The fertile grounds of reproductive activism in The Gambia: A qualitative study of local key stakeholders’ understandings and heterogeneous actions related to infertility

Abstract

IntroductionWhile several studies have focussed on the experiences of women living with infertility, there is a paucity of information related to understandings, representations and actions of key stakeholders (i.e. organisations and individual actors involved in activities or professional care surrounding infertility) when it comes to infertility in Sub-Saharan Africa. This ethnographic study conducted in The Gambia, West Africa, focuses on how key stakeholders in the country understand infertility, and on their activities to improve the lives of people with infertility.MethodologyThis ethnographic study draws on primary and secondary data for thematic analysis. Primary qualitative data were collected using in-depth interviews, observations, informal conversations and group discussion with various stakeholders (i.e. health care providers and representatives of non-governmental, governmental and international organisations). Sources of secondary data included government and non-governmental reports and media outputs.ResultsResults illustrated that most key stakeholders had a good understanding of the cultural frameworks and social realities of women living with infertility, with less focus on, or awareness of, men’s experiences of infertility. We distinguished three different positions of these actors and organisations, first, the infertility supporters, i.e. those who despite political challenges and a lack of funding, initiated activities to raise awareness about the problems people with infertility are facing and aim to increase access to infertility services. The second are moderate supporters, i.e. those who recognise the problems infertility poses and whose organisations target some of the perceived causes of infertility (i.e. lack of health education and harmful cultural practices). A third group of neutral or moderate opponents consist mainly of formal health care providers who do not consider infertility a current priority, given many competing demands in the resource-constrained healthcare system.ConclusionWhile international donors still largely neglect the emotional and social implications of infertility in Sub-Saharan African countries, some local stakeholders are working to bring services closer to people with infertility. The efforts of these local stakeholders require support and integration, and should include engaging with different groups for widespread sensitisation to reduce stigma and promote attendance to health centres for reproductive health challenges.

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

“…While cost is a major barrier in resource-limited health systems, some approaches–including early diagnosis and treatment of reproductive tract infections–are relatively simple and cost-effective [ 12 ]. This is particularly pertinent in sub-Saharan Africa, where untreated infections and subsequent pelvic inflammatory disease, are thought to be the main causes of infertility [ 3 , 13 , 14 ].…”

The Nairobi Summit and Reproductive Justice: Unmet Needs for People with Infertility

“…2,3 The prevention and management of infertility was recognized as a basic component of sexual and reproductive health care and rights during the landmark 1994 International Conference on Population and Development (ICPD) held in Cairo. [4][5][6] The ICPD Program of Action, which was signed by 179 countries, recommended bringing services for the prevention of infertility and appropriate treatment closer to those in need. Over the years, this promise was reiterated by the international community, for example, at the World Summit (2005) and as part of the WHO Global Health Strategy (2011).…”

“…2,3,7,8 There is also a global tendency to locate services for infertility within private health centers, making these services inaccessible and unaffordable for a most of the populations, particularly the most vulnerable. 3,6,9,10 This results in those more likely to be facing infertility also being less likely to receive care-raising important ethical and practical questions. 3,6,7,11 The Nairobi Summit, held in November 2019 on the 25th anniversary of original ICPD (ICPD25), aimed to mobilize political will and financial commitments that are urgently needed to implement "finally and fully" the 1994 ICPD Program of Action.…”

“…3,6,9,10 This results in those more likely to be facing infertility also being less likely to receive care-raising important ethical and practical questions. 3,6,7,11 The Nairobi Summit, held in November 2019 on the 25th anniversary of original ICPD (ICPD25), aimed to mobilize political will and financial commitments that are urgently needed to implement "finally and fully" the 1994 ICPD Program of Action. 12 The Nairobi Summit convened by the United Nations Fund for Population Activities claims to have represented "all nations and peoples, and all segments of society" and was deemed a great success, but the topic of infertility was not specifically mentioned in the accompanying Nairobi Statement released by the International Steering Committee on ICPD25.…”

“…The Nairobi Statement reflects an ongoing tendency by most international organizations and donors and national governments to ignore the subject of infertility. 4,6,14 Progress has been made in research efforts on infertility, but compared to the sociopsychological and financial burden of infertility, research remains underdeveloped and vastly underfunded. [15][16][17] Studies conducted to date have repeatedly shown how infertility constitutes not only a medical condition but also exerts a substantial effect on the psychosocial well-being of people wanting to have children.…”