Pakistan: Treatment of infertile couples by society; legality of in vitro fertilization (IVF) and the use of sperm donors (2011-January 2014)
1. Treatment of Infertile Couples by Society
Sources report that the prevalence of infertility in Pakistan is approximately 22 percent, a figure that includes both primary infertility (4 percent prevalence) and secondary infertility (18 percent prevalence) (Ali et al. 2011, 11; Khalid and Qureshi 2012; Sami and Ali, 2012). Secondary infertility refers to the inability to conceive for at least one year, in couples who have previously conceived, while primary infertility refers to couples who have never been able to conceive (Sami and Ali Jan. 2006, 19; Dawn 10 Nov. 2013).
Various studies have reported low levels of understanding among Pakistanis of the causes of infertility (Khalid and Qureshi 2012; Ali et al. 2011; Sami and Ali 2012, Sec. 1). A survey of 316 men and women seeking infertility treatment in Rawalpindi [Punjab Province], the results of which were published by Islamabad-based researchers in 2012, found that 40 percent of female partners and 20 percent of male partners correctly understood the causes of infertility, and that 80 percent of male respondents held their wives responsible for the couple's infertility (Khalid and Qureshi 2012). In a study of 447 men and women recruited from two tertiary care hospitals in Karachi, the results of which were published in 2011, researchers found that 24 percent of those surveyed believed that smoking could cause infertility, while 30 and 38 percent believed that jinns (evil spirits) and black magic respectively were causes, and 53 and 61 percent believed that a woman's past use of oral contraceptives or intra-uterine contraceptive devices respectively could cause infertility (Ali et al. 2011). Eighty-six percent of respondents indicated that only women are blamed by society for a couple's infertility, and fifty-seven percent believed that a woman's infertility was a valid reason for a man to take a second wife (ibid). In a 2006 study run by Aga Khan University [Karachi] researchers on the perceptions and experiences of 104 women in Karachi who had secondary infertility, respondents reported that women "bear the brunt of infertility" and that infertile women can be threatened with divorce, kicked out of their homes, or rejected by their husbands in favour of a second wife (Sami and Ali 2012, Sec. 3.4.1).
The report on the Karachi hospitals asserts that the "inadequacy of knowledge about infertility ... explains why such a strong stigma is attached to infertility in [Pakistani] society" (Ali et al. 2011, 5). Participants in the Aga Khan University study reported a lack of support from their families and husbands and a "negative attitude" from society that led them to consider suicide (Sami and Ali 2012, Sec. 3.4.2). One participant reported being kept away from brides during weddings for fear that she would transmit a "'bad omen'" to the bride (ibid., Sec. 3.4.1). The researchers concluded that "secondary infertility not only socially stigmatizes the women but also challenges their marital stability" (ibid., Sec. 4). The Karachi hospitals study similarly found that infertility is a common cause of "marital discordance" (Ali et al. 2011, 6). The report on the Karachi hospitals also suggests that newlyweds who are unable to conceive immediately after marriage face pressure from society, as immediate pregnancy is "a common expectation in the joint family structure in Pakistan" (ibid., 5).
In correspondence with the Research Directorate, a professor of anthropology at Yale University, who specializes in infertility and assisted reproductive technologies in the Islamic world, wrote that infertility is a "highly stigmatizing condition for Pakistani couples" and that being "childless is not an enviable position" (Professor 5 Feb. 2014). She added that women are typically blamed for a couple's infertility, despite high rates of male infertility, and that they are "often taunted and ostracized in their communities" (ibid.).
2. IVF and Sperm Donation in Pakistan
The Professor of anthropology indicated that IVF is legal in Pakistan, but that it "remains a very stigmatized technology," as well as one that is out of reach for most of the population because of its high cost (ibid). She also stated that sperm donation or any other form of third-party reproductive assistance (including egg or embryo donation, surrogacy) is not practiced (ibid.). She explained that there is "a widespread Sunni Muslim-majority ethical ban on third-party reproductive assistance across the Muslim world," for both men and women, and that "Pakistan follows the Sunni majority lead, and so donor technologies are not available there" (ibid.).
According to the Professor,
[d]onor technologies are considered haram, or religiously forbidden and highly sinful. Sperm donation is particularly sinful, because it violates patrilineal genealogy, inheritance, and descent, which is an Islamic mandate. ... [T]he disallowance of sperm donation is based on strict religious edicts (fatwas), which have prohibited all forms of third-party reproductive assistance. (ibid.)
