New Delhi: A majority of government health centres in India lack basic infrastructure and equipment for treating infertility, a survey by the Indian Council of Medical Research (ICMR) has found.
For the survey, published in the latest issue of theIndian Journal of Community Medicineand funded by United Nations Population Fund, ICMR surveyed 12 district hospitals (DHs), 24 community health centres (CHCs), 48 primary health centres (PHCs), and 48 sub-centres covering health facilities from six zones in India—the north, south, east, west, the north-east, and central.
The survey revealed that semen examination services were not available at 94% of PHCs and 79% of CHCs.
Advanced laboratory services were available in less than 42% of district hospitals and 8% of CHCs. Diagnostic laparoscopy and hysteroscopy were available only in 25% and 8% of district hospitals, respectively.
“Availability of most infertility management-related essential equipment, reagents, and consumables was inadequate at the DHs and CHCs. Drugs such as clomiphene citrate, gonadotropins, and bromocriptine, used for the treatment of infertility, were not available at any of the DHs," said Sanjay Chauhan, director, Department of Operational Research, National Institute for Research in Reproductive Health, and author of the study.
“Communication material on infertility was not available at any of the facilities. Misoprostol medicine was available at 58% of DHs, 29% CHCs, and 25% PHCs, while mifepristone was available at only 2 DHs and 1 PHC, that too only for active management of the third stage of labour. Colour-coded sexually transmitted infection (STI) kits were available at 75% of DHs, 42% of CHCs, and only 33% of PHCs," he added.
The study indicated that infertility prevention and management services have been inadequately addressed in government policies and programmes in India.
“There is limited focus on infertility services in the ongoing reproductive, maternal, neonatal, and child and adolescent health (RMNCH+A) programme," said Chauhan.
The study also highlighted a staff crunch in government health facilities. It said that while up to 92% of the sanctioned posts of gynecologists and medical officers in the DHs and CHCs were occupied, only 50% of surgeons’ posts at CHCs and 50% of radiologists’ posts at DHs were filled.
Infertility is now becoming a growing public health concern in the world as well as in India. Global estimates of infertility among couples are between 60 and 80 million, of which 15-20 million couples are estimated to be infertile in India alone.
“In the country, the demand for infertility services is estimated to be around 10 million and will be rising in the future. Therefore, the public sector needs to be geared up for meeting the unmet need of infertile couples," Chauhan said.
“Overall, the availability of inadequate resources and skills for infertility management in the study areas reflects the absence of infertility as a mandate in the package of services under National Health Mission. Therefore, immediate attention of government is required to incorporate infertility services in the national RMNCH + A program and strengthen infertility management services, particularly in the high prevalent districts," he said.