The common expectation is that after marriage, a baby will follow soon after. Our African culture, in particular, places a high premium on children, and comments such as, “We are looking forward to a grandchild soon,” are common during wedding ceremonies.
Today, just like in the past, childlessness is unsettling. Many couples have borne the brunt of inability to bear children, often putting their unions at risk of break-ups.
In the past, before the arrival of in vitro fertilisation (IVF) and other aiding reproduction technologies, childlessness was dealt with ‘the traditional way’.
Among many traditional African communities, a woman who could not bear a child faced immense stigmatisation and bullying. To help her have a child to call ‘her own’, she would bring her sister, cousin, or ‘marry’ another woman to bear children on her behalf. Alternatively, the husband was authorised by elders to marry a second wife who could bear him children.
The case was almost similar for men who could not make their wives pregnant. His family would arrange to have another man to “take care” of his conjugal duties with such arrangements being kept top secret within the family. Nobody, not even the children, would ever know the man they call dad was not their biological father.
The burden of infertility
Whereas it is obvious when a woman cannot bear a child because there is no pregnancy to show, men suffer a different kind of burden. In the past, they were taunted for being weak, or for not being ‘men enough’, and sometimes, they found it hard to ascend to leadership positions within their communities if their inability to sire offspring was known.
“When you cannot make a woman pregnant, your friends will always laugh at you for not being able to rise up to the occasion, or for firing blanks,” an infertility patient said.
Because children were, and are still, highly valued in many African communities, individuals who cannot bear children suffer extensive stigma, among other social consequences.
The arrangements to find children by engaging others outside the union of marriage, according to elders, brought harmony and peace since there was no technology to assist in reproduction.
It was a guarded affair
Mzee Juma Mwafitina, a Digo, a sub-tribe of the Mijikenda community, explains that when a man was discovered to be incapable of siring children, his older relatives would find him a man to help him out.
“The man had to be a brother or a cousin so that the offspring would have close resemblance to the man so as not to raise suspicion. It was a guarded secret that was only known to those involved,” Mzee Mwafitina says.
The case was almost similar among the Luo community where the infertile man’s wife was advised to have kids with one of her husband’s brothers.
“When a man was infertile, his wife was trained by her grandmother on how to treat the matter. She was advised to have kids with one of her husband’s immediate in-laws,” a Luo elder, Mzee Otieno Muga, says.
The elder avers that in some circumstances, the arrangements between the wife and the in-law of choice was not made public to the husband, but clarifies that the move was not considered cheating.
Even though the husband knew he could not sire children, the woman would never be victimised for having children with another man, the elderly man points out.
“The reason behind the practice was to build harmony within the household while at the same time keeping the genealogy of that particular household,” adds Mr Muga.
Such arrangements may sound awkward, but according to the elders, they eliminated violence and hostility among couples and also protected the union from unnecessary adversaries.
“Lack of proper communication in a relationship where one party is infertile can be tragic because the fertile partner might go out looking for a baby without seeking the opinion of his or her spouse. This is why we witness a lot of victimisation and hostility nowadays,” the elders noted.
Out of date practice?
Dr Ignatius Kibe, an infertility expert, says that there are different causes of infertility.
“The cause of infertility among people could be due to biological reasons, genetic disorders while others are unexplained. Biologically, it could due to low sperm count or sperm motility in the case of a man, or ovulation disorders or problems with the Fallopian tubes in the case of a woman, Dr Kibe explained.
While traditional ways of ensuring children were born within a marriage setup are no longer practised, Dr Kibe observes that even today, childless couples continue to be dogged by social stigma, with some experiencing extreme violence in their relationships.
“There is a belief that the ability to conceive is an aspect of strength, that you must have kids to be complete. Some people might, therefore, act violently to the fact that they cannot have kids.” Dr Kibe says.
Due to urbanisation, the family fabric is not as strong as it used to be, and many 21st century couples caught up in an infertility conundrum would rather keep the matter to themselves as they scout out for solutions alone.
Ms Jackline Mwende’s tragedy is perhaps one of the most recent and gruesome cases of violence witnessed in a childless marriage.
She was 32 years old when her husband of seven years attacked her and chopped off her limbs with a machete after she went out of their marriage and tried to have a child with another man.
Society in denial
Ms Catherine Mbau, a psychotherapist, says society is never prepared for infertile women, and always expects children to be born as soon as a woman is married.
In Africa, it is estimated that about 50 to 60 per cent of all the reproductive health clinic visits are related to infertility, while in Kenya, estimates show that infertility cases could be between two and 20 per cent, with two out of every 10 people suffering from one form of infertility.
“In Kenya, women get blamed more than men for the inability to bear children. It is not unusual to find more women seeking help from doctors with little or no support from their partners,” she says.
Due to advancements in science, many traditional practices, such as begetting children out of wedlock, have been fast replaced with very advanced technologies, such assisted reproductive techniques (ART).
