The World Health Report 2005: Make Every Mother and Child Count (WHO, 2005) recognizes the importance of mental health in maternal, newborn and child health, especially as it relates to maternal depression and suicide, and of providing support and training to health workers for recognition, assessment and treatment of mothers with metal health problems. The International Conference on Population and Development (ICPD) Programme of Action and the Beijing Platform for Action urged member states to take action on the mental health consequences of gender-based violence and unsafe abortion in particular so that such major threats to the health and lives of women could be understood and addressed better. In addition, the mental health aspects of reproductive health are critical to achieving Millennium Development Goal (MDG) 1 on poverty reduction, MDG 3 on gender equality, MDG 4 on child mortality reduction, MDG 5 on improving maternal health and MDG 6 on the fight against HIV and AIDS and other communicable diseases. Moreover, humans are emotional beings and reproductive health can only be achieved when mental health is fully addressed as informed by the WHO’s definition of health and the definition of right to health in the International Covenant of Economic, Social and Cultural Rights.
Infertility is a world-wide problem affecting people of all communities, though the cause and magnitude may vary with geographical location and socio-economic status. Approximately 8-10% of couples within the reproductive age group present for medical assessment, generally
following two years of failed efforts to reproduce1,2.ICMR 2000
It is estimated that globally between 60-80 million couples suffer from infertility every year3, of which probably between 15- 20 million are in India alone. The magnitude of the problem calls for urgent action.
Typically, infertile couples are reluctant to jeopardize or disturb close relationships (perhaps because social changes are usually permanent) because they hope or believe infertility will be a temporary problem. By the same token, reluctance to consider solutions may be due to the hope and promise often attributed to medical and/or spiritual interventions. Nonetheless, infertile couples use all three measures – social, spiritual, and medical – as remedies for their involuntary childlessness; numerous examples of these remedies exist throughout history and across all cultures.
Divorce, polygamy, and extramarital affairs remain, as they have long been, social solutions to infertility, as do various forms of adoption and fostering. Examples of other social solutions include the continuing practice in some cultures of multiple wives in response to infertility (or lack of a son) or the custom in some cultures requiring a sibling (usually an eldest son) to provide one of his children to a younger, childless sibling.
Women’s bodies, especially in developing countries, are frequently the locus through which social, economic, and political power is exercised. Where the role or status of women is defined by their reproductive capacity, as when womanhood is defined by motherhood, infertility can have significant social repercussions including unstable marriages, domestic violence, stigmatization and in severe cases, ostracism. Infertile women in developing countries may suffer life-threatening physical or psychological violence when having children is a woman’s only chance to improve her status in her society or family. Individuals who are thought to be infertile are generally relegated to an inferior status, and stigmatized with many labels. Hence, childlessness has varied consequences through its effects on societies and on the lifestyle of individuals. Parenthood is personal for some women, whereas by some as a duty.
Parenthood is one of the major transitions in adult life for both men and women. The stress of the non-fulfillment of a wish for a child has been associated with emotional related problems such as anger, depression, anxiety, marital problems, sexual dysfunction, and social isolation. Couples experience stigma, sense of loss, and diminished self-esteem in the setting of their infertility. Although infertility is primarily a medical condition, its diagnosis can greatly impact the emotional functioning of couples dealing with this problem. Infertility is often an unanticipated, stressful, and life changing event. Infertility and involuntary childlessness have been often referred to as a developmental crisis that can threaten a couple’s future goals, as the family does not progress from the married couple without children, as a developmental phase.