INFERTILITY AMONG YORUBA WOMEN: PERCEPTIONS ON CAUSES, TREATMENTS AND CONSEQUENCES

Abstract

Infertility is a global problem affecting a considerable number of people. However, perceptions on the causes and treatments of infertility vary across societies. This study was conducted to assess the socio-cultural perceptions of infertility and the implications of these perceptions on the lives of infertile women in Yoruba specifically, MakokoYaba, Lagos Nigeria, a town dominated by Yoruba people. The study specifically focuses on exploring the perceived causes and treatments of infertility from the perspectives of childless individuals, religious leaders, and community members. It also examines the experience of childless women, their coping strategies to the problem, and the socioeconomic and emotional consequences of childlessness. Data was collected through in-depth interviews with 17 childless women and 2 childless men, semi-structured interviews with a nurse and a doctor, a group interview with religious leaders, and 3 focus groups with community members. The data was analysed using “three bodies approach”, “social stigma theory” and “coping theory.” From the perceptions of childless individuals and community members, this study found out that there is limited level of awareness about the medical causes of and solutions to infertility. It was found out that besides the severe stigmatization on childless women, childlessness has socio-economic and emotional consequences. Childless women are not passive victims as they have developed different coping strategies to seek solutions for their childlessness and to deal with stigma. Based on the major findings, the study recommends the importance of raising public awareness on the medical causes of and treatments to infertility, incorporating infertility treatments as maternal health component, and planning old-age security programs.

CHAPTER 1

INTRODUCTION

1.1. Background

Infertility is a global problem that affects the social, economic and psychological wellbeing of couples. The definition of infertility may vary across professions as different experts employ definitions that are convenient for their purpose (Larsen, 2005, p. 208). However, the definition by the World Health Organization is widely used (ibid). The World Health Organization (WHO, 2011) defines infertility as an inability of a couple to conceive within two years of regular and unprotected sex. Infertility can be of two types: primary and secondary infertility (ibid). While primary infertility refers to the inability of a couple to conceive a child at all, secondary infertility implies inability to conceive again after a previous pregnancy (ibid). According to Reproductive Health Outlook (RHO, 2003), infertility is a global problem affecting about 8-10% of couples worldwide. Among these, about a third of the problem is female infertility, another third is male infertility, and the remaining third affects both partners or the cause is unknown (Inhorn and van Balen, 2002).

Infertility in Yoruba is arimobi meaning inability to bear a child. However, not all infertility are regarded as the same in Yoruba, there is a difference between not being able to conceive at all (bareness), not being able to deliver a live child, not having children or having only one or few children. Barrenness carries the highest stigma and having one or few children carries the least. There is a special name for a woman who has never been Pregnant (agan). There are women who cannot give birth to life children as a result of miscarriages or stillbirths, these women are known as iyaabiku or mother of abiku. Abiku is a spirit child born to die even in the womb and causes a lot of pain and sorrow to the mother.

Infertility affected 186 million couples in the majority world^[1] By the  year 2002, excluding China,(Rutstein and Shah, 2004, p. 53). Reproductive Health Outlook (2003) noted that SubSaharan Africa has the highest infertility prevalence ranging from 7% – 29%. In sub-Saharan Africa, the prevalence rate varies greatly among countries and even within a country (Ericksen and Brunette, 1996). This is because of the fact that infertility is strongly associated with social, behavioural and cultural factors that expose women to the risk of infertility due to sexually transmitted and other reproductive tract infections (ibid, p.209). Ericksen and Brunette (ibid) conducted a big survey that included twenty-seven African countries to identify patterns and predictors of infertility among women. This survey found out that there were high (16.7%-21.4%) infertility rates in the Southern African countries of Namibia, Zimbabwe, Botswana and Lesotho (ibid, 213). However, the Eastern African countries of Rwanda, Burundi, Uganda and Tanzania were characterized by a relatively low (9.8%-12.2%) infertility rate (ibid). The study also found out that, those who started having sex at very  early age (at or below the age of 13)  are found at greater risk of infertility (Ericksen and Brunette, 1996, p. 216).

