INFERTILITY IS ALWAYS A "WOMAN'S PROBLEM.” - Women are most often accused of being responsible for infertility.

“I feel ashamed, I hate my life, I hate everything, why should it be me, why can’t I have my own children just like every other normal woman, why should I face such humiliation from people, why should my life be filed with hopelessness”, recounted Mrs. Obong (not her real name). Mrs. Obong has been married for 15 years without a child the environment where she lived scorns her but the one that is most distressing for her was that of her husband’s relatives, for they had made life hell for her each time they kept reminding her of her childless status, telling her that she’s not a real woman and if she were she should prove it. All these have made life unbearable for her. Mrs. Obong wouldn’t do anything with herself only to cry, weep and isolate herself from everyone. Her husband didn’t help matters either as he was always on the side of his relations to torment his wife. During my interview with her Mrs. Obong said it wasn’t as if she didn’t seek medical help. Doctors said all was well with her, but her question was if all was well with her, why can’t she bear children. Several times the doctor has asked her to tell her husband to come; it took her husband ten years to go see the doctor. It was later noted that her husband was the cause of the infertility after all but even at that her husband’s relations still insisted she was the cause and told her husband to throw her out. By their 15th marriage anniversary tragedy struck and her husband died. “It was as if the whole world was turned upside down, all hell was let loose”, says Mrs. Obong. She was accused of using witch-craft powers to eat up all the children in her womb and above all kill her husband. They stripped her of all her husband’s belongings and chased her from her home so she returned to her father’s house.

A GLOBAL ISSUE
Infertility is a global issue; it exists in virtually all countries, 8 to 12% of couples around the world have difficulty conceiving at some point of time. Levels vary widely within and between countries, 11 to 20% in Sub-Saharan Africa, rates vary from 14 to 32%. Primary infertility is the most common type world-wide, but with Sub-Saharan Africa being exception with 52% infertile couples suffers from secondary infertility. (Source: Soc Sci Med 1996, vol 42, p212). According to Demographic Health Survey (DHS 1990), Nigeria has Infertility rates (Range %) of about 10.5% to 14.6%. There is about a 40 percent increase in rates of infertility among Nigerian couples in recent times, says a senior gynecologist with the Bridge Clinic hospital in Kaduna, Nigeria. One in every six married couples in Nigeria struggles with the issue of infertility, and about 25 per cent of newly married couples are infertile. Forty percent of that 25 percent would get pregnant on their own through some basic infertility investigations and counseling using some fertility drugs, but the remaining 60 percent of that 25 percent will require some form of assisted conception.

The problem of infertility has broken many homes, separated many couples and caused disunity among couples even when they are still living together. In cases of infertility in marriage, women are most often accused of being responsible for the infertility problem by Nigerian society. The society never sees anything good in a woman without children; even when she has a child they still complain. Sometimes you see a preacher telling women without children to search their lives to ensure they have not committed any sin, as if all the other women that have children are righteous and God is looking at our righteousness before giving us anything. Some other people make comments like, “she has lived a reckless life and has finished aborting all the children in her womb”, while others would say she is a witch and has finished eating up all her children or that she have children in the sea and that is why she can’t have children in the real world. Men and women who cannot bear children often face terrible consequences, including loss of status within the family and community. For women, infertility can be particularly cruel. Women may be ostracized in their families and communities, ridiculed by friends and neighbors, or abandoned or beaten by husbands. Infertile women may not be allowed to touch babies and may be feared as witches. Some women who have no children cannot inherit property and may find themselves without financial support in old age. They may be denied a proper burial. Among the Yoruba tribe in Nigeria, infertile women are called \"Agon,\" from a word that means “to hold in contempt” or “to despise”. EVEN WHEN MALE INFERTILITY IS THE REASON A COUPLE CANNOT HAVE CHILDREN, WOMEN MAY STILL FACE THE THREAT OF DIVORCE. There are a lot of negative effects that childlessness has, such as loss of self-esteem.

LOSS OF SELF-ESTEEM
Parenthood is so much a part of life that it is not just anticipated, it is expected. The inability to reach such a
basic life goal comes as quite a shock, especially to those who are accustomed to orchestrating their lives. It can injure their self-image and make them feel inadequate, like failures. “It's so natural, why can't I?”, is often the anguished plea. To remain childfree may even threaten their sexual identities, since some men equate fatherhood with masculinity and some women consider childbearing the ultimate expression of femininity. As their self-esteem is diminished, men and women often say they feel “incomplete” or “unworthy.” Women without children in Nigeria are always downcast because of all sorts of silly comments from members of the community. The psychological trauma alone that it gives them is outrageous; you see them shying away from even wearing good clothes, makeup or expensive jewelry even when they have the money to buy them. This is because of what is often said of them: people will say that that is the only thing she knows, she is still looking beautiful when she knows she is childless, others would say why won’t she buy expensive things, who is she taking care of. This may not be so in countries like the USA or UK, but in Nigeria and most of the African countries infertility is an OFFENSE. I often hear that in countries like the US or UK, a couple may get married and decide not to have children and will be happy with themselves because their culture allows them to live their life, but in Nigeria the reverse is the case. I have never seen or heard of a couple in Nigeria who gets married and decides not to have children; in fact most times, that’s the reason for the marriage and if after NINE months of marriage there’s no baby or no protruded stomach, everyone begins to wonder, people begin to call your mobile phones asking questions WHY? .

