from the book How to Have a Baby: Overcoming
Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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How can the community support
infertile couples ?
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 realize 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.
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 - 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, 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!
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