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Biomedical Research

Infertility and domestic violence: Cause, consequence and management in Indian scenario

Author(s): Pasi AL, Hanchate M S, Pasha MA

Vol. 22, No. 2 (2011-04 - 2011-06)

Pasi AL, Hanchate M S, Pasha MA

Department of Community Medicine, Santiram Madical College and General Hospital, NH-18, Nandyal-518501, Karnool, India

Abstract

Infertility is worldwide problem affecting people of all communities, though the cause and magnitude may vary with geographical location and socioeconomic status. Approximately 8-10 percent of couples within the reproductive age group present for medical assessment, generally following two years of failed efforts to reproduce. Evidences suggest that infertility is becoming a public health problem in India. It is estimated that globally 60-80 million cou-ples suffer from infertility every year, of which probably between 15-20 millions (25%) are in India alone. Globally studies show that, at least one in three women and / or girls have been beaten or sexually abused in their lifetime. National Family Health Survey 3 (NFHS-3) shows that approximately 21 percent of women who has been interviewed have experienced physical or sexual violence in last 12 months. It is now becoming more and more evident that Infertility and Gender-based Violence (GBV) are emerging health problems of India.

The present analysis was carried out with objective to study the association between Infertil-ity and GBV. Data collected by NFHS-3 from 23,722 women in reproductive age group by household survey shows that 2,023 (8.5%) women were infertile and 21,699 (91.5%) women were having at least one child. Out of total 2,023 infertile women 1,574 (77.8%) have experi-enced physical and/or sexual violence in last 12 months. Out of total 21,699 women having at least one child, only 1,332 (6.1%) have experienced physical and/or sexual violence in last one year. This shows that there is significant association between Infertility and GBV (p<0.001). Based on the study findings the recommendations are: (i) Infertility management should be coupled with counseling on GBV; (ii) Appointing a professional counselor in infer-tility management team; (iii) Infertility management specialist should be sensitized about the GBV.

Key words: Infertility, Childlessness, Domestic Violence
Accepted October 07 2010

Introduction

Infertility is worldwide problem affecting people of all communities, though the cause and magnitude may vary with geographical location and socioeconomic status. Ap-proximately 8-10 percent of couples within the reproduc-tive age group present for medical assessment, generally following two years of failed efforts to reproduce. Evi-dences suggest that infertility is becoming a public health problem in India. It is estimated that globally 60-80 mil-lion couples suffer from infertility every year, of which probably between 15-20 millions (25%) are in India alone (1-3). Although there are many stereotypes about victims of GBV, in reality it can happen to any woman. Victims of GBV can be wealthy or poor, educated or illiterate, and married, widowed or single. The World Health Organiza-tion (WHO) estimates that at least one in five women have experienced violence in their lives. Other studies estimate the statistic to be one in three women. GBV can have long-term psychological and physical consequences and effect many aspects of women’s lives (4).

Globally studies show that, at least one in three women and / or girls have been beaten or sexually abused in their lifetime. NFHS-3 shows that approximately 21 percent of women who has been interviewed have experienced phys-ical or sexual violence in last 12 months. It is now becoming more and more evident that Infertility and GBV are emerging health problems of India.

Domestic violence (DV) occurs in all socio-economic and cultural population subgroups and in many societies in-cluding India. DV is recognized as a criminal offence in India since 1983 and is chargeable under section 498-A of the Indian Penal Code. According to u/s 498-A IPC, DV is any act of cruelty by husband (or his family) towards his wife. “Protection of women from DV Act 2005” took effect in 2006 (4).

Present analysis implies Infertility clinic as potential place were women should be screened for domestic violence for case finding and suggests measures to tackle the problem of DV.

Objectives

  • To study the prevalence of DV in Indian women.
  • To study the prevalence of childlessness (Infertility) in Indian women.
  • To study the association between DV and infertility.

Methodology

Present analysis is done on the data collected and com-piled by NFHS-3 of India in year 2005-06. Data collected from 83703 (13,999 never married women and 68704 ever married women) or 67percentage of the entire NFHS-3 sample of women. Of the 49,682 un-weighted defacto women excluded, 40,117 women were not selected for the domestic violence sample because they belonged to household with more than one eligible women, only 477 (0.6 % of all women eligible for the module) could not be administered the module because privacy could not be obtained and 88 could not be inter-viewed for other reasons.

For security precautions it was predecided that only one woman would be administered the domestic violence module in each sample household and domestic violence module will not be administered if privacy is not achiev-able.

Results

Out of total 33,632 ever-married women of age 15-49 years (excluding widows) interviewed, 2,993 (8.9%) were found to be childless (Infertile) and 22,489 (66.9%) have experienced one or other form of the domestic violence in 12 months preceding the survey. This shows that there is highly significant association between Infertility and GBV (p<0.001) (Table 1).

