Sexual and reproductive health

Assisting couples and individuals – Fertility and infertility

Development of a strategic assessment tool

This project will develop an innovative Rapid Assessment Tool to assist key stakeholders, (i.e. policy makers, programme managers, providers) to determine how, where and at what level to provide fertility awareness and assisted fertility interventions within existing health care systems.

Development of a strategic assessment tool:

Integration of fertility awareness and assisted fertility care services to enhance access to care – to ensure a healthy start to pregnancy and to assist those desiring a wanted pregnancy.

Strategic assessments are the first stage defined within the WHO Strategic Approach.(1) This approach is a process which has proven to be highly effective, flexible and adaptable, and ensures country ownership. As it is an important mechanism for policy change, countries can therefore begin with “the end in mind:” scaling-up with sustainability and monitoring of integrated services (2).

A variety of factors have been found to impede women’s and men’s use of fertility awareness and assisted fertility health services, either at health system level (policies, organization, service delivery including quality, attitudes) or user level (need for care, attitudes, beliefs about and alternatives to formal health care), or a combination of both within both the private and public health care sectors. Such factors are highly contextual and vary considerably across settings, and therefore are addressed during the strategic assessment process at country level.

Tools and manuals exist which provide knowledge of which fertility awareness (pre-conception/pre-pregnancy) or clinical assisted fertility interventions could potentially be provided at various levels of care, however there are no tools to help stakeholders determine how to specifically integrate these services within their existing health systems, ensure access to needed human resources and commodities, coupled with strategies for ensuring sustainability of services with systematic approaches for integrated monitoring with specific attention to maternal and child outcomes.

Populations who will benefit

  • Couples are considering pregnancy within the next year or less, however may be currently contracepting
  • Couples or individuals who have tried but are unsuccessful in becoming pregnant
  • Couples or individuals with a disability which impairs their ability to become pregnant or make their partner pregnant
  • Couples or individuals diagnosed with a disease, such as a cancer, that requires a medical regimen that would affect their reproductive potential (or offspring), and request sperm or oocyte freezing.
  • Couples or individuals who are in an HIV+ discordant relationship and desire a child, and request an option of assisted fertility to avoid partner or neonatal transmission.


  • to develop a rapid assessment tool for integration of fertility awareness (pre-conception/pre-pregnancy) and assisted fertility care services into existing health systems;
  • to facilitate generation of information, through pilot testing, on how socio-demographically different countries would adapt the questionnaire to determine where and at what level to integrate and provide access to various components of infertility services;
  • to develop a tool that will identify gaps and barriers to access for fertility awareness and assisted fertility care services - at the policy, system and service-delivery levels;
  • to develop a tool that will provide strategic information for programme managers to develop targeted plans to improve service delivery within all sectors; and
  • to develop a standardized approach through use of country self-assessment to systematically assess and address integration of fertility awareness and assisted fertility care into health services as an essential part of country programmes including systematic monitoring of maternal/child outcomes – following successful pregnancy following implementation of fertility care.


Image of a painting
"Femme fleur"
Painting by C. Meynent