IVF debt, insecurity and judgment: The one-sided costs that women bear for ‘feritlity'
As the United Nations Population Fund's (UNFPA) State of World Population report for 2025 shows a significant decline in India's fertility rate — dropping to 1.9 births per woman — the guilt of a childless future has been quietly passed on to the woman. Most conversations ever since have centred on what's going wrong in the woman's body, her hormones, her eggs, her infertility or why she can't summon up enough resilience to ensure no societal expectation is unmet. The fact is, no matter how much we commit to parity and equity, motherhood continues to be the only recognition of a woman's completeness.
Look up any achiever's name — CEO, founder, business leader, inventor, sportswoman, banker, investor — and they all come with the suffix, 'also a mother to so and so.' As if every accomplishment falls short if one didn't pass the motherhood test. Great, if she did it despite it. Ambitious and careerist, if she did it without it. A childless woman is asked every day why she 'couldn't have' a baby when it could well be that she 'didn't want' one in the first place.
This allusion to motherhood as a societal duty rather than individual choice is the reason that successful women are queuing up at IVF clinics and egg freezing centres, even willing to take loans to continue their treatments. Many of them are trapped in what is being called 'IVF debt'. The procedure itself has a success rate of 40 per cent per cycle if you are under 35, but they are still willing to bet on it. Nobody even talks about the physical pain involved. In our cultural narrative, women, after all, are expected to be selfless and sacrificing when it comes to continuing the bloodline in a tactical transference of responsibility.
Here are some hard facts. Infertility isn't only because women have poor health and hectic lifestyles; men are going through the same, minus the guilt. Men are always assumed to be virile, and women are automatically assumed to be infertile. Men are as enthusiastic about fatherhood as women are about motherhood. Yet there is no prejudice against a childless man. That is reserved rather harshly for women.
Young women are far more informed and aware of the toll their work and home environment is taking on them, and are keen to freeze their eggs. But is it cost-effective enough? With costs ranging between ₹1,50,000 to ₹2,50,000 per cycle and doctors telling them it's best to freeze their eggs by 29, a young woman has to battle a dilemma. Should she still gamble on natural conception, or should she, with no savings in a career that has just begun, borrow the money for the greater good? Assisted reproductive technologies may be changing the face of parenthood, but only in cities. Accessibility is still an issue in the hinterland. There may be public schemes on women's health, but funding for crucial research on their reproductive health is all but paltry. Besides, women are rarely made part of clinical trials and research studies.
Economics layers every decision and agency to have a child. Women aren't always averse to having a child, but do they have the right partner to build a safe environment for raising a family or have pockets deep enough to go it alone till the child's college years? Even if she uses donor sperm, will the single mother be spared societal judgment of attempting a family in isolation? Nobody even dares to discuss parental desires of non-binary people and facilitating their baby journeys. And for all the well-meaning advisories on adoption, women hoping to be a single parent have to navigate a dark maze of legalese, scrutiny and most importantly, finances.
As for healthy women of childbearing age, delaying a family is often not a matter of choice but forced by circumstance. Most women delay births because they get offloaded mid-career or are denied the promotion that could get them out of middle management into leadership roles, the moment they seek work-life balance norms. In a dynamic world, workplace inflexibility continues to be a decelerator for women.
With societal complexities, stigma of childlessness and their own performance anxiety weighing down on them, many women are developing mental health conditions. These begin with stress, anxiety, depression and eventually a burnout. And as they wrestle with their private grief of childlessness, nothing prepares them for the public spectacle of their insufficiencies.
