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Infertility in India: social, religion and cultural influence

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DOI: 10.18203/2320-1770.ijrcog20150947

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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Sheoran P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1783-1788
www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150947
Research Article

Infertility in India: social, religion and cultural influence

Poonam Sheoran*, Jyoti Sarin

Faculty of Nursing, Maharishi Markendeshwar University, Mullana, Ambala, Haryana, India

Received: 29 September 2015

Revised: 01 October 2015
Accepted: 17 October 2015

*Correspondence:
Poonam Sheoran,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Society, culture and religion frame the major sphere of life for human kind since starting. Fertility has
been one of man’s desired attributes since the beginning of recorded history and remains a driving need for young
couples today. Infertility, however, continues to be a major worldwide problem, affecting an estimated 60-80 million
women and men, a vast majority of whom live in low resource countries. The aim of the study was to assess the
living-in experiences of infertile women under social and religional and cultural influence.
Methods: This was a phenomenological study conducted at Infertility clinic of Haryana, India. Data was collected
was semi structured interview guide and face to face in depth interviews. Participants were selected using criterion
sampling technique and data saturation was achieved after 22 interviews. All interviews were audiotaped using a
digital recorder.
Results: The findings of the study showed that three main themes related to social, religious and cultural influence
with core theme of Environmental influence of their infertility experience.
Conclusions: The study concluded that there is a huge burden on the part of female to have a baby after marriage.
Also the childless women face social and financial adversities at time and this is not limited to low income or low
education strata. Health care professionals need to understand cultural and social implications of infertility in order to
provide counseling, and referring women with fertility concerns for consultation and further treatment.

Keywords: Infertility, Phenomenology, Qualitative, Social influence, Religion influence, Cultural influence

INTRODUCTION As per DLHS 3 survey in India around 8.8% of currently

married women in reproductive age group had infertility
To procreate had been cherished dream of mankind since problems, with wide variation ranging from 14 % to 3%.
long. Couples start dreaming about their future life with At the national level, around 6% women have primary
kids’ immediately after marriage or in some cases after infertility where as 2% have secondary infertility.4
some time. Not all couples succeed in starting a family
when they wish for it and couples in India also face Since ancient times, many Indian couples have suffered
difficulties related to reproduction. Based on the census from infertility and have gone to great lengths to have a
reports of India for 2001, 1991 and 1981 researchers baby. Infertility touches all aspects of affected couples
show that infertility in India has increased by 50 percent life. However in India, infertility is a particularly
since 1981. The Marital infertility rate has gone up from important problem since it is associated with specific
11 to 16 percent.1 The WHO estimates the overall social, cultural and religious aspects stemming from the
prevalence of primary infertility in India to be between long and varied history of the country and the importance
3.9 to 16.8 percent.2 Research studies quote that 25 % of of religion in the life of all Indians. In most areas of the
total couples suffering with infertility are in India alone.3 women’s wellbeing is reported to be more affected by

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 Sheoran P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1783-1788

infertility then men. In developing countries position of area ensured prolonged engagement with infertile
women is defined by their reproductive capacity and their women. As a part of external audit, codes, subthemes and
failure to do so due to any reason leads to social and themes were discussed and analysed by two colleagues.
cultural repercussions for them. Women express Each of them independently coded interviews. As a
consistently lower scores on mental health, social group, themes were studied and examined, challenged
functioning and emotional behaviour domains in quality among each other and made adjustment. Apart from this a
of life and experience higher levels of stigma than men.5,6 record of all transcription and field notes were kept for
external audit. Finally, a cross checking of the whole
METHODS analysis process was done by the research supervisor.

