Poverty and Infertility in Africa: Medical Evidence versus Divine Providence

by Adepoju Paul Olusegun

Except there is national fuel scarcity, going from Monatan to Iyana Church in Ibadan will cost you just twenty naira hence we rarely witness drama between commuters and conductors on buses plying the route. But on this fateful Monday morning, I was left tongue drooped and speechless when a woman expertly arranged four kids on a seat meant for one, and had two more on her lap. Even the blood red eyed conductor couldn’t utter a statement. We didn’t know which is more baffling – her genius ideation as a result of her inability to pay for more seats that would make her kids sit more comfortable, or God’s unusual benevolence to this thirty something years old lady who already has six kids.

As the Bible rightly refers to children as the “heritage of God,” being blessed with the fruit of the womb is often the defining moment in the lives of married couples. Except in the developed world where many now choose to marry without giving birth to children, having babies is the major reason why many marry. In Africa, barrenness is the worst thing that can ever happen to a happily married couple. Various African cultures have different views to barrenness and none of them is desirable.

The childless woman goes through deep sorrows in African society and there are numerous proverbs to that effect, one of them is: “the woman whose sons have died is richer than a barren woman.” In Ghana, here and elsewhere, parental blessings often run along the lines of: “May you bear children like bees; May you bear children like calabash seeds…” Although today’s economic and educational pressures will force a change in these sentiments, they further validate the assertion that being fertile is a major prerequisite for happy marriage.

But not everyone is fertile. In the United States, more than five million Americans, both men and women, have problems with infertility. But unlike what we still battle with here, American couples generally open up to each other, they talk to their medical experts on time to remove the risk factors, and are fairly financially stable to afford recommended medical procedures and lifestyle changes which could be diet-related, hormone dependent, or entail treating underlying ailments and speedily addressing inappropriate drug dosage and usage. They also have the adoption option when nothing works.

Here however, many actions and traditions form synergy with the underlying cause(s) of infertility thus making life more unbearable for the worried couple. One of such is faith.

As a highly religious nation, most barren couples here wait on God before booking a gynaecology appointment. Just like Hannah in the Bible, Nigerian barren couples patiently await God’s appointed time. They pray. They are anointed. They sow seeds. They make vows. And they go for countless deliverance sessions. They believe the weapons for their warfare (with barrenness) are not, as the Bible puts it, carnal, thus leaving out the fact that sometimes, a simple health tip could answer their prayer points. However, God is not on the hot seat, neither is the efficacy of prayers in addressing infertility issues facing Nigerian couples the focus of this article. We are concerning ourselves with what looks like an anomaly – an aberration and deviation from the norm we are familiar with on this part of existence where the rich has it all.

I remember being on a research team that studied the correlation between the low standard of living of the poor people living in an overcrowded area in a remote part of Ibadan and the high incidence of cholera outbreaks in the area. Apart from evident malnourishment, we had so many children around us. We had an average of about twenty children per house unlike that of three children per house in a government residential area (GRA) in the same city while understudying the rich community. I know many factors apart from fertility are responsible for this very wide margin. For instance, we have to factor in the cost of birth control methods (though cheap, many poor people would prefer to buy two cups of garri instead of latex condoms) and illiteracy. Many rich men also have many wives that are blessed with many children, hence broadly saying that only the poor are fertile would be very wrong.

But as a medical scientist working in a government hospital, I know that poor pregnant women attending antenatal clinics outnumber the nouveau riches with bundles of joy (fetuses) growing in them many times over. On average, I attend to about fifty pregnant women daily out of which less than ten could be said to be well educated. I had the notion that I was the only sharing the view until a colleague pointed out similar concerns. This sent me to the medical library to unearth the mystery behind poverty-induced fertility and what those in search of the fruit of the womb can learn from Nigeria’s less privileged yet divinely blessed families.

Though there is extensive disagreement in medical science concerning the specific age range, the most fertile female years are in the twenties and fertility starts to decline for women from about the age of 30, dropping down more steeply from 35. As a woman grows older, the likelihood of getting pregnant falls while the probability of infertility rises. For a career lady who has bagged her bachelor’s degree, running her masters programme and thinking of starting a PhD programme before settling down to raise beautiful kids, she would have gone down the steep infertility slope. But the seventeen years old illiterate girl selling banana at the motor park has all the time in the world to raise kids with the dark tall lanky bus driver she secretly admires.

