By Jessie Ngoma-Simengwa –
INFERTILITY still remains a major sexual reproductive health issue for both women and men in African society.
In some African communities, infertility is still attached with some cultural norms and beliefs that have lead to psychological effects by those afflicted by the problem.
In some parts of Africa high value is still being placed on parenthood as children are believed to provide security, continuity and maintain the family lineage.
However, it is important that society must be made aware of the reality of infertility as a sexual reproductive health problem and facilitate for them to seek medical attention as soon as they experience failure in conceiving.
The World Health Organisation (WHO) defines infertility as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse with no other reason such as breast-feeding or postpartum amenorrhea.
Despite this view, infertility causes in African have seen women bear the blunt of the same as they are perceived to be the ones who are seen pregnant and nursing a child thus the problem greatly manifesting from the woman perspective in society.
According to research, some causes of infertility in males include abnormal sperm production or function due to genetic defects or un-descended testicles.
Health conditions such as diabetes and some sexually transmitted infections such as gonorrhea and chlamydia if not treated well can also cause infertility.
In women some of the causes of infertility include ovulation problems, damage to the fallopian tubes or uterus, as well as problems with the cervix can lead to infertility.
In addition age is also one factor in women that can lead to one not conceiving as when women are aging, infertility naturally tends to decrease due to the menopause which sets in thereby reducing chances of conception.
Like other developing countries, Assisted Reproductive Technology (ART) through In vitro fertilization (IVF) a procedure used to help with fertility problems and assist with conception of a child has been established in Lusaka.
However it is important to note that the concern of the service is the cost aspect attached to it and the likelihood of having a child is further reduced.
A traditional leader has observed how infertility today has become a silent subject in the community.
Currently in Zambia, Lusaka Fertility Clinic is the only private clinic that offers IVF and other related reproductive services.
It is for this reason that the Government has responded positively to issues of infertility which is now perceived as a public health issue by committing itself to establish fertility clinics countrywide in an effort to enhance reproductive health.
The cost of establishing fertility centers comes with high costs thus fertility clinics with advanced services in Zambia are limited, with more being accessible in private urban centers making the service only accessible to the few elite.
Merck Foundation, a global humanitarian organisation, has partnered with the Zambian Government, through the Ministry of Health, to train fertility experts.
Chief Madzimawe of the Ngoni people of Eastern Province said in an interview that both women and men who are married and having challenges of infertility have embraced the idea of keeping children in their homes.
Additionally, the traditional leader said in the past couples that experienced infertility moved with shame as stigma was attached to it.
He said infertility problems today are being handled by family members as women are still blamed for being the cause without knowing if it is a man who is at fault.
“Infertility problems today are like a forgotten issue and do not come out publicly as families have decided to handle the matter internally”. Observes the traditional leader
Chief Madzimawe said from his participation in gender matters in his chiefdom, cases of infertility have manifested themselves through gender based violence (GBV).
“Some cases of GBV that have come to the attention of the gender committee are as a result of couples failing to conceive resulting in domestic violence,” Chief Madzimawe said.
He says “ In a few instances, we have heard in the community how families particularly mother’s in-laws trying to interfere in marriages through the old patriarchal way by persuading their sons to seek divorce of their estranged partners and possibly remarrying in a quest to bear children.”
In addition from the rumor point of view, the chief said some families were encouraging women to become pregnant outside marriage secretly if she was to maintain her union, a situation that can promote extra marital affairs.
Society must sensitise the community from such perceptions on infertility matters as such measures could only fuel the risk of sexually transmitted infections including HIV/AIDS and increase in infidelity.
Although research shows that male infertility accounts for about 50 percent of the cases, the social burden in some parts of Africa still falls on women who are mostly to blame for the problem.
Infertility comes with some devastating social, cultural and emotional consequences which can affect couples and if not addressed properly, this can led to mental and emotional torture which has seen people suffer leading to depression.
He said that couples that are counseled from failure to conceive resulting in GBV are provided with sexual and reproductive health education and awareness on infertility ruling out the occurrence of gender-specific burden of infertility where men are in most cases ruled out of the infertility puzzle.
The traditional leader also said some couples were seeking help from herbalists rather than seeking conventional treatment in health facilities.
The reliance of traditional healers in Africa has been an established source of healthcare particularly in rural communities of Africa.
In some instances we have seen how some traditional healers have taken advantage of women by sexually abusing them as a remedy for treatment of their infertility problem.
Similarly, some end up visiting traditional practitioners who give them all sorts of medicines and often harmful at times and only visit hospitals for lack of an alternative solution after spending so much money.
However, Traditional Health Practitioners Association of Zambia (THPAZ) is aware of infertility problems in both men and women that have created marital problems in some households.
Mr Kashita Solo a traditional healer who is also the secretary general for THPAZ said in an interview that when patients consult traditional healers for treatment in fertility problems, diagnostic measures are employed basing on the history of the patient.
“We have a wide range of herbal remedies to treat infertility in males and females and after thorough investigations of what is presented to us we administer treatment accordingly” said Mr Solo.
He said some of the common problems presented that have contributed in not having children in some clients, include erectile dysfunction in men and also miscarriages in early pregnancies in women.
Mr Solo added that the drugs that are administered treat different ailments that contribute to one failing conceive.
He said in cases where the patient does not respond positively to herbal medication that is administered, they are encouraged to seek further investigation by referring them to the hospitals
Clearly, an improved system on increasing awareness in the community and health centers on how best they can seek treatment in health facilities needs to be embarked on.
Equally, there is need to invest and equip public health facilities with reproductive technology to address the fertility problems.