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Unlearn the construct of infertility as a lack......बांझ हूं अधूरी नहीं..... नारी हूं और पूरी भी।

Infertility is less researched and talked about. Both feminist and disability right activist has ignored infertility of women in developing world. Infertility in women is a condition of inability to produce or conceive.Currently, there are two overarching and conflicting models that define the nature, origins, and scope of disability: the medical model and the social model. Viewed through a medical lens, disability can be defined as “a physical or mental condition we have a strong [rational] preference not to be in” and is, in some sense, a “harmed condition” (Harris 2000, 97). Put simply, the medical model of disability views disability as a deficit, abnormality, or defect in the individual. By contrast, the social model of disability posits that social and political arrangements render a person disabled (Reindal 2000, 93). The social model of disability does not focus on one’s actual or perceived biomedical condition, but rather on the social and environmental factors that limit the cultural participation of disabled people (Schilling 2009, 192). The medical model takes disability as a deficit or a lack. The World Health Organization (WHO) labels this integration of the medical and social aspects of disability as the biopsychosocial model. This integration of both models synthesizes the aspects of disability that are internal to a given person (the individual’s medical impairment) with the aspects of disability that are external to the particular person (namely, societal response to the person’s impairment). Impairment refers to the actual medical abnormality, whether physiological or psychological. Activity limitation, in turn, is the restriction or limitation on performance and ability due to the impairment. Participation limitation concerns how the activity limitation impacts societal role fulfillment (World Health Organization 2002, 17).

Using this biopsychosocial WHO classification, both feminist and disability rights scholars should highlight the plight of infertile women in the developing world through advocacy for cultural, social, and political change as these women are uniquely negatively limited in their social and political participation. Infertility in the developing world is highly associated with women. The aspect of fertility in women’s life is integral towards her completeness as a woman. In the developing world women production capacity is equated as a boon socioculturally and geopolitically. The socialisation has ingrained the notion of procreation as a norm . From childhood onwards we learn and glorify procreation. This glorification impacted lives of women in developing world. People hardly talk about this as an issue. In Southasian countries marriage is associated with reproduction. The highly accepted societal marriage definition has programmed women and society to think in a linear way that is reproduction. I feel marriage is about partnership and understanding. However, in India inability to conceive or produce leads to ostracism of women. Everyone must have heard the word ‘baanjh.’ Even in some cultures inability leads to a second marriage.

In 2002 study estimates that more than one-quarter of women who have never been married in the developing world are infertile. There are two types of infertility in women.

1. Primary infertility

2. Secondary infertility.

Primary infertility is the inability of a woman who has never previously conceived to successfully conceive after one year of regular, unprotected intercourse. This form of infertility can be caused by genetic abnormalities, impaired oocyte transport through the fallopian tubes, hormonal imbalances, and poor male sperm count or quality, among many other causes. Secondary infertility refers to difficulty conceiving after a prior history of pregnancy. Some of them are amenorrhea (no menses), Obstetrical fistula and etc… The perception of infertility in developed countries is different from developing countries like India, sub Saharan Africa. In the developing world, infertility is considered to be always female in etiology (cause). Knowing that women are infertile she is more at risk in the developing world that can be attributed to the negative associations and stigma they face in attempting to obtain and use condoms is the high rate of HIV infection. One study in Zambia showed that only 11 percent of women felt they had the right to ask their husband to wear a condom “even if she knew he was already HIV positive.” This disheartening number can also be attributed to the “culture of silence” regarding sexuality as well as to a cultural belief that a man has a right to have sex (Luna 2009, 130; Cooper et al. 2004, 78).

The United Nations estimates that even if only 2 percent of pregnant women in the developing world endure obstructed labor, then more than 67,000 new cases of obstetric fistula occur each year in Africa alone (Rizvi and Zuberi 2006, 919; United Nations 2002, 43). Obstetrical fistula is an abnormal connection between a woman’s bladder, vagina, and/or rectum, most often resulting from obstructed labor and prolonged childbirth (Wall 2006, 1201). Women with obstetric fistula suffer from urinary incontinence caused by the flow of urine from the hole in the bladder into the uterus or directly out through the vagina. Because the obstructed head of the fetus causes a loss of blood supply to a wide area of pelvic tissue, women may also suffer from renal failure, fistula formation between the rectum and vagina resulting in frequent vaginal infections, urinary and fecal incontinence, loss of menstruation, pelvic infection, and secondary infertility, to list only a few possible medical complications. Due to incontinence and odor, women with obstetric fistulas are usually divorced, excluded from religious activities, ostracized by society, and banished to isolated huts, resulting in worsening poverty and malnutrition (Arrow smith, Hamlin, and Wall 1996, 568).

