Breaking infertility stigma: Need to consolidate subsidized Assisted Reproductive Technology

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Infertility
Infertility

Adwoa (Not her real name) got married at 29. She tried many times to conceive but all her attempts proved futile until she clocked 39 years.

Scenario
“I had my first child after 10 years of marriage, when I almost gave up on life. Pressure from my husband, his family and mine caused me depression until I opted for suicide,” she said.
Adwoa said she attempted to end her life to save herself the humiliation and name callings as result of her childlessness.
“A friend came to my rescue when I endeavoured to drink poison after living a suicide note in my room in Accra,” she said.

She disclosed that she had her first child through IVF, which was fully paid for by a group she belonged to after members heard about her ordeal and the suicide attempt.

The stigma and stress associated with infertility are widespread, thus the case of Adwoa was not any different from the many women confronted with infertility in the country.

What is infertility
Infertility, which is a term used to describe peoples’ natural inability to procreate usually within a year after several attempts, has been a topical global issue.

Although there is no accessible national data on the ratio of level of infertility in people, the women are phenomenally victimised by society.
Common causes of infertility

Dr Dixie Constantini, an Obstetric Gynaecologist at the Tamale Teaching Hospital, in an interview with the Ghana News Agency (GNA) said diabetic and hypertensive men are at higher risk being infertile due to erectile dysfunction while Sexual Transmitted Diseases like Chlamydia destroy fallopian tubes and leads to infertility.

Infertility could also result from uterine fibroid, thyroid, and other health related issues in women, while in men, it could result from low sperm count or low-level testosterone.

There are numerous medically related causes to infertility and in some cases, the causes remain unknown.
Implications of infertility stigma on victims

In Ghanaian societies, female infertility is mostly associated with sin, witchcraft and many other unscientific reasons and explanations.

These reasons augment societal stigmatisation, where women face verbal abuses and, in some cases, physical abuse from their husbands and members of society just as Adwoa encountered in her decade of childlessness.
The traditional Ghanaian setting compels many women, who face infertility stigma, to resort to drinking concoctions, which in most cases, worsen their health.

Stress, depression, emotional and psychological trauma, loneliness, and self-inferiority complex are some peculiar implications of infertility on women.

Often, women are victimised, such that stigma from others translates to the stigmatising themselves, the reason they isolate from their communities.

In worst scenarios, victims of infertility stigma resort to death through suicide.
Adopting Assisted Reproductive Technology for infertility
Assisted Reproductive Technology (ART) could be long sought remedy for both sexes to reduce infertility, thereby breaking the stigma associated with it.

Various ART processes have been medically proven ways of conceiving and giving birth to healthy babies, which is said to have started in the 1970s, according to a Gary Clarke’s human reproduction article published on April 10, 2006.
Scientific processes have emerged to combat infertility and are guaranteed as results oriented.

Research has found that the success of ART is dated as far back as 1978 globally, while its success in Ghana is dated as far back as 1995.

Dr Constantini mentioned some ARTs that could be considered to overcome infertility.
They include the In Vitro Fertilisation (IVF) where egg and sperm are combined in vitro for fertilisation. Intra-Cytoplasmic Sperm Injection (ICSI) where sperm is injected into the egg to increase its chances of fertilising the egg, recommended for women who have had previously failed IVF’s and when infertility cause is unknown.

Other ARTs the Obstetric Gynaecologist mentioned are In Vitro Fertilisation + Embryo Transfer (IVF +E) where ovulation is stimulated in the woman or the donor of the eggs, the eggs picked up, fertilized with partners or donors’ sperm, and deposited into the womb, and Intrauterine Insemination (IUI) where semen is washed, and sperm is deposited into the woman’s womb to find its way to the egg to fertilize on its own.

She noted that the cause of infertility determined the type of ART process, adding “People cannot be told to choose one ART process over the other as indications depend on the cause of fertility the individual is dealing with.”
ART, she indicated could be carried out on one or both partners based on preference and health conditions surrounding the couple and said the processes involve different artificial preparations and methods depending on the type being undertaken.

A publication by the World Fertility Services on IVF dated July 09, 2021, indicates that doctors suggest IVF to women with blocked fallopian tubes and men with low sperm count. Each of the processes has specifications and conditions considered prior to administration.

Costs of Assisted Reproductive Technologies

Dr Dixie, however, said the processes of ART and preparation was expensive for the average Ghanaian to afford.
Research by the GNA found out that IVF ranged from $4000 to $4500, IUI was from $300 to $1,000,00, while ICSI was processed from $1,400 to $2,000,00.

Even in the wake of medical ART targeted at reducing infertility, the average Ghanaian woman faced with infertility crisis still undergoes the “barren” stigma.

This is probably because the cost of ART is high for the average Ghanaian couple to afford.
Intervention/Way Forward

Women based organisations in Ghana have chalked many successes in their attempt to provide enabling environment for women. These have been in the areas of job creation and access to education for women.

It is without doubt that the stigma associated with female infertility is mental health threatening, and less discussed at national fora, thereby receiving little attention.

There is the urgent need for groups into women development and empowerment, to form a unit to mobilise enough funds to subsidise ART cost for women who are victimised as result of infertility.

Such support could be extended to partner with already existing national and international networks and non-governmental organisations, who are centred in fertility.

Reproductive Biomedicine and Society online, a journal dated June 2016 disclosed that “Currently, more affordable IVF is being introduced in Ghana on the initiative of the first Association of Childless Couples of Ghana (ACCOG) in collaboration with the Belgium-based non-profit organisation, the Walking Egg (tWE), representing another form of transnational networking.”

There may be other transnational networks to consolidate subsidies for the other ART processes just like IVF. The consolidation could comprise a medical team to determine the severity of victims’ infertility, whether there is the need for ART.

Mobilised funds could as well cater for women, who have infertility problems due to fibroid and related illnesses, who do not need solutions as much as ART to conceive.

Hundreds of people are unaware of the existence of ART while the few, who know about it, may be sceptical about their success.

There is therefore the need to consolidate the sensitisation programme to create the awareness on the benefits of the medical processes.

Addressing infertility issues should be considered a national health issue, to be incorporated in national health programmes and policies, aside individual and group efforts.

Tackling infertility stigma and societal assertions about it must be taken from an angle of finding an endless solution to the phenomenon itself, since years of education and “stop infertility stigma” campaigns have proved less successful.

This would technically give victims of infertility stigma the courage to overcome the stigma, knowing that there is a way out.

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