Infertility is the inability to conceive even though a couple frequently has unprotected sex. This might be due to either the female or male’s infertility or the female’s inability to carry a pregnancy to full term, resulting in a miscarriage. Common causes of female infertility include anaemia, ovarian disorders, and depression (leading to lower libido). Male infertility usually arises due to poor sperm quality, genetic disorders, and depression. Infertility remains a widespread problem. Approximately 48.5 million couples worldwide face infertility, and one in four couples in developing countries experience it. As of 2021, the fertility rate, measured in terms of the average number of children born to a woman, was reportedly the lowest in Taiwan: 1.07. In India, the fertility rate between 1975 and 1980 was 4.97. But this has since dropped to 2.3 between 2015 and 2020 and is estimated to decrease even further to 2.1 between 2025 and 2030. Putting this into perspective, almost 27.5 million couples trying to conceive in India suffer from infertility – around 14% of the country’s population. The drop in fertility rates is alarming. A stable population would have a fertility rate averaging 2.2; countries will see a population decline if it is lower. Not only is infertility a growing issue in India due to pre-existing health issues amongst couples, but also because of several external factors. Pesticides and fertilisers, urbanisation, pollution, job pressures and postponing having children are contributing factors. 

Although a decline in fertility rates is a well-known global problem, childless women face more stigma than support. Consider India: India’s patriarchal society assumes that the woman’s primary role in a household is to bear a child. It follows that a woman’s fertility is associated with her social status. Clearly, a woman’s social standing or value is not based on her ability to have children. In fact, many women choose not to have children in favour of independence or given an absence of maternal instincts. Yet, society blames women for infertility, forgetting or unaware that infertility can also be due to complications with men’s health. A lack of scientific knowledge on infertility means that people turn to religious and spiritual bases to justify excluding women socially. Indian women have been suspected of being possessed by witches, acting sinfully in their past lives, or not performing religious rituals properly. To spiritually ‘relieve’ women’s bodies, violent exorcisms are also occasionally conducted. Further, given the emphasis on families coming together through marriage in India, women fear being abandoned by their partners as well as their in-laws when they face infertility. A study shows that 53% of women experienced the threat of abandonment by their in-laws because of infertility. This demonstrates two problems: i) women who are economically dependent on their husbands lose financial support, and ii) entire families are implicitly reinforcing and imposing patriarchal values on younger generations.

Moreover, women who are involuntarily childless can experience severe domestic violence and/or mental health issues. Domestic violence and mental illnesses are not mutually exclusive since domestic violence often leads to anxiety or depression. Hence, both not only cause infertility, but they are also expected outcomes of infertility problems amongst couples. Women who face infertility with their partners are twice as likely to be victims of domestic violence than women with children. In Turkey, for instance, the most common form of domestic violence is reportedly psychological abuse. Looking at mental health issues, infertility means that women are socially ostracised and subject to societal assumptions that they have a lower quality of life and encounter marital discord. Women who experience infertility are also likely to struggle with their self-esteem and confidence. This leads to depression, which of course, only worsens chances of fertility. 

How can society support couples who struggle with infertility? First, societies in developing countries like India must implement or restructure medical aid provided to treat infertility issues. Many couples struggling with infertility are currently instructed to undergo complicated testing processes with specialists to identify problems. However, approximately 80% of infertility cases can be dealt with via simple procedures. After a simple treatment method, couples would then need to be referred to specialists for treatments like IVF or surrogacy. Second, given the immense impact of infertility on mental health and vice versa, therapy programmes should be developed for women facing domestic violence and mental illnesses. Such programmes could be integrated into fertility clinics. From a practical perspective, implementing straightforward procedures and mental health programmes would largely be facilitated by legislative reform. For example, India’s Health Minister, Harsh Vardhan, introduced the Assisted Reproductive Technology (Regulation) Bill 2020. This aims to oversee ART clinics and uphold ethical medical practices to prevent the exploitation of women and children. Enacting legislation to structurally reform processes like surrogacy would alleviate infertility in countries such as India and simultaneously normalise other means of having children. 

Credits – Shwetha Sivaraman

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