a presentation by NIZAMUDDIN AHMAD SIDDIQUI and

AMIT KUMAR

Normal spontaneous reproduction is a complex process which involves a series of steps in men and women including release of egg, interaction with sperm and implantation of embryo in females; and, production of sperm and fertilization in males. Conditions that affect any of these processes reduce the chances of conception and if chronic may lead to infertility. A.R.T. includes in vitro handling of both human oocytes and sperms, or of embryos for the purpose of establishing a pregnancy. This includes in vitro fertilization, embryo transfer, cryopreservation, embryo donation etc. But, does not include artificial insemination.

A.R.T. is practiced by more than 20 countries in Asia. According to a survey there are approximately (now more than) 260 centers in Asia serving an average population of 13 million people. [Ethical
and Legal Aspects of Assisted Reproduction Practice in Asia (Human Reproduction, Vol. 11, no. 4, pp. 908-911, 1996)]

Worlds second and Indias first IVF baby Kanupriya Das alias Durga was born on October 3, 1978 two months after Louis Brown. Since then ART has developed rapidly. The Law Commission of India in its 228th Report (August 2009) has addressed the issues of ART and surrogacy in quite detail. It emphasized upon the reproductive right as a basic right. [BK Parthasarthy v. Govt. of AP(AIR 2000 AP 156); Javed v. State of Haryana(2003) 8 SCC 369]. Then there is also the case of fertility tourism in India. [Baby Manji v. Union of India, JT 2008 (11) SC 150]

India:

The Assisted Reproductive Technologies (Regulation) Bill, 2010 regulates infertility clinics throughout the country. It lays down procedures for accreditation and supervision of infertility clinics, preservation of gametes and surrogacy related issues. Sex-Discrimination (Sex-Selection): The detection of the sex of fetus with the aid of ultrasound, amniocentesis etc., and aborting the fetus selectively if it is declared to be female by misusing the Medical Termination of Pregnancy Act, 1971, is the clandestine procedure followed in India. The Prenatal diagnosis, developed in the 1970s, reveals clear discrimination against the girl child leading to severe gender imbalances. [decline from 945 to 927 females per 1000 males in ten years (2001 census report)]. The two major procedures used for sex-discrimination are Prenatal Diagnosis (PND) and Pre-implantation Genetic Diagnosis (PGD). These techniques for sex-selection have all been banned by the PreConception and Pre-Natal Sex Selection/Determination (Prohibition and Regulation) Act, 2001

Pakistan: Empirical evidences from Demographic and Health Survey (DHS) data from 57 countries [Arnold F., Gender Preferences in Children(1997)] shows that son preference remains particularly strong in South Asian countries. Apart from Bangladesh, Pakistan has the second highest ratio of preference for sons over daughters. [Bulletin of the WHO, 2000, 78(3)]. In studies conducted separately by I.I.M.College, Rawalpindi [Pak J. Physiol. 2003;3(2)] and Agha Khan Hospital, Karachi [ J Coll. Physicians Surg. Pak. 2004 May; 14(5):270-3 ] it has been observed that there is a paucity of data in Pakistan as to the success of ART. Another study published in Human Reproduction [Vol.22, No. 2, pp. 605-609, 2007] observes that the number of women willing to subject themselves to the cytometric sperm separation is too small to cause a severe imbalance of sexes.

Bangladesh: Population is seen as the cause of all problems including socioeconomic, political, environmental and security in the conventional or mainstream discourses. Since early 2000, various reproductive techniques have found their way; notably among them are IVF or Test Tube Baby and Frozen Embryo. The first triplets of test tube babies in Bangladesh were born on 30th May, 2001 and named Hira, Moni and Mukta. The government has also taken steps to control birth as a part of population control policy. Instances are also there where poor people are coerced to reduce child birth. Assisted reproduction in general have borne more girls than boys [Out of 26 cases of Test tube babies 17 were girls]. Then, there is also the problem of sex determination technologies. The Draft National Health Policy, 2009 has put certain guidelines. However, it remains silent as to whether ART is included in health service.

Nepal: Married women of reproductive age make up 20% of Nepals population of 24.7 million. Use of modern methods of contraception have increased steadily (36% in 2001). Nepali Hindu-Caste women are more directed to use innovative modes of contraception. Sri Lanka: There is a considerable amount of interest in newer reproductive technologies, with the first IVF clinics opening as far back as in 1999. However, guidelines and laws governing the operation and regulation of these services are non existent. National Science and Technology Commission (NASTEC) of Sri Lanka has recently appointed a study group to draw up a policy on Biomedical ethics in Sri Lanka.

Maldives: The most common method for reproductive control is contraception. The reproductive healthcare services have mostly become affordable to the satisfaction of the population from 1999 to 2004. Afghanistan: In reproductive health, such as contraceptive use and family planning, women lack decision making power to negotiate about sex, childbearing and contraception as husbands assume sexual access and control. Bhutan: The current family planning policy provides for contraceptive methods. The reproductive technology limits itself to conventional methods including surgical contraception (tubectomy and vasectomy).

Reproductive behaviour in South Asian region has usually been studied in the form of issues relating to reproductive health. The normal gradients of research in the region are infertility among males/females and the use of contraception for birth control.

Use of technology in controlling child birth is practiced mainly in India, Pakistan, Bangladesh and Sri Lanka.
Further, the use of ART in relation to sex discrimination is limited specifically to India. For in Pakistan, the studies drawn on this relationship are inadequate; in Bangladesh, the effects are anticipated; and, in Sri Lanka the issues are still in infancy to be observed.