Abstract
Holly Donahue Singh. 2022. Infertility in a Crowded Country: Hiding Reproduction in India. Bloomington, IN: Indiana University Press. Xxvii + 311 pp. Glossary, bibliography, index. $32 (paperback—ISBN: 9780253063878).
Holly Donahue Singh’s Infertility in a Crowded Country: Hiding Reproduction in India is an important contribution to the list of topical ethnographies on reproduction in India. Singh brings nuance and value to the study and conceptualisation of fertility by engaging in a dialogue on, and experiences of, infertility in India. Firmly entrenched within classical anthropological studies on fertility, the book analyses fertility–infertility from the perspective of population planning and the questions surrounding images of the overpopulous. In this endeavour, Singh brings to the fore anxieties and social beliefs regarding adoption, minority rights and stigma and the meanings associated with child desire.
The Hindi–Urdu word aulad (children) has multiple meanings in Singh’s ethnography. She maps each of these meanings as they are represented in her respondents’ navigation of their fertility treatment in the North Indian state of Uttar Pradesh. In the Introduction, chapters 1 and 2, the author finds that aulad is both a social necessity and an experience. The social status and valuation of a woman are linked to her bearing and begetting an aulad, preferably a male child. In chapter 2, motherhood as an essential, non-negotiable socio-biological undertaking in North India is dissected through a study of popular culture representations in which it is eulogised. However, there is a catch: Singh finds that both Hindi cinema and individual respondents idealise and critique the value that biological motherhood may carry in social life. Nurturing and becoming a mother are more important than birthing a child. Much like Daniel Miller’s (1997) ethnography of upper middle-class mothering in a North London neighbourhood, in Singh’s ethnography too, the child makes the mother—except, in the latter, aulad itself becomes a valuation.
In chapter 1, Singh finds that ‘child desire’ (pp. 65–73) and valuation of aulad are embedded within a complex network of kin and kinship. Thus, in Lucknow city, where the ethnography is based, mothers-in-law come to symbolise the patriarchal needs of perpetuating lineages through male progeny. The struggle between the demanding, criticising mother-in-law and the daughter-in-law is all too real for many of the women frequenting fertility clinics in the city. Yet, the ambiguous figure of the husband within child desire complicates the familial demands for aulad. Most of Singh’s respondents find their husbands to be supportive and understanding of their struggles with infertility. This may be due to shared fertility issues or a sense of belonging that cements the couple’s intimate relationship. Yet, husbands continue to oscillate between familial pressures and wife-love in the ethnography.
In chapter 3, the ethnography turns to the fertility clinic. The Indian infertility–fertility clinic and the popularity of in-vitro fertilisation (IVF) have been an important part of recent ethnographic research (Bärnreuther 2021; Bharadwaj 2016). Singh contributes to these studies by showing how the IVF clinic is experienced as a dehumanising and ‘liminal’ space by women who underwent extended periods of waiting through multiple cycles of IVF. Recounting interviews with some of the ‘lady doctors’ (women obstetricians–gynaecologists or OB-GYNs) in Lucknow who specialised within the private and public health sector, Singh finds infertility technology and its practice centred on the dual propagation of secrecy and infringement of privacy. So, women patients frequenting OB-GYN and fertility clinics for treatment made these visits in secret—hiding their fertility issues from the extended family or neighbourhood. But, at the same time, once in the clinic, their privacy was violated through invasive tests and routine check-ups that did not respect informed consent. For Muslim women practising veiling, frequenting such clinics was a harrowing experience as they were subject to examination without proper consent and support. Singh’s description of the clinical space adds to the ongoing criticism against reproductive health support in India that dehumanises women and positions treatment and counselling within a hierarchical power relationship of doctor–patient. Despite having a majority of women practitioners, the delegitimisation of women’s reproductive health-seeking outside biomedicine and their personal journeys through treatment marks the clinical encounter in India. Infertility treatment adds to the continued forms of exclusionary practices wherein women are treated according to religious, class and caste stereotypes.
A novel part of Singh’s ethnography is its overt focus on exclusionary practices that Muslim women go through in their reproductive health journeys. In chapter 4, two non-governmental organisations are profiled as they support reproductive health-seeking amongst Muslim women in Lucknow, who are mistreated due to their class and religion in public and private clinics. Singh compares and reflects on her findings through the Sachar Committee Report 2006 on the state of India’s Muslim population. She finds that Muslim women suffering from infertility are ‘invisible’ as they continue to be marked by demographic politics and stereotypes that position them as ‘hyperfertile’. This particular form of exclusion is not restricted to Muslim women alone but also extends to poorer women living in urban slums and ghettos, where the lack of clean water and adequate sanitation facilities impacts their reproductive health.
In the final ethnographic chapter, the much-needed focus on adoption brings us back to the need to focus on adoption in conversations on infertility. The rise of IVF in India has meant that adoption has become the last option. This chapter engages with the legal hurdles and conversations around adoption in India, taking into account restrictive personal, religious laws, as well as equally prohibitive state laws such as the Hindu Adoption and Maintenance Act, 1956, and the Guardians and Wards Act, 1890. Social prejudices against adoption, including the preference for genetic ties and anxieties about inheritance, mean that couples and individuals seeking children often participate in ‘child circulation’ within the family. Despite the existence of the nodal adoption authority in India, the Central Adoption Resource Authority (CARA), most couples prefer to go through illegal routes to hide the adoption of an infant. In Singh’s account, desiring an aulad in India outside of sexual procreation within heterosexual marriage involves secrecy.
Infertility in a Crowded Country is an important addition to the mobilisation around reproductive justice. In giving space and voice to women from disenfranchised and minority communities, the author signals the need to look beyond policy hysteria and social perceptions, adding nuance to the study of fertility in India.