Across Africa, assisted reproductive technology (ART) is expanding at an unprecedented pace. Fertility clinics are opening in countries where, until recently, couples had little choice but to travel abroad, often to Europe, India, or within the continent South Africa—to access in vitro fertilisation (IVF) and related treatments. The costs of travel alone made this a prohibitive option for the vast majority of Africans, before the costs of treatment itself were even considered. This transformation should consequently be welcomed. For many individuals and couples experiencing infertility, ART offers the possibility of parenthood closer to home, reducing the financial and emotional burden of reproductive treatment.

ART refers to a range of medical procedures used to achieve pregnancy through the manipulation of human eggs, sperm, embryos, or reproductive tissues, typically involving laboratory handling outside the body before transfer to the uterus. ART is primarily used to treat infertility when natural conception is difficult or impossible. Common ART procedures include:

• In vitro fertilisation (IVF): Eggs are fertilised with sperm in a laboratory, and the resulting embryo(s) are transferred to the uterus.
• Intracytoplasmic sperm injection (ICSI): A single sperm is injected directly into an egg to facilitate fertilisation, often used in cases of male-factor infertility.
• Frozen embryo transfer (FET): Previously frozen embryos are thawed and transferred to the uterus.
• Gamete and embryo donation: The use of donated sperm, eggs, or embryos when a person’s own gametes cannot be used.
• Gestational surrogacy: An embryo created through IVF is carried by another woman (the surrogate) for the intended parent(s).

Much of this growth has been driven by African clinicians trained in Europe, North America, and South Africa who have returned to establish fertility centres in their home countries. Their entrepreneurial efforts are frequently supported by ongoing collaborations with international fertility specialists who provide technical expertise, training, equipment, and sometimes modest financial investment. These transnational partnerships have accelerated the diffusion of reproductive technologies across the continent and represent an important example of knowledge transfer benefiting African healthcare.

Yet this success story conceals a significant ethical and governance failure. While private investment has expanded access to fertility services, African governments have largely abdicated responsibility for both financing and regulating assisted reproduction. Fertility care has become almost exclusively the domain of private, for-profit providers, making treatment available primarily to those who can afford substantial out-of-pocket payments.  This contrasts with the broader healthcare system, in which essential or life-threatening conditions such as HIV/AIDS, malaria and tuberculosis are typically funded and delivered through the public sector.

The privatisation of fertility care therefore appears to reflect a selective pattern rather than a straightforward extension of how healthcare is generally organised in African settings. This marketisation is particularly troubling in a continent where infertility often carries devastating social consequences, especially for women living in strongly pronatalist societies characterised by persistent gender inequality. In many African communities, infertility is associated with stigma, marital instability, social exclusion, violence and economic insecurity. Despite these well-documented harms, fertility care remains largely absent from public health priorities.

The greater concern, however, is not simply the privatisation of fertility treatment. It is the privatisation of its governance.

In the absence of comprehensive legislation, fertility specialists are often left to determine their own standards of practice, ethical guidelines and operational procedures. Clinics effectively become their own regulators, developing internal policies regarding gamete donation, embryo storage, donor anonymity, consent procedures, surrogacy arrangements and parentage. While many clinicians undoubtedly strive to maintain high professional standards, self-regulation cannot substitute for state enacted laws and publicly accountable oversight. Regulation should not depend solely on the goodwill or professional judgment of individual practitioners.

South Africa remains one of the few African countries with a relatively developed regulatory framework governing ART. Elsewhere, legal uncertainty has created extensive regulatory grey zones. As ART services continue to expand across the continent, these gaps will become increasingly difficult to ignore.

Experience from other regions demonstrates why regulation matters. Assisted reproduction frequently gives rise to cross-border reproductive care, as intended parents travel to jurisdictions with lower costs, fewer legal restrictions, or access to services unavailable in their home countries. African countries are likely to become both sources and destinations for such reproductive travel. Without appropriate legal frameworks, this mobility raises complex questions concerning parentage, citizenship, legal recognition of donor-conceived children, and the rights and responsibilities of gamete donors.

Surrogacy presents even greater ethical challenges. International experience has shown that poorly regulated surrogacy arrangements can result in children being abandoned by commissioning parents, disputes over legal parentage, statelessness, and the exploitation of economically vulnerable women acting as surrogates. their occurrence elsewhere should serve as an early warning rather than a problem to be addressed only after crises emerge within African jurisdictions.

The absence of regulation also creates uncertainty for clinicians themselves. Fertility specialists operating without clear legislation may face legal disputes for which neither existing family law nor medical law provides adequate guidance. Patients similarly lack predictable legal protections when disagreements arise concerning embryos, donor rights, surrogacy contracts, or professional negligence. A legal vacuum benefits no one.

The ethical challenge confronting Africa is therefore not whether ART should continue to expand, it should. Infertility is increasingly recognised as a disease with profound physical, psychological, and social consequences, and access to effective treatment constitutes an important component of reproductive healthcare. Rather, the question is whether this expansion should continue without corresponding public investment and governance.

Governments need not replace private entrepreneurship. Indeed, the remarkable growth of fertility services owes much to the vision and commitment of private clinicians. However, governments cannot continue to outsource their responsibilities for regulating a complex area of healthcare with profound implications for families, children’s rights, women’s welfare and society more broadly. Public legislation should establish minimum standards for licensing, quality assurance, informed consent, donor registries, embryo handling, surrogacy, parentage, and dispute resolution while ensuring accountability through independent oversight.

As ARTs become firmly established across Africa, policymakers have a narrowing window within which to act. Waiting until disputes over citizenship, abandoned children, exploitative surrogacy arrangements, or unethical clinical practices emerge would represent a failure of responsible governance. Effective regulation should anticipate ethical challenges rather than merely respond to them.

Africa’s expanding fertility sector deserves recognition for bringing reproductive medicine closer to those who need it. But innovation without governance is an unstable foundation. Governments must move beyond viewing infertility as solely a private concern and recognise assisted reproduction as an area requiring public stewardship. The future of ART in Africa should be defined not only by scientific progress and private investment, but also by robust legal frameworks, ethical accountability, and a commitment to reproductive justice.