Ghana: One More ... Unpacking Secondary Infertility

1 November 2021

A family is the basic unit of society with children considered as the 'yeast' that swells families into society. For this reason, Africans, known to treasure large family sizes, encourage couples to give birth to as many as they could.

Per the World Population Data Sheet, Africa, with an estimated population of 1.4 billion in 2021, projected to be 2.5 billion in 2050, has the highest fertility rate and projected population growth than any region in the world.

The continent's total fertility rate is currently 4.3 births per woman, despite a 1.32 per cent decline from 2020. The rate was 6.5 births per woman in 1960. In Ghana, where the population is about 31.7 million people, the fertility rate is 3.745 births per woman, with a 1.32 per cent decline from 2020.

In view of this, giving birth to one child is regarded as odd. If you give birth to one, you are urged to add more to keep the first child company. Give birth to females and you are expected to produce a male to be an heir or sustain the family surname. And if the first child is a boy, a female is desired.

Years ago, some people believed that if you gave birth to many children, one would definitely become successful, or in the event that death strikes, some will survive, so, some couples had as many as 16 children.

In the Akan society of Ghana, for instance, having many children is considered an achievement. And so, a man is obliged to gift his wife a sheep upon delivery of their 10th child under what is termed "Baduguan" (10th Child sheep) to reward her for crossing such a milestone in childbirth.

Though civilization, family planning awareness, and economic woes have influenced a cut in the number of children couples are having these days, society is yet to fully embrace the idea of giving birth to only one child, thereby still mounting pressure on couples with one child to have at least one more.

However, medical experts say fertility is not a lifetime assurance and that the efforts of a parent to give birth to more children could be impeded by secondary infertility.

Secondary infertility and causes

Secondary infertility is the inability to conceive a child or carry a pregnancy to full term after previously giving birth and after trying unsuccessfully to conceive for six months to a year. The previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization.

Cleveland Clinic, one of the oldest medical facilities in Ohio, US, states on its website that the condition is just as common as primary infertility and could be traced to either partner or both partners. About one-third of cases originate in women and about one-third in men with the remaining one-third, attributed to a combination of factors or unknown.

Generally, it indicates that causes of the condition cut across increased age, complications from a prior pregnancy or surgery, increased weight, medications, sexually transmitted diseases, impaired sperm production, alcohol abuse, and smoking.

In women, factors include problems in the quantity or quality of eggs; issues with the fallopian tubes and the uterus; endometriosis (tissue growth on the ovaries or bowel), and polycystic ovary syndrome (hormonal disorder abnormal menstrual periods).

For men, reduced testosterone level, genital infections; thyroid diseases; diabetes; tuberculosis; mumps; smallpox, blood diseases; emotional stress; stroke; respiratory and congestive heart failure; testicular varicocele (enlargement of veins in the scrotum); poor-quality semen; prostate enlargement; use of commercial sexual lubricants that are toxic to sperm, and exposure to certain chemicals like pesticides and excessive heat.

"If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts", the Cleveland Clinic website stated.

These facts were corroborated by Dr Raymond Morbu , fertility specialist at Andel Medical Centre in Accra who asserted in an interview that secondary fertility could also be due to a long gap of about 10 years after first child during which there is not much sexual activity.

'Childless' mothers

Mansa (actual name withheld) is a mother of two who has been trying for a third one for the past three years. The next child is critical to the survival of her marriage because it would be the first with her new husband. She has been accused by her church of being possessed by an evil spirit that is preventing her from giving birth again. So she moves from one prayer meeting to another seeking deliverance while the husband has been spared the stigma and the agony because he is a revered man of God who is confident of his sexual prowess and believes in matters of the spirit rather than medicine.

The narrative surrounding the infamous case of Takoradi-based Josephine, the mother of one, who allegedly faked her pregnancy and kidnapping because she had lost her first pregnancy with her current husband is also an example of how secondary infertility challenges and societal pressure could inspire absurd actions.

Then there is Elorm (not real name), a mother of two boys who died during the birth of her daughter after defying the doctor's advice not to get pregnant again because of possible complications.

Diagnosis and treatment

Both Dr. Morbu and the Cleveland Clinic indicate that medical examination is required to determine if one has the condition. An X-ray of the uterus would reveal scarring or abnormalities while in the case of men semen analysis are done. It is advised that women trying to give birth again should seek medical attention if she has irregular menstrual cycles.

Whether infertility is primary or secondary, medical experts say the treatments are similar and include: medications to induce ovulation in women with an ovulatory disorder and improve semen quality; intrauterine insemination (IUI), In vitro fertilization (IVF), surgery to repair structural problems, such as removing scar tissue, polyps, and fibroids from the uterus and correct testicular varicocele in men.

Societal support

Infertility is an overwhelming condition that causes emotional stress on individuals and couples. In the event that treatments for secondary infertility do not work, couples are plunged into a series of emotions, including anger, grief, guilt, and isolation, or may crave empathy from family and friends.

If the family is indeed the unit of society, it behooves members of society to support each individual unit especially in their efforts to produce the 'yeast' that swells the family into society.

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