| The right
to have a baby is something most of us take for granted,
and we often lose sight of the fact that 1 in 10 married
couples will not be able to have the child they want.
Infertility is a very common problem, and if you stop
to think about it, you will realise that you know at
least one person who is infertile amongst your own group
of friends or relatives. However, it remains one of
those taboo topics which no one wants to talk about,
even though it interferes with one of the most fundamental
and highly valued human activities – building
a family.
Millions of infertile couples in Indian cities today
face many obstacles in their attempts to build a much-wanted
family, and one of the most frustrating is the lack
of insurance coverage for medical treatment. What this
means is that while infertility specialists in India
can provide even the most advanced reproductive techniques
to solve extremely complex infertility problems, at
a level of sophistication which is comparable with that
in the West (and at a fraction of the price), most couples
cannot avail of these techniques because these are not
covered by their insurance policy. So near – and
yet so far, would sum up the situation for most couples!
The financial burden that some of the treatments may
place on couples can be large, and adding this on to
the emotional and physical consequences of experiencing
infertility can literally be the last straw which breaks
the camel’s back. The strong desire to build a
family gives many the strength to face these obstacles,
but infertile couples also need additional support from
their employers and insurance companies.
While most diseases and medical conditions are covered
by insurance, the disease of infertility is often singled
out for exclusion, and such discrimination is unfair!
Thus, to add further insult to injury, infertile couples
not only face the emotional pain associated with not
being able to have a child, but also face obstacles
put in front of them by their health insurance and employers
for reimbursement of the medical expenses they incur
on their treatment.
Unfortunately, insurance companies in India still do
not provide health insurance coverage for infertility.
This is a very archaic attitude, but because the insurance
industry in India is still a monopoly, this situation
is unlikely to change, until the field gets privatised,
or Indian companies fall in line with their Western
counterparts.
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Insurance companies have traditionally
denied claims for infertility on one of the following
flimsy pretexts.
- Infertility is not an illness;
- Treatment of infertility is not medically necessary;
- Treatment of infertility is experimental.
- Infertility treatment is too costly for a country
like India to offer
However, it has now been well established that infertility
is an illness, which is caused by various medical causes
which result in the abnormal functioning of the reproductive
systems (such as blocked fallopian tubes or a low sperm
count); and that these can be successfully treated in
most cases.
Medically necessary is usually defined by insurance policies
as medically appropriate for treatment of an illness under
professionally recognized standards of health care –
and treatments such as GIFT, IVF, and ZIFT ( ZIFT Video
) are now universally acknowledged to be standard medical
treatments, which are no longer experimental.
While certain infertility treatments can be costly, most
are quite inexpensive, and only about 5% of all infertile
couples will need expensive treatments like IVF. Moreover,
if expensive medical procedures like bypass surgery can
be covered, then why should treatment for an abnormally
functioning reproductive system be excluded?
Why this discrimination against infertile couples in
India? Ironically, this is because of the high premium
Indians have always placed on the family unit! The major
role of the woman in Indian society was seen to be to
have children to propagate the family name. Therefore,
if a woman could not have children, she was singled
out, ridiculed, ostracised and stigmatised.
In fact, given the value Indians have placed on having
children, infertile couples should actually receive
even more tender loving care from others – and
be helped in their quest to complete their family!
However, because of centuries of misconceptions and
myths regarding infertility (for example, "a barren
woman has been cursed by God, and being punished for
the sins of a prior life"), it will take a long
time for social attitudes in India to change. Infertile
couples are an easy and soft target for everyone –
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Ranging from:
- friends ("life is incomplete without a baby!");
- in-laws ("when will I become a grandmother?");
- relatives ("what do they want to earn money
for – they do not have any children to leave
it to!"),
- neighbours ("they may have a lot of money,
but what’s the use, they don’t have any
children");
- acquaintances (" no good news yet? Go see this
doctor my sister-in-law’s cousin went to –
he’s the best!") ;
- co-workers ("you don’t have any kids,
so can you stay on a little longer to finish this
job – I need to go back to take care of my children!");
- right to servants (" the reason she shouts
so much is because she doesn’t have any children
– serves her right!)
(Gentle reader, if you recognise yourself here, please
suffer a pang of guilt, and promise to improve your behaviour
the next time round!)
Many otherwise enlightened people take the attitude
that infertility treatment is elective – and even
compare it to cosmetic surgery. However, infertility
is a serious medical condition – it is both a
disease and a life crisis.
Others pontificate that these couples should just adopt
a baby, rather than take treatment. While adoption is
an excellent method of building a family for some couples,
it is not acceptable to everyone– and forcing
couples to do so when they don’t want to is very
unfair.
A major problem is that infertile couples in India
are too ashamed to stand up for their own rights –
with the result that they often suffer in silence. However,
infertility exacts a high toll! Not only do many marriages
break up, many women are abused for being infertile
as well. Also, infertile employees, because of the emotional
stress they are under, are often not as productive in
the workplace as they could have been if their problem
was successfully resolved.
Fortunately, this discriminatory attitude is now being
challenged by advocates for infertile couples –
at least in the US. The pathbreaking Americans with
Disabilities Act (ADA), provides protection against
discrimination for Americans with a disability –
a disability being defined as" a physical or mental
impairment that substantially limits one or more major
life activities."
The US Supreme Court has clearly ruled that reproduction
is a major life activity. Since infertility is a physical
impairment that substantially limits the ability to
reproduce, this means that if an individual experiences
discrimination because of his or her infertility, a
claim can be made that this is illegal under the ADA.
Thus, a police woman employed by the city of Chicago
sued the city recently because it did not provide infertility
insurance coverage. The Court ruled that infertility
is a disability under the ADA, and today the city of
Chicago covers the cost of infertility treatment incurred
by all its employees.
Many employers in India are not still aware of the
issues and concerns facing those with infertility. Employers
need to be more understanding of the special needs of
those of their employees who are infertile, and be willing
to make workplace accommodations for those undergoing
infertility treatments – for example, allowing
the employee to change her work schedule or to take
some time off. Employers, insurance companies, and legislators
in India also need to take steps to recognize that reproduction
is a major life activity – and that infertile
couples need all the help we can give them.
Unfortunately, most infertile couples in India do not
feel comfortable speaking publicly about this very private
struggle, even though they represent all racial, religious,
socio-economic and ethnic groups, as well as both sexes.
Infertility Friends Voice mail: 9721834,
email: malpani@vsnl.com
India's first support group for infertile couples, plans
to actively lobby for recognition of infertility as
a medical problem by insurance companies to enable members
to benefit from Mediclaim and other medical insurance
facilities.
We all need to remember that infertile couples are
our neighbors, co-workers, friends and relatives - and
they just want to experience the joy of raising a family
- an experience that so many of us take for granted!
Dr Aniruddha Malpani, MD
This article first appeared in Mid-Day, Bombay's leading
evening newspaper.
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