Professor Atiene Solomon Sagay - University of Jos Institutional ...

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couples, no abnormalities are found (unexplained infertility). It is estimated that one out of every 6 couples in Nigeria are infertile. We evaluated 1000 consecutive infertile women in Jos, Nigeria and found that 410 (41%) had never ever conceived (primary infertility) while 590 (59%) have had at least one prior pregnancy (secondary infertility) (Sagay et al 1998). More than 4 out of every 10 (42.3%) of these women had blocked tubes on both sides (bilateral tubal occlusion). Of the 548 (54.8%) of these infertile women who were found to have pelvic adhesive disease, two-thirds (66%) had moderate to severe pelvic adhesions for which reconstructive surgical outcome is poor. What this means is that a large proportion (about 40%) of infertile women in Nigeria have badly damaged reproductive organs for which assisted conception in the form of in-vitro fertilization and embryo transfer (a.k.a. test tube baby) is required. The prevailing cost of this procedure in Nigeria (about 700,000 Naira) is however out of the reach of most infertile couples in this country. On the male side, we studied the semen quality of male partners of infertile couples in Jos (Imade et al. 2000). In all, we analysed the semen of 428 male partners of infertile women using the World Health Organisation (WHO) guidelines. The findings revealed that 124 (29%) of the men had normal semen parameters (normozoospermia) while 304 (71%) had abnormal semen quality. The semen abnormalities comprised; 39 (9.1%) with complete absence of spermatozoa (azoospermia), 89 (21%) with significantly reduced population of spermatozoa (oligozoospermia), 22 (5.1%) with poor movement (asthenozoospemia) and 18 (4.2%) with abnormal physical forms (teratozoospermia). Another 134 (31.5%) men had various combinations of these seminal abnormalities. The findings suggested that the male partner is a significant contributor to the problem of infertility in Jos. Psycho-social consequences of infertility A Yoruba adage says “Omo laso”, meaning children are clothes, without them you are naked. Infertile couples feel insecure and vulnerable to societal stigmatization. The psycho-social challenge faced by infertile women is age-long. Evidence from biblical time shows that women have contemplated suicide as a response to their continued barrenness. Rachael, wife of Jacob considered live worthless without a child of her own: [Gen 30:1 And when Rachel saw that she bore Jacob no children, Rachel envied her sister. And she said to Jacob, Give me sons, or else I will die]. Anthropologists who worked in different communities in the South-south region of Nigeria concluded that; "the necessity for a woman to have a child remains basic in this region. Motherhood continues to define an individual woman's treatment in her community, her selfrespect, and her understanding of womanhood" (Hollos et al 2009). In focus group discussions on the social meaning of infertility in south-western Nigeria, (Okonofua et al.1997) reported the following community perceptions; that infertility is not often discussed, and if at all, must be discussed carefully and privately. This was largely to avoid embarrassing those who were infertile. that an infertile person would be extremely sensitive to any discussion about children or pregnancy, and would assume that even comments in casual conversations were 2
meant to make fun of them. This is in the context of the belief that a person without children has failed in a fundamental way. that women are most often blamed for the infertility problem. There are many who believe that a man cannot be infertile, as fertility and potency are often thought to be synonymous. that a common consequence of a couple's infertility is the expulsion of the woman from the husband's house, with or without divorce. People most commonly responded by saying the husband would ‗send her packing‘. Thus, having children is clearly more important than loyalty to one's spouse, which is evidenced by the common practice of divorce because of childlessness, or forceful ejection of the wife from the husband's home, either by the husband himself or by his family. that infertile women are often excluded from inheriting property, from decisionmaking in the family, and from any type of financial or social security. that it is common for people to avoid those women known to be infertile, and women often tell their children to avoid these women, either because they think the women might harm their children because of their bitterness, or because they might not know how to look after other children properly. that there are strong beliefs that some infertile women were witches, had given birth to children in another world, and taken a secret vow never to bear children on earth. This belief justifies the attempt to ostracize these women, and to expel them from their households. that often, any subsequent misfortune of the woman or family which would ordinarily be taken in isolation may instead be attributed to her infertility and/or witchcraft. A woman‘s ability to make decisions within the family, and her ability to inherit her husband‘s property are almost exclusively dependent upon fertility. Clearly, infertile women in the Nigerian socio-cultural setting face tremendous challenges and perhaps as a consequence, there is a high prevalence of psychological problems among infertile women. In a Nigerian study, nearly one-third of infertile women were found to have diagnosable psychopathology, mainly depressive episode and generalized anxiety disorder. Compared with the control group, the infertile women experienced poorer marital relationships and polygamy was found to have a close association with psychopathology. (Aghanwa et al.1999) A recent article in the Canadian Medical Association Journal reported the finding that motherhood appears to protect against suicide, with increasing numbers of children associated with decreasing rates of death from suicide. Having children may protect against suicide because children may increase a mother's feelings of self-worth. Children may also provide emotional and material support to a mother and provide her with a positive social role. As well, motherhood may enhance social networks and social support. Recurrent pregnancy losses (Habitual abortion) There is no experience more difficult than having to go through a miscarriage during pregnancy. Miscarriage is not only physically taxing, but very emotionally challenging, as well. Yet, pregnancy loss can be even harder to deal with when it occurs time and time again. 3
Page 1: FACING THE CHALLENGES OF MOTHERHOOD
Page 5 and 6: estimates, more than 3,000 women di
Page 7 and 8: For every woman who dies, 15 to 30
Page 9 and 10: Table 1: Nursing personnel gaps in
Page 11 and 12: The tragedy of an obstetric fistula
Page 13 and 14: Figure 1: Diagram shows rising tren
Page 15 and 16: ankers or accountants. Table 2b. Th
Page 17 and 18: Table 2d. The associations between
Page 19 and 20: Figure 3: Health Facility Deliverie
Page 21 and 22: Figure 7: Hub and Spoke Illustratio
Page 23 and 24: The study documented a high prevale
Page 25 and 26: Evidence of declining prevalence Th
Page 27 and 28: 9. Henshaw SK, Adewole I, Singh S,
Page 29: 34. Sagay AS, Adisa OJ, Ekwempu CC,

Professor Atiene Solomon Sagay - University of Jos Institutional ...

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