Population Council Knowledge Commons Poverty, Gender, and Youth Social and Behavioral Science Research (SBSR) 2002 What about us? Bringing infertility into reproductive health care Okonofua Friday Bishakha Datta Follow this and additional works at: https://knowledgecommons.popcouncil.org/departments_sbsr-pgy Part of the Family, Life Course, and Society Commons, Gender and Sexuality Commons, International Public Health Commons, Public Health Education and Promotion Commons, and the Women's Health Commons How does access to this work benefit ou?y Let us know! Recommended Citation Friday, Okonofua and Bishakha Datta. 2002. "What about us? Bringing infertility into reproductive health care," Quality/Calidad/Qualité no. 13. New York: Population Council. This Case Study is brought to you for free and open access by the Population Council. “What About Us?” Bringing Infertility Into Reproductive Health Care té/Quality /Calidad /Qualité/Q t “What About Us?” Bringing Infertility Into Reproductive Health Care té/Quality /Calidad /Qualité/Q Quality/Calidad/Qualité, a publication of Projects are selected for documenta- the Population Council, highlights exam- tion by an advisory group made up of ples of clinical and educational programs individuals who have a broad range of that bring a strong commitment, as well experience with promoting quality of care as innovative and thoughtful approaches, in sexual and reproductive health. None to the issue of high-quality care in sexual of the projects documented is being and reproductive health. The series is offered as a model for replication. Rather, based on the philosophy that people have each is presented as an unusually cre- a fundamental right to respectful treat- ative example of values, objectives, and ment, information, choice, and follow-up implementation. These are learning expe- from reproductive health-care providers. riences that demonstrate the self-critical Q/C/Q documents projects that are mak- attitude required to anticipate clients’ ing important strides in one or more of the needs and find affordable means to meet following ways: broadening the choice of them. This reflective posture is exempli- methods and technologies available; pro- fied by a willingness to respond to viding the information clients need to make changes in clients’ needs as well as to the informed choices; enabling clients to be- broader social and economic transforma- come more effective guardians of their sex- tions affecting societies. Documenting ual and reproductive health; making inno- the critical choices these programs have vative efforts to increase the management made should help to reinforce, in practi- capacity and broaden the skills of service cal terms, the belief that an individual’s providers at all levels; combining health satisfaction with sexual and reproductive care, family planning, and related serv- health services is strongly related to the ices in an innovative ways; and reaching achievement of broader health and pop- underserved and disadvantaged groups. ulation goals. The Population Council is an international, nonprofit, nongovernmental institution that seeks to im- prove the well-being and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council conducts biomedical, social science, and public health research and helps build research capacities in developing countries. Established in 1952, the Council is governed by an international board of trustees. Its New York headquarters supports a global network of regional and country offices. Population Council, One Dag Hammarskjold Plaza, New York, New York 10017 USA tel: (212) 339-0500, fax: (212) 755-6052, e-mail:[email protected], http://www.popcouncil.org. Publication of this edition of Quality/Calidad/Qualité is made possible by support provided by the Ford Foundation, and by the Gender, Family, and Development Program of the Population Council. Statements made and views expressed in this publication are solely the responsibility of the authors and not of any organization providing support for Q/C/Q. Any part of this document may be repro- duced without permission of the authors so long as it is not sold for profit. Cover photograph by Tejal Shah. Number Thirteen 2002 ISSN: 1097-8194 Copyright © 2002 The Population Council, Inc. Introduction by Friday Okonofua Infertility is a major reproductive health social consequences are most accentu- problem throughout much of the world.1 ated in developing countries and are gen- Its prevalence in industrialized countries erally more severe for women than for ranges between 6 and 10 percent of wom- men. Male infertility is often not acknow- en of reproductive age; in developing ledged, and the female partner is typical- countries, it may be considerably higher. ly held responsible for a couple’s child- Sub-Saharan Africa has the highest infer- lessness. Indeed, in much of Africa, infer- tility rate in the world, with prevalence tility leaves women vulnerable to physi- exceeding 15 percent in many countries. cal abuse, ostracism, and severe psy- An area known as the“infertility belt” chological problems, as well as divorce. stretches through much of Central Africa; Where resources are available, a com- Gabon and Democratic Republic of the bination of conventional treatments and Congo, for example, have infertility rates new reproductive technologies has en- in excess of 25 percent (Farley and Bel- abled providers to resolve infertility in sey 1988). Furthermore, there is increas- more than 50 percent of cases. Unfor- ing evidence that the prevalence of infer- tunately, in the developing world, most tility has been rising in many parts of the health programs have fewer options. The world. This rise is largely attributable to new technologies are either unavailable an increased incidence of infections, es- or too expensive for the majority of pecially sexually transmitted infections patients. Few clinics serving the poor (STIs) that impair female fertility. Data have any trained staff or systematic pro- also exist suggesting a decline in sperm tocols with which to provide infertility counts in many parts of the world, al- services. Furthermore, unlike attitudes in though the evidence is not conclusive. some Western settings, adopting a baby The cause of infertility varies to some is still considered taboo in many devel- degree by region. Studies indicate that oping country cultures. infertility in developed countries is due Despite the prevalence and serious- mostly to such biological causes as fail- ness of infertility, the population and ure of ovulation (which may sometimes reproductive health field has largely be related to a woman’s age rather than neglected this problem. National poli- to endocrine disease) and “unexplained cies and international donor organiza- causes” (Cates et al. 1985; WHO 1987). tions have been one-sided in their focus By contrast, in developing countries, and on programs designed to prevent un- particularly in sub-Saharan Africa, infer- wanted pregnancies. Little emphasis has tility is largely secondary to undiagnosed been placed on “other kinds” of family or poorly treated STIs (neisseria gonor- planning, that is, on assisting couples rhea and chlamydia), unsafe abortion, who are unable to produce children. and substandard obstetric conditions— Although many countries with a high all of which are preventable. rate of infertility also have elevated rates Although involuntary childlessness is of unwanted fertility, these two are dis- a difficult situation for any couple, its tinct issues and each needs specific atten- 1 Infertility may refer to primary infertility (the woman has never conceived despite extended exposure to the risk of becoming pregnant), secondary infertility (inability to conceive despite previous conception), or pregnancy wastage (ability to conceive but not to produce live offspring) (WHO 1991). Conditions in the male and/or female partner may contribute to infertility. Number 13, 2002 • 1 tion. Undoubtedly, the principles articu- can do a great deal that generally they lated by the 1994 International Confer- are not currently doing for infertile cou- ence on Population and Development in ples. Family planning programs need to Cairo underscore the need to help indi- reexamine their view of infertility and viduals achieve their reproductive goals, consider ways to inform their staff and and advocate for holistic approaches to assist their clients with information and achieving developmental goals. provide at least rudimentary services. The time has come to reverse the Such a reorientation would involve men neglect of infertility and to press for im- in reproductive health care, strengthen provement in its prevention and treat- efforts to reduce STI and reproductive ment as part of reproductive health care. tract infection (RTI) rates, and foster This issue of Q/C/Q, with clinic-based openness toward sexuality issues. Fur- narratives and case reports from India thermore, by addressing an issue that is and Nigeria, illustrates what is involved both sensitive and neglected, family in trying to address the problem of infer- planning programs can win trust from tility in developing countries. In India, communities and enhance program use although 10 percent of couples experi- in developing countries around the ence infertility at some time in their lives, world. By assisting couples who want to resources for treatment are scarce.