SUDDEUTSCHE ZEITUNG

Female Fertility, Time To Get Blunt About Biological Clock

Children: right now or later?
Children: right now or later?
Felicitas Kock

-Essay-

BERLIN — There we were, a group of female friends in their early 30s sitting around the dinner table one evening and, somehow, the conversation turns to having children. We all agree it would be nice to be a young mother because it is strangely cool being a young mum. But we all have jobs, plans to travel and want to reach some level of self-fulfillment. Children yes, but not right now, thank you very much. Maybe later … at some stage.

We would rather suppress the thought that having children at a later stage may already have been decided for us. One of our friends, a doctor, says that it is probably not easy to have children later on, that the possibility of having a disabled child increases as we grow older. But we just roll our eyes at the warning and switch topics and talk about things we want to do before our lives are glued in place by our babies' hunger.

We don't mention the topic of in vitro fertilization (IVF) and, like many people our age, fall into the trap of thinking that we can have children whenever we want to. Without any trouble. Even if we are in our late 30s or even early 40s.

Indeed, 10% of German women are 38 years or older when giving birth to their first child. The reproductive medicine market is booming. About 96,000 IVF treatments were conducted in Germany alone in 2015.

Women's decisions to have children later in life is the main reason for the increase in IVF treatments but it's not the only one. The desire to have children among homosexual couples has become more recognized and accepted by society. With just a few clicks, information on IVF and sperm donation are easily available online.

"Those who come to my practice are usually well read on the subject," says Andreas Jantke, head of an IVF clinic in Berlin, adding that visiting an IVF center is in vogue at the moment.

It was quite a different story 10 or 15 years ago. "Infertility has always been a stigma," says medical technician Claudia Wiesemann, who, as a member of the German Ethics Council, deals with the ethical implications of reproductive medicine. But now, it is considered acceptable to have "assistance."

Late pregnancies are become normalized. Risks are not mentioned as much because of the promises made by the reproductive industry and the grateful silence of couples who underwent successful treatment. Biological facts are omitted.

Many couples do not address the subject of parenthood until much later in their lives. By then, often the only way to have a child is through the help of reproductive medicine. The reason for this being that many people are misinformed when it comes to reproductive health. The only thing we hear when we are young is to not have children and, under no circumstances, before we have finished our education.

We neglect to educate couples that women only have a handful of fertile days in each menstrual cycle and that we only have a 25% chance of getting pregnant on one of those days. We do this because we want youngsters to always have safe sex. But we should, between the ages of 17 and 30, also consider the finitude of our fertility. Many women misjudge the restrictions of their own fertility.

"Studies have shown that nearly half of all Germans think that the fertility of women only begins to decrease aged 40," says Jantke. But the chance of having a successful IVF treatment at that age is comparably low. Wiesemann therefore believes that reproductive health education should begin at a young age. For both women and men.

This is crucial knowledge nowadays as there are many reasons to postpone having children: A boss who thinks children are a setback to their employee's career and insufficient childcare arrangements. The arguments for waiting do not evaporate just because we are more familiar with the biological facts. But it enables us to put everything into context.

Female fertility begins to decrease at age 30. At first slowly and then very rapidly from age 35 onward. The quality of eggs that a woman carries from birth decreases with age. Even IVF treatment cannot succeed if there are no good-quality eggs left.

"Many people have exaggerated expectations towards reproductive medicine," says Jantke. His website clearly states that not even half of his treatments, 44.7% to be precise, were successful last year. Most of his female clients are in their mid-to-late 30s.

IVF treatments are not only quite expensive but come with a considerable psychological burden. "We offer psychological care from the very beginning," says Jantke. Most couples are, after all, already stressed by the time they choose to visit a clinic as many of them have been trying to conceive for years.

But does someone who sees a pregnant mid-40s celebrity or hears of a friend who just had twins in her late 30s think of all that? Probably not.

The discussion about reproductive medicine and its societal consequences have to be intensified. It maybe worth listening to your doctor friend at your next gathering of women when she says that having children is not that easy.

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Coronavirus

Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."


Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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