Endless POFibilities -- July 2001

Have You Heard of POF?
by Lakshmi Iyer

Certain issues have come to dominate my very existence these past few months. It is not as if I have not thought of them before, but the tendency then was to push them into the dusty corners of my mind and get on with the hustle and bustle of life. Or was it an urge on my part to wish them away, saying that if I don’t think about them, then they don’t exist…….I really don’t know. As you read on, you will find some issues cropping up, some might have solutions in the short run, but for some, the basic fabric of society will have to change, attitudes would need to change and that would take time.

I come from India, the land of a billion people, home to a fifth of the world’s population. In a land where fertility is the biggest problem, the voice of a woman who has potential childlessness staring at her face is very often unheard. Some of you who must be reading this will be wondering, “Isn’t that often the case?”. But what I would like to do is to draw your attention to the social and cultural context of the Indian POFer which make her very different from most of you.

These past few months, I have been reading a lot. And I have understood that the Western society is pronatalist and attaches importance to motherhood. But what makes the Indian scenario different is the gender ideology, parental power and an intrusive society.

We grow up listening to stories of ‘Ramayana’ and ‘Mahabharatha’, the two epics of the land which begin with the agony of childlessness where the Gods are worshipped to enable the woman to bear sons. The message of such stories that you have not paid your dues to your forefathers unless you produce an heir is deeply entrenched in the Indian psyche.

There are strong divides in the society in terms of religions and castes which are preyed upon by politicians as well. Indian society still does not take kindly to men and women choosing their partners. Arranged marriages are the accepted norm. A child solidifies a wife’s fragile bond with her in-laws
in an often arranged marriage and also improves her status in the larger community where bearing a son is a matter of pride. And eventually she would become a mother-in-law, a position that still holds considerable position and influence. The yearning for a son is not only for religious or ethical reasons, there is also the issue of inheritance in the predominantly Hindu society. Hence a woman’s ability to produce an heir is of paramount importance.

India has produced some strong women, but sadly it still remains a predominantly male society. Hence child bearing for some women is one way of wielding power. Childlessness is attached a lot of stigma in social functions. A married woman without children is never allowed to bless a newly married couple for fear that they will not have children if she did so. To wake up and see a childless woman’s face is said to ruin one’s day.

When Voluntary childlessness is commonplace in the western world, urban India has slowly started noticing this phenomenon. Married women who remain childless in India are invisible in social research, but they are highly visible in their families and communities. Society does not take kindly to women who deviate from the ‘norms’ and the norm here is once you are married, you should have a child.

Infertility is never openly discussed even when it is discovered after a marriage, so then the case of a woman who discovers before marriage that she might be potentially incapable of having children is not even acknowledged. It would have a crushing effect on her future which is more often than not,
not written by her, but by the society.

The structures of tradition are dissolving, but the shadows linger on. Even when the religious and ethical compulsions for a son have ebbed, the psychological compulsions for having a child remain. This is largely because Indian society is highly intrusive unlike in the West.

Apart from societal pressures, another factor that goes against the Indian POFer is the lack of medical infrastructure and facilities. There is a certain insensitivity seen in most physicians which can at times be argued in favour of them saying that otherwise they would never be able to carry on their work, but look at it from the individual’s point of view, in her prime, whose potential has been snatched away from her before she has even realized it……she needs hand holding.

I was diagnosed when I was 15 years old. I remember the physician saying, “Maybe you could marry a divorcee, for you have no future at all….”. That I have come a long way from all that is a different story, but today after 11 years when I look back, I see a scared teenager sitting inside a cramped room with her parents grappling with the enormity of what has just been told to her, being very brave trying not to cry. I do not think I understood fully what he told me……

This is the case of a POFer, daughter of very well educated, wealthy parents capable of giving her the best of medical attention that is available in India. I shudder to think the plight of less fortunate women and girls who are diagnosed.

That brings me back to where I started, of trying to wish some unwanted truths away…..but then if the most empowered and most fortunate amongst us don’t do anything, then situation will never improve. POF remains an unheard of health condition amongst women in India. There are no published data
available about POF in the country. According to calculations that I have done based on the Coulam study, there are more than 600,000 women with POF in India of which more than 60% are in rural India and cannot be reached through the Internet.

With a high poverty level and unequal income distribution, web access in India is limited to the privileged few that can afford it. Internet use in India currently stands at 0.4 percent of the adult population, or 1.8 million people. Although the online population is expected to grow, the
highly unequal distribution of income in India means that only a small proportion of the population can be considered potential Internet users. But the very fact that the Internet gives the user the anonymity she wishes for can be a favourable factor for a web resource that can be used by women who
have access and are looking for support and information. There is a need to understand the needs of the Indian POFer and put those needs in perspective with her Western counter-part from both an academic and practical perspective.

By L.Iyer
M.Sc International Marketing
University of Strathclyde
Glasgow, UK

Note: The author is currently doing a dissertation on developing a sustainable web portal for Indian POFers. She is keen to network with any Indian POFer who would be willing to share her ideas with her and would also like to be a part of this project. She can be contacted at lakshmi.iyer@strath.ac.uk or lakshmisiyer@hotmail.com. Comments regarding this article can also be sent to her email addresses.

POFer Profile: Tina Roldan