Infertility's grim consequences.

Infertility in the developing world is a widespread phenomenon affecting men and women alike. Rates of infertility differ markedly among regions of the world and even within countries. But they can be substantial. In some areas of Africa, for example, as many as a third of couples are estimated to be infertile. (1)

Research indicates that men contribute to or are the sole cause of a couple's infertility more than half the time, (2) but women often bear the blame for a couple's inability to have children.

Infertility is a devastating event for women in many cultures throughout the world. In rural Mexico, a woman who cannot conceive is typically stigmatized by the community, labeled a "mule" and "useless." (3) In Ethiopia, a study of a population-based sample of 6,179 ever-married women found that 95 percent of those who did not have a child during their first marriage divorced within 20 years, with the vast majority of these divorces occurring within the first five years of marriage. In contrast, only 23 percent of women who bore a child during their first marriage divorced within 20 years. While divorce in Ethiopia does not carry the social stigma that accompanies it in other settings, a woman's economic status and that of her family often suffer as a result. (4)

Infertility can also result in women engaging in extramarital affairs in hope of conceiving, behavior that places them at high risk of contracting a sexually transmitted infection (STI), including HIV. A 1997 study among diverse members of the Macua ethnic group in northern Mozambique found that nearly all of the 34 female study participants who considered themselves infertile had engaged in extramarital affairs with the hope of becoming pregnant. (5)

REFERENCES

(1.) Ericksen K, Brunette T. Patterns and predictors of infertility among African women: a cross-national survey of twenty-seven nations. Soc Sci Med 1996;42(2):209-20.

(2.) Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: is Africa different? Lancet 1985;2(8455):596-98.

(3.) Castaneda X, Garcia C, Langer A. Ethnography of fertility and menstruation in rural Mexico. Soc Sci Med 1996;42(1):133-40.

(4.) Tilson D, Larsen U. Divorce in Ethiopia: the impact of early marriage and childlessness. J Biosoc Sci 2000;32(3):355-72.

(5.) Gerrits T. Social and cultural aspects of infertility in Mozambique. Patient Edu Couns 1997;31(1):39-48.