DREAMING OF A CHILD

For several years now, the Milli Maclis has been discussing a draft law on reproductive health. Its main points that cause quite ambiguous and often polar opinions in society are issues of artificial insemination and surrogate motherhood. Despite the fact that it has been repeatedly put up for debate, this divide of opinions on the bill prevents the common denominator from being reached and a legal framework for partly existing practices from being defined. The main opponents of the bill are officials, the basic tenets of whose rhetoric are the preservation of national values and mentality, as well as religious leaders.

Not everyone accepts adoption

In general, laws on reproductive health have been adopted by 140 countries. This is mainly Western and European countries. In Muslim countries, including Turkey and Iran, no such law has been put forward, as it is believed that it is contrary to Islamic culture. But despite all this, in these countries, particularly in Turkey, family planning centres distribute contraceptives and conduct educational activities at the expense of the state. These topics are still considered a taboo in our country because of the "mentality" as they "do not correspond to national values". At the same time, the statistics of abortions and infertility are threatening in Azerbaijan. The infertility rate in the country is 13 per cent - a threatening situation develops already at 15 per cent. According to statistics for 2014, more than 27,000 abortions were reported in Azerbaijan with a large number of them - over a thousand - being abortions among young 15-19-year-old girls. If a competent policy of education is conducted based on legislative framework, such cases could have been prevented.

E. A. (name changed) unsuccessfully tried to have a baby for a number of years. After lengthy and expensive treatment, the doctors said that the only way is in vitro fertilization. "During the treatment, I had to go through a lot of unpleasant and painful procedures," our character says. "Besides, the IVF procedure itself is too difficult and expensive. At that time, they told us about an amount of 2,000 to 6,000 manats. If we consider that the IVF is not always successful for the first time, then, I would have to spend about 10,000-15,000 manats on the chance of becoming a mother."

Our character did not take that step, preferring to adopt a child. But it is known that even the procedure of adoption is very complicated in our country. "I have no complaints about the adoption law itself," E. A. says. "Yes, the procedure is lengthy, you need to collect a lot of papers, but it's fair. For example, the state of the family, material prosperity and the health of both prospective parents are taken into account. It is clear that genetic parents can also have diseases, but if a person has a disease that carries a potential threat to his life or normal functioning, then giving such people a child for adoption, to say the least, is imprudent." Positive feedback was also received by representatives of the executive authorities who are in charge of the initial collection of documents for adoption: "All necessary activities were carried out in due time, the documents were prepared carefully and issued on time." Problems began at the next level (which turned out to be the Ministry of Health). "Here we had to deal with bureaucracy, which lasted a year. Only after that, did they register us. I had to write complaints and beat down doors. We were lucky, we were able to adopt a girl just a year after registration, but there are people who are waiting in line for 4-5 years," our character says.

The most remarkable thing in this is the mismatch of the information provided. "We appealed to the Baby's House," she said. "We were told that they had about 200 children. But according to the Health Ministry, they had only 4-5 children, and the queue is too long. This gives rise to many questions about transparency."

It is clear that not every family that is not able to have children of their own can make such a choice. If the instinct of motherhood is natural for a woman, for a man raising someone else's child can be a serious challenge. The same applies to the need to use a third-party donor in the issue of artificial insemination. This, in fact, is one of the arguments put forward by opponents of the law.

However, the deputy chairman of the Social Policy Committee of the Azerbaijani Parliament, Musa Quliyev, said in an interview with R+ that the vast majority (99 per cent) of people in need of artificial insemination do not need a donor, while the remaining 1 per cent will not have a significant influence on society.

Surrogacy

By the way, there used to be a sperm bank in Azerbaijan. Its existence had no legal framework, but its activities were not considered illegal. And even so, in all the years of its existence, a very small number of people used it, perhaps, not being able to overcome prejudice. Apparently, surrogate motherhood will not become a threat to society as the opponents of the bill predict. According to our respondent, she herself would never choose surrogacy as a way to have a baby: "I understand that it is our own cells. But motherhood is not only about cells. This woman will bear the baby for nine months, and where is the guarantee that maternal feelings will not wake in her and she will not refuse to hand over the child?" According to our character, in any case, it is the choice of families and mothers, but she would not be able to raise a child, knowing that there is a woman who is in fact the biological mother and can find out where her child is. For the same reason, many people do not consider it possible, as recommended by some officials, adopting a child from relatives: "It is not enough that I will constantly be aware that this is a child of my relative, I will also be in constant or periodic contact with him. Discomfort is unavoidable in this case."

In any case, the ethic side of surrogacy is still subject to discussion and even court hearings in some countries. Therefore, if there is such a fact and if you hand over your child to relatives for raising, there must be state regulation to protect all parties. According to Musa Quliyev, for the most part the problem of surrogacy is not medical, but legal. You may experience issues with the status of a surrogate mother and with the possibility of problems in her health as a result of childbearing, etc.

The head of the Tamiz Dunya Public Union to Assist Women, Mehriban Zeynalova, also opposes surrogate motherhood: "This can lead to very unpleasant facts and even a crime. Abuse may begin, which will lead to a new stage in human trafficking."

