Infertility, Reproductive Equity, and Policy Pathways for Assisted Reproductive Technology in the Democratic Republic...

Infertility affects an estimated 1 in 6 adults worldwide, yet access to assisted reproductive technology (ART) remains highly inequitable, underscoring the need for policy action. The Democratic Republic of the Congo (DRC) constitutionally recognizes reproductive rights and ART. However, public ART services are virtually nonexistent, highlighting a critical gap in reproductive health services.

We conducted a mixed‑methods study combining quantitative analysis of 146 women presenting for infertility care at Elikya Clinic (Kinshasa, 2020-2024) with a normative review of Congolese law and international standards. Associations between categorical variables and infertility type (primary vs secondary) were tested with the chi‑square test; binary logistic regression produced crude and adjusted odds ratios (COR, AOR) with 95% confidence intervals (CI), ensuring robust evidence to inform policy decisions.

Primary infertility was observed in 51.4% (n=75) of women and secondary infertility in 48.6% (n=71). Loss to follow‑up after referral for ART occurred in 30.8% of referred women. In adjusted models, tertiary education (AOR = 2.58, 95% CI: 1.07-6.23), alcohol consumption (AOR = 2.45, 95% CI: 1.07-5.10), and referral loss (AOR = 3.20, 95% CI: 1.24-8.26) were independently associated with secondary infertility. Obesity was common (54.1%) but did not remain significant after adjustment.

While the DRC's legal framework recognizes medically assisted procreation, the lack of public ART infrastructure and regulation highlights opportunities for meaningful reform. Policy actions can improve reproductive health equity and align with human rights commitments.