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Roselyne Sachiti Features, Health and Society Editor
Infertility in both women and men is a reproductive health topic heavily “pregnant” with challenges that have resulted in many social issues, especially negative.
In Zimbabwe, trying to find the solution to why couples fail to conceive has for decades seemed like looking for a needle in a haystack or searching for the mythical Loch Ness monster.
The sad reality infertile women face is that most societies feel that wombs are designed to “receive” seed from men, and carry pregnancies to full term. When this does not happen women usually face a lot of stigma around who has the “problem” as it is their expected role to give life.
The condition is labelled as a women’s reproductive health issue, often turning a blind eye on the fact that men, too, can be infertile. Women bear the brunt and each day and night they try to find solutions.
From crying themselves to sleep, to drinking concoctions, herbal remedies, having procedures like cutting of “sare” (small chunks of flesh cut off women’s reproductive tracts) under unsanitary conditions in backyards, to drinking crates and more crates of raw eggs, dozens of lemons, drinking anything and everything, women have seen and done it all.
According to the World Health Organisation, infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”
Issues ranging from genetics, environmental exposures and infectious diseases have been linked to infertility risk. Uterine fibroids, cysts, ectopic pregnancies among others have also resulted in women failing to conceive. While infertility can affect both men and women, the majority of research on this topic focuses on women.
According to the Mayo Clinic causes of infertility in men range from abnormal sperm production or function due to undescended testicle, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhoea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
WHO further states that infertility affects up to 15 percent of reproductive-aged couples worldwide. WHO demographic studies from 2004 have shown that in sub-Saharan Africa, more than 30 percent of women aged 25-49 suffer from secondary infertility, the failure to conceive after an initial first pregnancy.
While male infertility has been found to be the cause of a couple’s failure to conceive in about 50 percent of cases, the social burden “falls disproportionately on women,” according to Dr Mahmoud Fathalla, previous director of the Special Programme of Research, Development and Research Training in Human Reproduction based at WHO.
In countries like Zimbabwe and most developing countries in sub-Saharan Africa, the cost of In vitro fertilisation (IVF) is out of reach.
IVF is a process of fertilisation where an egg is combined with sperm outside the body, in vitro. The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova from the woman’s ovaries and letting sperm fertilise them in a laboratory.
For example, in Zimbabwe, the service which is currently being provided by private health service providers at a hefty cost has proven successful and given hope to many couples.
The procedure was pioneered at the Avenues Clinic in the 1980s and 90s by obstetrician and gynaecologist Dr Tony Robertson.
According to IVF Zimbabwe official website, a total of 52 people who are adults now were conceived through Dr Robertson’s In Vitro Fertilisation (IVF) programme also referred to as the test tube baby procedure. The programme was discontinued when Dr Robertson left the country for a year in 2000.
Seeing the positive results of IVF, the team revamped the laboratory used for procedure, which adjoins one of the Avenues Clinic operating theatres.
The first IVF baby conceived in Zimbabwe following the reopening was born on April 2, 2017. To date the centre has recorded 26 live births and 20 ongoing pregnancies in 2019.
In Zimbabwe, medical aid service providers save for CIMAS do not pay for IVF procedure leaving more couples who cannot afford to pay for private services in a fix.
With all these challenges and successful IVF procedures that have given hope to many couples, First Lady Amai Auxillia Mnangagwa, who is also the health ambassador is helping childless couples conceive.
As an ambassador of Merck “More than a Mother” initiative, Amai Mnangagwa is using her health muscle to lift the “hard rock” which has been trapping infertile couples. Her programme seeks to ensure that infertile couples indiscriminately get treatment through IVF in public health facilities.
The Merck Foundation, which is funding the fertility training programme is the Philanthropic arm of Merck KGaA Germany. It is a non-profit organisation that aims to improve the health and well-being of people and advance their lives through science and technology.
They primarily focus on improving access to innovative healthcare solutions in under-served communities, building healthcare and scientific research capacity and empowering people in STEM with a special focus on women and youth.
“Merck More than a Mother” initiative aims to empower infertile women through access to information, education and health and by changing mind-sets. This powerful initiative supports governments in defining policies to enhance access to regulated, safe and effective fertility care.
It defines interventions to break the stigma around infertile women and raises awareness about infertility prevention and management. In partnership with academia, ministries of health and international fertility societies, the initiative also provides medical education and training for healthcare providers and embryologists to build and advance fertility care capacity in Africa and developing countries.
The “More than a Mother” initiative will not only provide medical education and training for medical students and embryologists respectively, but it will also support Governments to define policies to improve access to safe and effective fertility care and address the need for interventions to reduce stigmatisation and social suffering of infertile women and the necessity for a team approach to family building among couples.
“Through this initiative, we will address together the key challenges that are associated with resource constrained settings such as prevention of infertility, education self-development, ART/IVF regulation, geographic barriers, and limited resources arguments,” the Merck Foundation website notes.
Merck Foundation “More than a Mother” initiative has partnered with 15 African First Ladies.
Family Health director in the Ministry of Health and Child Care, Dr Bernard Madzima, on Tuesday said before the coming in of Amai Mnangagwa as the Merck Foundation “More than a Mother” initiative ambassador, the ministry was not doing much in terms of infertility issues as they were under resourced.
He said the First Lady through her ambassadorial role at Merck Foundation and partnership with the Health Ministry had facilitated obstetrician and gynaecologist, Dr Harrison Rambanepasi of the United Bulawayo Hospitals to go to Milann Fertility Centre which falls under the international Institute of Research in Reproductive Health Hospital (IIRRH), Bangalore in India where he is currently undergoing the fertility training fellowship.
Dr Rambanepasi left the country on July 15 this year and the fellowship programme is going on very well, according to Dr Madzima.
He said Dr Rambanepasi will be joined by two more obstetrician and gynaecologist doctors in September this year.
“These include Dr Gerald Madziyire of Harare Hospital and Dr Bostone Manyika of Chitungwiza Hospital,” he revealed.
Zimbabwe is a signatory of the 1994 Cairo International Conference on Population and Development (ICPD) Programme of Action. By endorsing this plan, the country committed itself to providing the highest possible attainable level of reproductive health for all — fertility included.
With the Merck “More than a mother” initiative, Zimbabwean couples can look forward to a better reproductive health services that address fertility issues.
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