Urban India's gynaecologists are consulting single women unable to find a suitable man or disillusioned with marriage, opting for assisted reproduction to nurture babies on their own. Sunday MiDDAY reports on how the joint family that turned nuclear, is now undergoing another change that could have to accommodate single-parent systems
Urban India's gynaecologists are consulting single women unable to find a suitable man or disillusioned with marriage, opting for assisted reproduction to nurture babies on their own. Sunday MiDDAY reports on how the joint family that turned nuclear, is now undergoing another change that could have to accommodate single-parent systems
When you run one of South Mumbai's most frequented infertlility clinics, have a blog that pontificates on the wisdom of Googling medical terms, when you have 249 followers on Twitter, you've seen it all. At least, you think you have.u00a0 Last December, the Malpani Infertility Clinic housed in one of Colaba's swanky buildings, had an unusual visitor. Shasha Parashar had an appointment with Dr Aniruddha Malpani, consultant IVF specialist with more than 20 years of experience in helping women conceive. She wasn't there to freeze her eggs; a popular trend now among young women unsure of whether they will meet a man fit to marry before their biological clock winds up. Neither was she the typical patient in her late 30s resorting to assisted reproduction because she was facing trouble conceiving.
Parashar, a bright 34 year-old, was single, attractive enough to land a man but not in a tearing hurry to find one. She could've perhaps conceived naturally had she been married or involved. But the absence of a man in her life, and the want for a child, had led her to Dr Malpani.u00a0"She had been too busy with academics, having recently landed a PhD degree, and hadn't found the man she would've liked to settle down with. She said she could no longer wait to start a family," says Dr Malpani. He'd think Parashar was an unusual case until he met Jasmine Dhingra, a 33 year-old successful banker with a failed relationship behind her.
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"Jasmine had been dating him for years. She was unsure if she was could ever get into another relationship, let alone give marriage a chance. But she was convinced that she was both, financially and emotionally ready to have a child of her own." Neither women wanted to wait for the 'right' man, resort to using donor eggs or consider adoption. They believed they were competent to bear and raise a baby, and had the support of immediate family.
Fertility specialists and gynaecologists practicing in India's metros are increasingly having to consult single Indian women, some as young as 30 and capable of conceiving naturally, resorting to Assisted Reproduction Technology (ART) that was once considered an option only by infertile or same-sex couples. Disillusionment with the institution of marriage is a potent factor, counselling sessions with them have revealed.
Dr Rishma Dhillon Pai, consutant gyneacologist at Lilavati and Jaslok Hospitals in Mumbai admits to having received more patients fitting this profile in the last five years of a career spanning close to two decades. She now receives three to four such patients a year. "No woman wants to compromise anymore. If she does not find 'the one', she is unwilling to settle with just about anyone. But because she feels the need to nurture a baby, she goes ahead with it (assistance reproduction)," says Dr Pai.
One such patient approaching Dr Pai had just ended a 12 year-long relationship. "Having invested so much time and emotion into it, she was disturbed at its failure, and wary at attempting another emotional partnership anytime soon. But she was keen to have her own baby; that was an emotional investment she was willing to make."
Dr Pai and her colleagues agree the trend is metropolis-centric, and in a nascent stage but has all the makings of a success. "Even a few years ago, a situation like this would have raised a lot of eyebrows. Not anymore," shrugs Dr Pai at the end of a busy day at her Waterfield Road, Bandra clinic. Bengaluru-based gynaecologist Dr Pallavi VR calls the trend a Western import that's fast catching on in modern urban India.
"There continues to be a social stigma attached to single women opting for ART but a growing number of educated, successful women are questioning the institution of marriage, and considering the possibility of bearing a child alone," she says. In almost all such cases, the women come from upwardly mobile families, unwilling to compromise on the career front vis a vis a husband's demands. Ironically, a child is not seen as a hinderance to professional progress.
