Updated: Jan 21, 2020
On a continent with the highest rates of fertility and one that has been described as overpopulated, many might ask – is infertility really a pressing issue in Africa, given the problems it faces? Well, let me tell you a story about a woman in a rural village in Uganda called Nambi. Nambi comes from a humble household and now that she has become of age; her parents are enthusiastic about her going off into marriage. This is because her family will receive bride price, earn admiration from the community as well as receive continued support in the future from her husband. Nambi, apprehensive about this new chapter, starts a new life with her husband.
Two months into the marriage, everyone in her community is searching for signs of a pregnancy including her husband, parents and in-laws. In her community, there is a lot of pride attached to becoming a parent. Parenthood is symbolic of the transition into adulthood and the only means of consummating a marriage.
Additionally, like many other agricultural societies in developing countries, having many children is often a source of labor and economic security. In old age, parents derive their livelihood and wellbeing from their children given the lack of social security supports.
Unfortunately for Nambi, one year later, there is still no sign of a pregnancy. Her community has started gossiping about her and worse still, her fellow neighbors all have two or more children to which they boast of their vitality. The women in the community have begun looking down on her, calling her demeaning names and no longer invite her to community gatherings. Her husband, like many others assumes that she is the problem and is becoming frustrated. He paid a high bride price for her and his family is pressuring him for grandchildren. Consequently, he has begun beating her, insulting her in public and having extra marital affairs. Finally, her in-laws step in demanding that if she cannot have a child, she is of no use to them and should leave the home so that they find a “fruitful” woman.
With no source of income, indigent parents that she does not want to burden; Nambi is left in a vulnerable position. To add to this, she has contracted HIV due to the infidelity of her husband. All these tragic events have led her with no choice but to enter into prostitution as a means of making a living for herself; after all who will marry a woman who cannot bear children? Unfortunately, she is now pregnant by a client and turns out it was her husband who has the issue and his second wife has now left him, also having contracted HIV.
This is how societies in Africa and many parts of the world victimize those facing infertility. Believe it or not, Africa has the highest rates of infertility, affecting 1 in every 4 couples. In this pronatalist society, the plight of infertility is predominantly burdened upon women. A lack of knowledge and resources for infertility causes societies to continue to assume those challenged are cursed or paying for their sins. Men who are infertile are often in denial and even when they are not, do not have the audience to ask for help without feeling emasculated. Infertility is an important public health issue in Africa because it presents significant lifelong ramifications on those affected by it.
Now you ask, what can be done in a context where resources are minimal and there are more pressing issues to be concerned with. I am glad you asked! First and foremost, prevention against the causes of infertility in Africa are achievable. Actions towards providing safer abortion services, improving obstetric and postpartum care and treating sexually transmitted infections in a timely manner can make a world of difference. Next, improving community knowledge on infertility and the fact that men and women can be infertile is important in reducing stigma and encouraging appropriate health seeking behavior. Furthermore, the medical community has developed simplified protocols offered through low-cost fertility treatment for developing countries. Low cost IVF treatment costs roughly $300, which is a far cry from the average cost of infertility treatment (roughly $3,000) charged by most private clinics found in developing countries. The strong desire to have children in Africa, often leads individuals (predominantly women) to sell all their assets in order to receive treatment, leading to catastrophic expenditure. Therefore, low cost IVF provides a viable practical solution to infertility treatment in a low-income context.
Finally, for anyone who argues that providing these services to a continent that is already overpopulated is a senseless use of resources; I pose this question to you. If your neighbor has 3 cars that are significantly impacting air pollution and the health of your community, should you not then be permitted to have one car to conveniently travel to work to make a living? I would imagine, you would feel as though your freedoms have been violated on the basis of another’s. Or maybe not.
Margaret Mutumba MPH, PhD(c)
Founder | Infertility Advocate