Cultural, environmental and economic factors influence the prevalence of infertility especially in countries where poverty and infections are widespread (Leke et al., 1993). The major preventable cause of infertility in many parts of the majority world is Pelvic Inflammatory disease (PID) which is caused by sexually transmitted diseases (STDs) and post-partum and post-abortion infections (RHO, 2003). In addition, more specific local or regional factors of infertility may have something to say. For instance, in Egypt, exposure of men to occupational toxic agents, water pipe smoking practices of men, and close cousin marriage contributed to infertility (Inhorn and Buss, 1994). Garenne (2008) noted that infertility is still growing in some of the “infertility belt” countries  (example Congo and Mozambique), in“late marriage” countries (Lesotho, Namibia and South Africa), and inother countries such as Ghana, Mali, Rwanda, Senegal, Tanzania and Nigeria.

The above mentioned statistics give us a sense of the magnitude of the problem, but tell as little about what it means to be infertile and how infertility is recognized, perceived and dealt with among people in a given socio-cultural context. A socio-cultural approach may help us to understand the problem of infertility from the perspectives of childless individuals and community members, and thus tell us beyond statistics and medical or technical definitions.

While men and women are assumed to have equal probability of being infertile, in many societies of Africa the problem of infertility is perceived mainly as women’s problem  (Deribeet al., 2007; Inhorn, 1996; Kimani and Olenja, 2001). In such societies, women suffer severe stigmatization since they are assumed to have failed to conceive (Ombelet et al., 2008). Besides, in many societies bearing children are valued as the main purpose in life. In these cases, fosterage and adoption will not substitute real motherhood and are only seen as temporary solutions to childlessness (Gerrits, 2002). In many societies of Africa, own children give significant socio-economic contributions to their families and are the ultimate sources of old-age security for their parents(Dyer, 2007; Hollos et al., 2009).

All these factors make childlessness totally unacceptable and thus it is up to the women to accept every advice and try every solution to get a child. If a woman remains childless after whatever trials, such a woman will often be considered as worthless and even not to be considered as a woman at all (Inhorn, 1996 and Kimani and Olinja, 2001). Because childless women have few options to lead a meaningful life, it is important at this stage to wonder what is left for the childless women. What are the personal experiences of such individuals, and how do they cope with the challenges of a childless life? As it is better to have firsthand information from women, let us listen to their voices!

1.2. Statement of the Problem

Nigeria is the second most populous country in Africa next to Nigeria. According to the 2007 population and housing census, the total population of Nigeria is about 73,918,505 (FDRE, 2008). Given the high birth rate of Nigeria, the government wants to reduce the fertility rate and provides access to contraceptives even to remote rural areas of the country. However, the fact that the fertility rate per women is 5.38 shows that the government strategy of reducing the fertility rate has not been successful so far (ibid).

In most rural parts of Nigeria, children are considered as assets and having many children is a symbol of high status. In the Nigerian context, giving birth is considered as a main purpose in life for couples. As children are assumed to be God’s blessings, life is meaningless for couples who fail to have children. Fertility has thus a great value in Nigerian context (Deribe et al., 2007). However, most Nigerian research on reproductive health issues focused on the problems of how to reduce the fertility rate of the country and what factors contribute towards a small family size (Alene and Worku, 2008). The other side of the story, infertility as a social and personal problem, is almost ignored. Despite the existence of a high fertility rate in the country, infertility as a social and personal problem has many dimensions in rural parts of Nigeria.

This research explores the socio-cultural perceptions of infertility in Makoko, Yaba Lagos, an administrative zone of Nigeria, and the implications of the perceptions on the lives of childless women. As we will see in the literature review chapter, the few existing studies on infertility in Nigeria are clinically based and researchers recruit their informants from those who undertake infertility treatments. My research focuses on the socio-cultural aspects of infertility and my informants are women identified as “infertile” in the study area. Most of these informants are rural individuals who do not get medical treatment and are hence not found at health centres.

