Education Critical to Curbing Infertility Stigma

Dr. Emmanuel K. Ekyinabah, President, Liberia Medical and Dental Council (LMDC)

-- Medical Doctor

The President of Liberia’s Medical and Dental Council, Dr. Emmanuel K. Ekyinabah, says the health sector could play a key role in the fight against infertility stigmatization in the country. He said this could be done through public education and sensitization.

He believes that such engagement by health workers could bring about behavioral change in the way people living with bareness are looked at and treated. “There is a need for public education on people living with the condition,” emphasizing that it is comparable to common illnesses like malaria. The scale of infertility stigma, he said, can be attributed to lack of education.

Dr. Ekyinabah, in a recent interview, added that people who suffer from infertility should not be held responsible for their infertile condition because infertility affects both men and women equally. Dr. Ekyinabah said health authorities in addition to educating the public, can also help to advocate for victims, noting that the public should be in sympathy with victims instead of stigmatizing them.

The only system put in place for now for infertile women and men, he said, is an adoption program at the Ministry of Gender, and Social Protection which he noted is not really proactive as its duty calls for people whose conditions cannot be corrected or reversed through medical means. Dr. Ekyinabah also disclosed that the country has many trained fertility specialists working with women and men to have the issue of infertility resolved, but they have been challenged by the lack of equipment to work effectively According to him, some of the equipment needed to diagnose infertility are very costly and that ordinary people cannot afford to buy them.

He wants government to establish fertility hospitals across the country since more doctors have been trained as Fertility Specialists and some doctors are outside the country currently undergoing training. He is recommending that such experts be supported by the government and international development partners to establish fertility hospitals across the country.

He is also suggesting that insurance companies invest in fertility treatment for their employees, as more insurance companies don't cover fertility problems. This, he said, weighs in on all; most especially survivors.

Dr. Ekyinabah acknowledged that there is a big stigma associated with childlessness. Such stigma, he said, can include being given nicknames and being called by all sorts of names such as wizard and witch, among others. He said because of the stigma, victims of infertility usually don't share their condition with friends and relatives and even if they visit a health facility, they do not disclose their condition for fear of being stigmatized. “They endure such conditions for many years without finding a solution to their problem,” Dr. Ekyinabah pointed out.

According to him, some infertility problems can be solved if diagnosed sooner. However, he said if the problem cannot be corrected through health means, there are available options. “The issue of infertility is something the public really need to know about and should be no secret,” he said. He is therefore recommending that education be the driving force in the stride to reduce or even eliminate the stigma.

“Secondly, there should be a partnership between health workers, Ministries of Health and Gender, development partners and insurance companies in making sure that the country gets fertility hospitals both in Monrovia and in rural places”, Dr. Ekyinabah said.

He said most often infertility problems go unnoticed. He has therefore underscored the need for people to always do regular medical checkups because the sooner the problem is diagnosed, the quicker it can be solved.

Most married couples, he noted, do not do medical checkups prior to getting married, even though it is a basic requirement at the National Archive, Records and Documentation, adding that if testing were being done before marriage, most problems could be diagnosed sooner and worked on. Dr. Ekyinabah named some of the causes of infertility as fibroid, hypertension, chronic urinary tract infection, diabetes, etc.

In Liberian society nowadays, infertility stigmatization has become so recurrent that it is almost becoming a normal way of life for women facing the issue of bareness. This has caused trauma and even divorce in the worst-case scenario for some.

The author of this story recently talked to five women with shared infertility stigmatization experience that they have been struggling to live with. Some even attempted committing suicide.

80 years old Hawa Kromah who is the oldest of seven siblings, said since reaching the age of puberty – the age of sexual maturity and reproduction, she has never conceived, unlike the rest of the siblings. She lost several relationships as a result, she says.

"I was insulted and disgraced publicly by the men I lived with before - from my days as a youth,” she said. Kromah has sought both medical and traditional treatments, but to no avail. 

Kromah has not just sat idle with her condition. After several men neglected her for not being a suitable partner, she has sought solutions from both medical and traditional herbalists, but unfortunately, nothing has worked for her so far. Kromah currently survives on charcoal sale to survive with no partner. She has raised and educated several children, though, some of whom are now in college while others are living in their own homes. 

For Amie Seh who’s now in her late 50s, she says no man desires to have a relationship with her simply because of her condition which she has found hard to get a solution.

"Most often I grieve when I’m alone, especially after being mocked at for being childless,” she narrated as she burst into tears during the interview.  

Despite the odds, she has an abiding faith in God and says often that those degrading her have failed to realize that it is God who gives Children and not man.

Amie Seh’s experience is not unique to her, as previously mentioned. Tonia Massaley, 39, is also grappling with the same problem of infertility stigma. Madam Massaley says being infertile is a condition no one can ever be happy living with because of the pains of trauma and discrimination and other dehumanizing treatments associated with it.

Madam Massaley added that due to her infertility condition, her husband divorced her in 2010 and entered another relationship with a woman very close to her. According to her, some within the community told her that men will always make fun of her as long as she is unable to bear a child for him.

“The most frustrating thing I ever experienced was when a town chief took a woman and gave it to my husband and told me that I was a mere decoration in the home”, Massaley recalled. 

She said that was why he gave her another woman to bear children for him. He said the chief went that far despite not being a relative of her husband. Most of her previous relationships ended after two years often over her inability to conceive and give birth. Despite being barren, Massaley has often mustered courage to encourage women faced with similar situations. She encourages other infertile women to remain steadfast and to know that’s the will of God.

Musu Paasawe, 50, is another infertility stigma survivor who figuratively likens infertility stigma to a daily meal as they face derision on a daily basis. 

Even though she has exerted all efforts to bear children through medical and traditional treatments, nothing has up to date happened in her favor.

Madam Paasawe said living without a child or children is like having a beautiful hospital without equipment. She said it is difficult to live the condition especially when seeing other community dwellers’ children and not having one of your own. Currently, her sister’s children live with her who also help with her domestic chores and other works.

The last of the five persons with similar condition I talked to is Hawa Fofana, 39, married, but without a child. Like the others, she is stigmatized and treated inhumanely daily for being barren. To make matters worse, she receives no bit of encouragement, especially from neighbors, either in enabling her to keep strong or in finding a solution.

Unlike others confronted with infertility, her husband is a great source of support and has stood by her all along, she says. He helps her become more optimistic and to have faith by telling her that one day she will hold her own child and that she shouldn’t lend credence to those making fun of her.

Is Infertility Stigmatization a Human Rights Violation?

The Acting Executive Director for the Independent National Commission on Human Rights Atty. Urias Pour, answered the question in the affirmative, evoking Article 2 of the International Covenant on Civil and Political Rights.

The protocol, he explains, prohibits discrimination on any grounds. “Additionally, Article 2 of the African Charter on Human and Peoples Rights prohibits stigmatization due to infertility”, Atty. Pour adds.

Atty. Pour also explained that the Maputo Protocol also calls on state parties to the convention to take corrective positive measures on those areas where discrimination against women continue to exist. “Most of these discriminations are tied to traditional practices where women and men who are infertile are accused of some spiritual influence”, he continued. He said some are accused of selling their fertility for money or wealth, while others are accused of being witchcraft or involved in the practice of it. 

Article 5 of the Maputo Protocol calls on state parties to prohibit all forms of discrimination including those that negatively affect women's rights and additionally, states are called upon to create awareness regarding harmful practices, Pour said.