Present paper has been originated from the doctorate RESULTS

study conducted by author. The Study investigated the
living in experience of infertility among married women Demographic findings of the participants revealed mean
of Haryana with respect to how they describe, make age of participants was 29.68 (23-40 yrs.). Educational
meaning in terms of social, psychological, physical, status ranged from being illiterate to Master’s degree with
financial, marital and sexual construct and how they cope two (02) participants being illiterate and six (06) with
with it. In addition this study investigated the medical and Master’s degree. Maximum (19) number of participants
conventional methods used by infertile women as were house wives where as two (02) of them teacher by
treatment. This paper highlights the social, cultural and profession and one (01) was working as counsellor. Mean
religious aspects of infertility experienced by women in duration of marriage among participants was 8.4 yrs. (3-
northern part of India. Qualitative research approach with 24 yrs.) and mean duration for trying for conception was
Hermeneutic phenomenology design was used. Data was 7.92 yrs. (1 yr. 9 months-24 yrs.). Cause of infertility was
collected with face to face in depth interviews using semi unknown for 06 participants whereas 14 were diagnosed
structured interview guide from infertile women with with female cause of infertility and 02 with male cause.
primary infertility attending OPD of selected infertility
clinic. Participants were selected using criterion sampling Themes
technique and data saturation was achieved after 22
interviews. All interviews were audiotaped using a digital During the data analysis three main themes along with 10
recorder. Participants were encouraged to express their subcategories emerged. Main core theme was
experiences freely and without any restriction. Length of environmental influence. Three subthemes which were
interview lasted from 45 min to 70 minutes. Interviews identified were 1) Influence of Society, 2) Influence of
were conducted from January 2014 to August 2014. All religion and 3) Influence of Culture. Below, the meaning
interviews were conducted in IVF clinic only. A contact of each theme is presented by using the participants’
summary was made at the end of each interview to direct quotations.
summarize the main points.
Influence of society
Ethical consideration
All participants described the message and beliefs they
Ethical approval for the study was taken from have received from the society regarding infertility.
institutional ethical committee of the Maharishi Society seems to influence the experiences of women
Markandeshwar University. To protect the identity of the with infertility. The way they perceive importance of
participants, confidentiality of the research data was motherhood depends a great deal on the societal
maintained through the use of pseudonyms for all the messages and beliefs. This subtheme comprised of four
participants interviewed. All women consented in writing categories as (i) Blame from society, (ii) Social pressure
to participate in study. All audiotapes and transcriptions to conceive, (iii) remarriage of husband and (iv)
of the participants were numbered Recorded interviews reputation in society.
and transcriptions along with consent forms were kept in
locked cabinet. Each participant was explained about Blame from society
outline of whole research and their right to withdraw
from study at any time. In Indian society, infertility is taken as women’s problem
and she is blamed for not able to procreate. As a dutiful
Validity wife she is expected to start a family immediately after
marriage and when fails to do so, she is blamed for her
Validity of data was ensured using Creswell’s (2007) role failure and often subjected to negative remarks and
validation techniques. Researcher used rich, thick blame from in laws and neighbors. Infertile women are
descriptions to describe in detail the experiences of often subjected to words like MANHOOS, VANJH
participants. Expert panel views were incorporated as (barren), possessing evil eye and visiting to tantric
research progress reports were presented before (person performing black magic). A young infertile
departmental research committee. Researcher woman of 23 yrs. reported to undergo various invasive
professional experience in Obstetrics and Gynecology procedures (hysterosalpingogram) just to satisfy her

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 Sheoran P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1783-1788

family and herself that there is no problem with her so conceives or delivers a child, she is considered as next
that nobody can blame her for infertility. person to give good news naturally.

