Pain and stigma that come with inability to bear children

Mildred Akello, 42, does not know exactly who infected her with HIV, but she readily admits having slept with dozens of men in her desperate attempt to get a child.

Her quest to be a mother has included visiting witchdoctors and trying all manner of unconventional things but, so far, nothing has worked.

“You cannot protect yourself when you want a child. You are hopeless; all you want is a child. In the process, I got infected,” she says, pausing to wipe tears from her eyes.

She is now in her third marriage and her husband, Mr Patrick Oduori, 48, is also HIV positive. The couple remain hopeful that one day they will be parents.

“Society has judged me harshly. After the death of my first husband, I was chased away from my land because I did not have a child,” she says, recalling how her house was burnt down and her property grabbed by her in-laws. She was forced to return to her father’s home.

Mr Oduori tells Lifestyle that he has since accepted that “children come from God” and that he will not force the impossible.

“People will insult her but I have faith because there’s God in heaven who can do the impossible. We are waiting,” he says.

Ms Akello is among the thousands of women worldwide who are unable to conceive for one reason or another.

Data from the World Health Organisation reveals that more than 180 million couples in developing countries suffer from primary or secondary infertility.

In sub-Saharan Africa, infertility is caused by infections in more than 85 per cent of women compared to 33 per cent worldwide, which underscores the importance of infertility prevention programmes on the continent.

In Kenya, it is estimated that two in every 10 people suffer from one form of infertility or another. Kenya has made great strides in birth control programmes, but not the treatment of infertility.

Like Ms Akello, Ms Mary Goretty, Ms Margaret Oketch, and Violet also shared their harrowing experiences. Prior to the interviews with Lifestyle, the women agreed to sign consent forms to have their pictures taken and stories published.

Experts have warned that societal biases as well as the exorbitant costs and stiff requirements for adoption are making it impossible for such women to find solace. High poverty levels mean that barren women are unable to afford proper medical services or adopt children.

An unintended consequence as some of the women fight against the stigma that surrounds couples who cannot get children is contracting HIV.

One of the women, who spoke in confidence, confessed she had slept with witchdoctors, following their instructions that this would result in conception. Nothing happened.  

“I am always asking God if the things I have done in the name of conceiving are sinful; I am ready to confess and start a new life and get a baby,” she says.

MISTREATED BY IN-LAWS

Ms Oketch, 56, sits in her living room in Gem, Siaya County, during the interview, gazing through the holes on the house’s roof, wondering why God has not given her a child of her own.

Childlessness, she says, has dealt a blow to her self-esteem, making her feel worthless. When she decided to seek medical attention, her husband was indifferent. It was a “woman’s disease”, he said.

Besides, she could not afford the medical costs.

She has been trying to conceive for 30 years but after realising that she could not get support from her husband, her dream of becoming a mother was blown away.

“I hate the term ‘infertility’. Apart from the pain and stigma that comes with it, it makes you ashamed for not being able to get pregnant,” she says.

Ms Oketch has been married to four men but still she has not been able to conceive. She recalls a day when she requested her husband for money to visit a doctor, only to receive a thorough beating.

“You keep postponing getting pregnant yet you want me to waste my money on you, go back and ask your mother how to get a baby,” she recalls her husband yelling.

All these years, she has never used any contraceptives.

With help from her friends, she went to a gynaecologist who conducted an X-ray known as hysterosalpingogram to check her fallopian tubes. Everything was fine and she was given fertility drugs to boost her chances of conceiving.

She took the drugs for another three months and waited for one year but still she did not conceive.

“I took the drugs religiously, but nothing happened. I was getting desperate to get a child and save my marriage,” she says.

Her doctor requested her to visit the clinic with her husband.

“He told me he was not willing to go out of his way to get a baby with me yet there were many women who could give birth,” she says.

He did not accompany her to the hospital, instead opting to marry another woman.

“This is where all my problems began. The other woman started insulting me that I was a witch and a bad omen to the family and that I should pack my things and leave,” she said.

Her husband stopped visiting her house and even blocked her from fetching water from the family borehole. She survives on doing menial jobs in the village like gardening and washing clothes for others.

Fed up with her in-laws, she returned to her parents’ home after suffering depression.

Two years later, she decided to give marriage a second chance. But soon, infertility stalked her, tearing apart the second, third and fourth marriages.

Another woman facing untold suffering is Violet. Despite frustrations from society for her inability to bear children, she has vowed never to leave her matrimonial home because she has nowhere else to go.

“I lost my mother when I was very young, grew up under the watch of my grandmother who has since passed on,” she says.

SOLACE IN ALCOHOL

She was married in 1978 and, after four years, her husband married another woman and disappeared for 12 years, only to resurface sick and paralysed.

“I have to do odd jobs like digging and cleaning to survive since I have no child to help me,” she says.

And for Ms Goretty, drinking has become her source of solace from abusive in-laws. She leaves her home in Busia  County early in the morning and returns at night, dead drunk.

“I find comfort in drinking. The abuses from my in-laws and the neighbours are too much. I go out to drink, come back and sleep like a baby. Even if they insult me, I do not listen to them,” she says.

She says her in-laws would spill her food whenever she cooked, telling her to feed the foetuses that she allegedly aborted. For 20 years now, Jennifer Nyaboke, who resides in Kisii County, has prayed year after year for a child.

