{
  "abstract": "Background: Infertility is a major public health challenge, yet access to assisted reproductive technology (ART) remains unequal, particularly where public provision is limited. This Policy and Practice Review examines the role of secondary-level hospitals in integrating ART into public health systems.\n\nMethods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and LILACS, without publication-date restrictions, including literature in English, Spanish, and Portuguese. Evidence on access, service organization, referral pathways, continuity of care, workforce, health information systems, governance, and financing was synthesized thematically and interpreted through expert-informed policy analysis.\n\nResults: The review identified geographic, financial, organizational, and health-system barriers to equitable ART access. Integrated models may allow specialized centers to retain high-complexity procedures while secondary-level hospitals support infertility assessment, referral coordination, follow-up, and pregnancy surveillance. Eight policy priorities were identified: integration of secondary-level hospitals; standardized referral pathways; workforce development; national ART registries; equity-oriented evaluation; patient and community participation; integrated governance and quality assurance; and sustainable financing. An implementation framework specifying responsible actors, minimum resources, implementation phases, barriers, and monitoring indicators was developed.\n\nConclusion: Integrating secondary-level hospitals into coordinated ART networks may strengthen continuity of care, geographic accessibility, and use of specialized resources. These potential benefits require prospective evaluation during implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Facultad de Ciencias Políticas y Jurídicas, Universidad Técnica Particular de Loja , ,",
    "Teaching and Research Coordination, Hospital Provincial General Pablo Arturo Suárez , ,",
    "Faculty of Health and Social Services, Universidad Estatal de Milagro (UNEMI) , ,",
    "Facultad de Ciencias de la Salud, Universidad Técnica Estatal de Quevedo (UTEQ) , ,",
    "Facultad de Ciencias Sociales y de la Salud, Universidad Estatal Península de Santa Elena , ,",
    "Facultad de Medicina, Universidad de las Américas , ,",
    "Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnológica Indoamérica , ,"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jesús Endara-Mina"
    },
    {
      "affs": [
        1
      ],
      "name": "Javier Bermúdez-Gavilanes"
    },
    {
      "affs": [
        1
      ],
      "name": "Franklin-Rafael Salazar"
    },
    {
      "affs": [
        2
      ],
      "name": "Lisset A. Manzano-Gallegos"
    },
    {
      "affs": [
        3
      ],
      "name": "Jessica M. Figueroa-Andrade"
    },
    {
      "affs": [
        4
      ],
      "name": "Dayan N. Ortega-Parraga"
    },
    {
      "affs": [
        1
      ],
      "name": "David E. González-Naranjo"
    },
    {
      "affs": [
        5
      ],
      "name": "Fernando Maldonado-Montalvan"
    },
    {
      "affs": [
        6
      ],
      "name": "Claudia Reytor-González"
    },
    {
      "affs": [
        6
      ],
      "name": "Daniel Simancas-Racines"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/eeta2vsaq62pe.bib",
  "cited_by": 0,
  "doi": "10.3389/frph.2026.1974930",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724580/?tool=EBI",
  "id": "eeta2vsaq62pe",
  "issns": [
    "2673-3153"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13724580",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Policy and Practice Reviews"
    ],
    [
      "openalex",
      "2743|Reproductive Health and Technologies"
    ]
  ],
  "openalex": "W7222944507",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724580/pdf/?tool=EBI",
  "pmcid": "PMC13724580",
  "pmid": "42973803",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/eeta2vsaq62pe.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13724580",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13724580"
    },
    {
      "first_seen": "2026-11-04T12:23:07Z",
      "native_id": "PMC13724580",
      "source": "pmc",
      "url": "https://doi.org/10.3389/frph.2026.1974930"
    },
    {
      "first_seen": "2026-11-04T15:20:48Z",
      "native_id": "MED:42973803",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42973803"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2743|Reproductive Health and Technologies",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Assisted reproduction in the public sector: why secondary-level hospitals matter for equity and continuity of care",
  "title_text": "Assisted reproduction in the public sector: why secondary-level hospitals matter for equity and continuity of care",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:21:01Z",
  "url": "https://research.draconitic.com/paper/eeta2vsaq62pe",
  "venue": "Frontiers in reproductive health",
  "versions": []
}