“like this only time will pass…tomorrow nobody should Fear of remarriage of husband
say that there is some problem in girl.. nobody should
blame….everybody in family told me not to get tube test Motherhood is considered a power for the new bride and
(hysterosalpingogram) done.. but still I underwent it… as lack of which makes her vulnerable. For men, remarriage
I have to satisfy myself and my family that there is no is the most commonly mentioned solution, based on the
problem in me..” (P8) belief that women are the source of infertility. Though
majority of participants shared to have a supportive
Women also expressed to be blamed for the expenditure husband but they also expressed constant fear of
which occurred on treatment mostly by their mother in husband’s remarriage under social pressure.
law.
“even though my husband refuses for second marriage
“mother in law says…whole savings of my son goes in now but who knows he may change his mind later on…..
your treatment….she taunts.. i listen…what else can I his thinking is good at present…but you never
do??” (P12) know…time changes everything….it may happen like
99% I believe he will not change but 1% I fear he may
This blaming from the society takes its toll on physical change with time (P4)
and psychological wellbeing of women and they shared
how a talk with neighbour or some relative becomes a Quite often, partner who is carrying infertility can ask her
matter of tension and stress for them and this constant spouse to find another partner, so that he can experience
blaming leave them drained emotionally and physically. fatherhood. Women often are pressurized for second
As shared by one woman: marriage of their husband.

“at times it happens 10 -15 days pass happily and then “yes…there is trend of second marriage…… family
on 16th day something of this kind happens that all past members pressurize husband and wife…… wife will be
15 days also goes in waste.. whatever energy I had emotionally blackmailed ..like I am there…after 2- 4 yrs.
gained.. that is lost because somebody will say perhaps same thing will be there with me as well… I will
something” (P2) be expected to prepare my husband for remarriage
stating that don’t I want his clan to expand.. dont I want
Social pressure to conceive him to be happy??” (P5)

Family is the most important social entity in India. After Being fertile becomes a base for continuation of marriage
marriage young bride moves to husband’s home and and infertile woman especially with diagnosed female
often live with his family sometimes even extended cause of infertility is more subjected to threat of husbands
family. The family and relatives of husband plays an remarriage.
important role in couple’s life. When a women is not able
to conceive family and even neighbours become involved “I do fear about his second marriage..(kahi mujhe chod
in the couple’s lives and put more pressure on women by naa de..) this is last chance to save my marriage…if I am
asking again and again and suggesting remedies or not able to conceive now.. i wont able to remain married
treatment outlets. As one participant shared: then…” (P22)

“I feel there is so much of social pressure on me to Reputation in society

conceive.. And this pressure is more from my family as
compared to outside.... there is pressure from every side Women with infertility are considered less than others as
and that why I am not able to do or concentrate at all….” they are not able to fulfil predesigned role of female as
(P14) approved by society. Participants reported to feel as
second citizen in comparison to those who enjoy fertility
Another one said: as expressed by one:

“we never thought having baby so soon , but with “there are girls who cannot cook, they don’t have
everyone’s suggestion we started trying… every one ask anything.. don’t respect their husband.. but just because
what happened….what is the problem…cousin of my they have babies they are respected.. and in us only
husband got married recently and now she is 5 month because of this problem all our good qualities are side
pregnant.. so now everyone says.. (P4) lined….we might have everything but that is not visible to
people.. they are not able to see those…” (P4)
Women also feel pressurized seeing other of same age
with their children. They expressed feeling more pressure
to conceive if somebody of same age in family or friends

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 Sheoran P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1783-1788

Influence of religion “I blame destiny for this……….. I pray even my enemies

should not face this…God do not do this even with my
Second subtheme under influence of environment enemies” (P5)
emerged as influence of religion. All participants at some
or other time during interview expressed their believe in One of the participant even mentioned that infertility in
God and majority of them quoted their struggle to their present birth is the result of bad karmas done by her in
past karmas (deeds). Two subcategories under this theme the past.
are 1) faith in God 2) game of destiny.
“don’t know…. I might not have done good karma in my
Faith in God last birth… now I try not to hurt anyone… not to disturb
any one… so that means this is the result of our past
In India, religion has a strong influence of life. Many birth… we are getting punishment of that now..” (P6)
beliefs and values related to procreation are embedded in
daily life and originate from holy books and ancient Influence of culture
stories. GOD is considered as creator and HE only can
give life. Third subtheme under influence of environment emerged
as influence of culture. India is a patriarchal society
Many of the participants reported that they accept which considers male to be the head of family. He is
infertility as the wish of God and that they have full faith considered as superior and all decision making power lies
in God. with him or other elders in family. Under influence of
culture experiences of infertile women were categorized
“I believe in God…have faith.. he will help me.. whatever under 3 subcategories (i) Cost of treatment to be born by
problem is there will be solved..” (P13) girls parents, (ii) decision making,(iii) burden of male
infertility.
“I think it is God’s wish…otherwise I was completely
well….” (P4) Cost of treatment to be borne by girls’ parents

