Marginalised Lives: Infertility, Childlessness, and Healthcare Seeking in Resource-poor Settings in Nepal and India

What are the challenges of infertility in terms of public health concerns and social marginalisation in resource-poor settings in Nepal and India?

Project Summary

Infertility in the developing South has remained largely invisible as a major reproductive health challenge and a serious public health concern. The overall aim of the project is to contribute to a robust and in-depth understanding of infertility as a major public health concern and how it creates conditions for social marginalisation and impacts well-being and social integration.

The project seeks to explain the neglected incidence of infertility in resource-poor settings of Nepal and India. The project’s research sites offer an unprecedented opportunity to make research-led interventions into the silent but swift emergence of preventable infertility burdens in the developing South. The cross-national perspective is essential for supporting data-driven policy formulation and from the perspective of fostering proactive outreach activities. The project is built around a multi-sited ethnographic methodology that maps the infertility terrain and its correlates through identifying and linking a diverse set of stakeholders. In doing so, the project offers to build a comprehensive terrain map profiling infertility prevalence, etiologic causes, social stigma and marginalization, treatment options and healthcare-seeking behaviour, patterns of seeking out informal and traditional interventions.

The analysis will be located within a detailed review of the current state of healthcare governance, national priorities and policies, and public and private partnerships in infertility care for the poor. The interdisciplinary team will draw upon approaches from anthropology, sociology, demography, development studies, policy studies, and biomedical expertise ranging from gynecology to public health. The team has strong partners in NGOs working within the framework of human rights perspective with a strong understanding of ground realities and years of active field experience in local framing and the implementation of reproductive healthcare initiatives.

Academic Output

Executive Summary

The main goal of the project is to contribute to a robust and in-depth understanding of infertility as a major public health concern in Nepal and India. It is based on the assumption that exploring the social and cultural implications of infertility is essential to develop strategies that are responsive to a universal human rights perspective on sexual and reproductive health. In the course of the project, researchers have undertaken in-depth terrain mapping of infertility, its lived experience at the community level and the access to biomedical and alternative traditional modes of health care. The overall research showed that perceptions and health-seeking behaviour were strongly informed by socio-economic status and support from the wider family. On the other hand, national and local stakeholders have an important role to play in creating an enabling environment for infertility prevention and in improving healthcare-related options. To ensure these objectives are met, the research and outreach activities will continue beyond the timeline of the project and even expand further via a dedicated initiative: the Platform for the Study of Reproductive Disruptions (PSRDs). PSRD aims to dovetail region-specific expertise with global policy developments in setting and formulating an agenda for action.

Working Paper

Infertility, childlessness, and healthcare seeking in resource-poor settings in Nepal

The inability to bear children is a tragedy for couples, bringing a sense of loss, failure and exclusion. This research consists of an exploratory study of the social meaning, cause and consequences and health-seeking behaviour of infertile couples in Nepal. Women without children have different experiences that may vary from one country to another including Nepal and that determine their reproductive health right. Infertility is a social as well as medical issues and it can lead to considerable distress. Existing studies show that infertility can be a devastating experience for many; with significant consequences for social and psychological well-being that put them in a serious life crisis.

Working Paper

Infertility, childlessness, and healthcare seeking in resource-poor settings in India: Sama activity report

A multi country study was initiated in 2018 to investigate the present infertility situation, with a focus on risk factors, treatment seeking for infertility, and impact of infertility in India and Nepal. The project seeks to dovetail region-specific expertise with global-policy developments in setting and formulating an agenda for action. In India, Delhi and Bodh Gaya were selected as research sites and the study was initiated in 2018. The project developed by Sama was co-coordinated by Gargi Mishra (till March 2020) with Sarojini N and Deepa V. The field work was conducted by Gargi with support from Ojaswini, Ritika, Rizu and Oshin

Research Team

Aditya Bharadwaj
The Graduate Institute

Christine Lutringer
The Graduate Institute

Hélène Bayeux
Principal Member
International Foundation for Population and Development (IFPD)

Nadimpally Sarojini
Principal Member
Sama Resource Group for Women and Health

Renu Rajbhandari
Principal Member

Alaka Basu
Associated Member
Cornell University

Jyoti Sanghera
Associated Member
OHCHR United Nations High Commissioner for Human Rights





Policy domains



India, Nepal

Host Institution