This chapter introduces the concepts associated with involuntary childless. Various socio-cultural norms world over, global and Indian statistical, prevalence of infertility, stratification of infertility, health care mechanisms available for addressal of infertility and reproductive health rights in the context of millennium development goals and sustainable development goals-2030 will be discussed in the chapter.
1.1Incidence and Prevalence
Infertility is a world wide issue affecting spanning across all geographical locations, across all demographics and socioeconomic status. It has been said that about eight to ten percent of all couples within the reproductive age have sought medical treatment and testing at some point in their lives for a suspected infertility. Globally, about sixty to eighty million people are said to be suffering from infertility, of which between fifteen to twenty million are in India. The World Health Organization (WHO) defines infertility, as the failure to conceive and have a biological child over twelve months of cohabitation and active sexual life. This chance of conception reduces in an individual aged thirty five and above.
Epidemiological data from the WHO has identified that regions of Central Africa has the highest incidence of infertility and has been known to reach fifty percent as opposed to twenty percent in he Eastern Mediterranean region, and 11% in the developed economies.
There have been no specific studies conducted in India to know the incidence and prevalence of the condition. The limited available data is from the National Family Health surveys and Census, which measures the number of women without children, but dosen’t evaluate the causes of the same. Childlessness has been found to be 2.4% among all married women in the country.
In the other South Asian countries, statistics the same as India have been seen. (Bangladesh, four percent; Nepal, six percent; Pakistan, five percent; and Sri Lanka, four percent). Globally, also three to six percent of the population has been identified to have infertility. Middle East, three percent; Latin America: three percent; Europe: five percent; North America: six percent; Caribbean: six percent)
UNFPA, 1994, in their charter on Programme of Action of the International Conference on Population and Development, has cited that ‘Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.’ This definition makes clear that the individuals have the right for seeking information, access to good health care services, right for safe family planning methods as granted to them by the law, right to seek appropriate health care services which ensures women to safely undergo pregnancy and childbirth and gives the couple every chance to have a healthy infant.
Based on these, it can be said that reproductive health care is an umbrella term used for explaining methods, techniques and services accessed by those in need for prevention on reproductive health care needs and also solving them. Sexual health also forms one of the important aspects of reproductive health.
1.3.1 Millennium Development Goals, Sustainable Development Goals (SDG-2030) and Reproductive Health
The World Health Report 2005: Make Every Mother and Child Count (WHO, 2005) has mentioned the importance of mental health for maternal, new born and child health. They have trained midwives and other based health workers for understanding and evaluating maternal depression, post partum psychosis, suicidal ideations and immediate first aid to manage such situations. The International Conference on Population and Development (ICPD) Programme of Action and the Beijing Platform for Action, has sought its member nations to take action for rectification of gender based violence and unsafe abortion, so that lives of young mothers can be helped 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. Good reproductive health can be achieved when mental health and functionality can be achieved by an individual.
There is a difference between developed and underdeveloped nations in terms of access to care and reproductive health care services. World over, the aim of reproductive health has been to address economic, demographical variations, health status and health service factors that impact morbidity and mortality. Unsafe abortion, hemorrhage, childbirth and the period of pregnancy have been identified to be of highest risk. Even though such constraints exist, mental health is has not been taken as major determinant of health pregnancy.