Beliefs and Attitudes towards Infertility and Assisted Reproductive Technologies in Bangladesh: An Anthropological Study

Abstract

With the rapid increase of global infertility, we observe vast development of assisted reproductive technologies. However, this western technological medication has formed and shaped into a “localization” (Inhorn and Balen 2012) process, that it has been accepted according to the cultural practices and belief system of the existing society. In countries like Bangladesh, where society is actively pronatal and infertility is often regarded as curse, not as a biological constrain; the recognition of the specific cause of infertility and its solution through assisted technological intervention faces socio-cultural, economic and psychological challenges. This study has observed the penetration of assisted reproductive technologies like, IVF, ICSI etc. in the context of Bangladeshi patient’s culture, belief system, knowledge and relationship to their society. Here, children are not only the related to love and affiliation, they are valuable as considered as the socio-economic security for the old parents. Moreover, religiously people belief that raising children, mothering and parenting are the most important duties of social life. The socio-psychological consequences of infertility in Bangladesh includes, family disruption, extra-marital relations, stress, suicidal attempts, vulnerable socio-economic status etc. Customarily, women suffer the most, as traditionally in the patriarchal practice, women are blamed for any reproductive failure. Thus, the notion of infertility is stigmatized and so it’s treatments are. In 2001 Bangladesh experienced first successful birth of IVF triplets. After that, the assisted reproductive treatments had been introduced in many private clinics. This study has explained how infertility and these western treatments are experienced by the infertile people. This thesis is written based on the field experience between the years 2016-2017. The research followed semi-structured questionnaire and separate checklists for the in-depth interviews with various categories of respondents (in total 70). Meticulously, the reflexive position of the researcher has intervened the data collection and analysis as a whole. Though, women are the core subject to reproduction, who experience the treatments and agonies more directly, they became the first choice of interrogation. However, the research has also indicated the situation of men with an infertile conjugality in the patriarchal society, Bangladesh. However, their kin relations, doctors and other naturally conceived people were also became the research respondents to understand the holistic attitude towards infertility and assisted reproductive technologies. The thesis demonstrates the way in which Bangladeshi infertile couples are represented and culturally defined. The subjective experiences of the infertile female, male, doctors and others indicates that the class, gender and belief system work as a encompassing force that shapes their living and understanding of infertility and it’s biomedical treatment. Though, urbanization and globalization has delayed the age of mothering (mostly in urban settings), still motherhood is a normative behaviour in the context of Bangladesh. Thus, the anomalies to the reproductive order make worried not only the woman but also her family (natal and in-law). However, it is the infertile women who becomes the most vulnerable in this situation. But, they does not act as passive victim of the situation. Most of the IVF seeking women showed their agency by choosing and changing medication and even imposing husbands and family to support them either directly or strategically. Many of them maintain close relations with co-hearts who can share similar problems and ask for advice to resolve different social taunts and hinders. However, still the limited knowledge of reproductive health and the uneven power relation between doctor-patients play role in the medication for infertility. But, it was interesting to notice that women are more optimistic to the assisted reproductive treatments than that of their husbands. The responses of the husbands towards infertility and assisted reproductive technologies are more passive, though they suffer psychologically no lesser than their wives. These emotional breakdowns constrains the conjugal bond and hampers their socialization, family tie, income and even occupational success. Moreover, the cycle of IVF and other options cost not only money but also relationships in many cases. The procedure of assisted reproductive treatment has challenged the traditional practice of pregnancy, thus it is stigmatized and kept hidden. As few forms of treatments are prohibited among the Muslims, the treatments became more stigmatized and questionable. Though, many of the infertile people are desperate to have children (with any option fit for them), shaping their mind that mothering is the precious opportunity of life. And, most of the IVF seeker do not consult religious expert to understand the ethical issues of it, though IVF experts and doctors are conscious about it. Depending on biological problem and affordability people travel for better treatment of infertility. Thus, medical tourism has offered new avenue for the patients who cannot seek their treatment in the cultural settings here in Bangladesh. However, the high expenses of these western treatments obstructs the solution to the fertility problem of the poor people, though they suffer the most. It is observed that though fertility is a human right, but the government and non-government agents have not subsidized the expenses of infertility treatments. For that reason, mostly all the infertility centers are capital city based. Thus, women with no financial support face socio-psychological and economic vulnerability with infertility. However, class is not only the only obstacle to this biomedical treatment. Many are not interest because of fear of wrong treatment or mingling wrong semen and egg. And still, many lack the information that there are biomedical treatments for infertility. Even, the successful IVF parents do not want to tell naturally conceived people about their experiences or disclose their identity, because of the cultural understanding of infertility and its biomedical solutions.

This research will contribute in the anthropological studies on reproduction, health, gender and culture and technology studies. The overall findings provide insights on the subjective experiences of infertile male and female and their struggle with assisted reproductive technologies. And concludes that with a stigmatized notion they search for a solution from infertility; show agency and strategic way out in the medical system, where infertile people have little and no access.