“now I have left everything on God…whenever he feels Under this sub category women shared their experiences
He would give..” (P7) of being subjected to humiliation and lack of finances. If
cause of infertility comes out to be female factor,
Even one explained about being blessed with everything women’s parents are supposed to bear the burden of cost
in life and is hopeful on seeing at others who cannot even of treatment. It may be noted that these experiences were
afford to get a treatment done. more profoundly experienced by women who belonged to
low socioeconomic status with poor education.
“I am very thankful to God that he has blessed me with so
many things…I can get treatment of my choice…there are “my mother in law father in law says we cannot afford
many who cannot do so…my servant also is also having your treatment… you go back to your home and get
infertility since last 15 yrs.… her husband drinks…. when yourself treated…. they have started taunting me.. (P22)
I see her life.. i thank God… there is day night difference
between me and her… I still feel hopeful… perhaps GOD “my parents are helping me out now… my brother and
will bless.. Doctors are doing their task.. but at the end bhabi are very nice… they are giving money now…”
God only has to bless…” (P6) (P12)

Two of the participants reported turning spiritual spiritual Decision making

and performing of certain rituals as these believed to gain
GOD’s blessings. In Patriarchal culture a women is supposed to submissive
and must agree to the decisions taken by her husband in
“have turned spiritual…. do lots of pooja.. have asked for order to prove herself as a dutiful wife. Newly married
blessings everywhere..”(P13) women are not entitled to take major decisions regarding
her life. As here participants expressed:
Game of destiny
“I think I should do something in my profession.. but then
Apart from God, a person’s own deeds also believed to nobody in family allow that no…your treatment is going
decide course of life. Participants believed that the on…don’t try anything now.. if only I had been
struggle which they are dealing might be the result of unmarried.. i would have touched new heights.. even if
their past karmas. Likewise they mentioned: want to start some work related to my profession as I
have so much time my husband say don’t do this all….”
“its my destiny only that after so much of medicines also (P8)
I am not able to conceive..” (P21)

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 Sheoran P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1783-1788

Treatment seeking is also decided by family members infertile women indicated that getting their husband
and if it is not as per their choice, couple is not allowed to remarry could be only solution to overcome their social
go for it. A male partner cannot have any problem and adversities and remarriage was most common mentioned
medical examination of him becomes a family issue. solution of infertility.8,13 Responses of the participants
also showed that they feel as second citizens and others
“when doctor suggested to get my husbands tests done.. consider them less than other even if they are talented.
my mother in law got angry.. why you got his tests done? Same feeling are echoed in findings of study where
Then there was some problem with his reports.. so doctor infertile women shared that child gives respect and
gave medicines.. which cost us of few thousand.. but my honour to women in eyes of in laws.14
mother in law did not allowed him to take and got all
medicines returned…”(P4) Religion played a significant role in influencing the
experiences of women and shaping their outlook towards
Burden of male infertility disease. In Hindu mythology GOD is considered as
creator and HE only can bless with life. Deeds of past
In terms of infertility male infertility carries bigger either in this birth or last birth and destiny play a
stigma and his virility is questioned. Male is supposed to significant role in shaping a person’s present. Studies
be masculine and capable of producing. Male infertility conducted in India and Iran also showed that infertile
brings a question to his capability as a men and threat to women believed in a supreme power, accepted their
him related to his responsibility to carry family lineage. infertility as God’s will and result of their karmas of last
birth.8,14,15 where as in another study infertile women
One participant shared her experience of carrying burden reported having lost faith in God due to struggle of
of her husbands' infertility: infertility.16

