Assessing research on assisted reproduction and abortion


A research paper (A. de la Hoz-Correaa; F. Munoz-Levivaa; M. Bakuczb, 2018), has used Co-Word Analyses and Bibliometric maps to place past empirical research studies on medical and health tourism into six distinct ‘meta clusters’ (groupings), based on similar and common research themed foci (see example image above).  These themes were grouped into:

  • Cluster 1. Studies on medical ethics, accreditation, stem cell tourism, etc. This may be explained by the concern of many hospitals and destinations to be the “first” in medicine and to look for accreditation, particularly by the Joint Commission International (JCI) as a guarantee of the quality of care. This cluster also includes themes relating to topics some consider “unethical” such as the practice of transplant tourism or stem cell tourism and China as a medical tourism destination.
  • Cluster 2. Studies on health, wellness, spa tourism and service quality. Comprises a group of papers linking medical tourism with other segments of health tourism such as wellness and spa tourism that are more oriented toward prevention rather than cure. Papers on service quality are also included as they reveal that superior service quality is an important factor of customer satisfaction and loyalty and contributes to a competitive advantage among the healthcare providers. 
  • Cluster 3. Studies on health-related issues (health care, health services, public health), medical treatments and tourism. Papers mostly relate to the impact of medical tourism services on national health systems in host countries, for example the EU Directive on cross-border health care and its implications for medical treatments, medical travel and tourism. These papers not only highlight the potential of medical tourism to attract doctors and generate direct investments, but the need for regulation, the lack of quality control among foreign providers, and the real or even potential cost of possible complications. 
  • Cluster 4. Studies on “sensitive” practices in medical tourism. Papers included in this cluster address different treatments and practices found in medical and health tourism destinations such as assisted reproduction, surrogacy or reproductive tourism. Most of these papers are qualitative studies focusing on equity and ethical concerns including the rights of women in recipient countries and how to regulate them. This group of themes were also highlighted in the study by Chuang et al. (2014) and linked to the ethics and risks of organ transplants (A. de la Hoz-Correaa; F. Muñoz-Leivaa; M. Bakuczb, 2018).
  • Cluster 5. Studies on medical tourism destinations and marketing. Works included in this cluster explore Asian medical tourism destinations and countries such as India, Malaysia and Thailand. Other papers evaluate marketing features of medical travel and how to effectively market these countries in global terms. These papers explicitly explore the use of a variety of messages and images in their attempt to attract international patients.
  • Cluster 6. Studies on globalisation, policies and the effect on international patients.  Comprises a number of heterogeneous papers dealing with the effects of globalisation and health policy. Examples include papers attempting to estimate the entire global medical industry and revenue gains in destination countries. 

These six clusters were further analysed, using appropriate database search engines, to uncover a more focused depth of knowledge into medical tourism.  A more exhaustive search expanded into other underutilised literature sources such as conference proceedings, professional association journals, media and other bibliographic outlets, and dissertation databases - which extracted more information for the six medical tourism sub-domains or clusters described in the paper. 

The research team believes that the six cluster themes that were identified and the proposals for more focused future lines of research suggested in the paper will contribute to a greater understanding of the rapidly expanding field of medical tourism. 

“Sensitive practices” in medical tourism (Cluster 4)

Keywords such as surrogacy, cross-border reproductive care, fertility tourism, abortion and assisted reproduction fall within the ethically “sensitive” fourth cluster. Most of the research that was found surrounding the keywords of Cluster 4 are qualitative studies that focus on equity and ethical concerns including the rights of women in recipient countries and how to regulate them. 

Some authors argue that the term “reproductive tourism” refers mostly to services surrounding surrogacy and fertility technology. However, this research paper argues it is also the converse and should include services such as abortion, contraception, and vasectomies. In other words, reproductive tourism can be thus both related to conception and the very opposite: preventing or terminating a pregnancy. Based on results produced from the searches surrounding the keywords of Cluster 4, the most impactful information was gathered relating to pregnancy termination and the issues related to increasing abortion tourism trends.    The research paper identified a number of recurrent topics influencing travel for abortion services, covering concerns for privacy and stigma; influence of legal restrictions; socioeconomic barriers and availability of backstreet abortions.

The findings suggest that studies on “sensitive practices of medical tourism” and “medical tourism destinations” will continue to be some of the most relevant themes for the future. The research paper suggests that the topics within Cluster 4 will be important for medical tourism development in the years to come due to the recent discussion and interest in the scientific literature surrounding them.


The research paper concludes that more discussion is needed on the social, ethical and political issues derived from these practices, with different points of views from the main parties involved (patients, policy makers or intermediaries). 

For the next study on “sensitive” practices in medical tourism, the paper suggests it may be advisable to continue conducting qualitative studies that focus on the first-hand experiences from women traveling abroad for reproductive services (including abortions) and to develop education around these points. 

The authors of this paper stress that “sensitive medical practices” are not, in and of themselves, wrong or deserving of scorn in any way. The dangers and stigmas that women may face should be addressed, as well as any legal considerations which may force them to become medically motivated travellers (including for abortion; vasectomy, etc.).

About the authors

F. J. DeMicco, Ph.D., Visiting Scholar, the Department of Human Dimensions of Natural Resources – Masters of Tourism Management Program at Colorado State University, Fort Collins, Colorado; Visiting Professor, the University of South Florida- Sarasota - Manatee and Aramark Chair Emeritus, the University of Delaware.

And graduate students in the CSU Masters in Tourism Management Program: Yiran Jiang, Sean Grabosky, Katelyn Novak, Samantha Pallazza


Hoz-Correa, A. de la ; Muñoz-Leiva, F. ;  Bakucz, M. (2018).  Past themes and future trends in medical tourism research: a co-word analysis.  Tourism Management 2018 Vol.65 pp.200-211



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