This was a policy analysis on infertility in the selected countries using the universal health coverage (UHC) framework. The choice and analyses of policy documents are explained in the following sections.
Definition
The policy documents were defined as all formal records and reports that were written by national governments, national scientific communities and academic societies, national authorities and international organizations' decisions, reports, plans and actions such as World Health Organization, World Bank, world health statistics, world development indicators and demographic and health survey. The type of evidence are as follows: provincial annual reports, core public health function/standards documents, health human resources (HHR), human resource planning (HRP) annual reports, business plan, commissioning policy documents, clinical guidelines, health profession legislation, and other public health (PH) reports such as competency development and leadership frameworks. Newspapers, online advertising sites, movie content, and marketing channels were not being included.
Selection of countries
In order to select countries, after an initial search, we selected 14 countries that had available policy documents related to the three dimensions of universal health coverage that are prevention, treatment, and supportive care for infertility services. However, the final selection consisted of Australia, the United Kingdom, the United States of America, Singapore, Turkey, Iran, and Ghana.
Selection of documents
An electronic search was conducted using PubMed, Scopus, ISI, Google Scholar, Google, all public websites, websites of health ministries, and websites of infertility clinics. Keywords included infertility, policy-making, affordability, accessibility, availability, acceptability, awareness, treatment, insurance, health policy, prevention, financial management, childlessness, equity, utilization, and cost. The search was conducted for each selected country. The search was limited to the year 1994 to the end of 2019. The year 1994 was chosen because since then the Cairo Conference has recommended countries to plan and implement action to prevent and treat infertility. Irrelevant documents were excluded. For instance, discussion papers, advertisements, and video clips were excluded.
Data extraction
A datasheet was prepared including the following information: name and aim of the policy, author(s) or organization name, and actors involved. These were tabulated and made ready for further analysis. Then, we identified three components for each policy document as defined by universal health coverage (UHC) in three scopes (prevention, treatment, and supportive care). These were: 1) financial protection 2) population coverage 3) and service package [13, 14].
Scoring and analysis
Finally, the indicators and practical definition of policy components were provided and was finalized in two sessions by an expert panel consisting of two specialists in health policy, two public health scientists, a gynecologist who specialized in reproductive endocrinology and infertility and a reproductive health specialist. The explanatory variables and indicators are described in Table 1. Then a scoring manual for the three dimensions of universal health coverage that were related to the infertility policy for each selected country was presented. For each dimension, a description of the scoring is presented in Table 2.