The Silent Epidemic

Infertility in Pakistan remains one of the least acknowledged yet most devastating public health issues, silently affecting millions of families while being shrouded in stigma, misinformation, and gendered blame. Estimates suggest that between 20 to 25 percent of couples in Pakistan face difficulties in conceiving, a figure far higher than the global average of around 10 to 15 percent.

This is not only a clinical problem but also a deeply social one, with infertility treated less as a medical condition and more as a moral failing. Women bear the brunt of this misplaced blame regardless of the actual medical cause, while men are often excluded from investigation, diagnosis, or even responsibility. The silence around male infertility is particularly striking.

A society that measures women only by their ability to bear children is a society that denies half its population the right to dignity. A healthcare system that allows quacks to flourish while failing to provide regulated fertility care is a system complicit in exploitation. A culture that silences men from acknowledging infertility is a culture that perpetuates injustice. The way forward lies in education, regulation, and compassion. The silent epidemic can only be broken if voices are raised collectively to demand that infertility be treated with the seriousness, sensitivity, and medical integrity it deserves

Studies in Pakistan and internationally show that male factors account for about 40 to 50 percent of infertility cases, yet cultural norms dictate that a man’s virility is unquestionable. As a result, women undergo invasive tests, harsh medications, and even dangerous unregulated treatments while male partners frequently avoid even a basic semen analysis. This gendered imbalance in how infertility is approached perpetuates a cycle of emotional abuse, marital breakdowns, and in extreme cases, domestic violence and abandonment.

The social pressure placed on women who cannot conceive is immense. In many communities, motherhood is seen not just as a role but as the sole measure of a woman’s worth. Infertility can lead to ostracization within families, denial of inheritance rights, second marriages, and in some cases divorce or desertion.

Stories abound of women being mocked by in-laws, excluded from family rituals, or denied basic respect within their homes. The language used around infertility itself is often dehumanizing, with terms like “banjh” or “barren” reducing women to their reproductive status. Such psychological abuse compounds the physical challenges of infertility, leaving women vulnerable to depression, anxiety, and even suicidal ideation.

In the absence of widespread access to affordable, regulated fertility care, a parallel and dangerous industry has thrived. Quacks, unqualified hakeems, and self-proclaimed fertility specialists profit from the desperation of couples who want children. They market concoctions of herbs, tonics, or injections that are either placebos at best or harmful at worst, often laced with steroids or heavy metals that damage the liver and kidneys.

In urban centres, the rise of flashy but unregulated fertility clinics offering procedures such as intrauterine insemination or IVF without proper licensing has created additional risks. Patients pay exorbitant amounts without guarantees of ethical practices, proper laboratory standards, or honest counseling about success rates. The business of infertility has become lucrative precisely because of the cultural silence around it. Couples often avoid public hospitals where confidentiality might be breached and instead turn to private operators who promise miracles. The absence of strict government regulation allows these practices to flourish unchecked, leaving vulnerable families financially drained and medically harmed.

Reproductive abuse extends beyond quackery into the way infertility is handled even in formal medical settings. Many women are subjected to repeated hormone treatments without adequate monitoring, exposing them to the risk of ovarian hyperstimulation syndrome. Others are pushed toward expensive IVF cycles without being informed of the relatively modest success rates, particularly in older women or those with underlying health conditions.

Ethical breaches such as misreporting embryo quality, mishandling of gametes, or even unauthorized use of donor sperm or eggs have been reported in various contexts, highlighting the lack of accountability. The lack of psychosocial support in fertility treatment further worsens outcomes, as patients are rarely counseled on coping strategies, marital communication, or alternative life paths when treatment fails.

Religious and cultural narratives also play a significant role in shaping how infertility is viewed and managed in Pakistan. While Islam does not stigmatize infertility and allows for medical intervention within ethical boundaries, local cultural interpretations often distort this perspective. Some families pressure women into visiting shrines, undergoing spiritual rituals, or consuming “holy water” as a solution, while simultaneously resisting medical consultation. Others manipulate religious rhetoric to justify polygamy or second marriages under the pretext of ensuring offspring. These distortions further entrench the gendered nature of infertility, reinforcing the idea that a woman’s failure to conceive is justification for her replacement.

The economic cost of infertility is significant as well. A single IVF cycle in Pakistan can cost between Rs 400,000 to Rs 600,000, an amount that is out of reach for most households where the average monthly income may not exceed Rs 50,000. With success rates often hovering around 30 to 40 percent per cycle, many couples either give up after financial exhaustion or continue borrowing money and selling assets in the hope of a child. Meanwhile, the money spent on unregulated hakeems and quacks, often over years, rarely results in any positive outcome. This financial exploitation is layered upon the psychological toll, leaving families poorer, more distressed, and in many cases still childless.

The healthcare system is ill-prepared to address this epidemic. Public hospitals often lack specialized fertility clinics or trained reproductive endocrinologists. Basic investigations like semen analysis or hormonal profiling are either unavailable or of poor quality in many public facilities. This forces couples to seek care in private centres where costs are prohibitive. Moreover, there is little public health messaging about infertility as a medical condition. Most public campaigns focus on population control rather than reproductive health as a whole. The silence on infertility reinforces the stigma, making couples feel isolated and ashamed rather than supported.

Addressing infertility in Pakistan requires systemic change at multiple levels. First, there must be widespread public education to dismantle myths. Campaigns should emphasize that infertility is a medical condition that can affect both men and women, and that male infertility is neither rare nor shameful. This shift would encourage earlier and more balanced diagnosis, preventing years of unnecessary suffering for women.

Second, regulatory frameworks must be strengthened. The government needs to enforce strict licensing for fertility clinics, monitor the qualifications of practitioners, and crack down on unregulated quack practices that exploit vulnerable families. Third, affordable fertility services must be expanded within the public health system, particularly in teaching hospitals and regional centres, so that couples do not have to rely solely on expensive private care. Fourth, psychosocial support should be integrated into fertility care. Counselling services can help couples manage stress, improve marital communication, and consider alternative life choices such as adoption when necessary.

There is also a need to confront the gendered exploitation embedded in infertility narratives. Men must be included in diagnosis and treatment protocols as a matter of standard practice. This will not only improve medical accuracy but also redistribute responsibility within marriages, reducing the unjust psychological burden placed solely on women. Legal protections for women subjected to abuse, abandonment, or forced polygamy due to infertility must be strengthened and enforced. Religious scholars and community leaders can play an important role in reshaping cultural narratives by emphasizing compassion, shared responsibility, and ethical medical intervention.

The silent epidemic of infertility and reproductive abuse in Pakistan is not only a health issue but a profound social injustice. It strips women of dignity, exploits families financially, and perpetuates cycles of misinformation and abuse. Left unaddressed, it will continue to burden the healthcare system, fuel quackery, and damage countless lives. Confronting this challenge requires courage, empathy, and policy vision. It requires treating infertility not as a shameful secret but as a legitimate medical condition deserving of care and support. It requires recognizing the humanity of women beyond their reproductive capacity and holding men equally accountable in the journey toward parenthood. And it requires dismantling the profiteering industries that thrive on the desperation of vulnerable couples.

Pakistan cannot afford to ignore this issue any longer. A society that measures women only by their ability to bear children is a society that denies half its population the right to dignity. A healthcare system that allows quacks to flourish while failing to provide regulated fertility care is a system complicit in exploitation. A culture that silences men from acknowledging infertility is a culture that perpetuates injustice. The way forward lies in education, regulation, and compassion. The silent epidemic can only be broken if voices are raised collectively to demand that infertility be treated with the seriousness, sensitivity, and medical integrity it deserves.