Dr Firuza Parikh, Director, Department of Assisted Reproduction and Genetics at Jaslok Hospital and Research Centre, one of Mumbai's most respected medical professionals in the field, shares the case of a single woman of mixed parentage who approached her recently. "She was keen to source sperm from a donor in the US since she wanted a Caucasian donor. Her father was Caucasian, and she wanted her child to have some of those traits," says Dr Parikh.
Currently, Dr Parikh is in the midst of counselling two single women who are contemplating motherhood. One of them is a 38 year-old banker who confided at a counselling session that she "was okay without a man but I will feel complete only if I nurture my own child".
Counselling is one of the most important stages most patients seeking assisted reproduction undergo with medical practitioners who are keen to gauge their mental preparedness before an ART procedure can be performed. The reasons for taking the decision need to be the right ones, they say. Specialists claim they have the right to turn down a patient in case they are unconvinced of either the motive or immediate support from family.
This is usually followed by either Artificial Insemination or In Vitro Fertilisation (IVF) procedures. While the former is an in vivo process (one that unfolds within the said tissue) where sperm from the woman's male partner or sperm donor is released into her uterus, IVF involves fertilization of the ova (eggs) by sperm outside the body, in a laboratory.
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The ambiguity of the legality of ART
While the medical practitioners quoted in this story confirmed that Indian laws did not prohibit such a practice, gray areas raise a few questions. The Assisted Reproductive...
What does Artificial Insemination involve?
If a consenting adult approaches a a doctor looking to have a baby in this manner, she is first put through a general health test, followed by counselling with an independent counselor who will try to ascertain her reasons for going ahead with the decision. This is to make sure she is of sound mental health and is not carrying any excess baggage that might lead to the wrong reason to carry a child. Both, the doctor and patient can refuse to go ahead with the procedure at any point. Consent forms have to be signed, and there needs to be proof of adequate family support for the woman and her child. Thereafter, insemination is the next step, and is a fairly simple medical procedure. Oral medication is administered to develop eggs.
When ovulation (the process in a woman's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum or egg) occurs, cryopreserved donor semen is processed and gently inserted into the uterus with the help of a catheter. The entire process takes anywhere between 15 days to three months, and can be repeated if unsuccessful. Typical costs vary from Rs 5,000 to Rs 20,000, depending on the clinic or hospital you choose.
Around the world: Are single women allowed to resort to ART?
In 2003, government agencies in China imposed a ban on the use of IVF by unmarried women. Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples. Costa Rica has a complete ban on all IVF technology. It has been ruled unconstitutional by the nation's Supreme Court because it 'violated life'. In 2007, the state government in the Australian state of Victoria announced changes to its IVF law, eliminating restrictions on fertile single women and lesbians from opting for the procedure. Earlier in 2000, the Victorian federal court had also ruled a ban on single women and lesbians using IVF constituted sex discrimination.
What does religion say?
The one quarter that this new breed of women can expect to receive little support from is religious groups. Bengaluru-based Shadaab Mumtaz, a researcher of Islamic studies, says the Quran propagates the idea of marriage and prohibits conceiving a child outside of it. "A live-in relationship and artificial insemination is not acceptable. In fact, the Quran mentions that, in cases where artificial insemination is the only way to have a child, the sperm donor should be none other than the father of the child."u00a0The Roman Catholic Church opposes in vitro fertilisation because, as with contraception, it separates the procreative purpose of the act of marriage from its unitive purpose.
Will the child find place in school? Yes, say princis
Technologies (Regulation) Bill, 2010, which aims to regulate practices related to ART procedures is yet to be passed in Parliament. The guidelines currently being followed refer to the National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India, 2005. According to Clause 3.16.4 of the 2005 guidelines: "There is no legal bar on an unmarried woman going for AID (Artificial Insemination of Donor Sperm). A child born to a single woman through AID would be deemed to be legitimate. However, AID should normally be performed only on a married woman and that, too, with the written consent of her husband, as a two-parent family would be always better for the child than a single parent one, and the child's interests must outweigh all other interests."