This imposed guilt is nothing but a new-age tool of gendered oppression, one that creates another hurdle for a woman to cross in her quest for equity. However, women must not slip into victimhood. Instead, one has to look at the many childless women who make excellent grandmas, aunts, and caregivers, caring for the young in their families. Childlessness doesn't automatically translate to a lack of maternal instincts. If anything, non-parenting women can raise the community's children with an all-new neutral perspective. As author Maya Angelou says, 'If our children are to approve of themselves, they must see that we approve of ourselves.'
rinku.ghosh@expressindia.com
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Indian Express
18 hours ago
- Indian Express
IVF debt, insecurity and judgment: The one-sided costs that women bear for ‘feritlity'
As the United Nations Population Fund's (UNFPA) State of World Population report for 2025 shows a significant decline in India's fertility rate — dropping to 1.9 births per woman — the guilt of a childless future has been quietly passed on to the woman. Most conversations ever since have centred on what's going wrong in the woman's body, her hormones, her eggs, her infertility or why she can't summon up enough resilience to ensure no societal expectation is unmet. The fact is, no matter how much we commit to parity and equity, motherhood continues to be the only recognition of a woman's completeness. Look up any achiever's name — CEO, founder, business leader, inventor, sportswoman, banker, investor — and they all come with the suffix, 'also a mother to so and so.' As if every accomplishment falls short if one didn't pass the motherhood test. Great, if she did it despite it. Ambitious and careerist, if she did it without it. A childless woman is asked every day why she 'couldn't have' a baby when it could well be that she 'didn't want' one in the first place. This allusion to motherhood as a societal duty rather than individual choice is the reason that successful women are queuing up at IVF clinics and egg freezing centres, even willing to take loans to continue their treatments. Many of them are trapped in what is being called 'IVF debt'. The procedure itself has a success rate of 40 per cent per cycle if you are under 35, but they are still willing to bet on it. Nobody even talks about the physical pain involved. In our cultural narrative, women, after all, are expected to be selfless and sacrificing when it comes to continuing the bloodline in a tactical transference of responsibility. Here are some hard facts. Infertility isn't only because women have poor health and hectic lifestyles; men are going through the same, minus the guilt. Men are always assumed to be virile, and women are automatically assumed to be infertile. Men are as enthusiastic about fatherhood as women are about motherhood. Yet there is no prejudice against a childless man. That is reserved rather harshly for women. Young women are far more informed and aware of the toll their work and home environment is taking on them, and are keen to freeze their eggs. But is it cost-effective enough? With costs ranging between ₹1,50,000 to ₹2,50,000 per cycle and doctors telling them it's best to freeze their eggs by 29, a young woman has to battle a dilemma. Should she still gamble on natural conception, or should she, with no savings in a career that has just begun, borrow the money for the greater good? Assisted reproductive technologies may be changing the face of parenthood, but only in cities. Accessibility is still an issue in the hinterland. There may be public schemes on women's health, but funding for crucial research on their reproductive health is all but paltry. Besides, women are rarely made part of clinical trials and research studies. Economics layers every decision and agency to have a child. Women aren't always averse to having a child, but do they have the right partner to build a safe environment for raising a family or have pockets deep enough to go it alone till the child's college years? Even if she uses donor sperm, will the single mother be spared societal judgment of attempting a family in isolation? Nobody even dares to discuss parental desires of non-binary people and facilitating their baby journeys. And for all the well-meaning advisories on adoption, women hoping to be a single parent have to navigate a dark maze of legalese, scrutiny and most importantly, finances. As for healthy women of childbearing age, delaying a family is often not a matter of choice but forced by circumstance. Most women delay births because they get offloaded mid-career or are denied the promotion that could get them out of middle management into leadership roles, the moment they seek work-life balance norms. In a dynamic world, workplace inflexibility continues to be a decelerator for women. With societal complexities, stigma of childlessness and their own performance anxiety weighing down on them, many women are developing mental health conditions. These begin with stress, anxiety, depression and eventually a burnout. And as they wrestle with their private grief of childlessness, nothing prepares them for the public spectacle of their insufficiencies. This imposed guilt is nothing but a new-age tool of gendered oppression, one that creates another hurdle for a woman to cross in her quest for equity. However, women must not slip into victimhood. Instead, one has to look at the many childless women who make excellent grandmas, aunts, and caregivers, caring for the young in their families. Childlessness doesn't automatically translate to a lack of maternal instincts. If anything, non-parenting women can raise the community's children with an all-new neutral perspective. As author Maya Angelou says, 'If our children are to approve of themselves, they must see that we approve of ourselves.'
