Social and Cultural Perceptions of Infertility
In 1961, a joint study by the United Nations and the government of India on the interrelation of demographic and socioeconomic factors in Mysore recorded that: ‘For a woman to have no children at all has traditionally been regarded as one of the greatest misfortunes, and even cause for ostracism’.71 Ten years later the influential Khanna Study, based on eight years of intensive fieldwork in rural Punjab and supplemented by a year-long follow-up a decade later, concluded that the inability of a couple to have children was often a major factor in causing divorce or separation.72 The assertion that infertility almost inevitably leads to marital breakdown in India has been frequently repeated since this period. In 1991, an advanced fertility treatment workshop held at Nowrosjee Wadia maternity hospital in Bombay reiterated that infertility was very likely to generate intense prejudice against affected couples, and that it dramatically increased the likelihood of divorce.73 Only one year later, the initial attempt of high-profile fertility doctors Anjali and Aniruddha Malpani to set up a support network in Bombay for affected couples foundered as a result of the stigma surrounding infertility. This group did not become active again until 1998, when there were sufficient members for a regular meeting to become viable.74
It remains the case that a high proportion of married couples in India are under a great deal of pressure to have children as soon as possible, and face intrusive questions from their relatives and neighbours if pregnancy does not occur within a few years of marriage. Those who cannot conceive easily - and especially women, who are invariably singled out for particular blame - are rapidly stigmatized within their communities, whether these are urban or rural.75 The decision of the actor Aamir Khan and his filmmaker wife Kiran Rao to make a formal statement after the birth of their son in 2011 that he had been conceived via IVF and surrogacy remains an exceedingly rare public declaration of fertility problems. Crucially, in this case, the announcement followed the successful birth of a child.76 The fact that childlessness is still seen as an aberration in India is underscored by a throwaway remark made in an otherwise deeply sympathetic investigation of couples suffering from involuntary childlessness in twenty-first-century Rajasthan: the author asserts in passing that the desire to have children is a universal drive shared by all humans which almost inevitably leads to deep unhappiness if it remains unfulfilled.77 Apparently, the author did not consider this statement to be problematic in any way, despite the unspoken implication that voluntary childlessness would be abnormal and potentially even unnatural.78
The silence and stigma that surrounds the subject of infertility in India has even extended to its treatment (or rather, lack thereof) as a plot device in film and literature. As cultural critic Monica Khanna Jhalani has pointed out, fictional representations of infertility by Indian writers were remarkably few in number until after the turn of the millennium.79 The Urdu short story Dada (‘Godfather’) by the Lucknow-born Pakistani author Khadija Mastoor (192782) was a rare exception in utilizing infertility as a plot device before this time.80 The humiliating treatment that can result from neighbours perceiving a woman as infertile was central to the plot of the 1986 Hindi film Swarag Se Sunder (More Beautiful Than Heaven), where the character of Lakshmi is abused and shunned by her entire village at the start of the film since she has not had children.81 Tellingly, this was a Hindi remake of the earlier Telugu- language film Thalli Prema (1968), and despite the social and cultural changes that occurred in India during this 18-year gap, the stigmatization of infertility was just as important in this later version and struck just as much of a chord with its audience.82 Even in recent years, such plots have remained confined to a small handful of works such as Suroopa Mukherjee’s novel Across the Mystic Shore (2006) and Abbas and Mustan Burmawalla’s Bollywood film Chori Chori Chupke Chupke (2001) - some of which are reactionary in their message rather than sympathetic to the characters they portray.83 Indeed, it is notable that in Chori Chori Chupke Chupke (the title of which translates into English as Quietly and Stealthily), the surrogate mother employed by the middle-class Indian couple at the centre of the story to carry their baby is actually a sex worker in her ‘everyday’ life. This plot twist reinforces a stereotyped and erroneous popular association between the two roles that has contributed to considerable prejudice on the Subcontinent against women who act as surrogates.84 The entwined themes of infertility, surrogacy, secrecy, and the impact of these on family life are also central to the plot of British author Meera Syal's 2015 novel The House of Hidden Mothers. The action in this novel moves between India and the United Kingdom, and Syal (whose parents were from New Delhi) grapples directly with the idea of foreign couples from a variety of backgrounds - including, in the case of the lead character, the Indian diaspora - relying on
Indian surrogate mothers while simultaneously attempting to avoid any overt exploitation of the women involved.85
As this discussion of literature and film suggests, in many ways there has been remarkable continuity in social and cultural attitudes to infertility in India since at least the mid-twentieth century. Marcia Inhorn has demonstrated that in the Middle East, among Muslim men there is currently a radical cultural reappraisal of attitudes to infertility underway which lessens the assumption that the condition is solely or primarily a ‘woman’s fault’.86 However, it does not seem that this social transformation is being replicated in South Asia. In fact, research by Inhorn and Aditya Bharadwaj strongly suggests that, for women in particular, infertility acts as a negative form of ‘master status’ - in other words, a role that overrides all other aspects of identity within a given society - and that it is best understood in this cultural context as a form of disability.87 Unlike countries such as Zambia, where ethnographic research suggests that there is little or no correlation between infertility and an increased risk of domestic violence, infertile women in India seem to be at high risk of abuse, including actual or attempted murder.88 In one example reported by the Times of India in June 2015, a 32-year-old woman living in rural Bihar was apparently subjected to eight years of systematic violence from her husband and mother-in-law, including being literally chained up in her home to prevent any chance of escape. Her abusers justified this treatment as a punishment for her inability to become pregnant. She was finally rescued when her brother became suspicious and alerted the authorities.89 If the stigmatization of the infertile in India is generally the same regardless of region, however, one factor above others may well strongly influence what sorts of biomedical or other means are chosen in order to try and solve this problem. This is the religion of the men and women in question, which plays a crucial role in decisions on what constitutes ‘acceptable’ treatments for the infertile in India.