction: A Comparative Analysis Across Latin America Through the Lens of Socioeconomic Indicators and Public Policies

Priscila Luiza Dos Santos¹, Maria Clara Oliveira Miranda¹, Marina Esteves Pelegrina¹, Katherine Ann Reimão Miller², Leticia Souza Santos¹

¹ Faculdade Santa Marcelina - São Paulo – Brasil
² Universidade Santo Amaro - São Paulo – SP - Brasil

Objective: To investigate whether socioeconomic development and the existence of public policies influence access to assisted reproductive technologies (ART) in Latin America, highlighting the Brazilian paradox: a country with the highest absolute number of ART cycles in the region but among the lowest per capita rates.
Methods: This ecological, cross-sectional and temporal study analyzed data from 15 Latin American countries between 2015 and 2020, based on official reports from the Latin American Registry of Assisted Reproduction (RedLara), World Bank, and UNDP. The primary outcome was ART cycles per million inhabitants; independent variables included gross domestic product (GDP) per capita, Human Development Index (HDI), and the presence of national public ART policies (categorized as Yes, Partial, or No). Statistical analyses comprised Spearman correlation, Mann–Whitney U tests, and multiple linear regression. Brazil was examined as a case study due to its unique pattern of high absolute volume and low per capita access. Time-trend analyses were performed separately for countries with and without public policies.
Results: ART cycles per million were positively correlated with HDI (ρ=0.818, p<0.0001) and GDP per capita (ρ=0.760, p<0.0001). Countries with public policies had significantly higher median per capita access (p≈3.10×10⁻¹³) and greater estimated treatment volumes. Among countries with public policies, per capita access increased significantly over time (ρ=0.928, p=0.0077). Countries without public policies also showed a smaller but statistically significant upward trend (ρ=0.943, p=0.0048). In multiple linear regression, HDI (β=1094.03, p<0.0001) and public policy (β=240.35, p<0.0001) were independent predictors of ART access, while GDP per capita was not significant (β=–0.0022, p=0.609; R²=0.775). Brazil, despite accounting for ~39% of ART cycles in the region, averaged only 201.5 cycles/million between 2015–2020 — significantly lower than Argentina (489.5, p≈0.0049) and lower than Uruguay (428.2), with a trend toward significance ( ≈0.053).
Conclusion
Access to ART in Latin America is strongly associated with HDI and, most notably, the presence of structured national public policies. Countries with public funding or universal coverage laws consistently achieve higher per capita access and treatment volumes. Brazil exemplifies a paradox of high production with low equity: despite performing ~39% of ART cycles in the region, its average per capita access (201.5 cycles/million) remains far below Argentina and Uruguay, both with universal coverage laws. These findings reinforce the urgent need for national guidelines and expanded public funding to reduce inequalities and promote reproductive justice across the region.