Sri Lankan Couples Face Significant Out-of-Pocket Costs for Fertility Care
Couples seeking fertility care in Sri Lanka incur substantial out-of-pocket expenses despite accessing treatments through government health facilities, according to a cross-sectional study conducted across three teaching hospitals in the Colombo District. Investigators determined that patients face ongoing direct medical costs for pharmaceuticals and diagnostic investigations, alongside notable indirect expenditures associated with clinic visits. Because health insurance coverage for subfertility care remains limited across Sri Lanka, virtually all of these accrued costs fall entirely upon household budgets.
Subfertility represents a complex challenge involving psychological, economic, and social consequences that extend well beyond physiological aspects. Although clinical interventions place a substantial economic burden on families, empirical data detailing the exact financial toll absorbed by households seeking reproductive healthcare within Sri Lanka have remained scarce. To address this evidence gap, researchers set out to measure the total household cost incurred by subfertile couples receiving clinical care within the state hospital infrastructure.
The study design utilized an analytical cross-sectional survey executed across three specialized subfertility clinics located in teaching hospitals within the Colombo District. The sample included 402 female partners of couples receiving treatment at these selected hospital clinics. Investigators established the study cohort using proportionate allocation across the medical centers, drawing participants through simple random sampling directly from the clinic attendance registers. Trained pre-intern medical officers collected primary data through structured, interviewer-administered questionnaires.
Evaluating the recurring financial demands of routine outpatient management, the researchers identified a median household cost of USD 14.58 per clinic visit, with an interquartile range spanning from USD 7.56 to USD 24.30. When examining routine monthly totals across all participating households, the median direct expenditure reached USD 25.62, with an interquartile range of USD 13.47 to USD 37.51. In parallel, median indirect expenditures per month stood at USD 10.80, with an interquartile range between USD 8.10 and USD 20.52. In aggregate, the overall monthly median household cost amounted to USD 36.42, with an interquartile range of USD 18.01 to USD 54.97.
Intrauterine insemination was performed in 144 instances, representing 35.8 percent of the patient cohort, and carried a median procedure cost of USD 11.07 with an interquartile range of USD 5.56 to USD 19.44. Within the preceding six-month window, 65 participants, or 16.2 percent of the cohort, had been admitted to a hospital facility specifically for subfertility care.
Participants admitted to government hospitals paid a median inpatient cost of USD 6.75, with an interquartile range of USD 2.89 to USD 15.63.
The study’s conclusions emphasize that the nominal availability of free services at government healthcare facilities does not shield households from persistent medical expenditures. Given the prevailing absence of insurance protections for subfertility treatments in Sri Lanka, the research team noted that addressing these financial burdens is essential to evaluate pathways that reduce household expenditures and enhance the affordability of reproductive services.
Subject of Research: Household costs and out-of-pocket expenditures for subfertility treatment in Sri Lanka
Article Title: Household cost of seeking fertility treatment in Sri Lanka: a cross-sectional study
Article References: Liyanage, A., Godakandage, S., & Weerasinghe, M. C. (2026). Household cost of seeking fertility treatment in Sri Lanka: a cross-sectional study. BMC Health Services Research . https://doi.org/10.1186/s12913-026-16119-0
Keywords: subfertility, fertility treatment, household cost, out-of-pocket expenditure, Sri Lanka, Colombo District, teaching hospitals, cross-sectional study, intrauterine insemination, healthcare economics, direct medical costs, indirect healthcare costs, public healthcare, private hospitals, health services research, patient financial burden
News Source: Ophelia Keating. (November 12, 2026). Sri Lankan Couples Face Significant Out-of-Pocket Costs for Fertility Care. Scienmag.
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