Bridging The Gap: Implementing The Tokyo Declaration's Vision To Expand Affordable Reproductive Care In Nigeria

Introduction

The International Federation of Fertility Societies (IFFS) 2025 Tokyo Declaration affirms reproductive health as a fundamental right, calling on governments and healthcare institutions to ensure equitable access to fertility care. By recognising infertility as a disease and advocating for ethical, well-regulated, and accessible reproductive services—including education, diagnosis, treatment, and postnatal support—the Declaration sets a global standard.

In Nigeria, where infertility remains a significant yet underserved public health issue, implementing these principles is both urgent and transformative. This article explores how Nigeria can align with the Tokyo Declaration's vision to improve access, affordability, and quality of reproductive care within its own healthcare framework.

Key Principles of Ethical and Inclusive Fertility Care Under the IFFS 2025 Tokyo Declaration

1. Equitable Access to Fertility Education and Care

All individuals who wish to have children should have access to fertility education and reproductive care. This includes general fertility awareness, clinical assessments, diagnosis, and treatment such as assisted reproductive technologies (ART). Services should be accessible regardless of medical challenges, genetic concerns, or social circumstances, and should be included under universal health coverage.¹

2. Non-Discrimination, Autonomy, and Human Rights

Reproductive care must uphold equality and be free from discrimination based on race, gender, religion, nationality, or social status. Individuals must retain full autonomy over their reproductive choices, including freedom of movement, medical decisions, and consent to treatment. No one should be coerced or detained during the process.²

3. Ethical Practices and Protection Against Exploitation

All reproductive services must be free from exploitation and human trafficking. Protection should extend to intended parents, surrogates, gamete donors, and children born through ART. Ethical standards must guide surrogacy and donation, with thorough screening and legal safeguards in place, especially for vulnerable populations.³

4. Informed Consent, Legal Support, and Counselling

Participants in reproductive care—including donors, surrogates, and intended parents—must provide fully informed and voluntary consent. They should receive clear information in their own language and at a level they understand. Independent legal advice, psychological counselling, and ongoing support must be provided throughout the reproductive journey.⁴

5. Quality of Care and Rights of Children Born Through ART

High-quality, safe, and respectful care must be provided across all stages—before conception, during pregnancy, and after birth. The health and welfare of children born through assisted reproduction must be prioritised, including access to their genetic and medical history. Accurate record-keeping and transparency ensure these rights are upheld across generations.⁵

Nigeria's Reproductive Landscape: Progress and Gaps

Nigeria's first assisted reproductive technology birth was recorded in 1989 at Lagos State University Teaching Hospital (LASUTH) through the pioneering work of Professors Oladapo Ashiru and Giwa-Osasie.⁶ Since then, more than 40,000 children have been conceived through ART, supported by both private and public facilities nationwide.⁷ While ART offers renewed hope to infertile couples, it has also introduced significant ethical, legal, financial, and social challenges⁸ that Nigerian society must urgently address. Key concerns include:

1. Lack of Quality and Safe Care: The Tokyo Declaration emphasises "quality and safe care" across all stages of fertility treatment. In Nigeria, however, there is a notable absence of legislation regulating the quality of ART services provided to patients. This deficiency is particularly pronounced in surrogacy and gamete donation, where surrogates and donors—often women from vulnerable backgrounds—are exploited and left to bear the consequences of poorly managed procedures.⁹ Additionally, Nigeria lacks guidelines limiting embryo transfers, contributing to high rates of multiple gestation pregnancies. These pregnancies increase the risk of preeclampsia, premature births, and long-term child health complications,¹⁰ directly contradicting the Declaration's commitment to safeguarding maternal and child welfare.

2. Fate of Surplus/Unused Embryos: The Declaration requires ethical handling of embryos with respect for human dignity and informed consent. Yet Nigeria has no legal framework governing surplus embryos, resulting in inconsistent practices such as indefinite storage or unregulated disposal.¹¹ This policy vacuum undermines the Declaration's call for legal safeguards, transparency, and respect for human life.

3. Commercialisation of Gamete Donation and Surrogacy: According to the Declaration, reproductive practices must remain free from exploitation and commercialisation. In Nigeria, unregulated commercial trade in gametes—particularly egg donation priced between ₦100,000 and ₦120,000—exposes donors to health risks, coercion, and exploitation.¹² Similarly, surrogacy arrangements are frequently treated as purely transactional, leaving surrogates exploited, unsupported, and without legal recourse.¹³ These practices directly oppose the Declaration's principles of ethical protection for donors, surrogates, and intended parents.

4. Anonymity and Genetic Identity: The Declaration prioritises children's rights to identity and genetic history. In Nigeria, donor anonymity remains widespread due to cultural stigma and lack of legislation, depriving donor-conceived children of access to their genetic origins.¹⁴ Furthermore, many intending parents and surrogates enter agreements without knowing one another's identities. The absence of a regulatory framework for collecting and preserving relevant data further jeopardises the rights of children who may later seek information about their origins.¹⁵ Such practices violate the Declaration's emphasis on transparency, accountability, and child welfare.

5. Financial Barriers to Access: The Declaration mandates "equitable access under universal health coverage." However, with ART cycles in Nigeria costing between ₦500,000 and ₦3,500,000, fertility treatment remains out of reach for most Nigerians earning minimum wage.¹⁶ This stark affordability gap contravenes the principle of inclusive reproductive healthcare.

