Opinion | Wait, Optionality Isn’t Universal? Rethinking Fertility, Access, And The Privilege Of Choice

Choice is never purely individual. It is shaped by money, healthcare infrastructure, generational belief systems, and social conditioning

We talk endlessly about choice and how the decisions we make shape the lives that we build. While we celebrate optionality as progress, choice is actually less straightforward than it appears. Options technically exist, but access to them is heavily dependent on financial, cultural, or emotional factors. So the question here is, who can actually exercise them?

This question became more real to me after hosting a fertility-focused session a couple of weeks ago. The conversation was meant to be educational and empowering, centred on helping women understand their reproductive timelines and available medical options. Renowned IVF specialist Dr Rishma Dhillon Pai spoke about fertility preservation tools such as egg freezing, embryo freezing, and IVF. She explained when these interventions make sense and how women can make informed decisions. Body positivity & mental health advocate Anshula Kapoor shared her personal experience navigating PCOS and egg freezing, emphasising that reproductive decisions should belong to women themselves, even though in Indian society they can often be dictated by family pressure or social timelines.

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What stayed with me was not just the medical knowledge or the emotional complexity of such sensitive decisions, but the conversations it sparked among the women in the room. Some women shared stories about families who would not allow their daughters to freeze their eggs because they misunderstand the procedure and view it as compromising traditional notions of “purity". But the conversation that really stuck with me was one with a well-respected gynaecologist who was also present at the session. She mentioned that insurance in India often refuses to cover prescriptions that include fertility medication, even when the treatment is unrelated to assisted reproduction. So when we talk about having choices, we’re talking about people who are privileged enough to make them real.

This paradox becomes even more apparent when we look at how marriage and motherhood timelines are shifting with each generation. According to recent Indian census and survey data, the average age of marriage for urban women has steadily increased, with many now marrying in their late twenties or early thirties. In metropolitan cities, first-time motherhood in the mid-to-late thirties is becoming increasingly common. Meanwhile, medical research consistently shows that female fertility begins to decline more noticeably after 32, with a sharper drop after 35. This is why fertility conversations are necessary.

India has one of the highest reported infertility burdens globally. According to WHO estimates, infertility affects roughly 10-15 per cent of married couples in India. The Indian Society of Assisted Reproduction estimates that the demand for IVF is rising by nearly 15–20 per cent annually, particularly in urban centres. And yet, the gap remains glaringly wide.

Most health insurance policies in India do not cover fertility preservation or assisted reproductive treatments. While some recent regulatory changes have nudged insurers to consider limited infertility coverage, comprehensive support for procedures like egg freezing, IVF cycles, or embryo preservation remains rare. A single IVF cycle in India can cost anywhere between Rs 1 lakh and Rs 5 lakh or more, and multiple cycles are often required. Egg freezing, including medication and storage, can cost upwards of Rs 1 lakh initially, with annual storage fees thereafter. For many women, these numbers alone make the “choice" theoretical.

There are women with the financial means to pursue fertility preservation who encounter resistance rooted not in cost, but in culture. Even within well-educated families, fertility treatments can be misunderstood or dismissed. Instead of viewing egg freezing as a practical strategy for future optionality, some families would prefer their daughters focus their energy on finding a partner. The underlying message is subtle but persistent: planning for reproductive autonomy is secondary to fulfilling a traditional timeline.

Both scenarios reveal the same truth. Choice is never purely individual. It is shaped by money, healthcare infrastructure, generational belief systems, and social conditioning.

In a previous column, I wrote about how sustainability depends on financial security and how choice is often framed as personal responsibility without acknowledging structural limits. The same lens applies here. India’s female labour force participation rate remains below 30 per cent. Financial independence among women is still uneven, so reproductive optionality naturally becomes limited too. The freedom to delay motherhood, preserve fertility, or pursue assisted reproduction is strongly connected to economic stability.

This isn’t about framing fertility technology as a universal solution. Not every woman wants children, and not every woman will choose medical intervention. The point is that meaningful choice requires real options with systems that support them. The fertility conversation is ultimately a mirror. It reflects how society negotiates women’s autonomy, how healthcare systems determine access, and how culture shapes perception.

If we truly value choice, we have to ask who gets to act on it freely and who is left navigating constraints disguised as decisions.

Choice is powerful, but only when it is real.

Juveca Panda Chheda is an entrepreneur, writer and unapologetic slow-living advocate who believes mindfulness should come with a sense of humour. Views expressed in the above piece are personal and solely those of the writer. They do not necessarily reflect News18’s views.

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