- Traditional, cultural and religious practices, low resource environment associated with non-genetic and preventable causes of infertility
- Mohanoe says his experiences confirm that this is a silent struggle which also affects males
MASERU – Infection is the cause of infertility in up to 85 percent of women seeking infertility care in Sub-Saharan Africa compared to 33 percent worldwide, research reveals. Traditional, cultural and religious practices, combined with a low resource environment are believed to be associated with higher levels on non-genetic and preventable causes of infertility such as untreated sexually transmitted infections and unsafe abortions. These, it has further been established, are coupled with poor nutrition, consequences caused by the practice of female genital mutilation as well as other environmental pollutants, among others.
Infertility equally causes emotional stress to men as it does with most women. Topisi Mohanoe shared his experiences as a man and confirmed that this silent struggle also affects males. He revealed that the stress borne by infertility has caused conflict and tension between him and his in-laws, as well as his wife, after being in marriage for five years.
Mohanoe says this has led him to work towards breaking the silence around infertility with information, helping women who are struggling with miscarriage, and couples struggling to conceive.
He says after finding out three years after marriage that he could not have children, he felt a sense of shame and inadequacy and was drowned by the pressure to fulfill societal expectations.
This, in turn, increased feelings of guilt and self-blame.
Along with everyday stress from the in-laws and the community, he often struggled with dreams of family and whether his family will grow. He further said: “Everyday experiences of seeing pregnant women, and even the announcement of a new pregnancy within my family from my wife’s side, added to the stress that I had already had.”
Mohanoe said he is among scores of men who have faced social and self-stigma, among others, which threatened his psycho-social well-being and self-esteem. Although infertility affects both sexes equally, he said it used to be women who were frequently blamed, causing them to feel guilty and threatening their self-esteem, but now the blame is slowly shifting to men.
As he works towards breaking the silence around infertility, especially for women and men who choose not to share their struggles out of concern that doing so will negatively affect them, Mohanoe said this is an issue that needs to be addressed not only by individuals, but needs a collaborative response. He said he believes that normalising the conversation can help create a more supporting environment “not only in our homes but in the whole society.”
“Infertile women experience greater emotional stress than infertile men, and they are often stigmatised for being infertile. I urge everyone who is going through this phase to come out, and seek help,” he added. Because a lot of women and men live in silence due to the stigma surrounding infertility, he said he is available to assist those who are ready to come out and talk about their situation.
This he does to assist them to heal from being called demeaning names. Education focusing on coping strategies is important as it might help against infertility stigma, he added. According to clinical manager-public health specialist and manager at Healthdirect Pharmaceutical Solutions and Clinic, ’Mamonica Mokhesi Makhozonke, infertility means being unable to get pregnant despite having frequent unprotected sex for at least a year for most couples of opposite sexes. Makhozonke says the inability to get pregnant despite engaging in frequent unprotected sex can lead to infertility. She further said the issue can come from either of the two partners because of certain factors from each, or both of them, that can cause infertility.
In addressing infertility, she said it is important to identify the underlying issue behind infertility, which sometimes has linkage to medical disorders. This she said simply means an undiagnosed problem can cause complications which are irreversible or those that can be life threatening.
She said the expectation is that anyone who is of child-bearing age, must be able to conceive, but if they cannot, the need to identify the problem should be addressed. If partners know their infertility status earlier, she said it becomes easier for them to explore options which include In-Virto Fertilisation. She also encouraged such couples to go for adoption if they both cannot have children.
According to the World Health Organisation (WHO), every human being has a right to the enjoyment of the highest attainable standard of physical and mental health.
WHO says addressing infertility can also mitigate gender inequality, adding that although both men and women can experience infertility, women in a relationship with men are often perceived to suffer from infertility more, regardless of whether they are infertile or not.
“Availability, access and quality of interventions to address infertility remain a challenge, where diagnosis and treatment is often not prioritized in national population and development policies and reproductive health strategies, and rarely covered through public health financing,” the organisation says.
Speaking at the sixth edition of the ‘Merck Africa Asia Luminary’ held in Accra, Ghana, on October 30, 2019, Dr Edem Hiadzi – president of the Fertility Society of Ghana, revealed 34 million African women, especially in Sub-Saharan Africa, were victims of infertility. The Accra assembly was hosted by the government of Ghana and co-chaired by Rebecca Akufo-Addo, the First Lady of the Republic of Ghana and Dr Rasha Kelej, Merck Foundation CEO.
Dr Hiadzi said infertility has been a part of African communities since time immemorial with bandied remedial actions confined to traditional and religious healers as well as guidance from family members and friends – with no particular rapt and properly guided medical solutions and reproduction alternatives.
He highlighted that since the genesis of modern medicine in Africa, several steps have been taken to address the medical condition across the breadth of the continent, with the right to reproductive health being a Sustainable Developmental Goal the global community had tasked itself to achieve by 2015.
