Imagine living in a community where childbearing is the greatest pride and achievement, whether young or old, whether married or not. Just picture yourself in this community where people are treated like gods because they have children, but you are above the age of 25 years, and without a child. Residents even have a term for it. They call such women ‘kene’.
“As for kene, we can’t stop calling people like that if they don’t have kids, unless you don’t rebuke or send somebody’s child, they will call you that. It usually hurts them to the extent that they cry, yet nobody cares. In this community, when you clock 20 years and you don’t have a child, people begin to insult you and they don’t care whether you are the one who has decided to wait or not,” a woman in the community who gave her name as Okailey said.
She continued, “As for Accra, we can never change this. We can never stop calling people kene. Sometimes a childless woman doesn’t even have to wrong anyone, people are just looking for opportunities to mock them, so they will keep jibing at them all the time”.
While, these people take pride in having children, no one cares if these children are well looked after or not. It is the least of the problems of some residents of Ga Mashie in James Town, Accra, mostly teenagers.
Having children is a big deal, or at least majority of couples in Ghana desire to have children after marriage. However, voluntary childlessness is very uncommon in Ghana. It is the expectation that after marriage, or at a certain point in a woman’s life in Ghana, she has to give birth, therefore growing up to a certain age for women in particular without bearing children becomes worrisome, as society puts pressure on them to meet these expectations.
Individuals who do not have children are ridiculed, insulted and face rejection and they are tagged as ”barren”.
Even though some men are infertile, and therefore are the reason why some couples are childless, the concept of male infertility appears to be less spoken about. In recent times however, the issue is gaining center-stage in Ghana. While men in childless relations are often shielded from social pressure, the women are mostly targeted, ridiculed and stigmatized.
And for the women unfortunate to live in Ga Mashie who do not have children at age 24, life in the community can be unbearable.
According to Dr Ellis Nutifafa Attah, a Senior Medical Officer of the Ghana Health Service, infertility is the inability of couples to conceive a baby after regular sexual intercourse for over a year.
“At least having sexual intercourse three times a week and nothing happens, qualifies one as infertile. The cut off point for a woman, 35-years-old or above to be considered infertile is six months of having sexual intercourse and not conceiving,” he explained.
According to Larsen (2000) the primary infertility rate for women in Ghana is estimated to be 2 per cent, the secondary infertility rate was 14 per cent. In Ghana, a number of studies have reported psychological distress among infertile women. Infertility-related stress and stigma were found among women seeking infertility treatment in Southern Ghana. (Donkor and Sandall, 2007; 2009).
The authors reported that 23 per cent of the women experienced moderate stigma and 41 per cent experienced severe infertility-related perceived stigma. Women who reported severe levels of perceived stigma had the highest mean score for fertility-related stress.
Another woman, simply known as Ruth shared her experience in the Ga Mashie community. “I was mocked and ridiculed at James Town where I lived and grew up because at that time, I was 18 years and hadn’t given birth. I was poked, insulted and called barren at that age until I couldn’t take it anymore. I literally fled from the community to go and live with my sister in another community, far away from Ga Mashie.”
The following year however, at age 19, Ruth had a baby. And when news broke in her former community that she has given birth, most of her old friends and foes were shocked. Because they all believed that she was infertile.
“Some people travelled all the way, to come and confirm whether indeed the news was true or false. Most were still in disbelief after seeing me, because they didn’t see me pregnant,” she said.
Ruth’s story sounded exaggerated, until we decided to take a trip down to Ga Mashie and do this story.
On a very sunny Wednesday afternoon, while in James Town to fact-check some of the stories and how infertile women are treated, we found more than we had expected.
Ga Mashie is located on the Atlantic Coast of the Greater Accra Region of Ghana. The area is referred to as Old Accra, because that is where the original Gas first settled, thus making it the oldest community in Accra. Ga Mashie, constituting Ussher Town and James Town, covers an area of 100 hectares along the southwest coast of Accra. This division came about as a result of the influence of Europeans from the Netherlands, Britain and Denmark, who were allowed to build trading lodges on the coast in the 17th century.
The community, is a completely built-up area, with very small compounds, congestion is a problem as the buildings are very small yet, the houses host more people than they can hold.