The Professor added, further, that using the sperm or eggs of a third party is "widely recognized" to be a form of zina, or illicit sexuality, that is effectively considered to be an adulterous act (ibid.). Corroborating information for this statement could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.
A 2013 article published by the Pakistani newspaper Dawn suggests that IVF is generally considered "taboo" but that the practice is becoming increasingly prevalent (Dawn 10 Nov. 2013). Interviewed in the Dawn article, the chief executive of the Australian Concept Infertility Medical Centre [located in Karachi] stated that IVF is permissible in Islam but that there are no sperm or egg donations in Pakistan (ibid.). The chief executive noted a growing demand for IVF in small cities in Punjab, but indicated that the demand had not reached the "remote corners of Pakistan" (ibid.). The Dawn article and the Associated Press of Pakistan (AFP) both indicate that, in late 2013, Pakistan's Council of Islamic Ideology (CII) ruled that IVF is allowed under certain conditions (ibid.; APP 6 Nov. 2013). Dawn, citing a CII member and chairman of the Pakistan Ulema Council, specifies that IVF is permissible for married couples using their own sperm and eggs, and that surrogacy and egg or sperm donation are "not at all permissible" (10 Nov. 2013).
In the Rawalpindi study of 316 men and women seeking treatment for infertility, researchers found that respondents considered intrauterine insemination to be culturally "objectionable," even when the procedure is performed with the husband's sperm (Khalid and Qureshi 2012). Assisted reproductive technologies were found to be "unacceptable both religiously and culturally" among rural populations (ibid.). The report on the Karachi hospitals indicates that approximately half of the respondents who were aware of IVF considered that the procedure was not socially acceptable "because of beliefs that it's not allowed in Islam or that the procedure may use foreign egg or sperm" (Ali et al. 2011, 6). The report also indicates that assisted reproductive technologies are allowed in Islam if they do not use any third-party donations (ibid.).
The Professor of anthropology indicated that any person who was known to have used a third-party donation to conceive a child, even abroad, would face "severe penalties" in Pakistan because they would be considered to have violated [Pakistan's Hudud Ordinance] laws that forbid zina (Professor 5 Feb. 2014). She added that the lives of such individuals and any children conceived with third-party donations would be in "jeopardy" in Pakistan, in accordance with the law (ibid.). Corroborating information for this statement could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.
This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.
References
Ali, Sumera, Raafay Sophie, Ayesha M. Imam, Faisal I. Khan, Syed F. Ali, Annum Shaikh and Syed Farid-ul-Hasnain. 2011. "Knowledge, Perceptions and Myths Regarding Infertility Among Selected Adult Population in Pakistan: a Cross-Sectional Study." BMC Public Health. Vol. 11, Article no. 760. [Accessed 3 Feb. 2014]
Associated Press of Pakistan (APP). 6 November 2013. "Sex Change Surgery, Cloning Unlawful: CII." [Accessed 7 Feb. 2014]
Dawn. 10 November 2013. Sumaira Jajja. "IVF Clinics - In Business Big Time." (Factiva)
Khalid, S.N. and I.Z. Qureshi. 2012. "Perceptions of Infertile Couples Regarding Infertility and Intrauterine Insemination (IUI) in a Rural Population and Services at Government Hospitals in Punjab, Pakistan." Human Reproduction. Vol. 27(suppl. 2). [Accessed 3 Feb. 2014]
Professor of anthropology, Yale University. 5 February 2014. Correspondence sent to the Research Directorate.
Sami, Neelofar, and Tazeen Saeed Ali. 2012. "Perceptions and Experiences of Women in Karachi, Pakistan Regarding Secondary Infertility: Results from a Community-based Qualitative Study." Obstetrics and Gynecology International. Vol. 2012, Article 108756. [Accessed 3 Feb. 2014]
Sami, Neelofar, and Tazeen Saeed Ali. January 2006. "Psycho-Social Consequences of Secondary Infertility in Karachi." Journal of Pakistan Medical Association. Vol. 56, No. 1. [Accessed 3 Feb. 2014]
Additional Sources Consulted
Oral sources: Attempts to contact the Lahore Institute of Fertility and Endocrinology were unsuccessful.
Internet sites, including: Center for Reproductive Rights; ecoi.net; Hellenic Journal of Psychology; The Nation; Shirkat Gah; United Nations – Office of the High Commissioner for Human Rights.