Infertility (Childlessness) In women and the impact of infertility in Africa

Tuesday, January 09, 2018

A BRIGHTER FUTURE FOR GAMBIA’S CHILDLESS WOMEN

The problem of infertility (unwanted childlessness) has long been a neglected health issue for many organizations working in Africa. Yet consequences of infertility in Africa can be very dramatic. In addition, in many Africa societies, the topic of infertility is often taboo and surrounded by myths. Several organizations are now addressing this problem and are trying to raise awareness and educate the public on causes of infertility and treatment possibilities.

Women’s Reproductive Health Rights & Care

To the casual observer of the international women’s health rights debate, it would appear that the greatest concern for women in Africa is the right NOT to have children.

The key areas for sexual and reproductive health investment in sub Saharan Africa have been the right to legal and safe abortion and the right to birth control ensuring that women can practice and enjoy sexual relationships without the risk of unwanted and unplanned pregnancies.

Yet the World Health Organization (WHO) demographic studies have shown that in sub-Saharan Africa, more than 30% of women aged 25–49 suffer from secondary infertility, the failure to conceive after an initial first pregnancy.

Infertility is deemed a low-priority issue in the context of scarce health care resources and infertility may be justified as a natural solution to reducing the birth rate and achieving accelerated economic growth from a declining and smaller dependent populations.

The Impact of Infertility in Africa

In addition to the personal grief and suffering it causes, infertility can create broader problems, particularly for the woman, in terms of stigma, economic hardship and social isolation. It is often considered a personal tragedy as well as a curse for the couple, impacting on the entire family and even the local community.

 Women who remain childless may be seen as a burden on the socio economic well-being of communities. Childless women are often blamed and suffer from stigma, discrimination and even violence. The man may divorce her or, if their culture permits polygamy, ‘take another wife’. She may be seen as an evil eye, a shameful subject, and banned from any family and community activities. Facing social isolation and ostracism, childless women often consider that without children, their lives are without purpose and without hope.

 Unlike the Western world, where infertility is openly discussed and help and information is widely available, in most African societies the topic is taboo, and help is scarce, contributing even more to the agony and isolation these women suffer.

 This situation is further saddened by the lack of support women face, both emotional and financial. Women are not encouraged to seek medical treatment and modern fertility care, if at all available is very basic. Assisted reproductive techniques such as IUI and IVF are either very costly or unavailable. Combined with the widespread lack of insurance coverage, seeking fertility care often means a lonely path for women wishing to conceive.

Infertility, the Myths

 In the Gambia, infertility is often thought to be caused by a curse or interference of spirits. Infertility is not considered a medical problem but causes, and therefore also remedies, are sought in the spiritual world. These may include prayer, spiritual healing, and herbal remedies. Gambian women struggling with infertility issues often spent thousands of dalasies on ‘marabouts’ and ‘black medicine’ before they seek medical help.

 Even though male infertility has been found to be the cause, or contributing factor of a couple’s failure to conceive in up to 50% of the cases, infertility is almost always assumed to be a women’s problem. The blame, and social burden falls disproportionately on women. African men sometimes seem to think they can impregnate women at any given time and that few nights together should be sufficient. Men living in the Diaspora often marry a wife who stays behind in Africa. If  pregnancy does not occur within one or two years, it is the wife that gets the blame, even if during that time the couple may have actually spent only two or three weeks together. Sexual and reproductive education should emphasize on correcting these ideas.

 Conventional help for infertility is very basic and may involve the surgical repair of blocked fallopian tubes and blind hormonal stimulation with Clomid. Hormonal stimulation without monitoring follicle development has a risk of multiple pregnancies that in turn are associated with a higher risks of pregnancy complications such as diabetes, premature labor and low birth weight. Highly controversial is the procedure of D&C (dilation and curettage). D&C as an infertility treatment has long been eliminated from the reproductive medicine textbooks, and government hospitals and most private clinics no longer offer this procedure as infertility treatment. Still, many Gambian women feel that the process of ‘cleaning out the womb’ or ‘stomach washing’ will remove any blockage that might prevent a pregnancy or affect its viability and some are willing to offer large sums for the procedure. Sadly as of to date some doctors still perform D&C for these reasons.

Infertility, the Reality

 Sexual and reproductive education should emphasize on correcting these ideas.

