By: Dr.Fiaz Maqbool Fazili
Every couple dreams of hearing a child’s laughter echo through their home. In Jammu and Kashmir, as elsewhere, parenthood is not merely a private aspiration but a deeply rooted social and emotional milestone. Yet for thousands of couples across the Union Territory, this dream remains painfully out of reach—not because modern medicine lacks solutions, but because the public health system has failed to make those solutions accessible. Infertility care,_toggle in J&K, has quietly become a privilege reserved for those who can afford private treatment running into lakhs of rupees. For everyone else, hope is rationed by income.
Infertility is neither rare nor elective. The World Health Organization recognises it as a disease of the reproductive system, affecting an estimated 10 to 15 per cent of couples worldwide. In Kashmir, factors such as high prevalence of polycystic ovarian syndrome, untreated pelvic infections, delayed marriages, chronic stress, environmental exposure, and lifestyle changes suggest the burden may be even higher. Despite this, infertility services in Jammu and Kashmir remain conspicuously absent from the public health landscape. There is no state-run infertility department, no functional assisted reproductive technology (ART) unit, and no structured pathway for couples who require interventions like IVF. What exists instead is a thriving, largely unregulated private market where desperation meets profiteering.
A single cycle of IVF in the private sector typically costs between ₹2 and ₹5 lakh, often more when medicines, investigations, repeat cycles, and travel are included. For most families in J&K, this is a catastrophic expenditure. Many sell land, borrow heavily, or exhaust lifetime savings. Others simply abandon the pursuit of parenthood altogether. The emotional cost is immeasurable. The social cost, particularly for women who disproportionately bear the stigma of childlessness, is profound. In a region where mental health is already fragile, infertility quietly compounds distress, marital strain, and social isolation.
What makes this situation particularly troubling is that Jammu and Kashmir is not lacking in medical institutions. SKIMS Srinagar, conceived as a premier tertiary-care and teaching hospital, and the Government Medical Colleges at Srinagar and Jammu, are expected to set benchmarks for comprehensive healthcare delivery. These institutions manage complex cardiac surgeries, organ transplants, advanced oncology, and critical care. Yet infertility—a condition with far-reaching psychosocial consequences—remains conspicuously absent from their service portfolios. This absence is not due to insurmountable technical challenges but due to policy neglect.
The irony is stark. A significant proportion of infertility cases do not even require IVF. With basic evaluation, hormonal treatment, ovulation induction, ultrasound monitoring, and simpler procedures such as intrauterine insemination, up to one-third of couples can achieve pregnancy. These services require modest infrastructure and trained personnel, both of which already exist in embryonic form within SKIMS and GMCs. What is missing is institutional commitment and administrative prioritisation.
Establishing state-run infertility clinics within SKIMS and GMCs would be a logical and ethically compelling first step. Such clinics could offer comprehensive diagnostic workups, counselling, and non-IVF treatments at nominal cost. This alone would dramatically reduce the number of couples forced into expensive private care. The next phase, within a realistic time frame of one to two years, should involve upgrading select centres—at least one in Kashmir and one in Jammu—into full-fledged IVF and ART units. Even a limited capacity of 150 to 200 IVF cycles annually per centre would be life-changing for hundreds of families and symbolically powerful in affirming infertility care as a public responsibility.
The inevitable counterargument is cost. IVF, it is said, is expensive and resource-intensive. But this argument collapses under scrutiny. The capital investment required to set up a basic IVF unit is modest compared to many large infrastructure projects routinely approved without hesitation. Moreover, once established, these units serve patients year after year. The social return on investment—measured in restored dignity, mental well-being, family stability, and public trust in institutions—is immense. The real cost lies not in action, but in continued neglect.
There is also a misconception that infertility treatment is a “non-essential” or “luxury” service. This view is outdated and discriminatory. Reproductive health does not end with contraception and childbirth. The right to attempt parenthood is as integral as the right to safe delivery. For cancer survivors rendered infertile by treatment, for women with blocked fallopian tubes, for men with treatable sperm disorders, assisted reproduction is not indulgence—it is the only medical pathway to biological parenthood. Denying access based on affordability alone violates the spirit of equity that public health systems are meant to uphold.
Jammu and Kashmir has an additional moral imperative. Decades of conflict have already disrupted social structures, delayed marriages, and strained mental health. The state has invested heavily in trauma care, mental health outreach, and rehabilitation. Infertility care must be seen as part of this broader healing process. Parenthood, for many, represents continuity, hope, and emotional anchoring. A welfare-oriented administration cannot selectively support some aspects of well-being while ignoring others that cause silent suffering.
Policy solutions exist and are well within reach. The UT health ministry can integrate infertility services into existing maternal and reproductive health frameworks. Subsidised or free IVF cycles can be offered to economically weaker sections, with eligibility criteria and transparent selection to prevent misuse. Public–private partnerships can be explored in the interim, but with strict price caps, outcome reporting, and ethical oversight to prevent exploitation. Most importantly, training programs for government gynaecologists and recruitment of embryologists must be institutionalised so that expertise is developed in-house rather than perpetually outsourced.
With GMCs almost in every district, and AIMs at Jammu started operating, in valley SKIMS, in particular, is uniquely positioned to lead. As a tertiary referral centre with academic mandate, it can develop infertility and ART services that combine clinical care, teaching, and research. This would not only serve patients but also train future specialists, reducing long-term dependence on private providers. GMC Srinagar and GMC Jammu can follow with satellite services, ensuring regional equity and access.
Silence on infertility in public policy does not make the problem
The author is a senior Srinagar-based consultant surgeon and a healthcare policy analyst. He writes regularly on public health systems, medical ethics, and the need for equitable access to healthcare services. He can be reached at [email protected].
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