In the peculiar hierarchy of African households the only rung lower than a motherless child is a childless mother – Taiye Selasi, The Sex Lives Of African Girls

Image: Conception Connections

I remember reading STAY WITH ME. I remember being half way through. I remember ending it. I was so furious! I will never understand why the burden of infertility lies on the woman. The fact that most people think a man can never be the cause of infertility in a marriage.

Two African books, The Secret Lives Of Baba Segi’s Wives by Lola Shoneyin and Stay With Me by Ayobami Adebayo both capture the theme of Infertility. In Stay With Me, Yejide made a goat suck her breasts and in the Secret Lives Of Baba Segi’s Wives, the wives went the extra mile to have children. Sexual dissatisfaction is a silent epidemic amongst many African Families and this has led to serial cases of infertility.

Earlier this year, I stumbled across an NGO that focuses on infertility management and fertility care – MERCK MORE THAN A MOTHER. I spent an entire weekend watching their videos, these are summaries of two stories.

Victoria John Kuba, a local house keeper, faced torture, threats and disgrace from her husband and in-laws because of her childlessness. Her husband had once told her that she had removed her womb and fed it to pigs. He had gone further to say that her family had known that she could not conceive, yet they had given her out in marriage.

Her father-in-law would leave the village to visit the town, just to know if she was pregnant. Without knocking or asking for permission, he would go into their room at night when she and her husband were inside, and he would begin to abuse her verbally. One night, Victoria’s husband pressed his hand against her face as he tried to choke her to death. She struggled for her life. Her breathing became laboured. She tried to free herself from his firm grip and that was when he bit the back of her head, she screamed and bit him before he finally let go. Once she was free, she ran out naked, picked a neighbor’s wrapper off the clothesline, tied it around her waist and ran for her life.

Khadijat Yaya, had had two miscarriages and one still birth. Her fellow women no longer whispered their insults. Intending that she should hear them, they called her names and warned their children to stay away from her. They were neither to talk to her nor eat her food. People would ask her husband why he put a barren woman in the house. She ate but still looked malnourished because she was lost in her pain, drowning in her misery and loneliness. She left her husband because she could no longer endure the verbal insults. He never beat her, but she would have preferred the beatings to the insults and abuse.

According to the World Health Organization, although infertility has various terminologies and definitions, clinically, it is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Demographically, it is defined as an inability of those of reproductive age (15-49 years) to become or remain pregnant within five years of exposure to pregnancy. Infertility was also seen as a disability (an impairment of function) and thus access to health care falls under the Convention on the Rights of Persons with Disability. An estimated 34 million women, predominantly from developing countries, have infertility which results from maternal sepsis and unsafe abortions (long term maternal morbidity resulting in a disability). Infertility in women was ranked the 5th highest serious global disability (among populations under the age of 60).

Infertility affects nearly 25 percent of couples in Nigeria and experts claim that 40 – 45 percent of all consultations in gynecological clinics are infertility-related. Although male infertility has been found to be the cause of a couple’s failure to conceive in about 50% of cases, the social burden “falls disproportionally on women.”

Some of the causes of infertility in women include; female ovulation problems, blocked fallopian tubes, advanced maternal age and uterine problems. Furthermore, cultural practices such as female genital mutilation, polygamy where mating dates are rotated between wives in a polygamous marriage and child marriages have also contributed to the problems of infertility in Nigeria. These practices are carried out ignorantly and remain rampant in many Nigerian societies.

In our culture, it is believed that, for a woman to be socially acceptable, she should have at least one biological child. All regions in Nigeria put emphasis on women having children. In the society, a woman has to prove her womanhood through motherhood and therefore infertility becomes a stigma of some sort and she is held responsible in virtually all cases of infertility. The specific consequences of infertility in any culture depend upon the value that is placed upon motherhood and upon children in that particular culture. Motherhood is a social mandate in Nigeria. This situation is further exacerbated by the lack of support women face, especially financial support. Financial independence is not only a source of confidence but also, it gives women the credibility to participate in important matters of decision making, for themselves and their families.

