A GNA Feature by Bertha Badu-Agyei
Accra, Aug. 5, GNA – In many parts of Ghana where having children is prized as the main reason for a woman’s existence, women are blamed for a couple’s childlessness and thrown out of their marital homes, to a life of isolation and destitution.
When Lucy Ayaw and her husband got married, they were looking forward to starting a family. Her husband was eager to become a father because he needed to prove to his family that he could continue the lineage before being installed as the head of their clan after his father’s death.
However, Madam Ayaw suffered three miscarriages, and months turned into years without a child. After five years of incessant demands from his kinsmen to produce an heir with his wife or get second nother wife, her husband gave in and married another woman. Within two years, his new wife delivered a set of twins.
Madam Ayaw sought help from ritualists and herbalists who gave her all manner of concoctions to help her carry the pregnancy to term, but nothing worked. After 15 years of marriage, her husband’s kinsmen said she was not worthy to be a wife and kicked her out of her matrimonial home.
“I lost my marriage and everything I had put into it because I am childless. They say I am responsible for the inability to bear children,” she told GNA.
Esi Aryee, 49, who suffered same fate was also kicked out of three marriages for not bearing children.
In Ghana, and many parts of Africa, marriage is synonymous with childbearing and infertility is stigmatised. A study on infertility in northern Ghana published by BMC Pregnancy and Childbirth found that childless couples are excluded from leadership roles. Women are often blamed, ostracised and suffer psychological abuse for childlessness, which is a major cause of marital instability and divorce. As a result, women, who are often dependent on men, suffer serious economic deprivation.
In Ghana, where women are often blamed for a couple’s lack of children, studies have found that the prevalence of infertility in Ghanaian men was 16 per cent, while that in women was 12 per cent. Ninety per cent of the time, sperm quality was the cause of male infertility, with smoking and sitting for long hours influencing sperm motility (movement) and count, respectively.
According to the World Health Organisation, infertility in men is also caused by premature ejaculation and erectile dysfunction and the quality of sperm. In women, infertility is caused by disorders of the ovaries, reproductive hormones, the uterus, and fallopian tubes. Untreated sexually transmitted infections or complications of unsafe abortions can lead to blocked fallopian tubes.
A couple is diagnosed with infertility when there is no pregnancy after 12 months of regular unprotected sex. However, many couples do not go to the hospital. The burden of bearing children is placed on women, who attribute involuntary childlessness to supernatural factors and seek treatment from herbalists unsuccessfully.
Mrs Yaa Wiredu, a Clinical Psychologist, told the Ghana News Agency (GNA) that many women do not seek treatment due to superstitious beliefs and those who seek medical attention does so at later stages.
“After a year of unprotected sex with no pregnancy, couples should seek medical attention and not take concoctions,” she said.
Many, eventually, go to the Hospital and according to three gynaecologists who talked to GNA, in nine out of 10 cases where the woman is given a clean bill of health and asked to bring her husband along for a checkup, the men decline. Upon diagnosis many can’t afford the treatment.
Madam Ayaw, who is now 45 years old, only went to the Hospital after being kicked out of her matrimonial home. She was diagnosed and treated for anaemia for a month. The doctor explained that she needed a relaxed atmosphere because stress could make it difficult to conceive.
Madam Aryee, on the other hand, was diagnosed with blocked fallopian tubes. She couldn’t afford the treatment and her husband refused to help her pay for it.
“He said he would not waste his money on Hospital treatment where herbal medicine had failed,” she recalled.
The World Health Organisation (WHO) notes that infertility treatments are not readily available or accessible in most countries because governments do not prioritise or allocate funds for the diagnosis and treatment of infertility. In Ghana, the National Health Insurance Scheme (NHIS) covers some costs like laboratory tests, but many other fertility treatment costs are not covered.
Where interventions like in-vitro fertilisation (IVF) are prescribed, they are only available in private clinics in major cities and are unaffordable, according to an international Pregnancy and Childbirth report in 2013, four in 10 women of childbearing age in northern Ghana said that IVF was neither accessible nor affordable and seven in 10 said it was too expensive.
A paper presented at the IVF Global Histories Symposium in 2016, found that many users of assisted reproductive technology in Ghana were wealthy, highly educated and owned or worked in private companies. Those without means had to save up for years, sell their property, take out loans or raise funds from relatives to get the 2500 Euro (approximately 31,000 Cedis) required for one cycle of IVF. The researchers said that while a lower-cost technology that uses a simplified laboratory method could cut IVF costs by half, it would still be unaffordable to many.
At Awutu-Senya, where Madam Ayaw and Madam Aryee live, the high levels of poverty mean that women cannot afford fertility treatments. Madam Faustina Krampa, who is a member of the Awutu-Senya District Assembly, told GNA that because many women depend on their husbands for financial support, they become even more vulnerable if their marriage ends due to infertility.
These women rely on non-governmental organisations like Merck Foundation to get back on their feet. The Foundation’s “More Than a mother” campaign seeks to inform, educate, and change mindsets on infertility in nine countries – Ghana, Kenya, Uganda, Nigeria, Tanzania, Central African Republic, Ethiopia, Liberia, and The Gambia – and help women without children gain social acceptance and skills to help them earn a living and live independent life.
Merck Foundation disbursed small business grants to a group of women including Madam Ayaw and Madam Aryee. Given that the district’s main economic activities are fishing, farming, and agro-processing, the women set up a cold store.
Madam Aryee told GNA that being part of the group gives her an income and a sense of belonging.
“I used to stay indoors for fear of stigma, but now that I work at the cold store, I am happy, and I can earn and save money to seek medical treatment. I hope I will have a child before I die,” she said.
Empowering women economically gives them power to seek and afford treatment and to sustain themselves. In addition to empowering women, the WHO proposes that governments focus on prevention through education and promoting healthy lifestyles to reduce, prevent and treat STIs, prevent complications of unsafe abortion and infections after birth and pelvic surgery. Moreover, governments should provide equitable access to effective fertility care by ensuring the availability of trained health workers and the necessary medication, equipment and infrastructure that would bring down the cost of treatment.
This article was produced as part of WA GBV Reporting Fellowship with support from the Africa Women’s Journalism Project (AWJP) in partnership with the International Center for Journalists (ICFJ) through the support of the Ford Foundation.
GNA