Hope rises for infertile women

The major difficulty associated with infertility in a developing countries like Nigeria is that it transforms from a private agony into a public stigma, with complex and devastating consequences. Reporters writes on how 'Merck More than a Mother' initiative is engaging professionals in Assisted Reproductive Technology (ART) to cause a cultural shift, and also empower affected women.

The expansive hall of the Oriental Hotel, Victoria Island, Lagos was filled to capacity. It was the Nigerian leg of the launch of the 'Merck More than a Mother' campaign. The campaign is a pan-African dialogue to empower infertile women in developing countries. Merck aims to empower them through access to information, health and change of mind-set with the initiative that was launched in June, last year.

Stakeholders from all walks of life - lawmakers, activists, pressure groups, sufferers, survivors, pen pushers, men, women, mothers, fathers, non-governmental organisations (NGOs) and even children - were in attendance.

Tears flowed. Some women stifled their cries. The participants wore a look of incredibility as viictims - one after the other - told their stories. This compelled the Chairman, Senate Committee on Health, Dr Lanre Tejuoso, to announce that his committee would ensure a quick regulation of Assisted Reproductive Technology (ART) in Nigeria.

Jackline Mwende, a victim of infertility stigma, was the first to relate her story. Jackline had her hands brutally chopped off for failing to bear children after seven years of marriage.

Jackline Mwende, a young woman of 27 years from Masii, Machakos County in Kenya, had her hands hacked off - not by thieves - but by her husband for failing to conceive, even though he was the one with fertility problems. Her husband told her 'today is your last day'.

"It is so shocking that someone would go to such an extent to batter his own wife and leave her nearly dead. Infertility should never be a reason to separate, hurt or kill your partner. There are so many options out there available to manage infertility," said Hon. Joyce Lay, member of Parliament and the ambassador for 'Merck More than a Mother' in Kenya.

"Through 'Empowering Berna' project, Merck will support Jackline Mwende throughout the rest of her life to empower and enable her to become an independent productive member in the society. 'Merck More than a Mother' initiative will provide Mwende with a monthly income of $250, it will establish a business for her through which she will be able to generate a sustainable monthly income of not less than $250.

"At the same time Merck will provide her with the needed physical and physiological rehabilitation to enable her to support herself and stand on her own two feet, despite the challenge of her disability that was caused by the stigma of infertility - even though her husband is the one who was found with the infertility problem, yet she is still the one who bore the devastating consequences of the public stigma associated with it," said Rasha Kelej, Chief Social Officer, Merck Healthcare.

Mwende didn't deserve what she went through and, especially, because her husband was the one with the infertility problem. Society, government and stakeholders need to continue to join hands with Merck in its campaign to encourage the acceptance of people living with infertility because the stigma associated with it puts pressure on them to a point where they do crazy and criminal things. We need to know that it's a shared responsibility, not just for the couple but for the society too.

"Jackline Mwende's story is the reason all people should appreciate 'Merck More than a Mother' initiative. No sane person should torture a woman for failing to produce children. Men should not think that their failure to be a biological father is due to women's infertility. Why torture a fellow human being and inflict such permanent bodily harm for a fault that could be yours? No amount of justice in the courts of law will bring back Mwende's arms. Justice will only prevail if Mwende's case marks a turning point in society that appreciates one fact- 'that women are women irrespective of their ability to bear children- they need to be respected,' emphasised Hon. Sarah Opendi, Uganda Minister of State of Health and the Uganda ambassador of 'Merck More than a Mother'.

"This terrible violence Mwende suffered has emphasised the significance of 'Merck More than a Mother' initiative for Africa. 'Merck More than a Mother' will continue working closely with partners to create a culture shift and to empower infertile women economically and socially through "Empowering Berna" Project to ensure no other woman in Africa should ever go through such violence, humiliation or misery again," Rasha Kelej emphasised.

Mwende's husband has been accused of attempting to kill her and is waiting for his trial.

Jackline Mwende is not alone. In many African cultures, childless women still suffer discrimination, stigma and ostracism. Infertility can transform from an acute, private distress into a harsh public stigma with complex and devastating consequences. An inability to have a child or to become pregnant can result in being greatly isolated, disinherited or assaulted. This may result in divorce or physical and psychological violence.

'Merck More than a Mother initiative' aims to define interventions to reduce the stigma and social suffering of infertile women, empower them and raise awareness about male infertility and the necessity for a team approach to family building among couples across the continent.

According to the World Health Organisation (WHO), lower levels of development are thought to be associated with higher levels of non-genetic and preventable causes of infertility. For instance, poor nutrition, untreated sexually transmitted infections (STIs), unsafe abortion, consequences of infections caused by the practice of female genital mutilation (FGM) or child marriage, exposure to smoking, leaded petrol and other environmental pollutants can lead to infertility.