Out of total 2,023 infertile women 1,574 (77.8%) have experienced physical or sexual violence in last 12 months. Out of total 21,699 women having at least one child, only 13,752 (63.38%) have experienced physical or sexual violence in last one year. This shows that there is highly significant association between Infertility and physical or sexual violence (p<0.001) (Table 2).

Out of total 970 infertile women 711 (73.3%) have ex-perienced emotional violence (either often or some time) and 259 (26.7%) have reported no experience of emo-tional violence in last 12 months (Table 3).

Out of total 8,940 women having at least one child, only 6,452 (72.3%) have experienced emotional violence in last one year. This shows that there is insignificant asso-ciation between Childlessness (Infertility) and emotional violence (p>0.05) (Table 4).

Table 1. Association between Infertility (childlessness) and violence (any type) experienced by ever-married women age 15-49 years in 12 months preceding the survey.

Table 1

Chi-square=133 Df=1 p<0.001

Table 2. Distribution of ever married women age 15-49 years (excluding widows) who have ever suffered physical or sexual violence committed by their husband by frequency of violence in the 12 months pre-ceding the survey.

Table 2

Chi-square=399.47; Df=6; p<0.001

Table 3. Distribution of ever married women age 15-49 years (excluding widows) who have ever suffered emotional violence committed by their husband by frequency of violence in the 12 months preceding the survey.

Table 3

Table 4. Association between Infertility (childlessness) and emotional violence experinced by ever-married women age 15-49 years in 12 months preceding the survey.

Table 4

Chi-square = 0.57; Df =1; P>0.05

Discussion

Out of total 23,722 women in reproductive age group by household survey shows that 2,023 (8.5%) women were childless and 21,699 (91.5%) women were having at least one child. In India, 13 percent of ever-married women aged 15-49 years were childless in1981 (rural 13.4 % and urban 11.3 %) which increased to 16 percent in 2001 (ru-ral 15.6 % and urban 16.1 %) (5).

Out of total 2,023 infertile women 1,574 (77.8%) have experienced physical and/or sexual violence in last 12 months. Out of total 21,699 women having at least one child, only 13,752 (63.38%) have experienced physical and/or sexual violence in last one year. This shows that there is highly significant association between Infertility and GBV.

Poorly documented evidence of the severe emotional har-assment experienced by large numbers of childless wom-en in their marital homes. Harassment comes in many forms: ostracism from family celebrations, taunting and stigmatization, negative attitudes, as well as beating, withholding of food and health care. One study of gyne-cological morbidity in the slums of Baroda has observed in focus group discussions and case studies that emotional harassment is often expressed by infertile women; for example, “My mother-in-law - always fights with me and if she has her own way she will see to it that I am divorced and my husband remarried” (6,7).

Childlessness (Infertility) is important factor for psycho-logical and social stress to married couples at least in In-dia. Couples seek medical care for childlessness (infertil-ity) but assault or violence done on wife goes unnoticed. If the physician treating for infertility is aware of the GBV it will help in early diagnosis and management of the DV cases. Infertility clinics should be equipped with not only counseling related to infertility but also the DV.

Recommendations

Based on the study findings and analysis done the rec-ommendations are:

  • Infertility management should be coupled with counseling on GBV.
  • Well-trained professional counselor should be an in-tegral part of infertility management team.
  • Infertility management specialist should be sensi-tized about the GBV.

References

  1. Roy SN; Talwar PP, Goel OP. Demographic, Epidemi-ological and Socio-cultural Study on Prevalence and Na-ture of Male and Female Infertility in Different Popula-tion Groups of India 1986. http://www.nihfw.org/Activities/ResearchStudies/ResearchStudies.asp?currentpage=13.
  2. Friday E. Okonofuaa FE, Harrisb D; Odebiyic A et al, The social meaning of infertility in Southwest Nigeria; Health Transition Review 1997; 7: 205-220.
  3. DHS Comparative Reports No. 9; Infecundity, Infertil-ity, and Childlessness in Developing Countries, Sep-tember 2004; http://www.measuredhs.com Publisher ??
  4. National Family Health Survey (NFHS 3), 2005-06, India, volume 1, Page No 493-503. Publisher ??
  5. http://www.iipsindia.org/pub/IIPS%20Research%20Brief%20No.%205.pdf
  6. http://gendwaar.gen.in/sawsg/text/articles/Fertility/fert11.htm
  7. Kanani S, Latha K, Shah M: “Application of qualitative methodologies to investigate perceptions of women and health practitioners regarding women’s health disorders in Baroda slums”. In Listening to women talk about their health: Issues and evidence from India, edited by Gittelsohn J et al, Baroda Citizens Council, page num-bers ?? (1994).

Correspondence to:
Pasi AL

Department of Community Medicine
Santiram Madical College and General Hospital
NH-18, Nandyal 518501
Karnool, India

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