The necessity for a woman to have a child remains fundamental in my region. Motherhood continues to define an individual woman's treatment in her community, her self-respect, and her understanding of womanhood. For example, in Amakiri in Delta State, Nigeria, barren women cannot attain full womanhood and join appropriate age associations since they cannot be circumcised without having given birth. Where to live in their later years is also a major concern for infertile women in Amakiri. Since a wife has no residence rights in her husband's house after his death, except through her son, not having a son means not having a rightful place as an older person. Many childless widows return to their paternal compound but live in marginal conditions, and the infertility stigma even extends to the woman's death.

What some people that care do not understand is that some words they say may be hurtful to women struggling with infertility issues without them knowing is painful to these women; words like, “You've got to get hold of yourself and calm down”, “You shouldn't feel that way when you have so much to be grateful for”, “You're becoming obsessed with having a child”, “Just relax”, “Quit work and you'll get pregnant” or “Adopt and you'll get pregnant”. Such comments reveal serious misunderstandings about infertility because until you are there, there is no way you can understand. A lot of women have gone through this painful path of infertility, one of the women I interviewed anonymously said “I have been through that painful path myself, having to struggle with the issue of infertility for seven years was a bitter experience that I don’t even wish for an enemy. I was downcast even when I try to pretend all was well, and deep-down I knew I needed a miracle”. “At this particular time in my life, most of my friends and family would tell me “leave all that you are doing and rest so that you can get pregnant”. I kept wondering how I could abandon everything I was doing to eat, sleep and have sexual intercourse in order to get pregnant”, She recounted.
In Nigeria, marrying and not having a child is an experience that will bring any one shame, humiliation, disgrace, name it.

INFERTILITY: NOT THE WOMAN’S PROBLEM ALONE
It is a myth that infertility is always a \"woman's problem.\" There’s a need for everyone to know that the problem of infertility is not with the woman alone, because infertility affects men as well as women. Of the 80 percent of cases with a diagnosed cause, about half are based at least partially on male problems (referred to as male factors)--usually that the man produces no sperm, a condition called azoospermia, or that he produces too few sperm, called oligospermia. (Source: excerpt from Infertility: NWHIC). The problem may be with the woman (40% of the time) or the man (40% of the time). In the remaining 20%, both individuals have problems or the reason for their infertility is unknown. Infertility affects about 12 percent of couples of childbearing age. Infertility is not just a woman's concern. A problem with the male is the sole cause, or a contributing cause, of infertility in about 50 percent of infertile couples. About one-third of infertile couples have more than one cause or factor related to their inability to conceive. About 20 percent of couples have no identifiable cause for their infertility after medical investigation. The medical examination for both couples is necessary in the diagnosing and treatment of infertility and should not be left for only the women to do. Since both the husband and the wife with issues of infertility have a stake in it, it becomes very necessary for both of them to seek medical help.

WHAT IS INFERTILITY?
Infertility is defined by the American Society for Reproductive Medicine (ASRM) as a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and depends on the proper function of many factors, including the following, as listed by the ASRM:

• Production of healthy sperm by the man.
• Production of healthy eggs by the woman.
• Unblocked fallopian tubes that allow the sperm to reach the egg.
• The sperm's ability to fertilize the egg.
• The ability of the fertilized egg to become implanted in the uterus.
• Adequate embryo quality.
As indicated by the medical definition, fertility requires the well-being of both man AND woman.

HOW FRIENDS AND FAMILY CAN HELP
In conclusion, the need for Nigerian society to expand their understanding of couples with fertility issues is very essential. Friends and family can help couples struggling with infertility issues feel better rather than hurt. Ultimately, many infertile women and men become enraged over these multiple losses. They are upset by other people's insensitivity, hurt by criticism from their families, tired of poor treatment, frustrated by limited options and resentful of their “fishbowl” existence. They feel the wound of infertility in every part of their being, and there are no simple remedies to ease such deep pain and extensive loss. But support from family and friends can help -- making infertile women and men feel better about themselves, relate better to those who care about them and respond better to treatment. One Houston endocrinologist has even suggested there would be “more successful pregnancies if family and friends knew how to be emotionally supportive.” This task will be easier if those who want to help respond in a more compassionate and understanding way to the losses of infertility.

This article is part of a writing assignment for Voices of Our Future a program of World Pulse that provides rigorous new media and citizen journalism training for grassroots women leaders. World Pulse lifts and unites the voices of women from some of the most unheard regions of the world.