1.3. Research Area

This study was conducted in Makoko, YabaLocal Government Area, Lagos,Nigeria. Makoko, Yaba Lagos is an administrativ zone of Lagos State. Makoko is a neighbourhood across the 3^rd Mainland bridge located on the coast of mainland lLagos. A third of the community is built on stilts along the lagoon and the rest is on the land. The waterfront part of the community is largely harboured by the Egun people who migrated from Badagary and Republic of Benin and whose main occupation is fishing. In July 2012, the Lagos State government ordered that some of the stilts beyond the power-lines be brought down without proper notice. This led to the destruction of several stilts on the Iwaya/Makoko waterfront and many families were rendered homeless (Wiki).

Makoko is sometimes referred to as the “Venice of Africa”. ^{(SoniMethu 2014)} Its population is considered to be 85,840; however, the area was not officially counted as part of the 2007 census and the population has been estimated to be much higher (This Day Newspaper 2009).

Religion: The Amhara population is predominantly Pentecostal Christians but some Muslim communities are also found. Religion has a great value in people’s everyday life. We can find at least one church in every single village. Most people start their day by going to the church for Morning Prayer. People have frequent communication with priests. Each family has one spiritual father (Baba emi) who is responsible for upholding family values.

Marriage: Customary and religious marriages are commonly practiced in the study area. The customary type of marriage is not judicially registered. The family of the bride and the groom contribute property  such as land, animals and cereals for the start up of the new family. The religious type of marriage is held at the church and the church gives a certificate. Since religious marriage strictly prohibits divorce^[2] , most people prefer the customary type of marriage which is not strict when it comes to divorce. As scholars argue, divorce is common in Amhara region and it is not followed by a high level of stigmatization or shame (Mammo and Morgan, 1986; Tilson and Larsen, 2000).

Marriage is a big festival, and in most cases, the woman moves to her husband’s family after marriage (patrilocality). In the past, arranged marriages of young girls even below 10 years were common. Dagne (1994, p. 36) in his article Early marriage in northern Nigeria identifiedfear of stigma and need to ensure daughter’s virginity among the important factors that sustained early marriage in Northern Nigeria. He found out that,if the girl was not married before adolescence, she and her family became the subject of public gossip. The girl would be stigmatized as ‘cheap’, ‘left over’, or unwanted for marriage. Besides, a girl who was not a virgin at first marriage was not considered as trustworthy and the marriage would be dissolved automatically. To avoid these risks, marring girls off at their early age before they started ‘roaming around’ with boys was seen as a solution (ibid).However, the practice of early marriage is decreasing these days mainly due to government actions.

1.4. Research Objectives

The main objective of this research is to assess socio-cultural perceptions of infertility and the implications of these perceptions on the lives of childless women in Yoruba. In addition to the main objective, this research has the following specific objectives:

• To assess the perceptions of childless women and different community members of the causes and treatments of the problem of infertility.
• To assess the experiences of childless women, with particular focus on the question of social stigma and discrimination.
• To explore the coping strategies childlesswomen have to deal with infertility related problems.
• To explore the socio-economic and emotional consequences of childlessness.

The main focus of this research is childless women. However, during my field work I came across two childless men who are known as infertile by the community.  I got the opportunity to talk to them and have thus included them as informants.

1.5. Organization of the Thesis

The thesis is divided into 8 chapters. Chapter 1 is a description of context and the general background of the study. Chapter 2 reviews relevant literature on infertility and points out the gap that this research tries to fill. Chapter 3 presents the theoretical framework for the research, which consists of Scheper-Hughes and Lock’s three bodies approach, theories on social stigma and selected aspects of a coping theory. Chapter 4 presents the research methodology. Chapters 5, 6 and 7 discuss the empirical findings. While Chapter 5 describes the perceived causes and treatments of infertility, Chapter 6 emphasizes the stigma and discrimination related to childlessness, and Chapter 7 presents the socio-economic and emotional consequences of childlessness. The last chapter (chapter 8) includes summery of the major findings, recommendations and topics that need further research.

[1] The name “majority world “ is used in exchange for the so called third world or developing countries.

[2] During the holy matrimony vow, the groom says: “I will not leave her even if she becomes infertile”-my translation

INFERTILITY AMONG YORUBA WOMEN: PERCEPTIONS ON CAUSES, TREATMENTS AND CONSEQUENCES

Sharing is caring!