Infertility is on the rise in India. Studies have linked this to both lifestyle factors as well as numerous diseases and the influence of air pollution. Despite this increasing prevalence, many hospitals remain inadequately equipped to deal with the issue.
Statistics for basic fertility services are shocking. A staggering 94 percent of primary health centres are not capable of analysing semen samples claims a survey by the Indian Council of Medical Research (ICMR). Community health centres (CHCs) are more frequently equipped for this service, though it is still not commonplace. Seventy-nine percent lack semen analysis capabilities.
The sample size for the survey was limited, involving twelve district hospitals, 24 CHCs, 48 primary health centres, and 48 sub-centres. However, this sample study does give an adequate overview of the state of infertility care across India, with six zones covered across the north, south, east, west, the north-east, and central regions of the country.
Advanced laboratory services were not available in 58 percent of district hospitals and 92 percent of CHCs. Diagnostic laparoscopy and hysteroscopy were unavailable in 75 percent and 92 percent of district hospitals respectively.
Fertility services appear to be a neglected area of healthcare. With primary health centres often not accommodating the most basic of fertility services, a number of private fertility clinics have opened within cities. However, it can often take months, and even years, of treatment to result in conception, if it occurs at all. Many find private fertility treatment entirely unaffordable.
Dr Rani Bang, recipient of the Padma Shri Award for her contribution to medicine, says that women’s reproductive health — in particular within rural environments — is one of India’s most neglected medical services. Dr Bang notes a significant lack of gynaecological morbidity studies in a community setting, with almost all taking place in hospitals and clinics.
Dr Bang’s study in the rural Gadchiroli district of Maharashtra revealed that 92 percent of women in the area had at least some form of gynaecological issue. Many of these issues related directly to childbirth, though some had menstrual problems, reproductive tract infections or sexually transmitted diseases. She also noted a proliferation of criminal abortions performed by quack doctors that pose a significant risk to the health of women in the community.
A major hurdle that India will need to pass, claims Dr Bang, is the stigmatisation attached to fertility issues. “A woman can die of obstructed labour only once,” she says, “but if she has infertility, she dies every day because everybody blames her.” Her study revealed that only around eight percent of women seek health for reproductive issues.
For as long as reproductive health is seen as a personal problem, and not a medical issue, people will be far less likely to seek treatment. If the issue is viewed as a common medical problem, it may also be more likely to see funding allocated and infrastructure improved.