The employment of modern medicine in the reparation of lost dignity and spousal fulfillment of infertile women and sterile men was important, he added, urging for the employment of alternative conception methods as a step in the direction towards addressing infertility – as backed by international organization Merck Foundation.
Merck Foundation is the philanthropic arm of Merck, which aims to improve the health and wellbeing of people and to advance their lives through science and technology. The Accra conference was attended by 58 countries from across the globe, Lesotho included, with African First Ladies and health, gender and education ministers from 20 African countries.
There were over 1 000 participants drawn from the academia, researchers, policy makers, health care practitioners, medical specialists and the media who took part in the discussions.
A Lesotho delegation headed by the then Minister in the Prime Minister’s office, Tšehlo Ramarou, deputy education minister ’Maphoka Motoboli, the First Lady ’Maesaiah Thabane Trust Fund director Keneuoe Machela, and programmes manager in the Office of the First Lady Monaheng Monyane presented the Lesotho case. ’Maesaiah Thabane had just been appointed Merck Foundation’s ‘More than a Mother’ programme ambassador in the country at that time.
Speaking to Public Eye on the sidelines of the Accra conference Motoboli urged Basotho to adopt choices brought forward by modern technological tools while also leading healthy lifestyles conducive to a good reproductive life.
The minister singled out egg fertilisation outside the womb as one of the best methods through which infertile couples could be assisted to conceive and bear children.
She appealed that Basotho societal structures should break the silence shrouding infertility and sterility in both women and men, while instantaneously advocating for reproduction through technology to mitigate childlessness and the stigma it carries.
Motoboli argued that it is vital that society should, from a very early age, be sensitised on the causes of infertility – challenging widely held untruths that fuel stigma and the abuse of women who cannot bear children.
The inaugural sessions commenced with the visiting First Ladies holding a high level panel where they presented country reports and discussed challenges and solutions to break the stigma around infertile women and interventions to empower them through access to information, health and change of mindset in Africa.
A scenario minister Motoboli noted was no exception to as despite enactment of relevant legislations women continued to be perceived as minors by society.
“Women are chiefly viewed by our society as baby makers, a role whose failure to perform lands them in the face of hostility and abuse from their families. The entire blame is laid on the woman alone.
“There are also constant threats of divorce and the whole society accepts polygamy if a wife cannot bear children. In some cases, even adultery is condoned which, in turn, leads to sexually transmitted infections, distress, depression, low self-esteem, self-blame and guilt – in most cases women bear this blame even without medical verification,” minister Motoboli elaborated.
The second day of deliberations focused on scientific sessions designed to serve unmet healthcare needs on the African continent, with special focus on disease prevention and early detection as well as nutrition awareness.
Focus was also put on the networking of healthcare providers, academia and medical faculty members to exchange knowledge and experiences and engage in an open dialogue to explore the educational gaps.
It was also meant to develop and implement comprehensive control and prevention programmes that would improve the overall access to healthcare in Africa, Asia and beyond through the successful implementation of the various Merck Foundation programmes.
According to a 2016 national report, Lesotho has a total population of 2 007 201 and the total fertility rate in the country stands at 3.3 children per woman, with childbearing peaking at age 20 to 24 (181 births per 1 000 women), dropping steadily thereafter.
And according to the country’s Demographic and Health Survey of 2014, rural women have 1.6 more children on average, more than the total fertility rate that is recorded at 3.9 versus 2.3 children.
The number of children a woman bears generally decreased as her education level increases, and women with some primary education or who completed primary education have, on average, 1.6 more children than women with more than secondary education.
Women in the lowest wealth quintile have more than twice as many children, on average, as women in the highest quintile.
The median birth interval in the country is 45.8 months, with 11 percent of all children in Lesotho born within 24 months of a previous birth.
In Lesotho, 19 percent of women aged 15 to 19 have begun childbearing; 15 percent have given birth and an additional four percent are pregnant with their first child.
Teenagers in rural areas are more likely to begin childbearing than their urban peers, with 23 percent of rural teenagers having had live birth or are pregnant, compared with 12 percent of urban teenagers.
Teenage childbearing is less common in the wealthiest households, and teenagers in the lowest wealth quintile are about five times as likely to have started childbearing by the age 19 as those in the highest quintile.
And minister Motoboli told this paper that cognizant of these national statistics, the trauma that infertile women go through is immense and heartbreaking, adding “they are looked down upon and ridiculed by souses and in-laws who are eager to see their off-springs whom they believe will shoulder the family legacy.”
“In Lesotho an infertile woman is not only banned from participating in social activities but also from participating in and contributing to a meaningful life. They are viewed as a burden on the socio-economic wellbeing of a community, and this has to stop,” she continued.
The minister concluded by encouraging women to avoid smoking as it aged one’s ovaries, to stay away from illicit drugs, cut down on alcohol and caffeine intake – factors she said are linked to lower infertility, appealing for a moderately active lifestyle and maintenance of healthy weight.