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Radio Review: Health Check - Fertility on a Shoestring

14 July 2014
Appeared in BioNews 762

South Africa has a hidden problem: suicides of women who are unable to conceive.

These tragedies are the final surrender to a cultural prejudice widespread across Africa. Women who do not bear children can face the loss of their husband, their family, their home, their identity even, and become alienated from society. An Egyptian saying came up at one point in this documentary: 'If you do not have children you do not have a name'.

It can continue even after death; in some African countries, childless women may not be buried according to their traditional rites for fear they will cause the ground they are buried in to become barren. Their bodies are left to decay elsewhere. This fate will include men also; both men and women will be forbidden to leave with their ancestors.

Africa venerates fertility, a trait found wherever life is fragile due to climate or poverty or conflict; it is almost as if there is a pulse in society resuscitating arid ground. Yet, as this BBC World Service programme informs us, the quest for life can mean death for some women.

African doctors may be familiar with the emotional pain of couples who come to them for help, but with such a focus on provision of resources for tuberculosis or HIV/AIDS, infertility treatments are low on the list of priorities and, most significantly, are expensive.

Dr Matsaseng from Tygerberg Hospital in Cape Town created a low cost fertility programme with a public-private partnership. His patients only pay for the treatment they have; their money isn't needed to cover the clinic's other expenses.

Other hospitals are focusing on providing surgery for women who have blocked fallopian tubes, which can cause fertility. This may occur secondary to sexually transmitted infections. And in a country where sexual violence is a serious social issue, women are put further at risk of gynecological problems including infertility.

There are so many pressures. When a woman marries, her family often provide a bride price, normally a number of cows. If she is unable to conceive, the family may ask for this back and she will be ostracized from both families. In other cases, some South Africans will sell all their assets, cut back on food and borrow from loan sharks to try to afford medical treatment for their fertility problems.

It was encouraging to hear about initiatives to provide fertility treatment to people in poverty in South Africa, as well as the ongoing battle to raise infertility on the political agenda. But this documentary may have focused too much on the promise of scientific medicine and not enough on the deep-rooted beliefs that can cause such widespread harm to mental health.

The programme would have been much richer if the cultural context, the traditional belief systems and the high value of childbearing had been examined in the discussions between patients and doctors.

Frequently in clinical consultations in South Africa, you mesh scientific medicine with traditional, symbolic beliefs about the human body. These beliefs often affect people's choices - there are many people in South Africa for whom clinical treatment is not an option and who will place their trust in traditional healers.

The role of ancestors, even in the phenomenon of new life, forms the backbone of traditional and cultural narratives in South Africa. I feel that kind of cultural context was missing here. A shame, as this programme raises issues that are too often ignored in Africa-based documentaries.

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