The World Health Organization (WHO) has defined infertility as a failure to conceive over 12 months of exposure (which is a good practical guide to management), and leaves a longer term residual incidence of infertility of 10–15%.1) However, the chance to conceive is reduced almost twofold after the age of 35 years. As per various epidemiological data suggestions, approximately 80 million people worldwide are infertile. WHO has identified that the highest incidence in some regions of Central Africa where the infertility rate may reach 50%, compared to 20% in the Eastern Mediterranean region, and 11% in the developed world.3
What is involuntary childlessness and infertility? The effects of involuntary childlessness varies by location. India being a largely pronatalist society the effects of being childless has more negative social, cultural, and emotional repercussions for women than perhaps any other condition which is not immediately life threatening and the consequences of which can be devastating . In most Indian cultures, it is equated with ill-luck, being cursed and being a bad omen. These factions of thought have a direct impact on the well being and mental health of the individual in the due course of time. The impacts are felt and affects in different spheres, the determinants of which are the gender and social role played by the person.
Defining infertility and involuntary childlessness It has been hard to quantify the definition of infertility as estimating the prevalence of fertility difficulties, infertility or involuntary childlessness is hampered by variations in the definitions of these conditions (Schmidt & Munster, 19953; Kols & Nguyen, 19974). Marchbanks et al’,19895 has opined that infertility is a condition that can be regarded as a heterogeneous group of health problems, influence-able by a range of risk factors.
The definition of infertility has a significant impact on clinical outcomes, including those reported in research studies. Definitions vary in terms of whether the condition is identified by self-report, or based on a life calendar of reproductive events, a physician consultation or a physician diagnosis. WHO 20026 explains infertility to be the difficulty in conceiving and reaching a successful pregnancy by an individual of having a consummated relationship if two years without the use of contraceptives. There is a lack of a fixed definition of infertility, other than the conceptual interpretation followed by the WHO.
Fertility Rates: What does it imply?
Malthus has mentioned in ‘Essay on the Principle of Population’, human fertility has been highly debated. In the current context, the Western countries have undergone fertility transitions with high fertility rates dropping to levels around the replacement rate1 and sometimes even below2. In recent years, a number of Asian countries have followed this example. However, many countries retain extremely high fertility rates, especially in Sub-Saharan Africa (Malthus, 1798; O’Neill et al., 2001:39-48).
Over the past quarter-century massive changes in fertility behavior have occurred in most world regions. Many developing countries have experienced large and rapid fertility declines, and a number of countries in Asia and Latin America are now approaching the end of their transitions with fertility around or in a few cases (e.g., China) even below 2 births per woman. In the “more developed” world (Europe, North America, Japan, Australia, and New Zealand) average period fertility was already low in the early 1950s and, after temporary baby booms of varying magnitude, has decreased further to 1.6 births per woman in the late 1990s (United Nations 2001).
These recent fertility declines have been more rapid and pervasive than was expected. For example, medium variant projections for the late 1990s prepared by the United Nations Population Division in the 1970s, 1980s, and early 1990s slightly overestimated the fertility levels observed in the 1990s for the world and many regions. These results are primarily attributable to the invalid assumption that all countries end their fertility transitions with fertility stabilizing at the replacement level of 2.1 births per woman. This assumption was widely accepted in the past, and it is fair to say that the UN incorporated the consensus of the demographic community on this issue. Starting with its 1998 revision the UN no longer takes 2.1 as the eventual end point of the transition, and countries with low fertility are now projected, in the most commonly cited so-called medium projections, to remain permanently below the replacement level (United Nations 1999, 2000a, 2001).
One reason for this uncertainty about future fertility trends is that conventional demographic theory has little to say about levels and trends in post-transitional societies (Caldwell 1982). In an attempt to remedy this shortcoming, demographers and social scientists are engaged in an active debate on the causes of low fertility and the prospects for further change (Chesnais 1996, 1998; Lesthaeghe 2001; Lesthaeghe and Willems 1999; McDonald 2000). The matter is of considerable importance because further declines in fertility or even a continuation of current low fertility levels will contribute to rapid aging of populations and will lead to a decline in the size of national populations. These demographic developments in turn are likely to have significant social and economic consequences (Coale 1986; OECD 1998; World Bank 1994).