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Economic barriers
• Stratification of ART services in India
• Elite practitioners serving high end Indian clientele as well as foreign tourists in large numbers (reproductive tourism)
• Costs lower than the US and Europe
• Weak or absent regulatory oversight
• Sky is the limit in terms of what one desires and can afford to pay
• Rural areas: do not even have access to basic infertility work‐up, no standardized laboratory set‐ups, weak quality control, turn‐over of IVF doctors, indiscriminate use of IVF without proper work‐up
• Publically funded tertiary hospitals in cities only provide infertility investigations but no treatment
• Cost of ART interventions often expected from woman’s family in rural areas and lower socio‐economic strata, fear of abandonment of women by their husbands for not providing a child to the family
Jiyo Parsi campaign
• Parsi community, total fertility rate 0.8
• Rapidly declining population (61000, 12% decline in every census decade) • No or very late marriages
• Marriages within close community, among cousins, congenital anomalies
• Voluntary childlessness in married couples
• Disproportionately high number of elderly within community
• Parsis often highly educated, number of big industrialists and philanthropists from this
communities, comparatively higher socio‐economic conditions at least in large cities • Zoroastrian religion and strict rules about identity
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