6. ART Awareness and Education: The Declaration underscores "fertility education and awareness" as essential components of reproductive health. In Nigeria, ART awareness remains low. Misconceptions persist—such as IVF babies not being as healthy as natural conception babies¹⁷ – while many healthcare providers lack adequate training in assisted reproduction.¹⁸ These gaps not only perpetuate stigma but also limit informed choices and equitable access to care.

7. Additional Considerations: Nigeria also faces weak enforcement of medical ethics in fertility care, limited data collection on ART outcomes, and inadequate psychological counselling for donors, surrogates, and intending parents.¹⁹ These shortcomings erode trust, compromise safety, and perpetuate inequities in reproductive health services.

Recommendations

1. Comprehensive Legal Framework on ART: Urgent legislation is needed to regulate all aspects of ART in Nigeria. Such laws should set minimum standards for ART arrangements, prohibit exploitation, and promote accountability. While two surrogacy-related bills are currently under consideration in the House of Representatives, the legislature must consult widely with medical professionals, legal experts, religious leaders, and civil society to produce legislation consistent with the IFFS principles and global best practices. Regulations must extend beyond surrogacy to include all forms of ART.

2. Adequate Funding of ART: Deliberate efforts must ensure ART is accessible regardless of economic status. Governments at national and subnational levels can leverage public-private partnerships, philanthropic donations, and targeted subsidies to fund or reduce ART costs. Investment should also cover training programs for professionals, infrastructure upgrades, and local research to improve outcomes.

3. Sensitisation Campaigns: Continuous awareness programs are needed to educate the public on the benefits of ART and the rights of all parties involved. Fertility education should be integrated into secondary school curricula to normalise discussions about reproductive health from an early age and reduce stigma.

Conclusion

Nigeria has made remarkable strides in assisted reproductive technologies, but unregulated practices, financial barriers, and inadequate awareness threaten to undermine these achievements. By enacting comprehensive legislation, ensuring equitable funding, and promoting robust public education, Nigeria can align with the Tokyo Declaration's vision for ethical, accessible, and inclusive reproductive care. Closing these gaps will safeguard vulnerable parties, uphold children's rights, and ensure that every Nigerian who dreams of parenthood can pursue it with dignity and fairness.

Footnotes

1 International Federation of Fertility Societies, 'IFFS 2025 Tokyo Declaration on Access to Fertility Care as a Human Right' https://www.iffsreproduction.org/assets/docs/IFFS_Tokyo_Declaration_2025.pdf accessed 2 September 2025.

2 Ibid, Principle 3 & 7.

3 Ibid, Principle 4.

4 Ibid, Principle 5, 6 & 10.

5 Ibid, 8 & 9.

6 O.A. Ashiru and L.A. Akinola, 'Emerging Roles of Anatomists: Development of Assisted Reproductive Technology in West Africa' (2013) 2 (1) Anatomy Journal of Africa, 85.

7 N.I. Okafor, N.N. Joe-Ikechebelu and J.I. Ikechebelu, 'Perceptions of Infertility and In Vitro Fertilization Treatment among Married Couples in Anambra State Nigeria, (2017) 21 (4) African Journal of Reproductive Health, 56.

8 O.A. Arebamen, 'The Practice of Assisted Reproductive Technologies (ARTs) in Nigeria: Current Ethical, Legal, and Social Issues' (March 2025) https://www.researchgate.net/publication/389517265 accessed 2 September 2025.

9 Blessing Oladunjoye, 'Surrogacy: Absence of laws spurs unethical practices in Nigeria (3)' (Premium Times, 13 August 2023) https://www.premiumtimesng.com/news/615803-surrogacy-absence-of-laws-spurs-unethical-practices-in-nigeria-3.html?tztc=1 accessed 12 September 2025.

10 O.Y. Olukoya and others, 'Multiple Gestations/Pregnancies from IVF process in a Fertility Center in Nigeria, 2009 2011: Implementation Policy towards fewer (Double and Single) Embryo Transfer' (2012) 22 (2) Nig. Q J Hosp. Med, 80-84.

11 Arebamen, (n 8).

12 Healthwise, 'Ovum Trading: Inside Nigeria's Multi-Million Naira Human Egg Business' (The Punch, 1 January 2020) https://healthwise.punchng.com/ovum-trading-inside-nigerias-multi-million-naira-human-egg-business accessed 27 August 2025.

13 Olanike S Adelakun, 'The concept of surrogacy in Nigeria: Issues, prospects and challenges' (2018) 18African Human Rights Law Journal605-624 https://www.ahrlj.up.ac.za/adelakun-o accessed 12 September 2025.

14 E.C. Ezugwu and others, 'Preference for Anonymity in Sperm Donation for Artificial Insemination: An Experience from Low-Resource Settings in Nigeria' (2018) 12 Patient Prefer Adherence, 499.

15 Ibid.

16 S.O Akande, I.O. Dipeolu and A.J. Ajuwon, 'Attitude and willingness of infertile persons towards the uptake of assisted reproductive technologies in Ibadan, Nigeria' Ann Ibd Postgrad Med 2019; 17(1): 51–58.

17 Medical Art Center, 'Top 5 Myths About Fertility Treatment in Nigeria — Debunked by Experts' (Medical Art Center) https://medicalartcenter.com/2025/09/02/myths-about-fertility-treatment-nigeria-debunked/#:~:text=Community%20Support:%20Cooperative%20societies%20(%E2%80%9C,Modern%20labs%20use: accessed 12 September 2025.

18 Olanike (n13).

19 Ibid.

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