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Infertility remains a setback; Africa has the brains but lack expertise

Wednesday March 21 2018
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Dr James Olobo-Olabo, the vice president of Africa Fertility Society. PHOTO | COURTESY

By EVELYN LIRRI

The vice president of Africa Fertility Society Dr James Olobo-Olabo, spoke to Evelyn Lirri on infertility on a continent that has one of the highest fertility rates in the world.

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A number of African countries including Uganda, Kenya and Tanzania, lie within what the World Health Organisation calls the “African Infertility Belt”— a phenomenon where infertility is most prevalent where fertility rates are also high. Isn’t this a contradiction?

That contradiction will always exist. We have fertile and infertile citizens and you cannot solve one end of the equation without addressing the other.

Fertility rates in Africa are high. But it is also true that the infertility rates on the continent are much higher than the rest of the world. So we have that dichotomy and it is our duty to prioritise both and allocate resources accordingly.

What are the major causes of infertility in Africa?

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Our major problem is secondary infertility — a condition that presents itself after a woman has had at least one pregnancy or a miscarriage. It occurs mainly as a result of infection because either the miscarriage was mismanaged or it was not attended to in a hygienic environment. 

So the challenge in Africa is largely preventable causes of infertility and that needs to be addressed through health education and general improvement in the standards of living.

Has there been adequate public awareness on infertility across Africa?

Tell me about education on any subject, not only infertility... there is never enough knowledge. Only on few occasions do we think too much knowledge is a problem.

Knowledge is empowering particularly if the subject is difficult, medical or scientific. In this case, it is best to put it in simple language for public consumption.

That way the public easily understands there is a lot they can do on their own, and when that is not possible, an early visit to the doctor will help.

Stigma remains a challenge for people with infertility. How can it be addressed?

The issue is multifactorial because it comes directly from the patient’s own relatives. For example, when younger siblings have had children questions start to be asked: What is happening to the older ones? Then you have the community aspect, and then the silent voice.

It makes you extremely conscious about childlessness and you feel as though all eyes are focused on you wherever you go.

The next conversation you hear about childhood and family is a hint that something is wrong. So, there is this guilty feeling all the time. Thus infertile people suffer silently and this is a major problem because it disrupts society and relationships.

Most interventions for infertility are costly. How can governments across the continent make care affordable to everyone who needs it?

In every situation, there is a cost. I look at cost not only in monetary terms but also in terms of time and energy to create awareness and generate the knowledge needed. Most people tend to equate cost with monetary terms.

Yes, I agree with you that the treatment for infertility, particularly using assisted reproductive technologies (ART) is costly. And if you counterbalance that with other requirements for health, you could be tempted to say it is disproportionately sucking away resources we could put to better use elsewhere.

But look at every case on its own merit. What we need is to improve the general wealth of the continent’s citizens, so that we can spread care. The focus should not be on crying over costs, but on the level of our economic development. So, it is a much wider concept.

Are assisted reproductive technologies widely accessible in Africa?

No. First, the technology originated from the developed world. Thus all the resources used for ART come from outside Africa — that compounds the cost element. Equally, ART uses sophisticated equipment that requires training and skills. That type of training is only available overseas.

Besides the technology, do we have the expertise to manage the problem?

We have the brains but not the expertise. At the African Fertility Society, we are trying to change the training paradigm and saying it is about time we started training the trainers so that they can train our own experts rather than training them abroad.

This concept is beginning to gain ground, but we are beginning to do a lot of cross-sectional studies as fertility experts in order to generate the required awareness. There has to be a paradigm shift for the training to be done locally.

What next after the February 8- March 2 International Infertility Symposium held in Uganda?

We hope to move forward on two fronts. First, we need to encourage our younger generation and healthcare professionals to engage in research.

Only through research are we going to embrace and be comfortable with the explosion of knowledge in the area of fertility — particularly genetics, which is far wider than reproduction.

Secondly, we need to open up the space so that we can allocate resources and determine our own priorities within our healthcare system.

We need to improve training and educate the population — so that all people are aware of their fertility and once they have signs and symptoms of the disease, they can see a doctor. A lot can be done in terms of health promotion.

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