Project's title: Follow-up survey of childless women in Andhra.

Introduction:
Despite its well-established links to other aspects of reproductive ill health, such as sexually transmitted infections and unsafe abortion, infertility is the most neglected component in the reproductive health programmes of many developing countries (Berer, 1999 Jejeebhoy, 1994). In case of India also, no special government interventions or programmes exist to treat infertile couples, and Indian researchers have neglected the subject of infertility. Studies on the type of treatment sought by infertile women are sporadic. The number of private hospital specialists offering treatment to infertile couples has increased tremendously and they have popularized their services by extensive advertising (Kakar, 1983; Rowe and Viklyaeva, 1985; Ryder, 1973). Under these circumstances people may be going for allopathic treatment as their first choice, rather than to traditional or religious healers as in the past. There is a dearth of information about the role of modern private health services in fertility treatments and about costs of treatment.

A study during 1996-99 was carried out to document the treatment-seeking behaviour and associated expenditures of childless couples in one district of Andhra Pradesh, and thereby identified major problems and possible remedies (Unisa, 1999, and Unisa, 2001). Andhra Pradesh is an appropriate locale for this study because reported rates of childlessness in this state are among the highest in the country and thus insights into the problem are particularly relevant for programmes (Pathak and Unisa, 1993). The earlier study was one of the most thorough non–medical investigations of infertility in India, and it will be strength if follow-up of the same couples are carried out to know the situation of them after six years. In the first survey women comprised those who had so far not been treated effectively. After six years of duration, some of them are likely to have children by natural course of time or treatment or adoption. It will be interesting to know the course of action through which they had children and if by treatment then how much cost was incurred in this process. There is a scarcity of studies, which give the total cost of infertility treatment until couples are successful in having children. Hence it is proposed to revisit the same villages and same couples to examine the current status of these couples, their fertility seeking patterns, the costs incurred by them. Specific objectives of the study are given below:

Objectives:

• To explore the fertility-seeking pattern among the childless couples.
• To estimate the magnitude and cost of successful fertility treatments when couples have children.
• To examine the husband's involvement in the treatment or adoption of children.
• To look into the level of satisfaction and change in the lives of childless couples after the fulfillment of motherhood and fatherhood by treatment or adoption.
• To study the changes over time in consequences and coping strategies among those childless women who never had any children.

Study design:
Same villages of Ranga Reddy district will be revisited and same couples will be interviewed to fulfill the above stated objectives. In the first survey 332 women were interviewed and it is expected that we will be able to get at least three hundred of them. Quantitative and qualitative methods will be adopted to collect information. This will help us to estimate the success rate of different treatments and current situation of all those who are still childless.