A young couple endearingly looks at the wall full of pictures of healthy new-born babies and the delighted faces of those holding them inside an infertility and gynae clinic in Bemina, Srinagar.
The waiting space in the clinic gradually fills in; younger strangers connected by their physiological conditions befriend each other and a bond of sisterhood is forged in no time.
The space that is now bustling with hope and expectations for a content and joyous future is conspicuously avoided by a visibly older couple. Abrar Khalid* sits secluded with an air of a silent, steady resolve; his wife, Saleema Jan*, is seated beside him, softened with hope and the prospect of their wish being granted.
After two failed In-vitro Fertilisation (IVF) attempts – where the egg is fertilised outside the womb – and seventeen years of childless marriage, the couple had travelled about fifty kilometres from Baramulla, north Kashmir, to Dr. Syed Sajjad Hussain’s clinic, Med Age Infertility Centre and Gynae Solutions, in Srinagar – hoping to conceive a child.
A study by Indian Society of Assisted Reproduction (ISAR), the oldest national organisation with specialists in the field of Assisted Reproductive Technology (ART), claims that there are nearly 27.5 million infertile couples in the country; Mr. Khalid and Ms. Jan are among them.
United Nation’s World Population Prospects 2017 report states that the fertility rate in India has plummeted by more than 50 per cent – from 4.97 to 2.3 – in the past forty years. Simultaneously – a report named, “Indian IVF Market Outlook 2020,” by RNCOS, a market-leading business consulting firm, claimed that – the IVF market is poised to witness an impressive Compound Annual Growth Rate of around 15 per cent from 2014 to 2020.
The report also states that by the end of this century, IVF might account for 4 percent of the global population — i.e. about 400 million babies.
Before Dr. Hussain, the couple had previously seen several doctors, who told them that there was no problem. Eventually, they were suggested to take a shot at IVF. A year and half ago, in 2018, the couple had outright failure in their first attempt. The second one, attempted merely three months later, didn’t last more than two months either.
“It takes a massive financial toll on us,” says the 39-year-old husband, a labourer by profession. “The circumstances only compound our situation. There is hardly any work. Sometimes, there is no money to even pay for travel.”
It is just not finances; Mr. Khalid feels humiliated when he is out seen. “They label me a naamard [effeminate] for not having had a child in all these years.”
His 36-year-old wife looks to the ground in helpless disappointment and adds: “People always taunt, they even deny us our rights saying what good is a baanj [a sterile woman].”
Speaking of their social strata, Ms. Jan tells that childless couples are often seen as a negative influence, “for casting an evil eye upon others children”. Mr. Khalid calls the economically well class – “Hi-Fi log” – different; “the poor have no social support.”
Not just harassment from society, the couple has suffered swindles from doctors as well. Choosing to not disclose the name of a certain doctor, Mr. Khalid recounts how once his wife was prescribed a surgery citing that her tube is blocked. Nothing changed, though. “The next doctor told us that there has been no surgery at all – just an incision and stitches.”
However, the couple is grateful to Dr. Hussain for not charging for his services after the first failed attempt under him.
In Kashmir, there are limited means to address the issue. The first concern, says Dr. Hussain, being matters of infrastructure: given that Lal Ded Hospital in Srinagar is the only tertiary healthcare institution with some official provision regarding infertility, however, their services are restricted, too, owing to mounting obstetrics responsibilities—pregnancy, childbirth, and postpartum services.
Hence, most infertile couples rely on private healthcare services to cater to their needs.
It took Dr. Hussain about seven years to get Indian Council of Medical Research (ICMR) registration for his clinic (among 423 other ICMR registered clinics in the country), which he runs with his gynaecologist wife.
“Even with the best facilities, as in America and the UK, the success rate of conception through IVF is 30 to 35 per cent,” says Dr. Hussain. “Claiming more than that would be a lie.”
Ordinarily, the very basic cost of treatment through IVF, that includes tests and medication, could go over 1.5 lakh rupees. Due to fewer reliable facilities and the social stigma coming in the way of this method of treatment, many prefer to seek this service outside Kashmir, mostly Delhi, Chandigarh, and Mumbai – if they can afford it.
This further adds to couples’ burden, financially, socially, as well as emotionally.
Infertility may have its roots in either male, female or in an unexplained cause, explains Dr. Hussain. “Male and female infertility have about 40 percent chances each and unexplained infertility has a 20 percent chance.”
And its roots also bring to light the prominent medical and social aspects that accompany this condition. Dr. Hussain tells that “in case of male infertility, options for treatment are promptly explored; in case of female infertility, it is common for the family to consider another marriage of the husband—in both these cases, there is acceptance of the disordered condition and treatment is sought readily.” But in unexplained fertility, he observes that the issue is accepting that there is a problem in the first place.
There, Dr. Hussain believes, IVF offers a solution. “Ideally, gynae and infertility experts must work in tandem for best results… there have been women as old as 50 who have born healthy babies.”
He believes that conflict in Kashmir is only a contingent factor and cannot be blamed for someone’s infertility. But Avantika*, 39, might opine in disagreement; in the 1990s, her family couldn’t leave Kashmir during the Pandit migration. A resident of Srinagar, and a school teacher by profession, she got married only two years ago.
“Our [Pandit] community is so small that a timely marriage could only be in a dream,” says Ms. Avantika. “It is difficult to find a match, and at a later age, you develop biological issues.”
Last year, she, too, had two fruitless attempts with IVF. “I have already spent more than six lakh rupees on my treatment so far. It is very frustrating,” she says, “I’m just unlucky. Due to my condition, I have very painful periods. I want to conceive not only to have a child but also to just end my suffering.”
Ms. Avantika suffers from endometriosis – a disorder in which tissue that lines the uterus grows outside the uterus – and was suggested to go to Delhi for treatment. This condition can be treated naturally by pregnancy by means of easing the painful symptoms.
“People see you as a child-bearing machine,” sighs Ms. Avantika. “They don’t see the pain and trauma you are going through.”
She narrates her ordeal: “This is indeed torture for me—the amount of money this is costing, there are social obligations, you cannot explain it to anyone. There are leaves to be taken, the pain is excruciating, the travels and stay are expensive—and you are seen as a criminal!”
She says that she is compelled to hide her condition from her parents and in-laws – “to not hurt them and add to the heavy emotional weight I carry.”
As she silently pursues her treatment, she finds her sole source of support in her husband, while awaiting the day her ordeal ends.
But, while the likes of Ms. Avantika and the couple – Ms. Jan and Mr. Khalid – await their miracle, awareness about infertility and de-stigmatising its treatment is arguably the way ahead.
*Names have been changed as per request.
Kavya Dubey is a Reporting Fellow at The Kashmir Walla.
The story appeared in our 2-8 March print edition.