Access, Equity and Ethical Challenges in Assisted Reproductive Technologies in India: An Empirical Bioethics Analysis

Assisted reproductive technologies (ART) have expanded rapidly in India, raising significant ethical and distributive justice concerns relating to accessibility, affordability and reproductive healthcare governance. Despite growing scholarly attention to ART regulation, empirical evidence examining public perceptions of access, perceived equity barriers and ethical governance within the Indian context remains limited. This study addresses this gap through an empirical bioethics analysis of public perceptions regarding ART accessibility and governance in India. A cross-sectional survey of 560 respondents from urban, semi-urban and rural settings was conducted using a structured questionnaire. Data were analysed using descriptive statistics, reliability analysis, correlation analysis and one-way ANOVA with Tukey post hoc comparisons. The findings reveal significant geographic disparities in access to ART services, with urban respondents reporting substantially greater access than semi-urban and rural respondents (F = 35.040, p < 0.001). Descriptive findings further indicate moderate levels of awareness and regulatory trust alongside lower perceptions of access and greater perceived equity barriers. The study highlights the continuing influence of structural inequality on reproductive healthcare accessibility in India and underscores the need for policy interventions aimed at improving equitable access, institutional accountability and inclusive reproductive healthcare governance.