Isha is sprawled out on a cot, three mobile phones lined up in front of her. “Yeh mummy ka, yeh papa ka, aur yeh bada waala, yeh mera hai (This is my mother’s, this is father’s, and this, the big one, is mine),” she chuckles. From the other end of the room, her brother Bhupender makes a dash for the bed and says forcefully: “Yeh mera bhi hai (The phone is mine too).” And with that, the nine-year-old twins get into an argument, each vehemently staking claim on the Intel handset.
Sitting on a chair nearby, their mother Bhateri Devi, 75, laughs indulgently. Dressed in a powder green salwar-kameez, with a dupatta that barely conceals her henna-streaked grey hair, and with large loops straining her ear lobes, she says, in Haryanvi, “As long as they play and fight in the house, I am fine… I don’t let them venture out too much. I was blessed with them after a long struggle.”
On May 29, 2010, the then 66-year-old from Satrod village in Haryana’s Hisar district had given birth to triplets, two sons and a daughter, after nearly 50 years of marriage, and three cycles of in-vitro fertilisation. The delivery, hailed as a “miracle” in medical circles, aroused curiosity and derision in equal measure, with the media descending in hordes to catch a glimpse of the wonder woman and her babies. But unknown to Bhateri and her triplets, a debate swirled around the question of medical ethics and the lack of regulation surrounding Assisted Reproductive Techniques (ART) such as In-Vitro fertilisation (IVF).
This debate was revived on September 5 this year, when, nearly 2,000 km from Hisar, 74-year-old Erramatti Mangayamma broke Devi’s record for being oldest to deliver, giving birth to twins through an IVF procedure in Andhra Pradesh’s Guntur, 57 years after her marriage. In a notice issued last week, the Indian Council of Medical Research (ICMR), the apex body that frames policies on biomedical practice, had asked the clinic, where Mangayamma gave birth, to explain why it had performed IVF for a senior citizen, thereby risking her life, and why its registration should not be cancelled for this “unethical practice”. On September 27, the agency issued a closure notice to the clinic.
While the Indian Society of Assistive Reproduction (ISAR) pegs the number of successful IVF cases among women aged 50 and above at around 50 in a little over a decade, cases of women above 60 opting for IVF are even rarer. ISAR is a body of in-vitro fertilisation (IVF) experts whose members stay updated on latest advances in the industry and who advocate the need for better practices.
The National ART Registry of India maintained by ISAR estimates that over lakh ART procedures, including IVF, are conducted every year in India.
While IVF expert Dr S Umashankar of Ahalya Nursing Home, where Mangayamma of Guntur delivered her twins, says he conducted “all necessary tests” on the 74-year-old and she was “found medically fit” for the procedure, other experts say there is a reason why pregnancy, even through IVF, is avoided after menopause. “Pregnancy changes the woman’s metabolism, pushing her body to the limits. Medically speaking, it is like getting the elderly to climb Mount Everest,” says Dr V Padmaja, Chairperson of the Andhra Pradesh chapter of ISAR.
When the ICMR released guidelines for ART in 2005, it mentioned no upper age-limit for women because until then, the issue of the elderly opting for the procedure hadn’t surfaced. It was sometime in 2010, around the time that Devi delivered her triplets in Hisar, that the debate over an upper age-limit picked pace.
In 2011, the ICMR formulated guidelines allowing IVF only for women aged 45 and below, a cap that the Assisted Reproductive Technologies (Regulation) Bill, which was drafted in 2010, stuck to. But with the Bill now in cold storage, there is little clarity. “There is no law yet, so no legal action is possible in cases where ART clinics don’t follow our guidelines. We expect them to self-regulate,” says ICMR scientist R S Sharma.
In the absence of a law, even if ICMR, for instance, cancels a clinic’s registration number, it is free to practise. Besides, couples rarely look up the ICMR registration status before approaching a clinic or expert.
