Abstract
Fertility treatment in Ireland suffers from a lack of public funding and therefore accessing such treatments can prove costly. However, cost is not the only factor which affects access to, and experiences of, fertility treatment as knowledge, awareness, agency, and emotions are key elements which affect, and are affected by, the fertility treatment journey. Although a breadth of academic studies exist which examine how people experience fertility treatment, a lack of research exists concerning how treatment is accessed, negotiated, and experienced in the context of Ireland and the Irish healthcare system. This study examined how people access, negotiate and experience fertility treatment in Ireland. Three key objectives were addressed in order to answer this overarching research aim; (1) examine, compare and contrast how access to different fertility treatments in Ireland is experienced; (2) analyse how people negotiate access; and (3) examine how knowledge, awareness, emotions, and agency affect, and are affected by, the treatment journey. Semi-structured interviews were conducted with participants from across Ireland who had either previously accessed fertility treatment or were currently pursuing access. All interviews were conducted online via Microsoft Teams.Interview data was analysed in the context of the research objectives and overarching research aim. The following themes were identified and examined; negotiating costs, time and travel costs, workplace relationships, access during the Covid-19 pandemic, knowledge and communication actors and sources, support networks, emotions and emotional geographies whilst accessing treatment, clinic atmosphere and environment, relationships with healthcare professionals, and free treatment and policy.
It was found that participants' life goals and decisions were either delayed or cancelled due to the significant cost of treatment in Ireland, and that participants utilised multiple different types of sources in order to finance treatment. The majority of employers were found to accommodate and facilitate the path of access for participants, however, the time costs associated with travel to city-centric services were detrimental to access and negotiation. It was also found that Covid-19 pandemic restrictions which prevented partners or close support actors to attend appointments contributed to a negative emotional experience for those attending treatment. However, the clinic also acted as a place of evasion and circumvention as pandemic restrictions in relation to eating out at restaurants did not apply to fertility clinic premises. Although a number of participants found clinic nurses to be valuable sources of information, the majority of participants felt that clinics offered little communication and information, and that a lack of patient-centredness contributed negatively to participants' emotional wellbeing and treatment-related decision-making. Whilst power was found to lie with the private healthcare providers, it was found that people carried out acts of resistance against this medical power. The processes of biosociality and biosolidarity were seen to occur amongst people who sought, or who had previously experienced, treatment through the formation of and communication within online communities in the form of infertility and treatment-related forums, identified as enabling spaces. Emotional geographies and the attachments to and detachments from place and actors was found to be central to accessing, negotiating, and experiencing treatment. The fertility clinic waiting room, and the actors within this place, was found to exacerbate negative emotional geographies as the environment contributed to the formation of a chain of negative emotional geographies. However, acupuncturists were seen to empower those people attending these professionals for complementary acupuncture alongside fertility treatment. Acupuncturists were seen to contribute positively to decision-making, knowledge accumulation and transfer, and emotional wellbeing, whilst it was found that the acupuncture treatment room forms a therapeutic landscape, or enabling space, which contributes positively to emotional geographies and the overarching treatment experience. Finally, this research contributes three new, key dimensions of healthcare access to the conceptual framework of access as defined by Penchansky and Thomas; accountability, agency and affect. This research contributes knowledge in relation to the social, financial, political, logistical, and emotional factors affecting how people access, negotiate and experience fertility treatment in Ireland. The research contributes empirical and conceptual knowledge concerning healthcare accessibility and affordability, knowledge accumulation and transfer, awareness creation, biosociality, biosolidarity, power and resistance, emotional geographies, and therapeutic landscapes. Furthermore, this work examines the issues surrounding the dominating private fertility treatment landscape in Ireland, analyses how people access, navigate and experience this system and its treatments, services, and actors, and informs healthcare policymakers.
| Date of Award | 1 Oct 2023 |
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| Original language | English |
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| Supervisor | Clare Herrick (Supervisor) & Bron Parry (Supervisor) |