Hans India
6 days ago
- Hans India
Why solving the fertility crisis needs public-private muscle
The United Nations Population Fund's 2025 report, The Real Fertility Crisis: The Pursuit of Reproductive Agency in a Changing World, was published on 10th June 2025 and challenges the long-standing global anxiety around fertility rates falling too fast. However, the real crisis, as the report argues, is not that people are having fewer children, but that they are unable to have the number of children they want. From rising living costs and inaccessible fertility care to rigid workplaces and outdated gender roles, millions today are trapped between desire and reality. In India, this gap is becoming increasingly visible, as with a Total Fertility Rate (TFR) of 1.9, the country is now below replacement levels while still grappling with wide disparities across states and socioeconomic groups. According to the report, 36% of pregnancies in India are unintended, and nearly one in three adults report not being able to meet their fertility goals. This is where a stronger ecosystem could prove critical: one that leverages public-private partnerships (PPPs) to not only expand services but also dismantle structural barriers. If governments, private health providers, and employers worked in tandem to improve access, affordability, and awareness, it could mark a significant shift in how reproductive health is understood and supported. But for that to happen, corrective measures must go far beyond financial incentives or pronatalist messaging. As the report emphasizes, the real solution lies in restoring agency and ensuring people have the ability to make informed, supported choices about if, when, and how to have children. This means universal access to contraception, affordable fertility treatments, workplace policies that recognize caregiving, and reliable childcare infrastructure. And here, private sector participation could be pivotal. IVF clinics, fertility tech platforms, diagnostic labs, pharma companies, and insurance firms, aligned with public health goals, can bridge critical care gaps. For example, co-developing fertility insurance plans, launching workplace fertility wellness programmes, or expanding fertility services to Tier 2 and 3 cities through PPP models could ensure reproductive health is not just a privilege for the urban few. Speaking to Abhishek Aggrawal, CEO, Birla Fertility & IVF, he shares, "The report offers an important lens on fertility, not just as a health statistic, but as a matter of agency, equity, and timely access. The challenge before us is the growing gap between people's aspirations and their ability to act on them, often due to late diagnosis, limited support, and constrained choices. This is where policy and partnerships must evolve. Fertility care needs to be integrated into how we think about public health: not as a specialized service for a few, but as preventive, inclusive care for all. That means awareness at the grassroots level, timely screenings, equitable access to assisted reproduction, and proactive fertility preservation, especially for those most at risk of being left out. For us, commitment to making this shift happen is of great importance, and hence we advocate for workplace reproductive wellness clinics and corporate fertility workshops to help individuals make informed decisions without stigma or delay. Bridging the gap between aspiration and access requires coordination across public health, private care, and the workplace. ecosystems. That is the call to action this report makes clear. And it is one we must all respond to with urgency, openness, and long-term commitment." While much of the fertility debate often centres around statistics and population projections, the report makes it clear that women's reproductive health lies at the heart of the crisis. Women are disproportionately affected by caregiving responsibilities, workplace discrimination, and stigma around delayed motherhood. Many report postponing or abandoning plans to start families due to career penalties, housing insecurity, or lack of partner support. The report also notes that unmet contraceptive needs, unsafe abortions, and delayed fertility diagnoses remain pressing challenges, especially in lower-income or rural settings. Mr. Sombrata Ray, Unit Head, CK Birla Hospitals, CMRI, reflects these concerns and expands on the need for timely intervention, stating, "Indeed, millions of families go through emotional, financial, and physical consequences of either a lack of timely information or support. Even more concerning is the fact that many unintended pregnancies are largely preventable. This signals a huge gap in reproductive awareness, availability of contraceptives, and open communication about family planning. Public and private healthcare systems must come together to take adequate measures. We need to make greater investments in community education, increase access to contraceptive counseling and fertility support, and make reproductive health services accessible to both men and women in both urban and rural communities. A free cervical cancer vaccination camp is an additional component of the CMRI's commitment to women's health, which vaccinates young girls and women against HPV, one of the main causes of cervical cancer. When delivered early and in an equitable manner, preventive care can, in many cases, reduce the long-term disease burden and save many lives." Ultimately, the report's message is not to alarm but to create a sense of urgency. People want to start families, but too many are constrained by circumstances they cannot control. Fertility is no longer just a personal decision. Today, it is a public issue, a workplace issue, and a societal one, and tackling it will require the kind of cross-sector collaboration that puts people's choices at the center.