Agra-based IVF expert Dr Narendra Malhotra says while medical complications are one reason to avoid IVF for elderly couples, there’s another ethical dilemma: “Will these parents be around till the time their children turn adults? Shouldn’t we worry about that?” In India, the average life expectancy for women is 70 years while that for men is 69. Erramatti is 74, her husband E Raja Rao is 80.
Despite these obvious misgivings around ART, what drives childless couples, especially women, to IVF clinics is another societal reality that they have to contend with — the stigma associated with infertility, and the prying questions and taunts that come with it.
Explaining how a woman’s worth is often measured by the number of children she has or how soon after her marriage she bears them, Naresh Selpad, who runs Rah Group Foundation, an NGO that works with women and the elderly in Haryana, says, “In these parts, because of societal norms, childless couples don’t want to adopt children. In cities, no one asks these questions, but in villages the pressure exists.”
The pressure, he says, usually begins with innocuous comments and probing questions of “good news”, before sliding into ostracism and even assault.
Slowly walking around her two-storey house, her shoulders only slightly bent, Devi says she hasn’t heard of Mangayamma or Guntur, but is not surprised that a woman would go to such great lengths for a child. “Only a childless couple will know what it is to go through life without children. The taunts, seeing other families with children… it’s very tough. My husband was desperate for children and I wanted to have them for his sake,” she says.
For several years, she consulted a doctor in the village. “One day, when I was completely dejected, he told me about a clinic in Hisar that could help. I didn’t waste any time, and told my husband Dewa Singh about it. Within eight months I conceived,” she says, a smile stretching across her creased face. Devi says Singh had taken a loan of Rs 7 lakh for her IVF treatment. “We had everything… land, home, but no children. The children made us complete,” says Devi.
She dismisses any concerns over her health — “I was healthy then and I am healthy now… My knees give me a little trouble, but it’s nothing serious.” Then, pointing to a photograph of her husband and herself in the house, she says, “Dekho kitna mota tagda tha (See how strong he was). He was four years younger than me. When I gave birth, people said I was old, unfit… But Dewa Singh died of blood cancer in March this year, before me. Now people have nothing to say,” she says.
In the living room of their new home, into which they moved after Singh’s death, the twins are still quarrelling over the “big phone”. Isha, her hair cut in a short bob, is in her school shirt and Bhupender has just finished his lunch of parathas.
After another failed attempt to break up their fight, Devi says, “Their father gave Isha the phone two years ago on her birthday. Bhupender got a cycle. But she shares the phone with him.” Isha shoots back, “But he doesn’t share his cycle with me….” Ignoring her daughter’s quibble, Devi continues, “Every year Dewa Singh used to throw them a big birthday party. He would call all our relatives, there would be a lot of food….” The twins light up at the mention of their birthday, and rush to the bedroom.
They return with a pile of albums, one for each of their eight birthdays. “They turned 9 in May this year, but we did not celebrate it because of their father’s death. I will do it next year,” says Devi, as her children pore over the photographs. “That is me,” says Isha, pointing to a photograph of herself on her seventh birthday. “She is dressed like a boy,” Bhupender teases her. “I wanted clothes just like him, so papa got me shirt and trousers,” she responds. The photograph has Singh and Devi standing behind their children, as they prepare to cut the cake.
Since Singh’s death, Devi has got her younger sister, Nanhi Devi, in her 60s, to move in with her to help with the children. “I have also been doing a lot of paperwork… I never thought I would have to do all this. I have just come back from the patwari (land officer). After Dewa Singh’s death, I have to now get all the land — 20 acres of it — transferred in my name. For now, I have given the land on rent,” she says.
In the bedroom, Isha, who is still flipping through the albums, lets out a squeal as she pulls out an old newspaper from the album stack. On the front page of Pehli Khabar, a local paper, is a photograph of a frail Devi with the triplets in the hospital, taken a few days after the Caesarean delivery.
