This paper examines how socio-economic contexts shape local meanings of infertility, how the prevalence of infertility affects these meanings, and how the above affect community responses, life experiences and infertility treatment-seeking behaviors in two African communities. The paper is based on interdisciplinary research conducted among the Ijo and the Yakurr people of southern Nigeria that included a survey of approximately 100 infertile women and a matching sample of 100 fertile women, as well as in-depth ethnographic interviews with infertile and fertile women in two communities: Amakiri in Delta State and Lopon in Cross River State. In-depth interview results show that female infertility is more problematic among the Ijo in Amakiri, where kinship is patrilineal (traced through the father's side), than among the Yakurr in Lopon, where kinship is double unilineal (traced through both parents). Childless women in Ijo society are not only disadvantaged economically but are prevented from attaining full adult womanhood. They therefore leave the community more often than other members. In Lopon there is also a strong preoccupation with fertility as a central fact of life, but infertile women receive support from maternal kin as well as voluntary associations serving as support groups. Our survey data confirm that there are significant differences between the life experiences of infertile and fertile women and between the infertile women of the two communities. The overall findings indicate that while there are variations in the extent to which infertility is considered problematic, the necessity for a woman to have a child remains basic in this region. Motherhood continues to define an individual woman's treatment in the community, her self-respect and her understanding of womanhood.

Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African Programme for Onchocerciasis Control (APOC), for large-scale distribution of ivermectin (Mectizan). Participatory monitoring of 39 of the control projects based on community-directed treatment with ivermectin (CDTI) was undertaken from 1998-2000, with a focus on process implementation of the strategy and the predictors of sustainability. Data from 14,925 household interviews in 2314 villages, 183 complete treatment records, 382 focus-group discussions, and the results of interviews with 669 community leaders, 757 trained community-directed drug distributors (CDD) and 146 health personnel (in 26 projects in four countries) were analysed. The data show that CDD dispensed ivermectin to 65.4% of the total population (71.2% of the eligible population), with no significant gender differences in coverage (P > 0.05). Treatment coverage ranged from 60.2% of the eligible subjects in Cameroon to 76.9% in Uganda. There was no significant relationship between the provision of incentives to CDD and treatment coverage (P > 0.05). The frequency of treatment refusal was highest in Cameroon (29.2%). Although most (72.1%) of the communities investigated selected their CDD on the basis of a community decision at a village meeting, only 37.9% chose their distribution period in the same way. There is clearly a need to improve communication strategies, to address the issues of absentees and refusals, to emphasise community ownership and to de-emphasise incentives for CDD. The investigation of the 'predictor indicators' of sustainability should enable APOC to understand the determinants of project performance and to initiate any appropriate changes in the programme.

The literature on male role and responsibility for reproductive health in Africa supports the impression that African men are uninterested in the consequences of their reproductive behaviour. This paper argues this view to be inaccurate and historical. The perceived apathy results from the feminization of reproductive knowledge and its confinement to clinical settings, which exclude and alienate men. Men were indeed principal providers of healthcare for their households in the pre-colonial period but were dislodged from this role by the incorporation of their societies into the international labour market, thereby creating working class poverty, and weakening their role in this regard in Nigerian family life. The campaign to involve men in reproductive health programmes should be accompanied by poverty alleviation and family support schemes to mitigate rising costs of modern medical care for themselves, their partners, and their children.

Nigeria's ambitious population policy, adopted in 1988, had its origins in the international population and development thinking of the time, set out in documents such as the World Population Plan of Action and the Kilimanjaro Programme of Action. The policy has had at most a modest effect in curbing the country's high fertility. This failure, it is argued, stems from the policy's implicit assumption of a single, monolithic cultural reality and its disregard of male reproductive motivation. Belief systems in Nigeria are extraordinarily diverse in detail but share a common interest in the fertility of crops, livestock, and people. Patterns of social organization are similarly varied. For an effective population policy, the government needs to find ways of incorporating distinct elements of the cultures of the different ethnic groups, leveraging rather than suppressing the country's cultural diversity. Copyright 2003 by The Population Council, Inc..

This paper examines the experiences of women with infertility in two Nigerian communities with different systems of descent and historically different levels of infertility. First, the paper focuses on the life experiences of individual women across the two communities and second, it compares these experiences with those of their fertile counterparts, in each community. In doing this, women who are childless are distinguished from those with subfertility and compared with high-fertility women. The research is based on interdisciplinary research conducted among the Ijo and Yakurr people of southern Nigeria, which included a survey of approximately 100 childless and subfertile women and a matching sample of 100 fertile women as well as in-depth ethnographic interviews with childless and subfertile women in two communities: Amakiri in Delta State and Lopon in Cross River State. The findings indicate that while there are variations in the extent to which childlessness is considered to be problematic, the necessity for a woman to have a child remains basic in this region.