By Ebere Agozie
Are you a woman struggling and praying to have a baby? Are you sharing in the pains of an infertile relative? You are not alone.
According to the World Health Organisation (WHO), infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.
It noted that infertility affects millions of people of reproductive age worldwide and has an impact on their families and communities.
Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally.
Infertility may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.
With these information, the way and manner Africans stigmatise infertile women makes it look as if infertility only occurs in women in the continent.
Although both women and men can experience infertility, a woman in a relationship with a man without a resultant pregnancy, is often perceived to be infertile, regardless of whether she is infertile or not.
Infertility has significant negative social impacts on the lives of infertile couples and particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem.
Being able to get pregnant is a big part of the marriage institution, especially in the African cultural context; hence infertility is associated with a lot of negative psychosocial and other consequences such as infidelity.
In an interview with the News Agency of Nigeria (NAN), most respondents concurred that infertility stigmatisation has led women into doing what they would ordinarily not have done just to have a child or children of their own.
Various studies suggest that there is greater stigma for infertile women than men, and in developing countries, the infertile women experience the negative consequences of childlessness to a greater degree.
The shame associated with infertility is so bad that none of our respondents wanted their names to be mentioned.
Mrs Nkiru Ogbonna (not real name) told NAN that her mother-in-law and husband called her a witch and declared that she had no womb.
Being the only child of her mother, she was deemed to have come from a home of infertile people.
“They threw me out of the house after five years of marriage to their son.
“I thank God they did that because after two years God gave me another husband and I now have four children with him while my former husband is still without a child, even though he remarried.
“It was latter I discovered that the problem of our childlessness was my former husband’s fault but he and his family put the whole blame on me’’ because it was in their interest to do so.
Hajia Amina Musa (not real name) said, “it is God that gives children but if He decides not to give me, who am I to question him?
“My husband has other wives with children and I take them as my own, although sometimes I wished I had one of my own”.
Some others said that they would be prepared to try other means of getting their own babies instead of being subjected to ridicule.
From their responses though, it could be seen that ignorance probably played a major role in arriving at that mind-set.
When asked if they would go for “In Vitro Fertilisation or adoption”, they reluctantly chose IVF, saying that adoption stigmatisation is still the same as that of infertility.
Majority said they will prefer to do whatever they did secretly, while some said they would prefer to have another man impregnate them secretly just to cover their husbands’ shame of being infertile.
They said adoption would simply tell the world that they are infertile, and that therefore they would have preferred IVF to adoption, if it is affordable and reliable.
Little wonder, a recent publication by the Premium Times showed that six of 10 children in Nigeria brought for DNA testing were not fathered by their supposed fathers.
Infertile women have been known to cope with infertility by infidelity, leading to the prevalent situation of women having children that are fathered by men other than their husbands.
“Our findings showed that most of these women sought medical help alone without their husbands.
In most cases, when a couple does not have a child, the only option is for the man to marry another wife that will give him children.
Bassey Emem, one of our male respondents who is a health worker, frowned at how infertility is usually wrongly regarded as a female problem in the continent.
“It is all about giving every woman the respect and the help she deserves to live a fulfilling life, with or without a child.
“It is sometimes difficult to get the male partner to bring a semen sample for analysis, more so if he has more than one wife or other children; though who is to say those children are actually his?”
He said basic investigations for infertility should assess both male and female factors.
“Some couples prefer to opt for traditional assistance so as to avoid detection of a male factor and the accompanying social blame.
Some men and women even patronise quacks where their medical records will not be taken, while some treat the perceived source of their infertility without their spouses.
“These unqualified health practitioners cannot prescribe appropriate dosages, don’t consider drug interactions, therefore successes of these herbs are difficult to ascertain and may sometimes cause more harm than good’’.
Emem said a lot of women still resort to the use of traditional medicines, mainly herbs which may not be as effective as conventional treatment.
“These women resort to different forms of treatment from faith healing to traditional medicine and even to patronising quacks.
“Vast herbal resources remain unexplored and studies need to be conducted to see if they have any potential for infertility treatment, and to ensure proper regulation, safety and non-exploitation of desperate women’’.
However, cultural and religious beliefs, and societal pressure to conceive may influence a woman’s decision to seek traditional treatment.
Most of the women shared bitter experiences on what they have been through to satisfy the people around them and end their suffering.
Dr Toochi Nwoye, Consultant Obstetrician and Gynaecologist, Federal Medical Centre (FMC), says fertility care encompasses the prevention, diagnosis and treatment of infertility.
He said that infertility amongst couples is a shared responsibility; therefore, both the man and the woman involved should seek fertility care together, and early, too.
“To conceive a child, a man’s sperm must combine with a woman’s egg.
“The testicles make and store sperm, which are ejaculated by the penis to deliver sperm to the female reproductive tract during sexual intercourse’’.
Nwoye noted that many different medical conditions and other factors can contribute to fertility problems, and an individual’s case may have a single cause, several causes, or in some cases no identifiable cause.
“According to statistics, one-third of infertility cases are caused by male reproductive issues, one-third by female reproductive issues, and one-third by both male and female reproductive issues or by unknown factors.
“In male reproductive system, infertility is most commonly caused by problems in the ejection of semen, absence or low levels of sperm, abnormal shape or motility of the sperm, and bad lifestyle habit.
“In the female reproductive system on the other hand, infertility may be caused by a range of abnormalities of the ovaries, uterus, fallopian tubes, and the endocrine system, among other possible factors.
“Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved’’.
Nwoye noted that many risk factors for both male and female infertility are the same fortunately, so there are many safe and effective therapies that significantly improve the chances of getting pregnant.
He advised that if you are a woman in a heterosexual relationship with regular intercourse and menstrual cycles, you should see your doctor after 12 months of trying to conceive or six months if you are over the age of 35.
Also, surrogacy – another way childless couples could use for having children of their own – has been labelled taboo in Nigeria due to cultural and religious factors.
A survey, conducted by the News Agency of Nigeria (NAN) showed that although there is no law prohibiting such practice, people consider the act as taboo.
This is just as the two prominent religions of Islam and Christianity prohibit same.
Although in a state like Adamawa in north-eastern Nigeria, the state government has only child fostering policy, and no adoption, no surrogacy.
Dr Aisha Liman, a Gynaecologist and mother of two residing in Maiduguri, also said that a woman who adopts the option of surrogacy would not be seen as being ‘woman’ enough.
“People see being able to get pregnant as a mark of womanhood, so surrogacy will affect womanhood negatively, especially where people place a lot of emphasis on a woman’s ability to get pregnant, gestate and carry the child,” she said.
However, Dr Usman Sunusi, a Consultant Gynecologist, described surrogacy as a normal practice in the medical field as it enables childless couples to have their own children, noting, however, that ‘the practice is against cultural and religious tenets’.
Therefore, there is the need to scale up campaign against infertility stigmatisation against women and change the mind-set of the public towards the childless couple.
This awareness will encourage and enhance access to regulated, safe, effective and equitable fertility care solutions
