Stigma: Plight of The Infertile Woman

Christmas is just round the corner – two weeks to be exact.

A time for the children, most people say. A time for giving and loving the children. But not for Emma Chinhara – “please call me Auntie Emma as everyone calls me,” the 39-year-old told The Afronews over the weekend.

“So much of the focus is on children, giving them presents,” Auntie Emma told this publication. “In my experience, when I come across people my age or those I last met a couple of years back – in school, college or early in my career, they usually ask: ‘How many kids have got now?’ and when I respond I don’t have any of my own, there is usually disbelief or stunned silenced,” she  says.

Auntie Emma says she accepts the question is well meaning and not nasty in any way – but the existing social narrative puts women who have never had children, like her, in the dock.

“We do not just face judgment, suspicion, and scrutiny, but in most cases, we are socially excluded and not only at Christmas but at most family and social gatherings,” she adds, explaining: “We are really socially on the periphery.”

Infertility or childlessness is an invisible defect or “a hidden disability” for most women in most community settings. It is not fatal but carries the burden of social stigma and results in a sense of personal failure, especially for women.

Auntie Emma’s condition is due to uterine fibroids.

Her medical report says these fibroids changed the shape of her cervix and affect the number of sperm able to enter her uterus.

“The doctors said the presence of these uterine fibroids made it difficult for me to get or stay pregnant,” she says. “These fibroids – submucosal fibroids – are responsible for diverting blood flow from the endometrium (uterine lining), preventing it from thickening and impeding the implantation of a fertilized egg or the development of an embryo,” she explains.

Many infertile women in developing countries consider that, without children, their lives are without hope.

“This feeling is more pronounced in our communities where womanhood and motherhood are important status symbols,” she says, explaining: “Hence, infertility, particularly for women, imposes profound emotional and social stress, which in turn evokes feelings of denial, depression, desertion, grief and guilt in the way of a social disability.”

“If you listen to the news, look at women’s magazines, so much of the focus is on women and their babies and their care,” Auntie Emma says. “It is such a wonderful thing to have a baby and I understand why children are the focus of so many articles.”

Her story is not isolated.

Zimbabwean women are usually not accepted by society unless they have a child and in many cultures, especially Sub-Saharan Africa – childless women suffer discrimination, stigma and ostracism. For example, Auntie has been married twice but the relationship did not last as the husbands could just not handle the social pressures. “The marriages dissolutions were for the best,” she says, throwing up her hands.

While male infertility has been found to be a major cause of a couple’s failure to conceive in about 50 percent of cases, the social burden “falls disproportionately on women,” according to Dr Mahmoud Fathalla, previous director of the Special Programme of Research, Development and Research Training in Human Reproduction based at WHO. “When a couple is unable to reproduce, the man may divorce his wife or take another wife if they live in a culture that permits polygamy,” he says.

This amplifies the guilt and shame felt by the infertile individual,” she says.

The stigmatization can be extreme in some countries, where infertile people are viewed as a burden on the socio-economic well-being of a community. Stigma extends to the wider family, including siblings, parents and in-laws, who are deeply disappointed for the loss of continuity of their family and contribution to their community.

Zimbabwe’s First Lady Auxillia Mnangagwa, founder of the Angel of Hope Foundation in the country, says that there is frustration and silent agony shared by all women who found themselves not able to conceive. 

“Our culture demands that, for a woman to be socially acceptable, she should have at least one biological child,” says The First Lady. “Almost all cultures across Africa put emphasis on women having children … marriage without children is considered as a failure of the two individuals.” 

Zimbabwe is one of the countries in the “African infertility belt” that stretches across central Africa from the United Republic of Tanzania in the east to Gabon in the west. In this region a phenomenon described as “barrenness” refers to the fact that infertility is often most prevalent where fertility rates are also high.

The Angel of Hope, in partnership with Merck Foundation, are now working to break the stigma on issues of fertility in both men and women in Zimbabwe under the “Much more than a Mother” project emphasizing the need for a paradigm shift from the patriarchal conceived norm of perceiving infertility to be a feminine issue. 

The First Lady mentioned that infections are the major causes of infertility in Zimbabwe. 

“Traditional, cultural, and religious practices combined with low resources can be catalysts for this condition. Factors that include poor nutrition, untreated sexually transmitted infection, unsafe abortions, consequences of genital mutilation and exposure to smoking also promote infertility,” she says, adding: ““There’s so much stigma attached to being infertile in Zimbabwe. It is so important to address this issue.”  

Through the partnership with the First Lady, Merck Foundation has pledged to train 10 Zimbabwean doctors in diabetes mellitus and hypertension while the other four are already being trained in India in areas of infertility and embryology.

Dr Gerald Madziyire, a gynaecologist with the Ministry of Health and Child Care, said there is a need for a shift from traditional perspectives which imply that infertility affects women to a realistic understanding of the truth that infertility affects both men and women.

The condition is labelled as a women’s reproductive health issue, often turning a blind eye on the fact that men, too, can be infertile. Women bear the brunt and each day and night they try to find solutions

Issues ranging from genetics, environmental exposures and infectious diseases have been linked to infertility risk. Uterine fibroids, cysts, ectopic pregnancies among others have also resulted in women failing to conceive. While infertility can affect both men and women, the majority of research on this topic focuses on women.   

According to the Mayo Clinic causes of infertility in men range from abnormal sperm production or function due to undescended testicle, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhoea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.

The World Health Organisation (WHO) further states that infertility affects up to 15 percent of reproductive-aged couples worldwide. WHO demographic studies from 2004 have shown that in sub-Saharan Africa, more than 30 percent of women aged 25-49 suffer from secondary infertility, the failure to conceive after an initial first pregnancy. 

All hope may not be lost for Auntie Emma.

In countries like Zimbabwe and most developing countries in sub-Saharan Africa, the cost of In vitro fertilisation (IVF) – a process of fertilisation where an egg is combined with sperm outside the body – is out of reach.

“The presence of the fibroids kind of eliminated the possibility of carrying my own children in the future,” she says but adds: “I am now considering having a child using my eggs as I have been told it is now possible.”

The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova from the woman’s ovaries and letting sperm fertilise them in a laboratory.

For example, in Zimbabwe, the service which is currently being provided by private health service providers at a hefty cost has proven successful and given hope to many couples.

The Merck Foundation, which is funding the fertility training programme is the Philanthropic arm of Merck KGaA Germany. It is a non-profit organisation that aims to improve the health and well-being of people and advance their lives through science and technology.

“Merck More than a Mother” initiative aims to empower infertile women – like Auntie Emma –  through access to information, education and health and by changing mind-sets. This powerful initiative supports governments in defining policies to enhance access to regulated, safe and effective fertility