This chapter discusses the concepts which are important to understand the phenomenon of involuntary childlessness as an effect of infertility. The relationship between infertility and involuntary childlessness, psychological dimensions of involuntary childlessness and causes for these conditions are being addressed in the chapter in detail.
2.1 Involuntary Childlessness And Infertility
The extend and impact of involuntary childlessness is felt mostly on pronatalist cultures. India is a pronatal society, a type of social functioning that guarantees respect and social dignity by conception and childbearing. These types of societies also have negate childless couples in social and emotional manners. Even though this condition is not immediately life threatening, it creates a sense of negativity, loss of autonomy , functioning and mental health in the long term. The impact is seen across various domains of the individual.
The lack of uniform definitions about infertility has been one the main difficulties faced by researchers. (Schmidt & Munster, 1995; Kols & Nguyen, 1997). WHO 2002 explains infertilty as the trouble faced by an individual for achieving pregnancy by a person of having a fulfilled relationship for a period of two years without the utilization of contraceptives. There is an absence of a settled meaning of barrenness, other than the reasonable translation taken after by the WHO. Infertility can be said as a group of heterogeneous conditions contributing to one’s inability to have a child,Marchbanks et al’,1989.
Jejeebhoy ,1998 has pointed out two main points that makes it difficult to define infertility, 1) a time period to be used for establishing infertility and 2) how to categorize women who have had one live birth but have not been to subsequently conceive.
For instance, the WHO definition, drawn up by the Scientific Group on the Epidemiology of Infertility (WHO,1991) has utilized a multi-year reference period: if the couple has never imagined regardless of dwelling together and introduction to pregnancy (not utilizing contraception) for a time of two years; essential barrenness is likewise alluded to as essential sterility; Infertility can be auxiliary, if a couple is not able to conceive after a failed attempt, in spite of living together and presentation to pregnancy (without contraception, breastfeeding or baby blues amenorrhoea) for a time of two years; this is otherwise called secondary sterility.
Childlessness is defined as the proportion of couples who have not had a live birth by the time of interview, despite at least five years of cohabitation and exposure to pregnancy and in the absence of contraception, breastfeeding or postpartum amenorrhoea. Unlike a couple with primary infertility, a childless couple also includes those who have successfully conceived but have failed to deliver a live birth. Similarly, secondary sterility in these studies refers to couples having difficulty bearing a second or higher order birth, despite usually five years of exposure, as in the definition above. The five year reference period is typically used, but not necessarily, in demographic surveys.
2.2.Medical Management of Infertility
The Penguin Dictionary of Psychology characterizes “barrenness as the state of having no offspring, which is transitory or reversible” .I .In medical terminology; infertility is an inability in a woman to conceive or a man to induce conception. According to standard medical definitions, a woman will be diagnosed as infertile when the woman does not become pregnant after a year of healthy marriage without any contraception.
Lindsay,1994 has said that treatments for infertility has developed as to keep up a paradigmatic case of a therapeutic circumstance in which all through a lot of its history doctors were men, patients were ladies, and the focal point of medicinal treatment was on the sexual organs . Despite there being equal chances of men or women being infertile, throughout history though women have been constantly targeted for being unable to bear a child.
This is a circumstance that has turned out to be significantly more noticeable with the approach of helped advancements in medical treatments in which the female experiences disproportionately more treatments, paying little heed to the etiology of the infertility could completely be on the man.
This worldview did not drastically move in spite of the appearance of artificial reproductive technique (ART), which started with the introduction of Louise Brown in Great Britain in 1978. Her origination through in vitro treatment (IVF) was the result of the work of British doctors Patrick Steptoe and Robert Edwards which started the concept that human propagation did not active procreative participation of a man and woman, instead utilized a variety of helped regenerative advances, and could be encouraged by donated gametes, embryos , and surrogacy.
With regards to headway of helped conceptive strategies, the infertility specific spectrum has extended to address the psychosocial difficulties of helped assisted reproduction and includes assessment, support, treatment, education, research and consultation. The focus of scientific researchers and researches become more inclined towards finding methods of assisted reproduction.
Evidence-based researches became more popular with a shift from assessment and intervention of an individual to that of group based approach. Pscyho-social research helps to identify such themes which need to be addressed and clinical issues which need immediate assessment.