Shattering the silence: Infertility is not a stigma

In numerous global societies, infertility is shrouded in shame and secrecy. This is particularly profound in Ghana, where cultural norms and traditional beliefs intensify the stigma surrounding infertility. However, individuals like Yoofi (pseudonym) are striving to shift this narrative and champion the message that infertility is not a stigma.

Yoofi’s revelation of his childlessness after over two decades of marriage was a stark reminder of the societal pressures couples face to have children. Despite the hurdles and challenges Yoofi has encountered over the years, his passion, enthusiasm, and tranquillity in the face of adversity are inspiring. He has always maintained that he has children, reinforcing the belief that infertility is not solely a woman’s burden but affects both genders equally.

Together with his wife, Yoofi has embraced their inability to conceive and encourages others in similar situations to refrain from stigmatizing infertility.

Understanding Infertility

Infertility is defined as a couple’s inability to conceive a child within a year despite regular intercourse and not using contraceptives. Infertility can be primary, where there has been no conception, or secondary, where there has been at least one conception. The United Nations reports that the current fertility rate for Ghana in 2024 is 3.604 births per woman, marking a 1.18% decline from 2023.

Infertility affects one in six couples worldwide (WHO, 2023). Traditional Ghanaian society is pro-natal (Nukunya, 2003). The primary infertility rate in Ghana for women is 2%, and the secondary infertility rate is 14% (Larsen, 2000). Male factor infertility is 15.8% (Blay et al., 2000). Both men and women are each said to be responsible for 30% of infertility cases. The unknown causes of infertility are rated at 10%.

For men, science and research have found that infertility can be due to the absence of sperm production (azoospermia) or poor quality of produced sperm, while for women, it can be caused by the absence or disorder of ovulation, blocked tubes, or an unfavourable uterus for implantation, such as fibroids.

The Silent Struggle

Despite advancements, infertility remains a largely unspoken issue in Ghana. Many individuals and couples grappling with infertility often suffer in silence, burdened by societal expectations and the fear of ostracization. The stigma is particularly harsh for women, who are often unfairly blamed for the inability to conceive and bear children.

Dr. Emefa Adzo Dzordzorme, Psychiatry Resident at Accra Psychiatric Hospital, states that biologically, stigma can lead to decreased fertility, hypertension, and cardiac illnesses. Psychologically, she says it can result in low self-esteem, mood disorders, suicide, anxiety disorders, relapse of existing psychotic disorders, sleeping disorders, and eating disorders. Dr. Dzordzorme adds that socially, stigma can decrease support and cause financial hardship for infertile couples.

Challenging the Status Quo

A growing number of individuals, healthcare professionals, and organizations are stepping forward to challenge these harmful stereotypes and misconceptions. They advocate for a more compassionate and understanding approach to infertility, emphasizing that it is a medical condition, not a personal failing. This is evident in the case of Yoofi, who had to dissuade his mother from constantly asking for grandchildren from his wife.

Many in-laws, families of both couples, friends, and even strangers tend to mostly blame women if there are no children in the family. However, Dr. Edem Hiadzi, an Obstetrician Gynaecologist and Fertility Specialist, affirms that infertility is indeed not a stigma. He asserts that infertility affects both men and women equally, adding that “about half of the causes of infertility are due to, or include, male factors. Infertility is one of the most common conditions affecting the reproductive age group between 20 and 45 years.” He urges couples to share the treatment journey together as “fertility is a shared responsibility.”

Dr. Hiadzi explained that in Africa, some traditional, cultural, and religious practices, combined with a low-resource environment, are linked with higher levels of preventable causes of infertility in women. These include poor nutrition, untreated sexually transmitted diseases (STDs), unsafe abortions, infections caused by the practice of female genital mutilation, exposure to smoking, leaded petrol, and other environmental pollutants.

He further indicated that in sub-Saharan Africa, infection is the cause of infertility in up to 85% of women seeking infertility care, compared to 33% worldwide. He advocates for both men and women to practice “safe sex” and avoid risky behaviour that can lead to STDs, which could cause serious complications, including pelvic inflammatory disease (PID), blockage of fallopian tubes, ectopic pregnancy, and prostatitis, which can subsequently cause infertility.

On sharing the journey together, Dr. Hiadzi advised couples facing such challenges to limit alcohol intake, stop smoking, avoid drugs, avoid high temperatures, exercise regularly and moderately, avoid exposure to industrial and environmental toxins, eat a balanced diet, and maintain a healthy weight.

The Role of Education

Education plays a pivotal role in dispelling the notion that infertility is a stigma. By raising awareness about the medical causes of infertility and the available treatment options, we can debunk harmful myths and foster a more supportive environment for those affected by infertility. Educational initiatives are also crucial in promoting reproductive health and empowering individuals to make informed decisions about their fertility.

The Power of Support

Support groups and counseling services play a vital role in breaking the infertility stigma. These platforms provide a safe space for individuals and couples to share their experiences, express their feelings, and receive emotional support. They also serve as a powerful reminder that those struggling with infertility are not alone.

Advocacy and Policy Change

Strengthening advocacy around infertility not being a stigma is crucial to influence policy changes that support individuals and couples dealing with infertility. This includes advocating for comprehensive infertility coverage in health insurance plans and pushing for legislation that protects the rights of individuals undergoing fertility treatments.

Conclusion

Breaking the infertility stigma in Ghana is a collective effort that requires the participation of all sectors of society. By fostering open conversations, promoting education, providing support, and advocating for policy changes, we can create a society where infertility is understood, accepted, and free from stigma. The journey may be long and fraught with challenges, but with determination and resilience, a future free from the shadows of infertility stigma is within our reach.