Infertility is a growing, serious public health concern [1]. In 2023, the World Health Organization reported that infertility affects about 17.5% of the adult population globally [2]. Infertility is also prominent in China, affecting nearly 50 million people [3]. However, the travel time and costs are often a significant burden faced by patients with infertility [4,5]. Here we used a web path planning engine [6] to explore the spatial-economic disparities in access to assistive reproductive technology (ART) centers in mainland China.

As of June 2022, in total, 543 health care institutions in Mainland China have received approved to conduct ART. However, only 55 (10.1%) institutions offer all 5 types of ART services. The distribution of ART centers in China predominantly favors the eastern plains and coastal regions (Figure 1A). Among 7 geographical subregions of China, East China boasts the highest number of ART centers (n=162, 29.8%). Specifically, Guangdong province leads with the greatest number of ART centers (n=56, 10.3%), with 83.9% (n=104) of the province’s counties accessible to ART centers within 1.5 hours and an average taxi cost of merely 66.7 CNY (US $9.21) [10]. In contrast, the Northwest region has the lowest number of ART centers (n=27, 5.0%). Tibet, in particular, has only 1 ART center, and a mere 12.2% (n=9) of Tibetan counties have access to it within 1.5 hours, with taxi costs soaring as high as 1485.2 CNY (US $205.08).

Travel time and costs to ART centers by province are presented in Table 1. Detailed information on travel time and costs is visualized in Multimedia Appendix 1. In China, a substantial portion of the population faces challenges in accessing ART facilities within a short time frame. Specifically, 76.8% (n=180,330,033) of the total population and 63.5% (n=36,390) of residential points are not reachable to an ART center within an hour.

The distribution of ART centers in China exhibits significant disparities. A higher concentration of ART centers is observed in urban and eastern regions, while individuals in northwestern and rural areas encounter prolonged travel times and elevated transportation costs when seeking ART treatment. The map serves the dual purpose of estimating the likelihood of individuals seeking ART treatment when needed and providing an evidence-based foundation for efficient allocation of limited ART resources to underserved populations (present and future). The government is suggested to implement a series of measures, including counterpart aid and effective initiatives to educate and recruit ART doctors in disadvantaged units. Residents in rural and remote areas contend with extended travel times and substantial travel costs when accessing ART services, which should be covered fully or partially through travel subsidies or paid leaves. The introduction of telehealth services is a viable solution to surmount these barriers for patients residing in remote areas, effectively reducing in-person office visits. Notably, ensuring privacy is paramount when helping patients seeking ART treatments. This study bears limitations. While we used the best available data, the residential point data sets remain susceptible to omission errors, which confines the algorithm’s usage to only 1 mode of transportation—a limitation not potentially aligning with real-world scenarios. Additionally, individuals may not necessarily receive ART treatment at the nearest facility or may opt for alternative transportation means.