“That’s me in the centre, Bhupender on the left, and that is our brother Bhupesh — woh mar gaya (he died),” says Isha, now turning to her mother. “He was born with low birth weight. He died 21 days after birth. I took a lot of care, but we couldn’t save him,” says Devi.
The photograph takes Devi back to the emotional upheaval that marked her early days of motherhood. The triplets were born a month and a half before they were due, with Isha and Bhupender weighing over 1 kg, and Bhupesh a mere 780 gm.
“Like any new mother, I was very weak after the delivery, but I wanted to protect my children with all my might. I would stay up all night. I had to feed them every two hours. After Bhupesh passed away, I got even more careful. I would wipe my two children with cotton every few hours, and use separate cotton balls for each part of their tiny bodies. Even if I touched a wall or a table by mistake, I would wash my hands. I didn’t want them to get any infection. We also got a pandit to suggest names for our children. We didn’t want anything to go wrong for them,” she says, as her children hang on to her shoulders, listening intently.
“I also breast-fed them for years… at least till three years, and would constantly boil water for them to drink,” she recalls. “Dewa Singh was also very helpful,” she says with a glint in her eye. “Uske jaane ke baad sab andhera ho gaya hai (Life has become dark after he passed away).”
There were other challenges too — the taunts that Devi had to put up with earlier had now given way to sniggers and snide comments about her age. “After the birth of my children, I didn’t leave our home for many days, so I didn’t hear much, but I know a lot was said. No one says these things on your face, but many people mocked us,” recounts Devi. “But none of it mattered to me. I was busy with my children. And now, almost nine years and five months later, many other old couples in nearby villages have had children like me, but no one admits to it. In fact, my brother-in-law, who lost his 20-year-old son in an accident, also had a child recently. Though his wife says it’s a natural birth, I don’t believe her,” she laughs.
Isha and Bhupender were in Class 2 when Devi first went for a parent-teacher meeting to their school. Cracking up as she recalls the day, Isha says, “Teacher ko laga meri dadi aayi hain (The teacher thought my grandmother had come). My friends said the same. But then I told them she is my mother.” The twins are in Class 4 now, in different sections.
“They may call me their grandmother, but I did everything that a mother would do. When they started school, I would wake up at 5 am, pack their lunch, get them ready, drop them to the bus stop, pick them up… everything. When they were younger, I would play with them too. Now they play on their own, they are very close… Par bahut shararati hain (They are very naughty),” she says.
Devi says she now wants her children to focus on their education. “I want them to learn to speak good English. I never went to school and Dewa Singh only studied till Class 9…They have been studying in an English-medium school since Class 1, but I don’t think they teach the subject very well, because I never hear them speaking English. Bol ke dikhao (Speak up),” she tells Bhupender, who buries his head in his sister’s back.
In the waiting area of the National Fertility and Test Tube Baby Centre in Hisar, several couples wait anxiously for their turn to meet Dr Anurag Bishnoi, an embryologist. Nine years ago, Devi and Singh had anxiously waited for their turn on one of these benches. The walls of the centre are lined with framed newspaper clippings of women in their 50s, 60s and even 70s, holding their newborns.
The hospital first made headlines in 2008, when one of its oldest patients, 70-year-old Rajo Devi Lohan, from Alewa in Jind district, give birth to a baby girl. Since then, with every “success story” at the centre — among them Devi’s and Dajinder Kaur’s, a 70-year-old resident of Amritsar, who gave birth to a boy in 2016 — the hospital has been seeing more couples registering themselves for consultations. The centre’s website boasts of at least 30 women, most above 45, who have conceived children through IVF in the last decade.
Dismissing allegations of clinics such as his running as baby factories, Dr Bishnoi asserts that “reproduction is a woman’s fundamental right”, and points out that there are no laws that prevent her from having children after menopause.
