Our own gift

Infertility is not just a problem in the West.
Sue Njanji Matetakufa reports from Zimbabwe
on the battle to remove the stigma of childlessness.

BETTY CHISHAVA and her 56-year-old husband Herbert have been married for 26 years and have no children. This makes them a rarity in Zimbabwe where few couples last that long in a childless marriage, especially in a society where a child is valued more than its mother and a woman's worthiness is measured by her ability to reproduce.

When a pregnancy fails to materialize in Zimbabwe, women are always blamed. Relating the agony she has been through for 25 years, Betty vividly narrates how she has been publicly humiliated and ostracized by relatives, friends, neighbours and even her husband. Spiteful relatives insult her by using her first name in a culture where it is respectful to refer to adults as the 'mother or father of so-and so'.

Fertility is highly prized in Zimbabwe. Women without children suffer social rejection and are made to feel personally inadequate. Male fertility, on the other hand, is a taboo subject, to be concealed at all costs. Covering up for men is usually done through a traditional practice called chiramu which involves the clandestine bringing-in of the husband's close relative (usually a brother) to impregnate the wife.

Betty said her own parents came under immense pressure when she failed to conceive. They could not stand the idea of their daughter being labelled barren. They tried discreetly to arrange for her husband's brother to go to bed with her. She rejected the idea outright, she says, because of her 'Christian principles'.

Experts have concluded that at least one in every four Zimbabwean women of childbearing age suffers from some degree of infertility. The pressure exerted on infertile women can be so great that even in the face of such deadly infections as hiv and aids some will take the risk and attempt to fall pregnant by multiple partners.

In desperation other women will go to the limits of faking pregnancy and even stealing newly born babies from unsuspecting mothers. They usually get caught and end up in jail. Meanwhile, infertile women are subjected to verbal and physical abuse from their spouses. In extreme cases some women are unable to endure the alienation and the pressure. They feel so worthless that they commit suicide.

Professor Jonathan Kasule, head of the Department of Obstetrics and Gynaecology at the University of Zimbabwe, says bluntly that 'the success of a marriage in Africa depends on a woman's ability to have children'.

'Society recognizes the family as the natural unit and basis of a society,' adds deputy health minister, David Parirenyatwa. 'If a couple has no children for two or three years the tendency is for a man to seek another partner, to exonerate himself from the stigma of being the infertile one. Infertility becomes the cause of unfaithfulness and divorce follows.'

Zimbabwe has one of the world's highest infertility rates - along with other southern African countries such as Botswana, Namibia and Lesotho - and infertility is officially reported to be on the increase. Unfortunately, because of sub-Saharan Africa's high population growth rate this is largely ignored.

Traditional beliefs linking infertility to witchcraft are rife. In fact, the main medical cause in both men and women is tubal blockages - the result of delayed or inadequate treatment of reproductive tract infections (RTIs). Disease-induced infertility accounts for the majority of cases in Zimbabwe. Only about five per cent of infertility is due to inherited or hormonal disorders.

In men the ability to produce quality semen can be affected by prolonged or recurrent infections. In women pelvic inflammatory diseases (PIDs) can lead to the blockage or scarring of the fallopian tubes. Although women may feel occasional pain, PIDs often go untreated because they are easily dismissed as period or ovulation pains.

[image, unknown]
Young mother: but Zimbabwe has
one of the world's highest infertility rates.

But why is there such an upsurge of infertility in the country now? Health Minister Dr Timothy Stamps has a simple answer: 'They (sexually transmitted infections) are on the increase because we (men) are more promiscuous than before.'

On the other hand, traditional healers, who are trusted by many, believe the increased use of modern oral and injectable contraceptives is the main reason for the rise in infertility among African women.

Despite its profound social consequences, infertility treatment attracts little in the way of public-health resources. Instead attention is placed squarely on limiting the number of babies. The National Family Planning Council did open a small infertility clinic in the capital, Harare, in the mid-1980s. But the Government has admitted it was not being 'serious' in helping people with fertility problems. 'We just give them the mechanics, do a few procedures, give them some pills, but don't go deeper into the real issues.'

I asked Dr Stamps whether his Ministry was prepared to spend $1,500 for a high-tech operation such as in-vitro fertilization to help a sub-fertile woman get pregnant. He repeated his Ministry's mission statement that every woman has a right to be pregnant and to decide on the number of children she wants. But he also noted that the Ministry has undergone hefty budget cuts in recent years under belt-tightening economic reforms. He believes that he could not justify spending a lot of money on an infertile woman when primary health clinics, even in urban centres, can't afford basic drugs like paracetamol.

Even the country's long-established women's movements have not risen up to fight for the rights of infertile woman as they have successfully done in areas like violence, sexual harassment and abuse. The Women's Action Group (WAG), the country's largest women's organization, has run theatre workshops and produced a booklet in the country's two main languages to try and demystify the traditional beliefs that are associated with infertility and to urge that those who are infertile be accepted into society.

'It's a big but sensitive problem,' says Edna Masiyiwa, health information co-ordinator for WAG. 'It's not talked about; but there is a need to lobby for the cause of the infertile woman.'

Meanwhile, others rely on less scientific methods. A religious sect calling itself 'The Apostles' offers faith healing to 'cure' infertility. The best-known faith healer is Boniface Muponda who claims to have helped at least 22,000 infertile couples conceive last year. He uses holy water and prayer and says that some of his 'patients' come from as far afield as Europe and the US.

But is faith healing the only solution for women like Betty Chishava? She feels that it is society's attitudes and prejudices against infertile people which need to change. Infertile people, she argues, should be accepted just as physically disabled people are.

In 1996 she decided she'd had enough. Together with two other women she set out to establish a support group for infertile women. The first of its kind in the country, if not in the region, they called it the Chipo Chedu Society, a vernacular expression meaning 'our own gift'. The name itself suggests an acceptance of infertility as something to work with, not against.

The response has been overwhelming. Chipo Chedu also provides counselling services to the infertile and is planning to set up funding to assist its members with high medical fees for specialized treatments such as the test-tube baby program. If Betty has her way, no infertile woman will have to go through what she did.

Sue Njanji Matetakufa is a Zimbabwean journalist with special interests in women and health. She also chairs an association of media women in the country.

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