Breaking the silence on infertility
In many cultures, including in Tanzania, women who cannot bear a child, suffer discrimination and stigma. Our culture demands that, for a woman to be socially acceptable, she should bear children.
For example, 39-year-old Mama Boniphace’s husband was pressurised to file for a divorce by his family because she couldn’t conceive.
Married in 2010, Mama Boniphace was ridiculed and discriminated from family affairs for six years because she was deemed infertile. “My in-laws made me feel worthless and there came a time I lost hope, in everything, including my marriage. I was convinced by my in laws that I didn’t deserve to be a mother because for six years we tried but I couldn’t get pregnant,” Mama Boniphace narrate to Your Health.
Upon medical consultation, she was told her uterus was not in position and that her fallopian tubes were blocked that needed a surgical intervention. She was also put on medication. Though she was blessed with a baby boy three years ago, Mama Boniphace says that she cannot forget the pain of discrimination and mockery she went through that has changed part of her completely.
Infertility, the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse, affects at least one in four couples in developing countries.
In an article published in the World Health Organisation (WHO) website on ‘the agony of infertility’, it said;
Although male infertility has been found to be the cause of a couple’s failure to conceive in about 50 per cent of cases, the social burden “falls disproportionately on women,” according to Dr Mahmoud Fathalla, previous director of the Special Programme of Research, Development and Research Training in Human Reproduction based at WHO. “When a couple is unable to reproduce, the man may divorce or plan to divorce his wife,” he says. Such was the case of Mama Boniphace.
Breaking the barrier
But not everyone is as lucky as Mama Boniphace. 48-year-old Angela Chanila has completely lost hope.
Explaining to Your Health, Ms Chanila said she had moved around many hospitals in the city to seek medical treatment for the past 12 years, but all have gone in vain. “I was viewed incompetent and a burden to the family. So my husband decided to impregnate another woman,” she says.
“Though infertility can affect both women and men but, we are more vulnerable to stimatisation than men. Having struggled for 12 years to look for an affordable treatment, I think there is a need for the government and health stakeholders to come up with affordable infertility services that includes prevention, care, treatment or consultation for couples like us,” Ms Chanila adds.
Infertility affects up to 15 per cent of reproductive-aged couples worldwide. WHO demographic studies from 2004 have shown that in sub-Saharan Africa, more than 30 per cent of women aged 25–49 suffer from secondary infertility, the failure to conceive after an initial first pregnancy.
Tanzania is one of the countries in the African infertility belt that stretches across central Africa from Uganda in the east to Gabon in the west, WHO research determines.
For instance data revealed from Kairuki hospital in Dar es Salaam show that 800 patients who go for medical treatment daily, at least 240 are women with infertility problems and out of those, 12-17 women require infertility treatment, such as IVF.
Despite their importance, infertility prevention and care often remain a neglected public health issue in Tanzania.
According to WHO, for many infertile women, particularly those with problems such as blocked or severely scarred fallopian tubes where surgical tubal repair is either not successful or not advisable, in vitro fertilization (IVF) can help. This technology enables eggs to be fertilized directly by sperm outside the woman’s body, without the egg or sperm having to pass through a blocked tube. The fertilized embryo is then transferred back into the woman’s uterus.
Unfortunately for most women in developing countries, infertility services are not widely available and IVF is unaffordable. The cost can range anything between Sh10 million to Sh5 million. Understanding this gap and neglect, Kairuki hospital are in the process to establish a fertility centre to provide an In Vitro Fertilization (IVF) services to women, which remains a limited treatment option in the country.
Speaking during an event to commemorate Hubert Kairuki, Kairuki Hospital’s Deputy Director General and Fertility Consultant, Dr Clementina Kairuki, said that they were in the final stages to open a fertility centre that will be located Bunju. She explained that they decided to come up with such initiative after discovering that reproductive health among Tanzanian women was still the biggest challenge in the country.
“Kairuki hospital attends to at least 800 patients every day but, out of that number, 30 per cent are women and 5 -7 per cent of those require IVF,” Dr Kairuki explained.
Explaining further, Dr Kairuki said though the country does not have evidence based data on reproductive health problems, women with infertility issues is quite huge. “About 30 per cent of women who come at the hospital require medical treatment and the treatment depend on how much they are affected. Others come with blocked fallopian tubes while some come with completely damaged ones,” she said.
She stressed that infertility issues can be found in both men and women but number of women with such problems who come at the hospital are higher compared to men.
Some of the factors that cause infertility are fibroids, high blood pressure and cancer.
Through Kairuki Midwifery University, they have already have started training experts who will be specialised in IVF and some experts will come from India, South Africa and China.
Stigma should end
Modesta Kimonga, a pysychologist based at Muhimbili National Hospital (MNH) explains to Your Health on the negative attitude towards childless women. He says that when a couple gets married, they quench to get a child but it becomes difficult when the couple cannot conceive.
According to her, when a couple fails to conceive after marriage, people tend to point fingers at a women even before going to the hospital for medical checkups to find out who has infertility problem among them.
“As you know in most cases, men do not like going for any medical checkups even if they are the ones with a problem,” she said.
She stressed that infertile women feel isolated because they normally fear to be judgeed. “It does not matter whether you are educated or not, in African culture, the social burden of unable to conceive falls on women,” she said.
The issue of infertility is very serious in the country, unfortunately, victims themselves shy away to talk about their situation.
WHO demographic studies also show that in Sub-Saharan Africa, more than 30 per cent of women aged 25 - 49 years suffer from secondary infertility, the inability to achieve a subsequent pregnancy.
The study further elaborated that infertility is a major reproductive health issue for females as well as males respectively. Many couples suffer from infertility worldwide and in Sub-Saharan Africa, which has a cultural preference for high fertility; women shoulder the highest infertility consequences.
It is generally believed that more than 70 million couples suffer from infertility problem worldwide and this constitutes 15 per cent of reproductive aged couples.
Infertility or childlessness is a global reproductive health issue for female as well as male sexes yet often not discussed in public and most of the times neglected especially in an African setting.
According to a PSI Tanzania [a non-government organisation dedicated to improving the health of Tanzanians] report, shows that the reproductive health burden on women in Tanzania is high. A recent survey suggests that the average Tanzanian woman has about 6 children during her lifetime, and that over half of all women deliver at home, without any access to skilled birth care.
Around 10,000 maternal deaths are recorded each year. For every woman who dies in child birth, another five live with chronic illness or permanent disability.
Many women in Tanzania today would like to space or limit the number of children they have.
Only one in five women currently use a modern contraceptive method, even though over half of married women report that they would like to begin using one.
