A study on infertility and health care seeking among the poor in India and Nepal

While infertility and childlessness have emerged as affecting between 8 to 12 percent of reproductive aged couples worldwide and approximately 28 per cent in India and Nepal, there is a severe lack of attention given to these issues in the two countries. In developing nations at large, it is overpopulation rather than infertility, which has emerged as the focus of governments and policy makers alike. Overpopulation, therein, is seen as leading to poverty and lack of development, creating an ‘anti-natalist’ atmosphere within the State. This is despite the fact that infertility has significant socio-cultural and health implications for those who are affected by it. Moreover, affordable facilities and programmes for its prevention and treatment are majorly lacking within policy agendas and the public health systems of both India and Nepal. Even globally, no major international organization sees infertility as a serious reproductive healthcare issue. The ICPD does not foot any recommendations regarding access to safe and affordable treatment. Neither is it recognized as an important issue by any of the major international philanthropic organisations. This, then, becomes a major lacuna that needs to be addressed at the earliest.

A study titled “Marginalised Lives: Infertility, childlessness, and healthcare seeking in resource poor settings in Nepal and India” seeks to do so by bringing together a number of partners to look into the incidence of infertility in the two countries.

The collaborators on this project, along with Sama, include The Graduate Institute, Geneva; International Foundation for Population Development; Women’s Rehabilitation Centre, Nepal; and Agragami, India. Funded by the Swiss Network for International Studies, the project seeks to examine the policy and scholarly blind spots, which exist within discourse around infertility. It further seeks to unravel the lack of public health dialogue around the issue; the unaffordability of assisted reproductive technologies for a large section of the population; the social stigma and ostracism resulting from the condition; the gendered experiences of it; the state of healthcare provision both formal and informal, traditional and modern; and the policies and programmes around ensuring access to treatment for the poor.

Over the years, Sama has worked extensively on issues of infertility, reproductive technology, as well as on related themes like surrogacy. This project, therefore, provides us the chance to revisit many of the questions and issues that have come up through the course of our previous studies. Through an exploration of its socio-cultural impact, the local perceptions and understandings of it, the community specific experiences of it, the treatment seeking behaviours of those affected by it, the different kinds of treatment providers, as well as the policies around it, we want to further the conversation around infertility as a public health concern. Designed as a multi-sited study, different partners are to undertake the data collection in the different sites. Not only does this offer Sama a chance to collaborate with other organisations, each with their own expertise, it also provides the scope for a comparative analysis of the terrain of infertility, across different locations.

We are confident that this study will further the discourse around infertility in the global south and are glad to be a part of this collaboration.

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