Infertility treatment versus fertility control: the challenges for developing countries

July 01, 2003

Madrid, Spain: Infertile couples from developing countries face different challenges to the rest of the world. The national health policies and government resources of such countries place greatest emphasis on fertility control, with the result that they do not channel sufficient resources towards infertility issues and couples are being neglected, an international conference of fertility experts heard today (Tuesday 1 July).

Professor Friday Okonofua, a consultant obstetrician and gynaecologist from the University of Benin, Nigeria, told the European Society of Human Reproduction and Embryology annual conference that treating infertility in developing countries is difficult due to problems with basic health infrastructures. He said that high rates of infertility (ranging from between 20 to 30% of the population of Africa) need to be tackled primarily through basic sex education.

Infertility carries a particular stigma in the developing world, with many couples facing social ostracization. "Due to the perception of infertility being caused by evil forces, many infertile couples often first seek traditional and religious treatments, while delaying orthodox treatments," said Prof Okonofua, who has studied infertility in developing countries in sub-Saharan Africa, such as Nigeria, Tanzania, Gabon, Central Africa Republic, Democratic Republic of Congo and Cameroon.

Traditionally, women are blamed for infertile marriages, even when the problem is with the man, and the result is often the breakdown of the relationship. The situation is exacerbated by the fact that orthodox infertility treatments are expensive and can only be accessed by a few rich couples, who travel overseas, or through expensive private sector services. In the public sector, however, the provision of new reproductive technology is not considered a cost-effective option.

A more practical solution, said Professor Okonofua, would be to give people access to appropriate preventative treatments. Infertility in developing countries is largely due to preventable causes, such as sexually transmitted diseases (STDs), that, if recognised promptly, could be treated to prevent long term complications.

He said the first step should be to create widespread awareness of the problems of STDs. In men STDs can cause damage to the testicles and their accessory glands, resulting in reduced sperm counts; while in women STDs damage Fallopian tubes causing blockages and tubal infertility.

"Preventative treatment measures wouldn't be too expensive if integrated into existing family planning and reproductive health programmes in primary and secondary levels of care. But because of the high cost of infertility treatments, I feel that tertiary methods should be regionalized rather than provided in every tertiary unit," he said.

"Introducing new reproductive technology as a public health policy should only be considered after preventative approaches have become well established," he added.

Adoption and child fostering might provide interim alternative solutions that could be promoted in developing countries. "Adoption has not been popular, but with better information and counselling, it is now being used increasingly in several African countries," he concluded.
-end-
Abstract no: O-143 (Tuesday, 14.30hrs CET, Madrid room)

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