Men and infertility in The Gambia: Limited biomedical knowledge and awareness discourage male involvement and exacerbate gender-based impacts of infertility

Abstract

Introduction Infertility in Sub-Saharan Africa constitutes an important social and public health problem. Yet, there is a paucity of research on the experiences of men living with infertility, especially in West Africa. This study explored men’s aetiological knowledge, views and experiences of infertility in the West Coast region of The Gambia, West Africa. Methodology An explorative qualitative study was conducted among men living in the rural and urban communities of the West Coast region of The Gambia using in-depth interviews. Data collection and analysis were performed concurrently, and thematic data analysis was an iterative process carried out using NVivo 11 Analysis Software. Results Gambian men had generally poor knowledge of infertility, allocating it to God, spiritual powers and bodily (biomedical) factors. While societal norms meant that infertility was generally attributed to women, some men allocated male-factor infertility to poor sperm quality and impotence. Infertility threatened participants’ sense of masculinity and resulted in psychosocial distress, including stigma, feelings of isolation, and low self-esteem. Conclusion Normative gendered frameworks of infertility result in high levels of female responsibilisation in the Gambian context. Yet men diagnosed with infertility experience significant, often unrecognized, psychological and social distress. We therefore call for increased attention to male-factor infertility, and the promotion of male engagement with infertility-care and services, both of which are essential for successfully addressing infertility and it’s psychosocial consequences in The Gambia.

Availability of services for the diagnosis and treatment of infertility in The Gambia`s public and private health facilities: a cross-sectional survey

“…This is further confirmed in this study, which indicate that male partners are more involved in infertility treatment in follow-up visits compared to initial visits. These findings also illustrate similarity with a studies conducted in SSA [ 34 , 49 , 50 ]. Surprisingly, in our study, less than 25% of the consultations are reportedly for male factor infertility, as many studies [ 51 – 54 ] conducted elsewhere have found that the causes of infertility are equally split between genders (in heterosexual couples).…”

“…Given that the majority of institutions reported most of the consultation were attended by women and the members of the couple visit the facility alone, we can conclude that women attend initial consultations for infertility without their partner [ 48 ]. Although in approximately half of initial consultations by women for fertility problems their partner was not present (results are comparable in both health sectors), the preference of the medical practitioners is to manage infertility as a couple’s issue [ 34 ]. This is further confirmed in this study, which indicate that male partners are more involved in infertility treatment in follow-up visits compared to initial visits.…”

“…This could also be the result of men attending visits of their spouses without being themselves diagnosed. Research has previously shown that stigma surrounding fertility problems for men could results in poor health-seeking behaviour, and increase the already scarce male involvement in the therapeutic journey [ 34 ]. It is imperative to understand the aetiology of infertility issues from a Gambian perspective.…”

“…In this regard, The Gambian health system may consider adapting its HMIS form to collect consultations for infertility-related issues, disaggregated by sex, in a systematic and comprehensive way. This could stimulate The Gambia to investigate further concerning the true prevalence of infertility in its population and to adapt its reproductive health services for greater inclusion of neglected issues, especially among men [ 34 ].…”

Male Infertility in Nigeria and South Africa: A Ten-Year Observational Study

“…It is estimated that about 48 million couples and 186 million individuals suffer from infertility [2,3]. Although infertility is not a life-threatening condition, it is often associated with emotional, physical, psychological distress, social and socioeconomic factors [4][5][6][7].…”