The distribution and accessibility of assisted reproductive technology clinics in mainland China from 2006 to 2018: a population-based retrospective study

Infertility is a global health problem that carries a high social and economic burden. Assisted reproductive technology (ART) has been developed in mainland China for over 30 years. We aimed to evaluate the accessibility and equity of distribution of ART facilities in mainland China from 2006 to 2018 and quantify the population with reduced geographic access to ART services. A retrospective study was conducted to describe the trend and analyse the equity of distribution of ART clinics in 2006, 2012, and 2018. The accessibility of ART clinics in mainland China increased significantly in the 12 years to 2018 (p ˂ 0.05). Eastern China had the most extensive coverage, followed by the central region, while the western region had the least coverage (p ˂ 0.05). The Gini coefficient for the distribution of ART clinics in 2018 was 0.213, indicating that the equity of distribution of ART clinics was relatively balanced over the country. However, at the end of 2018, there were still 354.9 million people (25.4% of the population) living in 148 cities without access to any ART clinics, which has spurred more targeted policies and cost-effective measures to improve the accessibility and availability of ART services in such areas.