Infertility gap grows behind Africa's tradition of big families
Infertility in Africa is a silent public health crisis, obscured by tradition and compounded by stigma and inequity in treatment.
When Malian Halima Cissé gave birth to nine babies in May 2021, her story predictably broke the internet.
Here was a woman who doctors thought was expecting septuplets, only for her to give birth to the world's only surviving nonuplets – five girls and four boys born prematurely at 30 weeks.
In her native Africa, where having a large family is traditionally considered a blessing, the news evoked more than just a feeling of incredulous awe.
Halima and her newborns represented not just a medical miracle, but also a departure from a modern – and almost hidden – reality that affects millions of African couples: infertility.
"There is a perception that Africa does not have fertility problems," Dr Wanjiru Ndegwa, consultant and fertility specialist at Footsteps To Fertility Centre in Kenya's Nairobi, tells TRT Afrika.
"I recently attended a seminar and a professor from Germany suggested that funding should not be wasted on fertility issues in Africa because the continent is already overpopulated. Imagine my shock on hearing such a remark."
Population size has nothing to do with fertility levels in any particular region. A country can have millions of people and still face widespread infertility problems.
The World Health Organisation (WHO) defines infertility as a couple's inability to conceive after 12 months or more of trying. Based on worldwide data, it affects one in six people of reproductive age at some point in their lives.
"Infertility is one of the most overlooked public health challenges of our time and a major issue of inequality worldwide," says WHO's director-general Tedros Ghebreyesus.
"Millions face this lonely journey. They are isolated by the high cost of care, pushed towards cheap treatments that are dangerous and unproven or forced to choose between their hope of having children and their financial security."
First global guidelines
WHO's first-ever international guidelines on infertility, released this November, aims to improve prevention, diagnosis and treatment.
The 40-point advisory cites cost-effective options at every stage while advocating the integration of reproductive health care into national health strategies, services and funding.
"We are literally missing everything. We don't have enough specialists who understand how to manage infertility. We don't have enough IVF centres. We don't have embryologists. We don't have institutions that provide such training," says Dr Wanjiru.
WHO's guidelines include recommendations for better clinical management of infertility. They also call for increased investment in prevention, including information on fertility and infertility, age-related factors, school-based services, primary health care and reproductive health facilities.
Pressures and stigma
Social pressure remains one of the biggest challenges surrounding infertility, particularly for couples assumed to be racing the body clock.
In tradition-bound societies, women are often blamed for being unable to conceive after marriage, causing stigma that largely stems from ignorance.
"When it comes to infertility, it isn't just the couple who is affected. Society jumps in, creating stigma associated with it," Dr Wanjiru tells TRT Africa.
"To this day, even before she gets married, a woman is under pressure to conform to the idea that she will have to raise a family. Society seems to say, 'We appreciate your degrees but you have another important role to fulfil'."
So, are questions surrounding infertility only directed at women?
Dr Wanjiru points out that clinics in Kenya have seen a significant increase in men seeking advice or treatment, indicating that more male partners now acknowledge that the problem may lie with them or that they need to be part of the solution.
Available treatments
The WHO guidelines emphasise the need to address risk factors for infertility, including untreated sexually transmitted diseases and tobacco use.
Lifestyle changes – a healthy diet, exercise and quitting tobacco – are recommended for individuals and couples planning or trying to conceive. Doctors say educating people about fertility and infertility early can help them make informed family planning decisions.
But when should someone investigate or seek fertility treatment?
"I have had couples who have been together for a month and are surprised they haven't conceived. I tell them it doesn't necessarily happen in a month. I advise them to try conceiving for at least a year before we get worried. I don't think there is a need to rush into early or regular testing," says Dr Wanjiru.
Recognising that infertility can lead to depression, anxiety and social isolation, the WHO guidelines stress the need to ensure ongoing access to psychosocial support for all those affected.
WHO also urges countries to review their domestic healthcare policies and monitor infertility trends. Successful implementation of strategies to combat this growing problem requires collaboration across ministries of health, health professional associations, civil society and patients' groups.
Experts say treatments are available, but they depend largely on the specific reasons for an individual or couple's inability to conceive.
"There are solutions. The right treatment depends on what the cause of your infertility is," Dr Wanjiru tells TRT Afrika.
For most African couples facing infertility, the challenge now is to narrow the gap between knowing treatments exist and opting for them.