Poor childless women who have no money of their own are most badly affected. In other words, along with gender, class plays a dominant role in terms of the consequences of childlessness in Nigeria. This lack of money coupled with infertility leads to low self esteem, marital insecurity, distress and ultimately loss of identity. 28 per cent of all women, almost a third of all women in Nigeria, have experienced physical violence, a significant number in a country of over 160 million, where almost half are women. One such form of conducting this violence is by using “controlling behavior” i.e., restricting access to financial resources. Hence, women who face abuse often have no option but to continue living in the same house with their abuser as they lack financial independence, which would otherwise enable them to have a choice. If Victoria John Kuba and Khadijat Yaya were independent financially, they would not have stayed that long in the hands of abusive men.

Unfortunately for most women in developing countries, infertility services are not widely available and In Vitro Fertilization (IVF) is unaffordable. 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, IVF can help. IVF 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.

The lack of Infertility treatment in the public health sector indicates a failure to ensure health treatment equity in the system. Infertility treatment should be included in primary health care services and services to assist infertile couples need to be integrated and holistic – starting from the community level to demystify the cause and prevent infertility when possible, and also, to provide referral for affordable care if infertility is unavoidable.

There is always room to do more, to empower these women and change the orientation of people towards childless women. The Merck More than a Mother initiative is doing just that. Through “Merck More than a Mother” initiative, women leaders, Africa Fertility Society, healthcare providers and media are invited to define interventions to raise awareness about infertility prevention and management. They seek to build fertility care capacity, support government to improve access to regulated, safe and effective fertility care, decrease the social suffering and stigmatization of infertile women and fertility at large in order to achieve a systemic shift in the current culture of gender discrimination in the context of fertility care in African societies. They have seen that it is very important to empower infertile women by providing treatment so they can bear children as part of their human rights. In case they can no longer be treated, Merck empowers and train them to establish their own small business so that they can be independent and re-build their own lives.

Victoria John Kuba and Khadijat Yaya are beneficiaries of the Merck More than a Mother initiative in Nigeria. Through the zeal and passion of this organization, these women have been able to re-build their lives and reclaim their dignity. Today, Victoria owns a kerosene business and she plans on using the money gotten from the sales of her kerosene to further her education. Khadijat Yaya now owns a food store located at a strategic point in her community.

A central difficulty associated with infertility is that it can transform from an acute, private distress into a harsh, public stigma with complex and devastating consequences. But we can change the way it ends. We can create a culture shift to respect and appreciate women with fertility problems. We can create awareness about infertility prevention and management and male infertility by integrating it into health care infrastructure such as HIV/AIDS, maternal health and mother and child programs. We can help raise funds for these women to start up businesses that will enable them live independent lives.

A woman should not be defined by her inability to bear children. A woman is more than a mother.

Chimdinma Adriel Onwukwe.

BIBLIOGRAPHY

Merck More Than A Mother – The Story of Empowering Victoria John Kuba, Nigeria; http://youtu.be/r36tBURbdGM. Retrieved, 18th January, 2017.

Merck More Than A Mother – The Story of Empowering Khadijat Yaya, Nigeria; http://youtu.be/2z20i8aAaDU. Retrieved January18th, 2017.

World Report on Disability; http://www.who.int/disabilities/world_report/2011/report/en/. Retrieved 18th January, 2017.

Rise of Infertility in Nigerian Couples; http://www.mamalette.com/fertility-pregnancy-baby/rise-of-infertility-amongst-nigerian-couples/. Retrieved 18th January, 2017.

Okonofua, F.E. (2005): Female and Male Infertility in Nigeria, Stockholm, Sweden: Karolinka University Press, p. 9.

Bulletin of the World Health Organization, Past Issues, Volume 88, Number 12, December 2010, 877-953.

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