The ‘silent pandemic’

Otis Daniels_Finck
Windhoek • Dr David Emvula

Infertility is a global health problem characterized by failure to achieve a pregnancy. It affects both women and men regardless of race, religion, culture, class, or socio-economic status. Although both women and men can experience infertility, women in a relationship are often perceived to suffer from infertility, despite men contributing about 40% of the causes.

Infertility has significant negative social impacts on the lives of infertile couples and particularly women, who frequently experience intimate partner violence, divorce, social stigma, emotional stress, depression, anxiety, and low self-esteem.

In 2009 the World Health Organisation (WHO) recognised infertility as “a disease of the reproductive system” defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Available data suggests that Africa has the highest burden of infertility. In many African countries, the success of marriage overlies on the ability of a woman to bear children.

Therefore, an inability to have a child or to become pregnant can result in great serious psychological trauma and social stigma, may be used as grounds for divorce and will often justify a denial to access any family traditions.

The causes of infertility can be classified into male factors, female factors, or both. These causes vary from congenital to acquired such from past reproductive system infections. If a couple is struggling to conceive, they are advised to see a gynaecologist early so that they can be worked up to find a possible cause.

Once a cause is identified, this will guide appropriate patient management; however, in up to 30 percent of the couples, no cause is found, leading to what is known as unexplained infertility. This too can be treated.

Contraception use or vaccination do not cause infertility. Lately, there has been rumours linking the Covid-19 vaccine to future infertility. Based on how the vaccines are developed and from past experiences with the vaccines, this is unlikely.

While the cause of infertility can easily be found, the biggest challenge globally has been accessing treatment. Availability, accessibility, and quality of interventions to address infertility remain a challenge in most countries, and Namibia is not an exception.

The diagnosis and treatment of infertility is often not prioritized by most countries, especially in Africa with other health challenges such as human immunodeficiency virus (HIV).

In addition to this, most medical aid schemes do not cover for infertility treatment. Assisted reproductive technology (ART) gives hope to infertile couples, even though only a few can afford it.

To address infertility effectively, governments and medical insurance schemes need to recognize infertility as a disease like any other disease, thereby reducing the need for costly and poorly accessible treatments.

*Dr David Emvula is a specialist obstetrician & gynaecologist.