“In Devi’s case, she was absolutely healthy. The third child died because of low birth weight. There were no complications in her pregnancy. We get a lot of old couples who want to have children. We run a series on tests on them, including a physical test, cardiac test, orthopaedic test, uterus test, and only then decide if they are fit to have children. If they are not, we don’t go ahead,” he says, sitting in his room, where he has just finished advising a patient who had come to him after 11 failed IVF cycles.
Bishnoi even has a “gender equity” argument for why there should be no upper age-limit on women opting for IVF. “Men leave their wives and marry younger women to have children. IVF technology has helped many women give birth and keep their families together,” he says, adding that he gets hundreds of cases in his clinic every month.
Back in Satrod, Devi says she hasn’t planned too far ahead, except that she wouldn’t want her children to go “far away”. “If my daughter gets a job or gets married, she will have to leave home… I want her to stay with me. Rahegi na (You will stay with me, won’t you)?,” she asks Isha.
“I don’t even let them leave the house these days. There have been a lot of child-lifting rumours doing the rounds. Their school bus stops right outside the house, and they come straight home,” she says.
But Bhupender has plans. “I want to join the police,” he says. “Okay, maybe he can get a job,” Devi smiles. And, does she worry about not being around for her children as they grow older? “Haryana ki auratein balwan hai (Women of Haryana are strong). I will be there to see everything,” she says.
Erramatti Mangayamma, 74, from Andhra Pradesh, delivered twins on September 5
(Written by Tabassum Barnagarwala)
Along with her 80-year-old husband E Raja Rao, she visited Ahalya Nursing home in Guntur in 2018 after having failed to conceive a child in 57 years of married life. Ahalya Nursing home’s IVF expert
Dr S Umashankar says Erramatti felt “barren and stigmatised” by not having an heir. “When I conducted all necessary tests she was found medically fit,” he says. He fertilised her husband Rao’s sperms with a donor’s eggs and placed them in her uterus. As a practice, doctors place more than five fertilised eggs to increase conception chances. Subsequent sonography showed the 74-year-old was carrying twins in her womb. On September 5, she delivered the baby girls through Caesarean procedure.
Both the underweight babies and the mother required hospitalisation. Since Erramatti could not produce milk, the twins were administered formula milk. “We discharged the babies last Sunday (September 22). They weighed 1.8 kg. They are both stable, the parents have returned to their village to look after them,” Umashankar said.
Rajo Devi Lohan, 70, from Jind, gave birth to a daughter in 2008
(Written by Sukhbir Siwach)
Now 80, Rajo says she and her husband were blessed with a child nearly 60 years after marriage. “We had approached the clinic (National Fertility and Test Tube Baby Centre in Hisar) after reading a report in a newspaper.
Naveen is now 11, and Rajo says she is healthy and is doing well in school. “I stood first in Class 4. I scored 500 out of 500,” says Naveen over the phone. Talking about Rajo’s health, Dr Anurag Bishnoi says, “Rajo was operated for a tumour about a year and a half after Naveen’s birth, but it had nothing to do with the IVF treatment.” Rajo adds that since the birth of their child her husband Bala Ram Lohan, who is about seven years older, “has given up drinking, and his health has improved”.
Dajinder Kaur, 72, from Amritsar in Punjab, gave birth to a boy in 2016
(Written by Kamaldeep Singh Brar)
Their son Arman is three-and-a-half years old now and has started school. Father Mahinder Singh, who was 79 at the time of his son’s birth in 2016, says that are living a happy life. “We have not hired any help to take care of the child. We are doing it all ourselves,” he says. Adds Dajinder, “We are fit to look after him. We will see what to do in the future once we are not able to take care of him… But for now we are a happy family,” says Dajinder.
Dr Anurag Bishnoi of the National Fertility and Test Tube Baby Centre in Hisar recalls that the only problem that Dajinder had reported when she came to his clinic was of joint pain. “But that is normal at her age. She was healthy,” he says.