The same guidelines mention a contradicting corrigendum. Corrigendum Point No. 7 states, without any explanation, "Para 3.16.4 is to be deleted". Radhika Thapar Bahl, Advocate, Surrogacy Laws India, a New-Delhi based law and financial consultancy firm that provides comprehensive services in the area of surrogacy laws in the country, says, "The guidelines are extremely ambiguous. They can be interpreted to state that in India, ART clinics cannot allow a single woman to conceive using this technology. Thus, if ART clinics are allowing single women to conceive, they can be taken to court."u00a0 Keeping in mind that adoption laws are strict for unmarried and single parents, it appears that the guidelines espouse the belief that the best interest of the child to be born is to be brought up in a two-parent family.
According to Anurag Chawla, Bahl's colleague at Surrogacy Laws India, the situation is an interesting one since there is an increasing demand for ART procedures. "They are being considered not only by those fighting infertility but also those keen to bear children without getting into a relationship, and by same-sex couples. The legislature should address the needs of a modern society that's evolving and come up with a comprehensive law, accordingly." This seems unlikely if the 2010 bill is passed. While it mentions single persons or individuals opting for ART procedures, it defines patients opting for ART in Section 2(x) as, "patient(s), means an individual/couple who comes to an infertility clinic and is under treatment for infertility". Bahl says one could interpret the bill to state that only individuals or couples who suffer from infertility can resort to ART clinics, and not single fertile women.
Is it good for the child?
According to a 2009 statement by the American Society for Reproductive Medicine (ASRM) which looked into various studies on the psychological impact on children who were raised by unmarried or gay and lesbian parents, "There is no persuasive evidence that children are harmed or disadvantaged solely by being raised by single parents, unmarried parents, or gay and lesbian parents," and that the data "does not support restricting access to assisted reproductive technologies on the basis of a prospective parent's marital status or sexual orientation."
However, Dr Rukhsana Ayaz, counsellor and psychotherapist practicing in Mumbai, says such a scenario, which she sees as a sort of evolution from the joint to the nuclear to now a single family set-up, although progressive, puts the child under pressure. "Social acceptance will be tough. Children of divorced and separated parents come to accept their situation after several years. If born to a single mother who chose not to have a man in her life, what will the child say if asked about his father? The mother may be financially and emotionally secure but she cannot play both roles."
But it will find schooling
With most parents worrying about 'booking' a school for their to-be-born while booking a room at a nursing home, and the practice of parent interviews rampant when seeking school admission, the question of whether schools will be open to kids born of mothers who are single not by divorce or death of a partner, is a valid one.
Dr Vandana Lulla, Principal at Podar International School, a Mumbai school that offers the IB curriculum, says their institution will admit any child who fulfills their admission requirements. "It is our job to provide education. As long as there is someone sufficiently responsible for the child, we don't deny admission," says Dr Lulla who says the school has not yet come across the case of a student born to a single mother through ART procedures. But the Santacruz-based school does receive a number of children parented by separated, divorced, single and adoptive parents.
The Hauz Khas Enclave based Laxman Public School in New Delhi, in fact, gives preference to children born of single parents, says Principal Dr Usha Ram. "Because they (parents) are more cooperative and protective towards the child. It's a myth that single parents are not good parents."
Schooling of course, say experts, is a far off concern, considering most patients have to make several attempts before they can conceive. At the Malpani Clinic, Parashar was not as lucky as Dhingra. Far from disappointed, she knew she could give it another shot. "When the tests were negative, I asked her why she wouldn't consider marriage. She laughed, 'You never find a nice guy these days. All the good ones are taken'," shares Dr Malpani. If anyone who has raised a brood is to be believed, humour is far more critical to battling the struggles of motherhood than dexterity is. Parashar has what it takes.
The costs
Artificial insemination Rs 5,000 - Rs 20,000
In Vitro Fertilisation Rs 2 lakh approx
Egg freezing Rs 2 lakh
With inputs by Priyanjali Ghose, Namita Gupta, Sheetal Sukhija and Amit Saini (Names of patients have been changed on request)
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