For Victoria John Kuba, a resident in the Northern part of Nigeria, she walked out of her marriage when she could not bear the beatings by her husband due to childlessness. She met her husband while she was still in school through a friend. They dated for a short period and got married. They hoped to have children but no pregnancy. Then problems arose in their home. Her husband insulted and made jests of her. Her father-in-law would often come from the village to check if she was pregnant.

Recapping her experience, Victoria said after her husband and she got married, they lived together for two years without a child. He got impatient, causing her to seek fertility solutions. She went to a hospital, there the doctor confirmed that her womb was tampered with, and that it would take the grace of God for her to conceive. When her husband heard this, they started having marital problems. Things really got bad between them. Whenever he came back from work, he beat her, insulted her and alleged that she removed her womb and fed it to pigs. He said her family knew she could not conceive, yet they gave her out in marriage to him. He beat her continually and Victoria had nowhere to run to.

As for her father-in-law, who resided in the village, whenever he visited the couple, he always said Victoria's mother-in-law sent him to check if she was pregnant. He went into the couple's room at night when the couple is sleeping without knocking, or asking for permission. He insulted her husband that he wasted money in marrying her.

There was a night; Victoria's husband pressed her face forcefully, almost choking her to death. She struggled for her life. She could not breathe. She struggled and screamed. She tried to free herself but then he bit her at the back of her head. She screamed and bit him back, he then let go of her. She ran out naked, picked up a neighbour's wrapper, tied it around her waist and ran for her dear life.

Moved by her story, the audience went dead. If a pin had dropped, the sound would have sounded like a clanging cymbal. It drew empathy.

Victoria went to her sister's house, and then she called her pastor and informed him of what happened. The pastor scheduled a meeting with her husband and her. At the meeting they could not reach an agreement, so they separated from each other.

Victoria said if God comes down today she will ask him why He did not give her a child, even if it is just one. "God didn't give me a child, or peace of mind. No peace from my husband, no child. I will ask God all these questions. If I could turn back the hands of time, I would never have gotten married. I will live without a husband," moaned Victoria.

She said she appreciated Merck for helping her to live a better life. "And I thank God and believe he has not forgotten me. Merck has set up a Kerosene business for me. I hope to go back to school from the profit I made from the sales. Before now, I was into laundry work. I don't get regularly paid, and may not even have transport fares. During the raining season, it is difficult for clothes to dry sometimes. And if stained in this period, I don't get paid," Victoria explained.

Victoria doubts her remarrying again. Chinelo Azodo, Ijeoma Ezeaku, Oluchi Omenife, and Nneka Omenife shared their experiences as well. And have been reached out to by the "Merck More than a Mother" initiative.

President, Africa Fertility Society (AFS), Prof Oladapo Ashiru, said according to the World Health Organisation (WHO), lower levels of development are thought to be associated with higher levels of non-genetic and preventable causes of infertility such as poor nutrition, untreated sexually transmitted infections (STIs), unsafe abortion, consequence of infections caused by the practice of female genital mutilation, exposure to smoking and to leaded petrol and other environmental pollutants. Hence prevention awareness is very important.

"Together we can create a culture shift", the 'Merck More than a Mother' social media campaign will challenge the social and cultural perception of infertile women in Africa. Moreover it will raise awareness about male infertility, prevention of infertility and infertility management at large. Women are the ones who seek help when they cannot get children. Yet in most of the cases doctors keep treating women who have no problem. Men need to accompany their women to the clinic. When men do this the success rate of fertility treatment is higher," said Prof Ashiru.

Vice-President, Africa Fertility Society, Dr. James Olobo-Lalobo said, "We are very happy to partner with Merck, through this historic campaign, "Merck More than a Mother" where specialised practical training for our embryologists will be provided and awareness about prevention of infertility and male infertility will be raised across the continent for the first time in history. Together with Merck, we can challenge the perception about infertile women, their roles and worth in society, both within and beyond the medical profession in order to achieve any systemic shift in the current culture of gender discrimination in the context of fertility care".

Dr Tejuoso said the National Assembly organisation is committed to ensure the issues are bought to the front burner as he said, "Nigeria has a population of 180 million people and so also has a big infertility problem. When there is infertility people believe it's more spiritual than physical. Therefore, members of parliament (MPs) have a big role to play as we can go all over the country to educate people and I commit to be an ambassador of "Merck More than a Mother" campaign in Nigeria.

Dr Abayomi Ajayi of Nordica Fertility Centre, Lagos said ART has come to stay in Africa, nay Nigeria and should be explored by fertility challenged couples.

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