Infertility, social construction in many cultures

Infertility is socially constructed in many cultures including Ghana, as men and women are presumed by the society as being destined to become parents and that women are especially socialised 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 falls 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 stigmatisation 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 a couple’s infertility on the doorsteps of female partners.

Stigma

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

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

Mansa said she had 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 her to do something magical to change the situation.

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

Such are the stories of many 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.

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

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”.

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

Causes of infertility

He gave some of the causes of infertility in women as cervical hostilities, which could 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 (FGM) and poor post-natal care among others, were some of the common causes of infertility while ovarian problems such as polycystic ovaries, contributed about 30 per cent to the problem.

Dr Henaku-Larbi said some individuals had self-induced causes; meaning their bodies naturally produced hormones and secretions that rejected or repelled the male sperms and destroyed them at the cervix even before they could make their journey through to the fallopian tube for fertilisation.

On the male part, the doctor advised against any activities that put pressure, introduced heat or external shock to the testicles, which he said worked 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 were made, they would need drive to climb into the woman, anything that caused lack of energy for the sperms would lead to infertility, he further explained.

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

Redefining the frontiers of fertility

Dr 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 might be the fault of men and not women, as it was usually assumed.

Currently in Ghana, no insurance policy covers fertility treatment but invitro fertilisation 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.

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 evidence on infertility, childless women still suffered discrimination, stigma and ostracism within many cultures globally.

She said such women were isolated, disinherited, assaulted or divorced, but said the Merck More Than a Mother initiative had been created to define many interventions to empower infertile women through access to information, health and change of mindset.