Waiting for baby: infertility a growing concern for couples in Goa By Frederick Noronha
PANJIM, July 12: Decades back, it was grounds for legally permitting polygamy in colonial Goa. But today, infertility is becoming a growing concern of Goan couples, leading to a new kind of problem that this small region is left to grapple with. 'Infertility clinic' sign-boards are more visible in this state's small towns, and the anguish of childless couples is writ large on many faces. On a recent weekday, it's past dinner-time but the doctor's consultancy is still full with waiting patients. "It's a very powerful problem. Upto 20 per cent of couples could have problems (in conceiving a child)," says obstetrician and gyanecologist Dr Kedar Padte, who specialises in maternity and infertility issues in this state-capital. On another weekend, the local Rotary Club drew a full-hall. A team of 12 doctors worked till late Sunday afternoon, even as couples mostly in their thirties sat patiently -- many since early morning -- in the large hall, where chairs seem deliberately to be arranged in pairs. These visible signs are reflected in the hard facts. "(Goa's) fertility is already well below replacement level," says the National Family Health Survey India (NFHS-2). "The substantial decline in fertility in Goa over time is evident.... Fertility has declined sharply at all durations....," comments the NFHS-2 in its recent special 284-page report dealing exclusively with Goa. Dr Babasaheb Raosaheb Desai, Belgaum-based KLE Hospital's assisted reproduction centre programme director, points out that as many as 70 couples flocked to the recent Rotary camp organised at a very short notice. "Unless one does a study, it's difficult to say. Pelvic infections are one of the commonest causes of infertility. People are getting married later too," he says. Statistics show that women in Goa tend to marry at a much older age than women in most other states. Only six percent of women age 15-19 have ever been married, which is substantially lower than the national average of 40 percent for that age group. Recent surveys found the average female in Goa gets married at 25 years -- much older than the legal minimum age of 18 years. But not all those attending the camp were in their thirties. Organisers said the youngest was 24, and had waited for three years after marriage. Women upto 41 held out hope, after ten years of marriage. Shanta Naik (name changed) is hopeful but undecided. "Will I get a chance to meet the doctor today?" she asks, in anticipation. Her home is just outside the Sant Inez venue of the infertility camp, and she says she could get her husband along if he doesn't have to go to work. "Isn't this more important," chides a doctor, "where's the question of work on a Sunday?" Other patients look to medical personnel with a clear mix of anticipation and trepidation in their eyes. Goans who are issueless are increasingly finding the only way out as taking to adoption. Recently, Panjim specialist Dr Kedar Padte made headlines when Goa's first test-tube baby was born this year. Things were different in the recallable past. Ironically in the colonial Portuguese era, the absence of "issues by the wife" was grounds enough for permitting simultaneous polygamy under the family laws governing some sections of the population. Article 3 of the law governing the quaintly-named 'Usages and Customs of Gentile Hindus of Goa' of the family laws of this region provided an exception for simultaneous polygamy to have 'civil effects' in case of the "absolute absence of issues by the wife of the previous marriage until she attains the age of 25 years". But times have obviously changed. Today, 25 years is about the age an average woman in Goa gets married. Fortunately, no one is now known to have taken recourse to this little-noticed provision of the law. Dr Padte believes that this trend has been showing up in Goa since at least the "last couple of decades". "Go in and see the files," he smiles, when asked for an indicator of how many couples face the problem of infertility. Late marriages could explain part of the problem. It's known that the number of children that a woman will have in her lifetime is strongly influenced by the age at which she marries. In Goa, the age at first cohabitation with the husband is 23.2 years for women in the 25-49 age group. This is more than six years higher than the media age at first cohabitation in India as a whole (17 years). This age of marriage and cohabitation has gone up sharply from 21.2 years to 24.1 years for women between the 40-49 age group and the 30-34 age group. This means there has been a "notable increase" in delayed marriages in a "relatively short period of time". Padte argues that stress is growing more common in this once-rural but fast-urbanising society. Social pressures, delayed time at marriage, multiple sexual-partners resulting in blocking of the reproductive tubes, poor food habits aggravated by alcohol and smoking-intake by the males, and the reduction in the sperm count could be some of the causes, says Dr Padte. The termination of the first pregnancy can also cause complications. Strangely, Goa is a case in point where family planning programmes have been propelled more by voluntary initiatives and economic considerations, rather than government pressures. Pressures push younger couples to wait longer before they have their child. "Some want their own home, or a car before having their child, while leads to a delay," points out Dr Padte. "Age is another big problem. By 35 years, fertility rates come down. Even with the latest facilities, one should not waste a lot of time and hope for the best," says Dr Dessai of KLES. Former Director of Health Services Dr Ananda Helecar, who served from 1984-1990, says the fertility is obviously declining -- and becoming a problem in some cases -- though Goa still doesn't have a clear understanding of the causes. "It's visible in our families too," says he. "Sometimes, even just counselling helps in conceiving," says Desai. But high-end treatment could end up costing upto Rs 70-80,000. At this cost too, the chances of conception, say doctors, is around thirty percent. Mark D'Gama (name changed) of South Goa meanwhile waits for his wife to finish a consultation with the doctor, while confiding the travails of not getting a child when wanting one. "We've spent 40,000 rupees already, and will have to pay up 40,000 more for the treatment," says he. 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