Causes of ambiguity

Of course, the law on reproductive health cannot ignore the question of the affordability of artificial insemination for all segments of the population. The provision of reproductive support to low-income families at the expense of the state was also discussed.

Musa Quliyev: "This is a very serious problem, but I think that it will be resolved. Specifically, the introduction of health insurance can help this. "In general, according to the deputy, the main cause of the delay in the introduction of the bill is the fact that many officials do not quite understand its essence and form a distorted view: "Artificial insemination is the result of the introduction of the most modern medical technology. But some believe that the birth of a child in this way is contrary to Islam. About this I can say that the strictly Muslim Iran has long introduced and successfully carried out such medical procedures. Ordinary people do a lot of what is forbidden by religion - they smoke, drink alcohol, etc. If we are loyal to such negative issues, why should we blindly rely on the spiritual aspect of reproductive health and family planning despite the fact that IVF can give many families hope to have long-awaited children?"

According to the MP, in any case, the law is designed for people who want children but cannot produce them. This law is not mandatory, no one is forcing anyone to use it. Its main goal is to reduce infertility and thus prevent the disintegration of families.

As for the position of religious leaders, it is often clearly negative on all counts in this issue. The theologian and Doctor of Philosophy Haci Aqil Sirin comments on the situation as follows: "In Islam you can only have a child within the family. That is to say a man cannot have a child with a woman who is not his wife. Therefore, all religious leaders have a clear attitude to surrogate motherhood, as well as surrogate fatherhood, i.e. in cases where a male donor is used. With regard to artificial insemination, I can say that it is allowed only if both spouses' cells are used. In this case, if conception is not possible in the usual manner, it is performed in medical, laboratory conditions. There is nothing unnatural and contrary to religion here." The theologian says that we live in a secular state where religion is separated from the state, so strict Islamic regulations are not a mandatory condition for a ban, but Islam's position on this matter is clear.

Medical aspect

Gynecologist Narmina Asgarova clarifies the situation: "Let's define what infertility is. It is the inability of a couple who regularly have sex throughout the year to have a child without protection. There is primary infertility when a woman who has a sexual life has never been pregnant (including ectopic, frozen pregnancy, abortions, etc.) and secondary - when she has already been pregnant (repeated births, abortions, etc. but the woman cannot get pregnant).

According to statistics, about 5 per cent of couples in the world are sterile. This figure is arbitrary and ranges from 2 to 6 per cent depending on the country and the region. For example, in Africa and South America, these figures are extremely low. The doctor recognizes that in her practice she often faces a diagnosis of infertility. "All over the world, the causes of infertility are now about equally divided: 50 per cent - men, 50 per cent - women. In view of my own practice, I can say that in our country this division is from 30 per cent to 70 per cent or from 40 per cent to 60 per cent with the number of women increasing." The causes of female infertility have a whole spectrum.

"In my practice, I have repeatedly recommended that patients do IVF," Narmina says. "Although the effectiveness of the first procedure is about 30-40 per cent, most of the procedures have been successful." The contraindications of IVF, according to the doctor, are the same as in natural pregnancy - severe chronic diseases and acute diseases that prevent normal pregnancy.

With regard to a possible ban on IVF, Narmina says: "I cannot understand who might be looking to ban in vitro fertilization. Thousands of families cannot have children, and in vitro fertilization gives them a chance to have one."

Another gynecologist said: "Most of my patients suffer from inflammatory diseases of the genitourinary system. Infertility is more common in women after 30. There are many cases of male infertility. With regard to IVF, we are visited mostly by women of late reproductive age, whose hormonal system does not allow them to conceive normally. Most are women over 38." The doctor believes that this is due to the fact that women marry later. Since late childbirth is associated with health risks, the doctor believes that the ban on IVF will not lead to a critical situation in society: "On the one hand, it may not be a bad thing, since nature protects us from the birth of sick children with a poor gene pool. Mainly, couples with a hereditary disease on both the paternal and maternal sides cannot have children." However, the doctor said that if IVF is not done here, those who can afford it will go abroad.

With regard to the situation surrounding surrogacy, the gynecologist speaks in its favour: "It would be nice if such we had such an opportunity. Since there are women who cannot physically bear and give birth to a healthy baby for health reasons. Such women get divorced, find a surrogate mother or buy a donor ovum in Iran, but very few can afford it. Many simply lose their family."

As reported by one of the Baku hospitals, at least 90-100 people undergo the procedure of artificial insemination every month. The cost of the procedure varies from 1,700 to 2,500 manats. Another 1,300 manats are required for additional tests and procedures.

Even despite the fact that the first procedure may be unsuccessful and the following ones require additional financial investments, there are still many who want it. To perform this procedure there is a need for highly qualified professionals. We should note that last year at the training medical clinic of Azerbaijan State Medical University it was planned to create a department that would conduct artificial insemination operations.

At the present stage, work on a new draft law "On reproductive health" has been completed in Azerbaijan. Opinions on this bill have already been received from three government agencies and the Department of Muslims of the Caucasus - work on the new draft law is almost complete and articles that cause discontent have already been agreed. In the near future, the bill will be put up for debate by the Health Committee and then by the plenary session of the parliament.