Infertility, a social construction in many cultures

Infertility is socially constructed in many cultures including Ghana, as men and women are presumed by society, as being destined to become parents, and that, women are especially socialized to become mothers.

The issue is also a huge problem socially because we live in a society where womanhood and manhood are generally tied to motherhood and fatherhood respectively, therefore, any individual who fall short of fulfilling this perceived destiny, is scornfully treated as being under a sort of curse or overwhelmed by evil forces.

Within the African culture, the true meaning of marriage is only fulfilled if the couple are able to bear children, because Africans consider their children to be a source of power and pride, and an act of insurance for their parents in their old age, as well as an assurance of family continuity.

These perceptions have been the underlying causes of the stigmatization of persons with fertility challenges.

The World Health Organisation (WHO), for instance defines infertility as the inability of a woman to conceive within two years of exposure to pregnancy, that is having unprotected sex, but the use of the word “inability to conceive” is problematic, as it places couple infertility on the doorsteps of the female partners.

Sammy and Mansa (not their real names), have been married for 15 years without being able to have their own children, but their resolve to keep sustain their love and marriage vows to each other, and to wait for God’s appointed time, has been a very challenging the journey.

“Our challenge started barely a year after our marriage with incidences of initial empathy from our respective families, friends and our community, to that of perpetual harassments from these people on regular basis,” Mansa explains.

As usual, she is being blamed for the dilemma, and has been assigned names that affects her dignity, but “I was a virgin when I got married, and has never experienced any sickness that should make me infertile,” she said.

Explaining her current predicament with streams of tears pouring down her rather pale face, Mansa, admitted that her husband has rather remained very calm and loving, but said “my mistake was to accept the proposal of my in-laws to live in their family house after our marriage because Sammy is their only child”.

“I feel very guilty and hurt about our situation, because I now see visible signs of premature aging with its attendant gray hair on my husband, as a result of the burden and frustration of our childlessness”.

She said “my husband used to be a very jovial person, but has suddenly stop relating to some of his friends and even refuse to talk about the issue with his parents, no matter how hard they tried, but once admitted to his mother that we are seeking medical care”.

Mansa said she has become an object of ridicule both in her husband’s family and in the community, making it difficult for her to relate to her peers without anyone reminding her of the need for me to do something magical to change our situation.

She has abandoned her pursuit for medical care and currently resorted to running from one church pastor to the other in search for a solution, because they cannot afford the huge medical bills.

Such are the stories of many women other women in Ghana and the world over, seeking for answers to their infertility problems to free them from the social shame and stigma they are facing, and salvaging their dignity and human rights.

Some statistics from both the Ghana Health Service (GHS) and the World Health Organisation (WHO) shows that there is currently a rising prevalence of infertility among Ghanaian couples and globally, with limited access to fertility services.

In spite of these statistics, women continue to incur the wrath of their societies and endure the worst of the blame for infertility problems, as in most cases leading male Obstetricians and Gynaecologists are often quick to attribute couple infertility to female factors leading to the belief that is widely held.

However, the education that is yet to get down to the core of society is the acknowledgement that there are scientific evidences of infertility having underlined causes resulting from both medical, social and genetic factors, and the fact that infertility is a shared responsibility between men and women.

Despite the widespread of problems of infertility, not much has been done to understand community's perception of infertility and childbearing in Ghana.

Dr Nana Kwame Henaku-Larbi, the Medical Director of the Accra Fertility Centre (AFC), explains that a couple is said to have an infertility problem after one year of marriage and having enough sexual intercourse, that is “not less than three times in a week, and too much in a day”.

He stressed that infertility is not a curse, but a shared responsibility, as each partner contribute 40 percent to the problem, with the remaining 20 per cent equally shared between genetic and unknown causes.

He gave some of the causes of infertility in women as cervical hostilities, which can be due to untreated pelvic infections leading to tubal damage or blockade and other complications in the female reproductive system.

He said infections due to unsafe abortions, Sexually Transmitted Infections (STIs), appendicitis, Female Genital Mutilation and poor post-natal care among others, which common causes of infertility in women the problem, while ovarian problems such as polycystic ovaries, contribute about 30 per cent to the problem.

Dr Henaku-Larbi said some individuals have self-induced causes; that is their bodies naturally produces hormones and secretions that reject or repel the male sperms, and destroy them at the cervix even before they can make their journey through to the fallopian tube for fertilization.

On the male part, the doctor advices against any activities that puts pressure, introduce heat or external shock to the testicles, which he said works effectively as the sperms production unit under very low temperatures “below the normal body temperature of 37 degree Celsius”.

He said the testicles must always hung freely in an airy environment, and further cited untreated STIs, poor nutrition, stress, and birth defects as other causes of male infertility.

“Anything that makes the testosterone low can affect the factory’s ability to manufacture the sperms and finally get the sperms to move,” meaning that any man under any particular kind of stress can have infertility issues because the sperms will exhibit the exact type of stress being experienced by the man.

He said once the sperms are made, they will need drive to climb into the woman, anything that causes lack of energy for the sperms will lead to infertility, he further explained.

Dr Henaku-Larbi urged men with suspected challenges of infertility to seek help from an appropriate health care facility.

Doctor Mathew Yamoah Kyei, who is a Consultant Urologist at the Korle-Bu Teaching Hospital at a recent programme on the Joy Business Health and Wellness Trade Show in Accra, on the topic: “Redefining the Frontiers of Fertility," admitted that most infertility problems in Ghana may be the fault of men and not women, as it is usually assumed.

He said infertility has been a stressful experience and a threatening crisis for couples in all cultures worldwide, and advised men to wear less boxer shorts, and protect their scrotum from heat and harm, and also cautioned them to pay attention to their lifestyles in order to reverse the trend.

Currently in Ghana, no insurance policy covers fertility treatment, but Invitro fertilization technology has been available in some private health clinics for about 17 years, with access limited to the affluent in the major cities because they are expensive.

A combination of scaled-up diagnosis and treatment options, targeted attempts to reduce stigma, and a diversified picture of family life are needed, and the social issues can be addressed through the strengthening of the social welfare and old age support systems, to reduce the economic pressure on couples who struggle to have children.

More broadly, a concerted effort is needed to redefine the family to include childless couples, which might, for example, take the form of public campaigns to highlight the diversity of family life in Ghana.

Dr Rasha Kelej, the Chief Executive Officer of the Merck Foundation, a philanthropic Organisation for health and wellness, and the President of the “Merck More Than a Mother” initiative, at the launch of an educative children’s story book on infertility titled “The Kofi’s Story,” in Accra, said despite available scientific evidences on infertility, childless women still suffer discrimination, stigma and ostracism within many cultures globally.

She said such women subjected to isolation, disinherited, assaulted or divorced, but said the Merck More Than a Mother initiative, has been created to define many interventions to empower infertile women through access to information, health and change of mind-set.

She urged the media to heighten awareness creation and education on the known causes of infertility to ensure prevention, early treatment and elimination of Stigma and misconceptions.