Feature

Selling the parenthood dream

As the world’s population passes six billion, parenthood remains a distant hope for many. Sandhya Srinivasan reports from India

While demographers debate whether or not India has joined the ‘one billion population club’, some 33 babies continue to be born every minute in the country, blissfully unaware that their arrival prompts experts and leaders to fret over the world’s ‘population explosion.’ But unnoticed by the outside world, there is another kind of explosion taking place in India: an infertility industry thriving on desperate couples seeking a child of their own. Targeting such couples – rich and poor, in cities and towns – are a host of unregulated private clinics.

Couples seeking medically-assisted conception will do anything – borrow from banks, families, friends, even sell their land – to pay for treatments like in vitro fertilisation (IVF), for which Mumbai (Bombay) clinics charge up to Rs100,000 per treatment cycle.

Many couples are deliberately misled. They are told the success rate is 40 percent, whereas it is no more than 15 percent in the best of clinics. The media, often the only source of guidance, is of little help: their glowing accounts of the latest state-of-the-art techniques only lead couples to troop from clinic to clinic.

‘We are already in debt for the last treatment which failed,’ says Jayant Nerurkar, whose wife Meena sits tensely beside him in the waiting room of a Mumbai IVF specialist.

Their quest for a baby began ten years ago. ‘The first doctor guaranteed success, but nothing happened. The second took Rs10,000 when I was earning just Rs3,000 a month – he didn’t even tell us his charges until after we started treatment, and we couldn’t stop half-way through,’ says the man. He plans to borrow another Rs60,000 in case ‘we should regret later not trying’.

Lack of data means no one knows the true extent of the problem: a 1992-93 National Family Health Survey estimates 2.4 percent of married women aged 45-49 years have never given birth. What experts do know is that much infertility in developing countries is caused by untreated reproductive tract and sexually transmitted infections (RTIs, STIs). Although regional or national statistics are unavailable, some researchers believe RTIs and STIs affect about 40 million Indians every year. Specialist health facilities, particularly in villages, are often non-existent or may be inaccessible and poorly equipped with diagnostic facilities or drugs. In any case, used as they are to ignoring their own health needs before those of their families’, women rarely attend them. Physically, they are less likely than men to have symptoms of RTIs/STIs and more likely to be embarrassed to discuss their condition with doctors.

‘The tragedy of infertility is that so much of it is preventable,’ says Dr Meera Shiva, of the Voluntary Health Association of India, a non-governmental organisation.

A couple’s inability to bear a child can also be traced to a physical problem with one or both partners. Although men are just as likely to be infertile, the repercussions of infertility are often more devastating for women. It can provoke a husband’s violence or be used to justify his divorcing or taking a second wife. The director of the Academy for Nursing Studies in Andhra Pradesh state, Dr M Prakasamma, who has conducted group discussions with childless women and couples, says the woman may even be considered bad luck and isolated from religious celebrations such as naming-ceremonies for newborns.

‘At the village level only traditional remedies (faith healers, pilgrimages) are available,’ says Dr Sharad Iyengar of ARTH, a nongovernmental organisation based in Rajasthan state. In theory, some infertility treatments are available in government hospitals but only the poorest and most desperate seek them.

‘It can take up to a year for a couple to get a complete diagnostic work-up in most public hospitals,’ agrees Dr Kamala Ganesh, who worked in a government hospital in the capital.

Filling the treatment vacuum – for a hefty price – are the infertility specialists. The 1980s saw the growth of private ‘five star’ hospitals and clinics – mostly financed by loans from banks or financial institutions – investing in sophisticated medical technologies.

According to infertility specialist Dr Puneet Bedi, IVF is needed in barely two percent of couples seeking treatment, but he adds, ‘what’s to prevent the doctor from telling the patient she needs IVF?’

But infertility treatment can be risky for women: unsafe surgical investigations can cause internal damage or infection. Carelessly prescribed drugs are known to cause multiple pregnancy and ovarian hyper-stimulation syndrome – a potentially life-threatening condition – congenital abnormalities of the foetus and cancer. Although the World Health Organization has issued guidelines for the diagnosis and management of infertility, some practitioners are unethical, offering inappropriate, unnecessary or potentially hazardous treatments.

A 25-year-old woman from Bhiwandi, a town near Mumbai, was underweight and six-and-a-half-months pregnant when she delivered quadruplets at the state-government-run hospital. The babies died within 12 hours of birth. Ovulation-inducing drugs were ‘150 percent’ responsible, said a specialist. Often women undergo a hotchpotch of treatments without basic tests like semen analyses performed first on their husbands. Still couples flock to clinics, despite the emotional and financial costs.

One such – a college lecturer and his wife – were at an expensive Mumbai hospital recently, having borrowed more money to return for their second try at IVF. ‘I am confident things will work out. I only wish we had come here first,’ he says as his wife breaks down at the thought of failing once again. Privately, the doctor admits theirs is a hopeless case: ‘But if I don’t do it, they will go somewhere else’.