The community lacks adequate social and public amenities, such as parks, gardens and playgrounds for the children.
There are few schools for the few lucky children to attend, no adequate water supply for the large number of people living there, and the deplorable state of sanitation is telling, with the management of solid and liquid waste fraught with challenges.
Drainage is virtually nonexistent, with existing narrow ones, choked with solid waste, emanating some quite offensive stench.
The Population and Housing Census of 2000 recorded a population of 97,646, but as at 2010, the Ghana Statistical Service projected the number to be about 125,000.
The population in this neighborhood is growing fast as many more children are being born, putting pressure on the few amenities available.
Walking through the community, it wasn’t difficult to notice the many young girls in their teens who were already mothers, with their babies sucking hungrily at their breasts, and others sharing the playgrounds with clay ovens, firewood, goats, chickens and so on.
These seven women engaged in loud conversation, didn’t notice as we signaled and interrupted them. We wanted to find out more about the rather cruel treatment meted out to infertile women.
Surprisingly, they all in chorus and laughter replied, “how can we stop mocking barren women.”
According to these women, for now, the latest expectant age for a woman in the community to give birth is around 20-22 years, but if at that age you have no child, you will definitely be a subject of ridicule.
To them, they have no remorse whatsoever for mocking people in that situation because God did not bring anybody into the world as barren.
They believe sometimes the mockery helps the women to conceive because it compels them to go the extra mile to give birth when they are mocked.
These women held very entrenched opinions about the causes of infertility. To them, the only cause of infertility is abortion because they believe God did not create anyone to be infertile, they said.
For instance, Aunty Naa one of the women we spoke to, said, “God did not create anyone infertile, if he did, then I shouldn’t even have children because as I sit here, I can’t even feed myself, not to talk of other mouths, yet I have plenty children. He would have made me barren and then give the children to someone else who can take proper care of them. So infertility happens as a result of our own deeds. If you want to abort a baby, you should do it within two months, but some women here wait until about six months before they try to terminate it.”
“So if you want to terminate pregnancy you have to go to Korle-bu, but if you don’t it can affect your womb, so that is what brings about infertility, but God never brought anyone to this earth not to give birth,” she said.
As the conversation heated up, the women mostly in their 40s and 50s heartily contributed to the discussion. They put a spiritual twist to the issue of infertility. They indicated that infertility could occur when someone puts a curse or witchcraft on a woman. They argued it is one of the major reasons for infertility.
On the idea of the possibility of men also being the cause of infertility, they had very little to say.
“If you think the problem is from the man, move to another man or just find a good herbalist to help you,” one said.
Meanwhile, Dr Ellis Attah, elaborated some causes of infertility. He said, the causes can be grouped into two – the male factors and female factors.
With regards to the male factors, he said, “it is the inability of the male to produce sperm that is healthy enough to be able to travel from the male, through the female reproductive system to fertilize a female egg.”
“The female factors could range from a number of points, the first one could be the hypothalamus. The hypothalamus is part of the brain that releases certain substances that help in the normal production of an egg for it to be fertilized. You can have problems with the ovaries themselves, the ovaries are where the egg emanates from so you can have problems with that. You can have problems with the tube, the tube through which the egg travels to meet the sperm. You can have problems with the uterus itself. The uterus is where the fertilized egg sits to be able to grow. Then you can have cervical factors. Cervical factors are responsible for the inability of the sperm to go through the cervix to meet the egg for fertilization to take place,” he explained.
The only cause of infertility the women got right was abortion, a fact that every mature person knows. So Dr Attah added that “there are also uterine factors. Uterine factors can do with one, the endometrium, whereby there are so many adhesion as a result of repeated abortions, when that happens it causes uterine scarring, and that prevents the sperm from travelling along the uterus.”
People in these situations shouldn’t lose hope. Dr. Attah says most cases can be corrected through medical means. He said, “if it has to be male factors, there are certain medicines that can be administered to rectify that. If the problem is with the cervix, it can be corrected, if the problem is with the uterus sometimes it can be corrected. If it’s the tubes, it can be accessed and corrected. If it’s the ovaries, they can be accessed and corrected. So the most important thing is to identify what the problem is and then seeking to address it as such.”
So, obviously there are more to infertility problems than stated by these women.