She is optimistic that at the age of 46, she will still get pregnant and give birth to a boy.

“In Kisii community, if you do not have a son, you are considered an outcast and the bigger problem comes if you do not have a child. Whatever I have gone through for these years is hell,” says Ms Nyaboke.

She is banking on God to give her a child. She says she has done everything  to get a child.

“I have gone to all the witchdoctors I know of, taken all concoctions but I am still waiting for my lost womb,” Nyaboke says, adding that she does not have money to go for fertility tests.

She believes that God will one day remember her with a child the way He did to Sarah and Abraham.

She says Abraham and Sarah remained childless for many years. But God kept on assuring Abraham of the promise of a child yet to come.

“And I will bless her and also give you a son by her. Then I will bless her and she shall be a mother of nations,” she quotes Genesis 17:16.

“Who am I to doubt my God, all am left with is my God. I am banking on Him to give me a child. If Sarah could give birth at the age of 90, I am just 46, I can give birth by the grace of God,” says Nyaboke, while preaching the word of God.

She began to wonder whether something might be wrong with her in her third year of marriage but, with the less-than-sufficient efforts by her husband, she did not manage to get any medical attention. “My husband is not concerned with me any more. He got married to another woman with whom they now have two children,” she says

She says it pains her that her husband called her a witch and told her that she might have aborted when she was young and that’s why God was punishing her.

“With all the abuses, I am hoping that one day they will come begging for forgiveness,” says Ms Nyaboke.

Delays in conception

According to Dr Aggrey Akula, a gynaecologists in western Kenya, infertility is on the rise worldwide due to multiple factors. Among these factors are delays in conception.

“Egg production from the ovaries reduces with age and this can make it very difficult to conceive when one is old,” he says.

Dr Akula says that in women, blocked fallopian tubes account for 70 per cent of cases of infertility reported at Jaramogi Oginga Odinga Teaching and Referral Hospital.

“This is a serious problem that should be addressed. In all the patients that I attend to every day, half of them suffer gynaecological problems which are closely related to infertility,” says Dr Akula.

He attends to over 120 patients suffering from the problem every month.

MORE THAN A MOTHER

Endometriosis is another factor leading to infertility in women, he says.

This is a medical condition that occurs when the lining of the uterus grows in other places, including the fallopian tubes, ovaries or along the pelvis.

“The normal menses should flow downwards to the birth canal but, for some reason, some women experience endometriosis which makes chances of conception very low,” he says.

Fibroids

Fibroids in the uterus are also a major cause of delayed conception among women in Kenya. Fibroids interfere with implantation of the embryo in the uterus, making conception impossible.

With women, the condition can be reversed by operating the blocked tubes.

“If the ovaries are not able to produce eggs but they are functional, we give fertility drugs for conception to take place,” he says.

Dr Akula says some cases of infertility are caused by untreated sexually transmitted diseases. Late diagnosis of the sexual organ infections or late treatment can make one infertile.

Ms Catherine Mbau, a psychotherapist, says society is never prepared for infertile women. They always expect results immediately a woman is married.

“Women get blamed more than men for the inability to bear children. It is not unusual to find more women seeking help from doctors to help in conception with little or no support from their male partners,” she says.

Some childless women would prefer to adopt children but the legal framework, according to Mary Makokha who works with barren women, does not always favour those from modest backgrounds.

“Adoption is left for the rich. A woman with no income and is childless cannot prove to the government that she can take care of an adopted child,” says Ms Makokha.

She says the insurance companies are making it worse for the couples to get medical services: “No insurance company will cover infertility.”

“Merck More than a Mother,” a pharmaceutical company, has started an initiative in East African countries to change the culture of discrimination and abuse towards infertile women.

“Access to adequate comprehensive reproductive health services, including infertility care, is a basic right regardless of the economic circumstances in which individuals are born,” says Rasha Kelej, the head of Global Business Responsibility and Market Development at the firm.

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INFERTILITY IN MEN

According to Dr Aggrey Akula, one of the leading gynaecologists in Western Kenya, in men, low sperm count and dead sperm are the main causes of infertility.

“On average, men should produce between forty and three hundred million sperm for every millilitre and if they are less, getting a woman pregnant will be a struggle,” says Dr Akula.

“With low sperm count, we always advise men to eat a healthy diet to boost their sperm count. In cases where there is no sperm at all, we always prefer In-Vitro Fertilisation (IVF) by harvesting the sperm from the testes,” says the gynaecologist.

IVF is a method of treatment in which the man’s sperm and the woman’s eggs are combined outside the body.

“The fact that the country does not have any single IVF in public hospitals is a problem. We have like six of them and all are in private hospitals. If we had one in a public hospital, the cost would be affordable,” he says.

For couples seeking IVF, one of the biggest obstacles is the cost, which is not covered by insurance companies. A session of IVF costs an average of Sh350,000. And if the procedure is not successful in the first round, the cost can go up to Sh1 million depending on how many times it is done.

He says only five per cent of the population which suffers infertility can afford treatment and that’s why many couples suffer in silence.

“The testtube baby costs around Sh400,000 yet the probability that pregnancy will occur in one cycle is not guaranteed. On average, a couple needs three cycles which cost Sh1.2 million or even more,” says Dr Akula.