Why is infertility a disability in the developing world?

In the developing world, we have the activity limitation of not being able to reproduce. This is true across both the developed and the developing world; however, in the developing world, this disability translates into a severe participation limitation with devastating consequences since these women cannot fulfill their strict social roles. In these cultures, a woman’s identity and personal value depend on her fertility (Dudgeon and Inhorn 2004, 1384; Remen-nick 2000, 822). Indeed, “the achievement of parenthood is regarded as the sine qua non for the attainment of the full development of a complete person to which all aspire” in sub-Saharan Africa (Hollos and Larsen 2008, 160). It is, therefore, because of this unique imperative to bear children, that infertile women in the developing world are especially limited in their social participation, and certainly more so than their counterparts in the developed world.

The devastating consequences of infertility for women in the developing world include disastrous social, medical, and psychological effects. It is certainly true that the psychological and social implications of infertility are difficult for any woman to overcome, regardless of whether she lives in the developed or developing world. Yet, the sense of being devalued as both a woman and human being for not producing children is magnified and multiplied several times over in the developing world due to the strong cultural, social, and socioeconomic pressures to be fertile (Remennick 2000, 839; Butler 2003, 1). In the developing world, infertile women do not so much as suffer passively with a medical condition, but are regarded as actively challenging core societal values by not bearing children. Thus, infertile women there face severe sanctions that are only compounded by violence and their low socioeconomic situation (Remennick 2000, 824; Dyer et al. 2002b, 1666; Cooper et al. 2004, 79). The extent and nature of much of this suffering is unknown due to the lack of completed studies on infertility in the developing world, while the plight of infertile women in the developed world has been extensively researched (Dyer et al. 2002a, 1662). Thus, while infertile women in the developed world have a disability (according to the WHO biopsychosocial model) that limits their activity; infertile women in the developing world have the additional disadvantage of being greatly limited in participation in society.

The participation limitations of infertile women in the developing world (when analyzed according to the WHO’s biopsychosocial model) are complex and depending on several factors in nature; for that reason, the remedies for these limitations that should be advocated by feminists and disability rights proponents should combine various factors, and should include both medical and societal components. As in general medical improvements such as improving preventative services and providing knowledge about reproductive health would help to empower women and preventative services should highlight and improve, medical services for treatment should also be provided, including adequate obstetric care, medications for STDs and HIV, general infertility services, surgery to repair obstetric fistulas, as well as assisted reproductive technologies (ARTs). Some critics argue that due to the great financial costs of ARTs, as well as their low success rates (less than 30 percent), it is difficult to justify the use of ARTs in regions of the world plagued with other health problems (Butler 2003, 1). They also point out that in many of these countries, national efforts are focused on reducing fertility rates, and thus the suffering of infertile women is ignored as representing “barrenness amid plenty” (Dudgeon and Inhorn 2004, 1388). If we look closely the great heterogeneity of the developing world reveals that many of these countries and regions (India, Latin America, the Middle East, and sub-Saharan Africa) already have in place some of the facilities and personnel to provide these expanded medical services (Butler 2003, 3). Persistent demand for infertility services including ARTs is high in the developing world, with one study indicating that more than 25 percent of infertile women in these parts of the world have unsuccessfully attempted to access infertility treatment for more than five years (Dyer et al. 2002a, 1661). Thus, though infertility services and ARTs are often already in place in the developing world, they are not available, accessible, or affordable to a large portion of the women who could benefit from them—a point that critics often ignore. Now both group should begin to advocate for an end to the focus on the reproductive abilities [i](or lack thereof) of women in the developing world. Procreation should not be socially mandatory and sex should not be a man’s right, but both should be a woman’s personal choice. A conscious raising group must be made to enlighten women to talk about infertility related problems. These groups will highlight the plight of these women. So, feminist and disability activist should focus on layered vulnerabilities of infertile women. It requires change in medical and socio-cultural factors.

[i] Infertility in the developing world: The combined role for feminists and disability rights proponents Author(s): Kavita Shah and Frances Batzer

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