Unlike in ladies, age is not really a fertility factor for men. Even in Nigeria, we’ve had reports of octogenarians impregnating women of all ages. However, obesity, heavy coffee consumption, medications and busy sex schedules have all been associated with male infertility.

Nigeria’s successful male bankers can afford to buy air-conditioned cars to move from one place to another. They don’t sweat. They expend few calories hence the excess is accumulated and ultimately lead to obesity when left unchecked. From an erection stand point, anything that’s good for the heart is good for the penis. Too much saturated fat can, over time, clog arteries and, in doing so, prevent an adequate flow of blood from reaching the genital region. This not only interferes with the ability to “perform”, but also with sexual pleasure, semen production and transportation thus resulting in secondary infertility.

But a man struggling with poverty rarely struggles with obesity and excess saturated fat. Unlike those that accumulate calories they don’t use, a poor man has less than enough food for his digestive system to breakdown. His arteries are not clogged, there is adequate blood flow to his genital region and no excess fat is interfering with his sperm production hence he is fertile except he’s into alcoholism or heavily smokes tobacco and marijuana which are even expensive!

Libido, quality and frequency of sex also go a long way in determining an individual’s fertility status. Fertility experts often recommend that couples should consistently have sex two or three times a week because for healthy couples who want to conceive, there’s no such thing as too much sex. For most poor couples, this is all it takes. But for the rich busy business-minded couple, the secretaries will have to cancel lots of appointments for their oga and madam to make love.

The fertility conundrum is not totally against the rich. It’s been documented that they have easier access to fertility experts to sort out what the problem really is. While most poor couples beseech churches, mosques and traditional healing homes in search of the fruit of the womb, their rich fellow baby seekers often book appointments at gynaecolog

y clinics and IVF centers like the popular Nordica Fertility Centre in Lagos which might cost fortunes. Also, couples with fatter bank accounts and better living conditions often have it easier with the child welfare department when considering adoption; and when they finally get the much sought after child, they go to any length to shower such kids with love; something that is resource-limited in a relationship where the couple can barely afford to put food on the table.

In our nation, the financial strengths, economic might and social statuses of men and women can determine who is barren, and whose children outnumber the stars in the sky. Furthermore, these dividing factors also suggest the course of actions to take.

Men and women in cash-trapped relationships are advised to marry as early as possible and start the process of conception before age-induced infertility sets in. And for the rich in the society who are thinking of building many mansions, bagging emeritus professorship and touring the world before walking down the aisle, there is the need for them to set up a fertility trust fund, fight obesity with [un]holy anger, guard against illicit sex life, treat all infections, and go for regular medical examinations to determine their fertility statuses.

In many developed countries of the world, men and women now operate savings accounts in a very special kind of bank where semen and eggs are the accepted fixed deposits. I know few of such banks are springing up in Nigeria, but the cost of opening and operating such account is quite expensive – very expensive for some rich people in the society hence there is the need for government’s involvement. Government’s involvement could help lower the cost which is currently running into several hundreds of thousands of naira monthly. The government can establish fertility centers, eggs and sperm banks across the nation. There is the growing need to regulate the activities of existing fertility facilities to determine and ascertain the safety, efficacy and potency of stored eggs and semen.

Whether natural or artificial, nature and man are creating solutions to the most dreaded nightmare of African couples. For ages, infertility has been the major cause of unhappy marriages and lack of information on what to do, who to talk to, how and when to act are not just prolonging the unhappy days but without quick interventions, not doing the right thing on time could make any intervention at a later date a futile effort.

Medical researchers have provided new expensive methods and insights into cheap lifestyle changes that can help every baby lover. Whether it’s an improvement in sex life using Viagra, eating baby-friendly diets like soy, staying off tobacco and marijuana, or just studying the ovulation calendar, combating infertility is a resource intensive, time dependent, psychologically challenging and socially intimidating process. But the good news is that whether you are poor or rich, there is something you can do apart from waiting on the Lord. That, I think, is what the baby wants to see before choosing to come to you.

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