 Conventional help for infertility is very basic and may involve the surgical repair of blocked fallopian tubes and blind hormonal stimulation with Clomid. Hormonal stimulation without monitoring follicle development has a risk of multiple pregnancies that in turn are associated with a higher risks of pregnancy complications such as diabetes, premature labor and low birth weight. Highly controversial is the procedure of D&C (dilation and curettage). D&C as an infertility treatment has long been eliminated from the reproductive medicine textbooks, and government hospitals and most private clinics no longer offer this procedure as infertility treatment. Still, many Gambian women feel that the process of ‘cleaning out the womb’ or ‘stomach washing’ will remove any blockage that might prevent a pregnancy or affect its viability and some are willing to offer large sums for the procedure. Sadly as of to date some doctors still perform D&C for these reasons.

Infertility, the Reality

 We speak of infertility when a couple has not been able to conceive after at least one year of trying; having regular unprotected sex. A woman is fertile only around the time of her ovulation, usually a few days once a month around midway through her menstrual cycle. On average, only 20% of the couples trying to conceive will do so within one month. Approximately 70% will conceive within six months and about 85% will conceive within a year of trying.

 Infertility can be caused by various factors; Male, female, or a combination of the two. In approximately 30% of cases no reason will be found. The main cause of infertility in Africa is genital infection. This may have been sexually transmitted or caused by traditional practices such as FMG, illegal abortions and home deliveries in unhygienic circumstances. If left untreated these infections often result in scar tissue and blockage or dysfunction of the fallopian tubes causing infertility. Teaching young people on how to avoid getting STD’s and encourage them to seek adequate diagnosis and treatment if they suspect any (risk of) an STD therefore is crucial to avoid infertility later in life.

 Reproductive health issues are not discussed with adolescents and many misconceptions on the subject of infertility remain alive today. Especially girls and young women should be educated on this since they are the group most at risk from the main causes of infertility such as STDs and other infections, but also young men should be taught on how to avoid STDs and fertility in general.

 Health care workers in Gambia are often already overstretched and infertility is not a priority. Medical staff may not be familiar with the subject which may result in infertile women being wrongly or over prescribed with drugs or treated with unnecessary or harmful procedures such as D & C.

Infertility Organizations In Africa

With the exception of the WHO, few NGOs are prioritizing or funding infertility efforts or initiatives that will address the problem of infertility in Africa.

MERCK MORE THAN A MOTHER

The Gambia’s First Lady, Her Excellency Fatoumatta Barrow, has recently been appointed by The Merck Foundation as an Ambassador for the “Merck More Than A Mother” initiative.

The “Merck More Than A Mother” initiative specifically aims to empower infertile women in Africa by delivering infertility awareness, prevention and treatment initiatives that will address the medical, financial, social and emotional problems of African women tortured by the silent agony of childlessness.

http://www.merck-africa.com/ en/media/related_articles/ merck_more_than_a_mother.html

Organizations addressing Women’s Health Issues and or Infertility.

1. FATOUMATTA BAH-BARROW FOUNDATION

Fatoumatta Bah-Barrow Foundation is a non-profit charity organization that supports disadvantaged communities, women, children and vulnerable groups in The Gambia. The foundation is established for charitable purposes aimed to benefit areas in health, orphans,

children, widows, youth and women through educational projects and social development programs.

http://www.fabbfoundation.gm/

DIMBAYAA FERTILITY FOR AFRICA PROJECT

In the future they hope to further develop and expand their range of fertility treatments to Low Cost IVF (in vitro fertilization).

In order to break the taboo and demystify the causes of infertility Dimbayaa also aims to develop educational outreach programs, working with local women’s groups such as The Kanyaleng. Ideally combined with low threshold mobile clinics providing for early and appropriate diagnosis and treatment of STD’s that often lead to infertility.

http:// dimbayaafertilityafrica.com

SAFE HAVEN FOUNDATION

Safe Haven has a vision to ensure the Gambian community has increase awareness on misconceptions surrounding issues of infertility and create a platform for women to share experiences with a view to getting the required guidance and counselling from experts in the

area.

http://safehavenfdn.com/

Author: Dr Cynthia Witsenburg

Fertility physician

info@ dimbayaafertilityafrica.com  

Author: Dr Azadeh
Source: Picture: Dr Azadeh