Ending the option of carrying a child is about taking control of the body

Hindustan Times | By
Feb 16, 2018 08:11 PM IST

American actress Lena Dunham’s poignant article in the March issue of the US Vogue about her decision to have her womb surgically removed at 31 when many young women begin considering having a baby is not just about her ending her decade-long battle against endometriosis.

(Illustration: Mohit Suneja)
(Illustration: Mohit Suneja)

It’s about choice and taking control of her body, even if it means ending the option of carrying a child.

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The night before the surgery, when the nurse asked her one last time: “Is there any chance you could be pregnant?” The star of the TV series, Girls, said: “‘Well, not after tomorrow,’ I say. I wish there were a word for when nobody likes your jokes but you make them anyway.”

Endometriosis occurs when the tissue that should grow inside the uterus also grows outside of it, causing debilitating pain when it thickens, ruptures and bleeds with every menstrual cycle. While many women get cramps during their menstrual cycle, women with endometriosis have chronic pelvic pain and severe, unbearable pain during their periods.

Describing her pain, Dunham writes: “In August, the pain becomes unbearable. I am delirious with it, and the doctors can’t really explain. The ultrasound shows no cysts, no free fluid, and certainly no baby. But that doesn’t help the fact that it hurts so bad that the human voices around me have become a sort of nonsense Teletubbies singsong.”

What a pain

Worldwide, one in 10 women have endometriosis, which is one of the leading causes of infertility and miscarriages. This estrogen-dependent inflammatory disease is often mistaken for period pain, which prevents women from seeking treatment. Even when they do visit a doctor, it often remains under-diagnosed, with physicians doing little more than plying them with painkillers.

Around 48.38% women being treated for infertility at a hospital in Ahmedabad had endometriosis, reported a study in the Journal of Clinical and Diagnostic Research. The condition remained underdiagnosed because the signs were often mild and few women underwent laparoscopic evaluation for diagnosis, said the study. The researchers recommend diagnostic laparoscopy of the uterus (hysterolaparoscopy) to detect endometriosis among all infertile women who complain of uterine tenderness and chronic pelvic pain.

Infertility affects 10-15% people in the reproductive age worldwide, but the India’s apex research organisation outs the number much lower for India. Primary infertility is 4 % in urban areas and 3.7% in rural areas, found study of 37,570 women across 13 states done by Indian Council of Medical Research.

Super mum

Losing the womb does not end motherhood. Dunham hopes to become a mother one day knowing that she will never be able to carry a child. “I may have felt choiceless before, but I know I have choices now. Soon I’ll start exploring whether my ovaries, which remain someplace inside me in that vast cavern of organs and scar tissue, have eggs,” she writes.

Hysterectomy usually involves removing the womb and fallopian tubes and not the hormone-producing ovaries. So even after surgery, women keep producing egg, which can be harvested and frozen for surrogacy. Preserving the ovaries prevents the onset of menopause symptoms, such as hot flashes.

India’s surrogacy law bans commercial surrogacy but allows altruistic surrogacy, where women can legally carry someone else’s child if no money (other than medical cost and insurance), favour or coercion are involved.

And then there’s adoption. There are thousands of children who need caring parents but don’t get them, not so much because there are not enough people who want a baby badly but because the red tape around adoption laws is a deterrent. Only 2,671 children were adopted in India between 2016 and March 14, 2017, shows government data. There are no official figures for the number of orphans in India, but non-profits put the number at about 50,000.

Changes in laws to make adoption easier are in the offing. The proposed amendment to the Juvenile Justice Act of 2015 empowers district courts to declare children legally free for adoption, moving away from the busy courts of civil magistrates, will bring the time taken per adoption down from two years to about two months.

“Adoption is a thrilling truth I’ll pursue with all my might. But I wanted that stomach. I wanted to know what nine months of complete togetherness could feel like. I was meant for the job, but I didn’t pass the interview. And that’s OK. It really is,” writes Dunham.

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    Sanchita is the health & science editor of the Hindustan Times. She has been reporting and writing on public health policy, health and nutrition for close to two decades. She is an International Reporting Project fellow from Paul H. Nitze School of Advanced International Studies at the Bloomberg School of Public Health and was part of the expert group that drafted the Press Council of India’s media guidelines on health reporting, including reporting on people living with HIV.

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