By Jessie Ngoma-Simengwa –
THE common notion in a typical Zambian society that marriage is only fulfilled when a woman bears children has come under scrutiny.
Today, infertility has become a global reproductive health issue that is affecting many individuals and couples.
According to John Mbiti, author of ‘African Religions and Philosophy’, unhappy is the woman who fails to give children, for whatever qualities she might possess.
Mbiti observes that the fault may not be her own, but this may not excuse her in the eyes of society.
Some marriages have dissolved on account of a couple failing to have children, with much pressure exerted on a woman.
However, such viewpoints are being challenged as infertility affects both male and female.
The World Health Organisation defines infertility as the inability to conceive within two years of exposure to pregnancy.
A 2018 Zambia Demographic Health Survey Report explains how the overall fertility rate in Zambia has declined over the past 26 years, from 6.5 births per woman in 1992 to 4.2 births per woman in 2018.
A Urologist says social and economic issues such as couples staying separately because of their careers are affecting couples who want to conceive.
Simon Mukosai, a consultant at Ndola Teaching Hospital, said in an interview that couples who spent little time together had low chances of pregnancy.
This is because their time together should happen in the same window as ovulation.
There is frustration when there is no pregnancy and this may result in conflicts between couples.
Dr Mukosai explained that meeting after ovulation has already occurred has a likelihood of one failing to conceive, as the egg only remains ready for conception for about twelve hours.
He said there are several factors that may cause infertility problems in both men and women.
The commonest causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix.
Dr Mukosai said age could also contribute to infertility because as a woman ages, her fertility naturally tends to decrease.
“Infertility in men can be prevented by avoiding poor lifestyles such as excessive alcohol drinking and smoking, which also play a significant part in such matters,” he said.
Furthermore, sexually transmitted infections (STIs) play a leading role in infertility in both men and women.
Some men who have a surgical history also have presented with some signs of infertility.
Studies have shown that some genetic surgical causes for infertility had no treatment, but other reproductive alternative treatments such as in-vitro fertilisation may help.
And an Obstetrician/ Gynaecologists at CfB medical centre in Lusaka says because of societal expectations, infertility has been surrounded with inequality as women still endure the worst of the blame for infertility problems.
Mutinta Muyuni said women without children are stigmatised as the burden to carry a pregnancy lies with them.
“Women still endure the worst of the blame for infertility regardless of its medical origins. This has caused emotional pain because it’s the woman who is seen pregnant and nursing a child,” Dr Muyuni explained.
She said today, Zambia has benefitted from some sort of infertility treatments, including the use of advanced reproductive technologies (ARTs) that are provided in both private and public institutions.
“Untreated sexually-transmitted infections in both men and women can cause long-term effects that may lead to infertility,” she said.
Dr Muyuni said STIs, which were prevalent in some men and women, had contributed to infertility as they contributed to tubal factors.
“Tubal factors of infertility is one of the causes of infertility in women which may result in one not conceiving, as this is also caused by endometriosis,” she said.
Endometriosis is a disorder in which tissue similar to that which forms the lining of a uterus grows outside the uterine cavity.
However, there is a caution. She said not all patients with infertility problems who present with tubal factors have been treated for STIs.
She also said the other cause that may cause fertility are fibroid that are tumors which grow in or on the uterus and womb.
Dr Muyuni added that sometimes, infertility in both men and women could be caused by hormonal imbalance which may affect the sexual life in men and also affect ovulation in women.
And Gabriel Ahimbisibwe, a resident doctor at Lusaka IVF and Fertility Clinic , explains that the causes of infertility are largely the same worldwide in males. This is usually associated with failure to produce normal quality sperm.
Like any other problem, infertility could be tackled by preventing some causes.
Dr Ahimbisibwe said infertility rates in Zambia accounted for about 10 to 15 per cent of couples of child-bearing age
“Prevention of sexually transmitted diseases by using condoms and avoiding multiple sexual partners can help prevent pelvic infections that lead to tubal blockage in females and sperm obstruction in males,” he said.
Similarly, Dr Muyuni stresses the importance of preventing infertility in both men and women by seeking early diagnosis and treatment, if affected.
She said men’s participation in fertility clinics was an integral part in treating couples.
“Some treatment options for couples with infertility problems are straight and simple, but the problem is that most couples delay in receiving treatment until they have become of age,” she said.
Dr Muyuni said adopting children in Africa still remains a remote thing but we need to encourage couples whose infertility alternatives fail to work.
Regrettably, infertility services are not widely available or within reach for most couples in developing countries.
Last year, the Government announced its intention to introduce fertility clinics in all provinces of Zambia in a bid to enhance reproductive health services.
All fertility treatments are currently available in Zambia though distribution is still not equitable due to costs of investigation and treatment.
Similarly,the cost of establishing infertility centres is high. Therefore, fertility clinics with advanced services in Zambia are limited, with more being accessible in private urban centres.
Merck Foundation, a global humanitarian organisation, has partnered with the Zambian Government, through the Ministry of Health, to train fertility experts.
Lusaka IVF and Infertility Clinic is the only one of its kind in Zambia that offers a full range of fertility treatments.
The clinic diagnoses causes in both males and females, and offers tailored treatments including intra-uterine insemination.
In addition, the clinic also offers in-vitro fertilisation treatment described as a major component in fertility treatment.
It involves fertilizing the egg externally from a woman and transferring it back into the uterus to implant, therefore aiding a woman to conceive.
Since the clinic started, over 300 couples have been helped with close to 500 babies delivered.
“We need continuous mass sensitisation on issues of fertility preservation and safe sexual practices, as well as addressing the stigma surrounding infertility so that affected couples can seek timely medical interventions to help them conceive,” Dr Ahimbisibwe said.
There is clearly need to step up sensitisation campaigns so that people realise that infertility is a matter both women and men should take keen interest in.