As far back as in 1997, doctors in Kashmir underlined the issue of infertility in Kashmir, the features highlighted in a study titled “Epidemiologic and aspects of primary infertility in the Kashmir region of India”. The research carried out by a group of noted endocrinologists led by Dr Abdul Hameed Zargar deducted that 15 percent of the over 10,000 couples interviewed had primary infertility. Nearly 5 percent of these had unresolved infertility. About 15 years later, even after many studies into the issue of infertility confronting married couples in Kashmir, not much has been worked upon for addressing it.
A 2018 paper, ‘Perception among married couples towards infertility, causes and treatments in Kashmir valley’ by Bilal Ahmed found that the knowledge of Assisted Reproductive Technologies was ‘poor’ across Kashmir, irrespective of the area of residence. On the perception about infertility, 27.62 percent male and 24.76 percent female respondents thought infertility could only occur after 40 years of age while 72.38 percent male and 77.14 percent female respondents felt it would not be easy to conceive after 40 years for women without taking medial support. Infertility can affect a person at any age, studies show; however, the incidence increases with age.
The years have seen more and more private practitioners and hospitals offering consultation and treatment, many a times on referral basis, for infertility. Every day, the hoardings on the busy roads, the advertisements on newspapers and now also on television promise couples the ‘happiness of having a child’. The ‘happiness’ comes with a price tag. Despite infertility, primary and secondary, being a major health issue with a socio-economic connection, Kashmir’s health sector has steered majorly clear of any efforts to address this. Although diagnosis of infertility is quite commonplace, the places of reversing it are yet to come up in a meaningful manner here. A few years ago, Government Medical College Srinagar made some basic investigations required for addressing infertility available at Lal Ded Hospital with the help of some basic equipment. This, years later, was followed by the first Intrauterine Insemination (IUI) Center at this hospital. Soon after, it became defunct and continues to be so.
Prof Shehnaz Taing, ex-HoD of Gynecology and Obstetrics at GMC Srinagar said the supply of ‘Medium’ required for assisted insemination soon got exhausted and was never replenished. “The Media costs around Rs 1000 per cycle and the overall running costs of the Lab would be around Rs 4-5 lakh. Plus, we need trained manpower to keep the Lab running,” she said. She said when the Center was started at the Hospital, a postgraduate scholar was carrying out the processes. “It was not sustainable and when she left, there was no one trained to run the Center,” Prof Taing said. The IUI program, she said, is the primary level program that can be kept available for treatment of infertility. “Even this facility could help thousands of couples across Kashmir.
Prof Taing said the Government needs to allocate funds towards programs on infertility. “Early diagnosis could help a lot of people out there have earlier interventions. That could help in making the lives of so many women better, those that face the social and familial pressures and stigma when they are unable to give birth,” she said. Prof Taing said although a considerable number of couples who remain childless could be helped with Assisted Reproductive Technologies, it seemed difficult. “Kashmir’s healthcare sector needs funds for the two most expensive conditions people face – heart diseases and infertility,” she said. “We are far away from having Intro-Vitro Fertilisation set-up. We need to work on the basics first.”
Prof Farhat Jabeen, who retired from GMC Srinagar as HoD of Gynaecology after Prof Taing feels the issue is a compound one. Infertility is a concern in Kashmir, she said, adding that it could not be said with certainty that the problem has worsened in recent years. “Earlier, if a couple was unable to have children, the husband would marry again. It was common. Now, people are exploring treatment for infertility rather than parting ways. That is one thing that seems to have changed and that brings women and men facing difficulty in having children to us,” she said. In addition, she said, the rising prevalence of Polycystic Ovarian Syndrome (PCOS), obesity and late marriages was contributing to the issue.
She said IUI Centers could be started outside Lal Ded Hospital as well and not much infrastructure was required to run these. “We need trained manpower, basic investigations and funding. The ART centers could run on a no-profit no-loss basis, to help these be economically viable and sustainable,” she said. She said “a small but trained team” for ART was needed at Lal Ded Hospital with support from Government and administration. “It should have sectors, nurses and paramedics. It doesn’t need a separate building but a small space in the existing infrastructure could also work,” she said. “We have proposed this to the Government many times, but the COVID19 and many other things have pushed us back,” she said.
Recently, the Directorate of Health Services Kashmir (DHSK) issued a circular to its functionaries across districts to set up IVF Centers in hospitals, starting with IUI Centers. Dr S M Qadri, Epidemiologist and in-charge of this program said the circular was to ‘mark a beginning’ as the department had started to get its doctors, gynecologists and others, trained in assisted reproduction. “We recently trained our doctors through a brief online class system. It will take time, but we need to start somewhere to help thousands of people struggling with infertility in Kashmir,” he said.
Over the past five years, the Total Fertility Rate (TRF) of J&K has fallen to 1.5 from a little above 2 as per the latest National Family Health Survey 5 (NFHS 5).
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.