Geographies of Fertility Treatment: A Study of Availability, Accessibility, Awareness and Experience in England and Ireland

这项研究是在获得生育治疗的机会变得越来越配给，希望获得这些服务的人面临的障碍变得越来越多样化和严重的时候提出的（Marsh, 2018）。在英国，免费获得NHS试管婴儿相关治疗的机会正在显著减少，这造成了邮编抽签，迫使一些人搬迁（Khan, 2017; Marsh, 2018）。相比之下，爱尔兰的试管婴儿完全不是由政府资助的，获得治疗可能会很昂贵（Holland, 2018）。非ivf形式的治疗是可用的，包括恢复性生殖药物（RRM），但仍然很昂贵。RRM旨在恢复自然生殖功能，而不是像ivf相关治疗那样绕过它（Neo Fertility, 2018； IIRRM, 2018）。然而，这些服务在很大程度上仍然不为人们所知，关于获取的学术研究似乎很少。这项研究的目的是检查和比较英格兰和爱尔兰所有形式的生育治疗的可用性，可及性和意识，并分析人们如何获得这些服务。为了回答这个首要的研究问题，将解决两个关键目标：检查、比较和对比影响英格兰和爱尔兰所有形式生育治疗服务的可得性和可及性不平等的空间和空间因素。分析每个国家提供生育治疗的方法和认识，并检查人们如何体验获得这些服务的过程。这项研究坐落在概念和经验的关键社会科学方法的交叉点，以健康-跨越地理学，社会学和人类学-和公共卫生。拟议的研究首先将通过确定不同地理尺度的空间和空间因素如何影响生育治疗的获得、认识和经验，为卫生地理学提供信息。医学人类学将通过检查地方、区域和国家政治、文化、社会和宗教规范之间的关系，以及这如何影响卫生服务的提供和可及性来解决。这项研究将通过确定社会因素，包括寻求治疗的人、医疗机构、医疗保健提供者和政府的行为，如何影响可及性、意识和获得经验，为医学社会学做出贡献。这项工作将通过分析获得生育治疗的公平性以及审查如何获得治疗和资助，为公共卫生、社会政策和政治方面的辩论提供信息。

This research is proposed at a time when access to fertilitytreatment is becoming increasingly rationed and the barriersfaced by people wishing to access these services arebecoming more diverse and severe (Marsh, 2018). Freeaccess to NHS IVF-related treatment in England is beingsignificantly reduced, creating a postcode lottery and forcingsome people to relocate (Khan, 2017; Marsh, 2018). InIreland, by contrast, IVF is not publicly funded at all andaccessing treatments can prove costly (Holland, 2018). NonIVF forms of treatment are available including RestorativeReproductive Medicine (RRM) which can still be expensive.RRM aims to restore the natural reproductive function ratherthan bypass it as is the case with IVF-related treatments(Neo Fertility, 2018; IIRRM, 2018). However, these servicesremain largely unknown to people and academic researchconcerning access appears scarce. The aim of this researchis to examine and compare the availability, accessibility andawareness of all forms of fertility treatment in England andIreland and analyse how people experience accessing theseservices. Two key objectives will be addressed in order toanswer this overarching research question:1. Examine, compare and contrast the aspatial and spatialfactors affecting inequities of availability and access inrelation to all forms of fertility treatment services in Englandand Ireland.2. Analyse approaches to fertility treatment provision andawareness in each country and examine how peopleexperience the process of accessing these services.This research sits at the conceptual and empiricalintersections of critical social scientific approaches to health- spanning geography, sociology and anthropology - andpublic health. The proposed research will, in the firstinstance, inform health geography by identifying how fertilitytreatment access, awareness and experience is affected byaspatial and spatial factors across different geographicalscales. Medical anthropology will be addressed by examiningthe relationships between local, regional and national politicsand cultural, social and religious norms, and how this affectshealth service provision and accessibility. This research willcontribute to medical sociology by determining how socialfactors, including behaviours of people seeking treatment,medical institutions, healthcare providers and governments,affect accessibility, awareness and access experience. Thiswork will inform debates in public health, social policy andpolitics by analysing equity of access to fertility treatmentand examining how treatment is accessed and funded.