These include in vitro fertilisation (IVF) or surrogacy to help couples have their own children. Couples who cannot bear children, therefore, have some of these options at their disposal, even though they tend to be quite costly for the average Kenyan.
A desire fulfilled
After staying for seven years without conceiving, Ms Lydiah Ndiho Kariuki and her husband finally opted for adoption. The couple are now happy parents of a beautiful baby girl.
During a party that she hosted to welcome their new member of the family, Ms Kariuki revealed that the adoption process, which took over a year, was long and tedious, but they were grateful to God for the success.
Married in 2010, Lydiah and Kim longed and prayed to have children, just like many other couples, but this did not happen, causing them a lot of pain and distress.
When it dawned on them that they could not bear children, they turned to gynaecologists and infertility experts for advice.
“The gynaecologist carried out tests on both of us, but could not find anything wrong. I was put on fertility drugs with the hope that this would help, but it was fruitless,” she says.
Ms Kariuki, who later turned to blogging to sooth away her distress and to voice the agony of other women like her, recounts that theirs was a complex case since they had no medical problem, according to reports from all the specialists they visited.
In 2015, they were advised to try in vitro fertilisation (IVF), but the cost was too prohibitive for them.
“We have had nasty comments from people. Overzealous women tried to sympathise with my situation by offering me a range of solutions. Some suggested that I try making a baby with another man, while others recommended herbal medicine. Many more advised that I see a certain pastor, who could pray for me to get a child,” Ms Kariuki says.
She is grateful to her husband for standing by her through their struggle to get a child. “If he was not supportive, I think our marriage could not have withstood the test of time,” she said.
Elsewhere, Edna Moraa* has had to put up with accusations of witchcraft and discrimination from relatives for being unable to bear a child for her husband of 10 years.
Knowing too well how African culture highly holds children, Moraa convinced her husband to visit a fertility expert after two years of trying for a child without success.
“My husband was the first to be examined — the results indicated that he was fertile. Unfortunately, my results said that I was infertile. I couldn’t bear the devastating news,” Ms Moraa narrates.
A shocked Moraa decided to seek a second opinion from a different doctor, but the result was the same. She was infertile. In their situation, it did not take long before eager relatives lost patience with the couple’s childlessness.
Ms Moraa recalls how after the third year of their marriage, her mother-in-law came knocking.
“She travelled from upcountry and pitched tent in our house, demanding to know why I hadn’t conceived yet. She advised her son to marry another wife, who would bear him children. My sisters-in-law soon joined their mother’s side and accused me of bewitching my husband. They said I had cast a spell on him to prevent him from marrying a second wife. They went as far as trying to evict me from my matrimonial home, saying that I was wasting their son’s and brother’s money,” Moraa said.
However, her undaunted husband stood by her through it all. “My husband remained very supportive. We are still together,” Moraa says.
Besides adoption, childless couples can try IVF or surrogacy, if they can afford the money required for the procedures.
In IVF, female eggs are fertilised with sperms outside the body, then implanted into the woman’s womb. An IVF cycle usually starts at the beginning of the woman’s period. During this time, the woman is counselled and tested for sexually-transmitted infections including HIV, to ensure that necessary precautions are taken before implanting the embryo.
IVF is applicable for women whose Fallopian tubes are damaged or blocked, a condition that affects seven out of 10 women with infertility. It may also be used if the woman has a problem producing an egg or if the male partner has low sperm count or sperm with very slow speed.
The technology can also be used when there are genetic problems in either partner or in cases of unexplained infertility.
IVF and fertility treatments in general are not covered by insurance, meaning that a couple has to raise the money required for the initial investigations and for the procedures. However, the National Hospital Insurance Fund (NHIF) pays for such treatments for civil servants.
Surrogacy, on the other hand, is an arrangement in which a woman (the surrogate mother) agrees to carry a pregnancy for another woman or couple (intended parents) then surrenders the baby to them at birth.
In full surrogacy, the surrogate mother carries the pregnancy created from the egg and sperm of the intended parents through in vitro fertilisation, while in partial surrogacy, someone, including the surrogate mother, can donate the egg to be fused with the sperm of the intended father.
Kenya does not have laws governing surrogacy arrangements, which, therefore, makes it a complex option. According to Dr Kibe, heritage and continuity of the family tree piles a lot of pressure on couples to have children.
Society believes that anyone failing to sire or to conceive a child is missing the norm. Other pressures come from friends and relatives.
Infertility is an emotive issue because many people believe that children are the fulcrum on which their personality, success and riches rest. “As a result, those who miss the norm are considered less endowed,” Dr Kibe remarks.
The expert adds that the uncertainties that one might not have an heir to take care of them in old age, and also to continue their lineage, often sparks outrage, which couples respond to differently.
Dr Kibe advises that sex education be taught from upper primary all the way to secondary school. “Children today tend to engage in sex quite early when their organs are not yet fully developed, a factor that could damage their organs, leading to infertility.”