Interestingly, they have an entrenched cultural mindset that mockery is one sure way for an infertile individual to give birth, but clearly that cannot be accurate as Dr Attah explained.
Aunty Kaa’s story
The story of 62-year-old Aunty Kaa is no different. Probably she has suffered more.
Her situation seems hopeless due to her age. As she narrates her story, she tried hard to fight back the tears. She sounded strong initially as she put in an effort to mask her emotions, but as the conversation went on, the pain and bitterness couldn’t be concealed anymore.
She was 18-years-old when she had an abortion. Few days after, she started feeling severe abdominal pains and was rushed to the hospital, to her dismay; there was one more fetus in her womb, that wasn’t removed during the initial abortion procedure. She was however, successfully operated on and the other fetus was also removed safely.
Six years later, she began trying hard to conceive, it was impossible even though the abortion did not affect her womb according to what the doctors told her. She said, several doctors checked on her and told her there was nothing wrong with her reproductive system.
She combed the length and breadth of the country, just to have one baby so that she can fit in at her Ga Mashie community, but it never happened. She hopped from orthodox doctors, to herbalists, to shrines, river gods, pastors and so on, but nothing worked.
She spent a lot of money, selling her few properties in the pursuit of a child just to please herself, family and the society, but to no avail.
“I used to trade, so all the money I saved, I used it to move from place to place just to have one child. I went to pastors, herbalists, name them. I even went as far as the Weija river, and that was where I saw a crying tree. It scared me so I decided never to go anywhere again.”
The worse happened when her partner left her. “I became like chewing stick in the mouth of everyone around me, even including family members who I expected to comfort me,” she said almost in tears. Adding that, people who can even pass as her grandchildren have subjected her to ridicule because they have given birth, and she hasn’t.
She feared to send anyone’s child on errands, because she feared she would be insulted. So whether she was sick, weak, tired or whatever her situation was, she had to do whatever she needed to do for herself. Her only sister, who could also help, is physically challenged. She went into a state of depression according to her and almost gave up on life.
But at age 62 years, there is nothing she hasn’t seen when it comes to infertility stigmatization.
She is well accustomed to it now, and even though the stigma hasn’t reduced in anyway, she says she tries to go about her normal business, “after all there is nothing I can do now,” she said.
Asked if something could be done about the stigmatization, she shook her head with watery eyes and said “no, not much can be done about it.”
However, the President of the Association of Childless Couples of Ghana, (ACCOG) Nana Yaw Osei believes that most of these infertile women are being paranoid.
He said because of the problem they face, it affects them emotionally and psychologically, therefore some unintended actions by other people seem to trigger emotions of such women.
ACCOG is a Ghanaian non-faith based Non-Governmental Organization which provides a platform for childless couples to find options for accessible infertility care.
It also aims at eliminating stigma associated with childlessness.
It provides counseling and other support services to childless couples to enable them cope with their situation.
The Association which was established in 2012, has helped more than 2,000 patients who are going through various challenges, Osei said.
The ACCOG president who is also a fertility specialist, is very optimistic that most of the infertility cases can be solved somehow.
This is because there are several options available to couples or single women who want to have children and end the stigmatization they face.
Some of these options include, Assisted Reproductive Technology (fertility treatments that handle both a woman’s egg and a man’s sperm) to have babies, as well as adoption. Others too have been able to deal with infertility after counselling.
“It’s not like we want to get standing members of the Association who are saying that we cannot have children so we are going to belong to the Association forever. Our objective is to help people go through fertility treatment, so it is not really to have standing members. So as I speak to you, we don’t have like couples contributing dues or they are standing members, no. But we have a lot of clients, some have gone through the process, and they have been successful,” he added.
An opinion leader at Ga Mashie, told me how worrying the trend is, and pleaded with stakeholders to intervene.
“It depends on how government will go about it. They have to educate people on all the media platforms to stop mocking people. Sometimes the men are also part of the problem because they are irresponsible. They should educate them to take care of their babies,” Ruth Blankson said
“I believe if massive campaigns are pursued, this issue of female infertility stigmatization will end, contrary to my fellow women at James Town who believe absolutely nothing can end this menace. To them NGO’s, and other stakeholders have to channel their efforts into something more ‘productive’,”she added.
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