Review
Cross-border reproductive care: a review of the literature

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Abstract

Cross-border reproductive care (CBRC) has attracted considerable attention in media and professional publications. The aim of this review is to present a critical narrative overview of the published evidence on CBRC. A systematic search of key academic databases was undertaken with no time restrictions set for publication. This was supplemented by additional searches of key websites, reference chaining and enquiries to people working in the field. A total of 54 items are included in the review, including both empirical research studies (18) and debate papers (36). The key themes discussed are: terminology and definitions; incidence; experiences; explanations; implications; and policy responses. Significant methodological limitations and gaps in the literature are identified. Evidence on incidence is scant, though it suggests that CBRC is increasing. The literature suggests legal, social and political drivers, which vary in importance geographically and between individuals. Limited findings on patient perceptions suggest a broadly positive patient experience. Suggested policy responses include prohibition, regulatory harmonization and harm minimization. There is a need for better international data collection tools and both quantitative and qualitative work which encompasses views of patients, donors, surrogates and professionals and which explores the implications for healthcare services in sending countries.

Introduction

Seeking assisted reproduction technologies across borders appears to be a growing phenomenon, part of a wider trend of what is often termed ‘medical tourism’ (Gray and Poland, 2008). The globalization of assisted reproduction technology has paralleled the growth of a ‘consumer culture’ in health care more generally (Slater, 1997). Technical advances in treatment have accompanied a growth in the commodification of reproduction, producing a highly lucrative ‘fertility–industrial complex’ (Spar, 2006) operating in a global market that transcends national boundaries. This phenomenon has attracted a steady increase in public, professional and academic discourse. A review of the evidence base and emergent academic debates in the context of these developments was therefore considered timely. This review of the current state of knowledge on cross-border reproductive care (CBRC) in the English-language literature was conducted as part of a research project exploring the experiences of UK residents who are seeking travel abroad for fertility treatment, the results of which will be published separately.

Section snippets

Database search

Given the new and contested nature of the topic and the fragmented nature of the literature on CBRC, a conventional systematic review was not considered appropriate. Instead, this study undertook a systematic search of academic databases, combined with additional searches to produce a critical narrative overview of the current state of knowledge, rather than attempting to ‘rank’ individual research papers (Dixon-Woods et al., 2006). Given the fact that the phenomenon of travelling across

Results

The strategy described above yielded 54 papers to be included in the review. To assist the presentation of the review the papers are grouped according to their focus, publication status and whether or not they are based on empirical research or are commentary or opinion papers (Table 2). In summary, they are organized as follows: (i) published studies based on empirical data with a central focus on CBRC (n = 9); (ii) unpublished or partially published studies based on empirical data with a

Discussion

The majority of papers identified in this review are based on commentary rather than empirical research. This finding is of significance, since it implies that although it is of interest to a range of disciplines, CBRC is under-researched and under-theorized. The growing range of commentaries provides important perspectives on a range of issues and highlights the anxieties that CBRC appears to generate in a number of arenas. However, without empirical data, the hypotheses presented cannot be

Acknowledgements

The authors acknowledge the support of the Economic and Social Research Council in funding the study on which this paper is based: ‘Transnational reproduction: an exploratory study of UK residents who travel abroad for fertility treatment’, Grant ref: RES 000–22–3390.

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    Nicky Hudson is a sociologist and researcher at De Montfort University with interests in medicine, reproduction, gender and ethnicity. Lorraine Culley is Professor of Social Science and Health at De Montfort University and has lead several projects exploring social aspects of assisted reproduction treatment. Eric Blyth is Professor of Social Work at Huddersfield University and co-chairs the British Association of Social Workers Project Group on Assisted Reproduction. Wendy Norton is Senior Lecturer in Nursing at De Montfort University, specializing in the management of sexual health, gynaecology and infertility. Frances Rapport is Professor of Qualitative Health Research and leads the Qualitative Research Unit (QUARU) at Swansea University. Allan Pacey is Senior Lecturer in Andrology at the University of Sheffield and Head of Andrology for Sheffield Teaching Hospitals.

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