Time of India
11-06-2025
- Time of India
UN report: India's population hits 1.46 billion, fertility drops below replacement rate; experts warn of alarming urban TFR decline
In a shocking update, a United Nations (UN) report revealed on Tuesday that India's population for 2025 is estimated at 1.46 billion as well and it has also flagged a declining total fertility rate (TFR) in the world's most populous country. According to the UN Population Fund's (UNFPA) 2025 State of World Population Report, released on Tuesday, the population is expected to rise to about 1.7 billion before it starts to fall around 40 years from now. Moreover, the population of China is estimated to reach 1.41 billion in 2025. On the other hand, India's population was 1.44 billion previous year, as per the World Population Prospects-2024. India's fertility drops below the replacement rate The report titled 'The Real Fertility Crisis' states that one in three adult Indians (36 per cent) face unintended pregnancies, while 30 per cent of them experience unfulfilled desire for having either more or fewer children. Additionally, the UNFPA report showed India's TFR has dropped to 1.9, which is below the replacement level fertility of 2.1 births per woman. This number indicates that women are having fewer children than needed to maintain the population size from one generation to another. What can be done to reverse the decline? We should not take comfort in the fact that India's population has reached 1.46 billion. Instead, we should be concerned about the steadily declining Total Fertility Rate (TFR), which has now dropped to approximately 1.9. 'Reversing declining fertility rates requires a multi-faceted approach. Improving reproductive health services, including quality maternal and child healthcare, family planning resources, and STI prevention, is crucial,' says Dr Usha BR, Consultant - OBGYN, Robotic surgeon, Fertility & Laparoscopic Surgeon, Fortis Hospital, Bannerghatta Road, Bengaluru. Family-friendly policies like paid parental leave, childcare support, and flexible work arrangements can encourage childbearing. 'Fertility awareness education and community involvement can dispel myths and misconceptions. Investing in maternal and child health programs to reduce infant mortality rates can increase confidence in raising children. Additionally, offering fertility support services like IVF can help those struggling with conception, ultimately supporting a healthier demographic balance and mitigating declining fertility rates in India,' adds Dr. BR. Risk factors for the declining fertility rate in India 'If this trend continues, our population may begin to decline significantly, possibly falling to around 930 to 940 million by the year 2100. What is even more alarming is that in urban areas, which comprise about 45 per cent of India's population, the TFR is even lower, between 1.6 and 1.7,' warns Dr Manjunath, Deputy Medical Director, Birla Fertility and IVF, Bangalore. 'This decline is largely attributed to delayed marriages, and among those who are married, delayed pregnancies, with many couples opting to have only one child. Compounding this issue is the growing incidence of diminished ovarian reserve among young women, which is becoming increasingly common. Additionally, the rising trend of women prioritising careers and postponing childbirth is contributing to the fertility decline.' Southern states are particularly affected, with sharper drops in TFR compared to their northern counterparts, prompting governments like Andhra Pradesh's to consider incentives for couples having more children. According to Dr. Manjunath, 'If this trend continues, India may soon face fertility patterns similar to those seen in parts of Southeast Asia and developed European countries, leading to the loss of our demographic dividend.' What can be done to manage the situation? To counter this, it is important to encourage young couples to plan during their peak reproductive years. Dr. Manjunath says, 'We also need to raise awareness that fertility significantly declines after the age of 35. Conceiving naturally or with minimal medical assistance is typically easier between the ages of 25 and 35, and timely family planning is key to preserving reproductive health and national demographic stability.'
