A plea for reproductive health support amid crisis in Lebanon

For the past 2 years, Lebanon has been grappling with social anarchy, political turmoil, and one of the world's most crippling economic crises.¹ The country was then pummelled by the COVID-19 pandemic followed by the third-largest non-nuclear explosion in history that destroyed Beirut in 2020.

Lebanon is hence amid an escalating humanitarian emergency emanating from the synergistic effects of these crises in addition to a collapsing medical sector demolished by mass immigration of health-care workers, severe shortage in crucial hospital supplies including electricity and diesel, and slashing of subsidies on over 1500 medicines making them exhaustively unaffordable, if found.1, 2

Although most light is shed on addressing chronic illnesses, reproductive health can take a major hit if not adequately tackled. Studies have shown that grave conflicts lead to dismal repercussions on reproductive health culminating in increased morbidity and mortality risks among women.³ Menstrual poverty is an additional endured struggle with prices of sanitary pads quintupling, forcing women to find sub-optimal substitutes associated with deplorable sequelae including higher infection risks.⁴

Assisted reproduction ranks among the highest on the list of marginalised reproductive health needs with the false perception of being a mere upper-class prerogative. Treatment delay until a glimpse of financial stability arises is not a possible option for many patients. Women with advanced age, poor ovarian reserve, or individuals with cancer do not have the luxury of waiting. Each treatment cycle costs around US$2500 with the current average wage at less than $150 per month. Loss of health insurance along with hyperinflation have greatly limited the number of patients attempting any form of assisted reproductive technology.

To provide equitable access to fertility care for all, physicians were compelled to adopt minimal stimulation in-vitro fertilisation protocols and alternative lower-class gonadotropin injections with no proven efficacy to limit the financial burden. These approaches, however, might translate into reduced oocyte yield and quality with restricted implantation potential, forcing patients to withstand the burden of additional cycles to guarantee treatment success. Although these adjustments were initially implemented to buy time until the economic situation improves, there are no tangible signs of any reforms. On the contrary, the financial crisis is currently ranked as being among the top three most severe crises globally since the mid-19th century.⁵ The crisis will inevitably lead to a cascade of calamities, including surges in maternal deaths, sexually transmitted diseases, and delays in cancer detection. This is an urgent plea to fertility societies, drug companies, non-governmental organisations, and UN agencies to aid in supporting patients from deplorable resource paucity, especially those requiring fertility treatment and oocyte cryopreservation with delayed treatment being sorrowfully detrimental. With the help of international support, we can further solidify our stance in helping the reproductive health sector face this raging storm.