By Dr Gauri Agarwal
As the pandemic hit us in the face earlier this year, all other healthcare services were thrown off the gear to reduce the exposure of a contagion. Infertility treatment was also a casualty that is yet to start on the path to recovery. There are thousands of dedicated infertility clinics across the country who are facing a tough time, but more important is the fact that striking out infertility treatment from the list of essential medical services have left about 30 million couples suffering from infertility, i.e. 60 million people, at various stages of their treatment, in the lurch.
There are several reasons why infertility has reached the magnitude of an epidemic – poor lifestyle, rising infections, falling sperm count are some major aspects of the exponential rise in infertility. In turn, it has been a root cause behind several social ills such as poverty, abuse, mental health issues, and divorce, to mention a few. In comparison to the rise in infertility, the growth of trusted and recognised infertility treatment providers is dismal. The first assisted reproductive technology (ART) was introduced in India in late 1980s, but till date, it has been able to attend only 1 per cent of the people who need it. The suspension of services due to the pandemic has been a further blow to about 80 per cent of the infertile couple who are aged 45 or more, for every passing day is a draught of opportunity slipping by. Almost equal number of people are reaching the advanced age where the chances of successful pregnancy reduces. Resorting to assisted reproduction is the only way in which they can become parents and therefore, gain a respectable social standing, and the pandemic has only increased their risk of living a life stigmatised by childlessness. The social importance of having a child necessitates ARTs be considered essential service and ensure they reach all those who need it.
Social impact of the absence of ART
According to the demographic trends, fertility rates in India have slumped – India’s total fertility rate (TFR), i.e. the average number of children per woman in India, if she lives to the end of her child-bearing years, was 2.3 in 2013. This is quite close to 2.1, the TFR that keeps the population stable. However, the TFR for rural areas was 2.5, while in urban India, it was at 1.8; in states like Tamil Nadu, Punjab, Himachal Pradesh, and Delhi, it is 1.7. While the current TFR has driven the population towards stability and may seem a cause for celebration for the world’s second-most populous country, any further significant drop may cause a social imbalance eventually due to inadequate number of people in the productive age group and a growing burden of geriatric population.
Infertility is a silent factor that no one talks about – providing infertility treatment today successfully to even half of the affected couples would mean nearly 15 million people ready to join the workforce in the next 25 years. It assumes greater importance in the wake of the fact that India’s 37-year-period of ‘demographic dividend’ began last year. Unless there are enough people to substitute them at the end of their productive phase, along with keeping a check on the growing burden of infertile couples, it may have a significant but adverse impact on India’s workforce.
Time to bring a shift in focus
The fear of COVID-19 transmission in people is only adding to this problem – it is preventing couples from visiting doctors at the treatment facilities for a discussion that answers their questions and boosts confidence. An aspect that does not feature in any discussion is the plight of the couples who have been diagnosed with some problem leading to infertility or who are ‘in-cycle’ – some of them may have resigned to the fate of being childless forever. But it is important to give hope and help to those who still have a chance.
While health concerns such as infant mortality rate (IMR) has a role to play, policymakers have systematically ignored the infertility aspect, for the focus, was more on birth control than planning for a family in a systematic manner. It is time to turn the tables and focus on a policy framework that helps couples struggling with infertility for the sake of the country. The government should also establish a statutory regulatory environment to ensure genuine and certified practitioners can offer their expertise – as of now, about 400 centres of an estimated 1,500 to 2,000 centres are enrolled with ICMR. Having a robust regulation, as opposed to the restriction or prohibition will also help bring infertility treatment under insurance cover – for a treatment that is largely perceived as a prerogative of the rich, having an insurance cover will help in extending the benefits of ART to millions of couples. At the same time, a comprehensive and coordinated awareness campaign is needed to remove the stigma surrounding childlessness, so that more couples take it in a way they address diseases such as hypertension or heart disease.
(The columnist is an IVF & Infertility Specialist, and Founder, Seeds of Innocence & Genestrings Lab. Views expressed are the author’s own.)