“My husband does not want to talk about it…even though Participants in present study shared lack of financial
I want to share my feelings with him. But don’t say support from in laws and no power of decision making
anything with fear that he may feel I am blaming him….i which is similar to other study in South Asia where
have not disclosed it to anyone but that adds up my infertile women did not get proper care, refusal of food
burden….so many times neighbours ask me and I have to and clothing, abuse from husband and in laws and have to
pretend that I have some problem because of which I am consult mother in law for treatment options.8 New bride
not able to conceive…so many times my mother in law has to prove her worth via her fertility and until she does
taunts me in front of others regarding not giving her that, she remains at weak position in house hold. Male
grandchildren…but I cannot say anything to her…have to infertility attracts greater stigma and cannot be disclosed.
hear everything…have to undergo all this pain Women only are expected to bear the burden and endure
alone..(sobs) (P 18) the pain of social blame and pressure. Even if husband is
infertile, a woman in Jorden reported to endure this
DISCUSSION feeling on behalf of their husband and bears the
consequences of being infertile and social ehaviours.13
The findings of this study provide insight in the influence
of environment on experience of infertile women in CONCLUSIONS
North India. Studies have shown that infertile women
face systemic, societal level stigmatization. In our study To conclude, in Indian society a baby is of great
also participants reported facing social blame for their significance and having a baby has religious implications.
inability to conceive and being targeted for her role When a couple is childless, women are explicitly held
failure. These findings are consistent with other Asian responsible. Because of social norms an infertile female
studies of where women explained facing rude inquiries have lesser status and prestige in society and may be
regarding their fertile capabilities and being termed as subjected to refusal of fulfilling of basic needs in extreme
‘Manhoos’, inauspicious and bearer of bad luck.8,9 In cases. Male infertility puts a question on virility of men
present study participants expressed feeling of social and questions masculinity, hence is kept under cover.
pressure to conceive. Couples are pushed to have children Women face social and financial adversities at time and
as soon as possible and remedies and treatment this is not limited to low income or low education strata.
suggestions are bombarded from all sides on young wife. Study recommends use of IEC (information, education
In India if a child is not conceived quickly, couples face and communication) strategies at community level to
pressure and stigma from their family and community.10 decrease stigma attached with infertility. Health care
In some cases relatives, mostly from the husband part, professionals need to understand cultural and social
have frequent contacts with the women and this makes implications of infertility in order to provide counselling,
the pressure even worst for them.11,12 Participants also treatment and referring women with fertility concerns for
expressed threat of second marriage of husband owing to consultation and further treatment.
their inability to provide a heir to his family and at time
wives are expected to get their husbands remarry. These
findings are consistent with the findings of studies where

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 Sheoran P et al. Int J Reprod Contracept Obstet Gynecol. 2015 Dec;4(6):1783-1788

ACKNOWLEDGEMENTS urban slum populations in Bangladesh. Reproductive

Health Matters. 2000;8(15):33-44.
Researchers sincerely express their gratitude to all the 9. Mumtaz Z, Shahid U, Levay A. Understanding the
participants for willingly participating in this study and impact of gendered roles on the experiences of
providing us the opportunity to know about the infertility amongst men and women in Punjab. BMC
experiences related to infertility. Reproductive Health. 2013;10(3).
10. Barua A, Apte H, Pande R, Walia S. Infertility
Funding: No funding sources concerns among young couples in rural India
Conflict of interest: None declared Available at
Ethical approval: Ethical approval taken from http://www.researchgate.net/publication/265042162_
Institutional Ethical Committee of Maharishi Infertility_Concerns_among_Young_Couples_in_Ru
Markendeshwar University, Mullana, Amabla, India ral_India. Accessed on 02.08.2015
11. Tahiri FB, Kalaja D, Bimbashi EK. The Lived
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