According to WHO data, more than 180 million couples in developing countries (which is one in every four couples) suffer from primary or secondary infertility. In Sub-Saharan Africa, infertility is caused by infections in over 85% of women compared to 33% worldwide which emphasize the importance of prevention programs in the continent. The social stigma of childlessness especially for infertile women still leads to isolation and stigmatization in many cultures. The differences between the developed and developing world are emerging because of the difference in availability of safe, effective and equitable infertility care and different socio-cultural value surrounding parenthood and procreation.

It is very important to take into consideration that accessible infertility treatment can only be successfully introduced in developing countries if socio-cultural, economic essentials and needed skills are fulfilled and governments are ready to support their introduction.  A discussion with the relevant authorities is needed to address the strengthening of infertility services, education, auditing, regulation, community awareness and the need to integrate them with Mother and child, HIV prevention and family planning programs.

The consequences of infertility are much more dramatic in developing countries and can create more wide ranging social and cultural problems compared to Western societies, particularly for women. A central difficulty associated with infertility in Africa is that it can transform from an acute, private distress into a harsh, public stigma with complex and devastating consequences. In some cultures, childless women still suffer discrimination, stigma and ostracism. The inability to have a child or to become pregnant can result in being greatly isolated, disinherited or assaulted. This may result in divorce or physical and psychological violence which personally makes me very sad.

I am quite sure that through the “More than a Mother” initiative, we will challenge the perception of infertile women, their roles and worth in society, both within and beyond the medical profession in order to achieve a systemic shift in the current culture of gender discrimination in the context of fertility care in African societies

I truly believe in what has been stated by UN universal declaration of human rights, that access to adequate comprehensive reproductive health services, including infertility care, is a basic human right regardless of the economic circumstances in which individuals are born into. Therefore, the Merck Fertility Capacity Advancement Program will contribute to identifying and implementing strategies to improve access to effective, safe and regulated fertility care in Africa and to defining interventions to decrease social suffering from infertility and childlessness.

We totally understand that the level of infertility care we are aiming for will differ from country to country. Many variables can be important such as the economic and political situation of the country, the level of education and reproductive health care, actual facilities concerning medical care including the quality of the hospitals, the available equipment and facilities to perform surgery in case of complications, the level of mother care and many others. This will be open for discussion later during our panel.

We also realize that in most developing countries, the reduction of maternal mortality and the promotion of contraception are considered to be the only reproductive health priorities. Improved “reproductive health education programs” have proven to be an excellent preventive tool against overpopulation, sexually transmitted diseases (STDs) and pregnancy-related infections. Prevention programs are more cost-effective and benefit a greater number of people. These types of awareness programs can be more effective in eliminating the social consequences of infertility and will improve the health status of women in other ways.

Therefore, fertility awareness and prevention is number one priority in resource-poor settings and not only in improving access to fertility care which will definitely depend to a large extent on the availability of the appropriate skills and experience but also in the ability to optimize ART technologies in terms of availability, affordability and effectiveness and above all safety.

But even with better education and preventative care programs, infertility treatment will remain an important problem for millions of couples. Universal access to safe, equitable and effective fertility technology will require well-organized education and training programs and regular audits and systems of accreditation and registration should be implemented in order to maintain appropriate standards of care in all centers involved. 

Infertility awareness should be part of an integrated reproductive care program including family planning and contraception, mother care, and reproductive health education and women education. Although male factors contribute to about half of all cases of infertility, women are overwhelmingly perceived as being the party responsible for a couple's infertility, and subsequently the social suffering associated with infertility tends to be greater for them than their husbands.

Through “Fertility is a Shared Responsibility “initiative we will be able to contribute together to raising awareness about male infertility and encourage men to acknowledge and openly discuss their infertility issues and strive for a team approach to family building with their partners in order to progress toward Shared Fertility Responsibility among couples.

By Belen Garijo,
Merck Healthcare CEO.