10th January, 2014
Dr. Odidika Umeora is the Head of Department, Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki. He speaks to NKRUMAH BANKONG-OBI on the problem of infertility in Nigeria
Why do you think people patronise baby traffickers?
People go to baby sellers because they can’t make babies. It is as simple as that. But why do people want babies? The remote reason is the society. In African society, we place such premium on children, especially male children. This is the thing that drives people to go to any extent to get a baby, legally, illegally, whatever means. Unlike in some developed countries, where babies are secondry in marriage, the case is different. I tell you, I know a couple who have been married for over 20 years but they said they don’t want babies. And they are there and they are happy.
In Nigeria?
No. In Nigeria, it is not possible. They are in the United States. It is impossible in Nigeria because, why do people marry? They marry because they want to have babies. Marriage should go beyond babies. It should be about companionship; when babies come, fine. But if they don’t come, then everything should be fine too. From this point, I think the traditional rulers have got a role to pay to discourage this narrow understanding of marriage in Africa. When people marry, we give them nine months; we start counting from the day you get married. If nothing happens within the period, the mother becomes agitated first, then the in-laws. There is so much pressure both from within and without. You can’t know the extent of this pressure, if you have not gone through it. We gynaecologists handle a lot of infertility cases. We understand the pressure people go through. If left alone, these people can manage these emotions. But there is pressure from the society.
Unfortunately, Nigeria is sitting on the so-called infertility belt of Africa. This belt stretches from Senegal, it cuts across Cote d’Ivoire, Ghana, Cameroon to Equatorial Guinea. You can’t run a gynae clinic without having one or two cases of infertility – some primary, some you can’t find a cause for them.
But you see, the good thing these days is that those cases you find the cause, there is treatment. And if a case is treated and the woman succeeds, there may be many people like that. And for those cases you can’t find a reason, it is difficult to find medical treatment for such. This is why you now have infertility clinics scattered all over the country. The only problem is now the cost; it goes for above N750,000 to N1 million or more per cycle. But be that as it may, it has offered so much hope to many childless couples.
You said the geographical location of Nigeria is a major cause of infertility. Are there specific areas in the country that are worst hit by this? I asked because of the prevalence of baby markets and racketeering here?
No, the whole of Nigeria is within this belt. And we have not really had a study that situated this in a particular part of Nigeria than the rest. But you see, I talked about pressure, if you understand the mentality of the Igbo, you will know that the Igbo like to acquire properties and they want their lineage to go on and on. If an Igbo man acquires so much property and at the end of the day, there is no child, particularly, a son, he feels unfulfilled. He asks: ‘Who is going to take over all these things that I have worked for? Who is going to keep my memory?’ That is the pressure on the Igbo man. And then for the women, you know there are some organisations where if you don’t have a child, they may even address you as a man. Such women are discriminated against and as a result, they have low self-esteem. Sometimes, they are depressed. Nobody wants to be in that situation, so they go to any extent to obtain a baby.
Look at the cases you have handled, can you say this problem is on the rise or declining?
It is prevalent. I won’t say it is increasing or decreasing.
How many cases do you get, say, monthly or quarterly or annually?
This [last] year, we got 493. Apart from the four months strike and other breaks, last year, I don’t think, as a department, we saw less than 500 cases of infertility. Just 500 is on the low side.
There is no day I go to the clinic that I don’t have a minimum of four, five or six cases of infertility. So, if you take four and we run five clinics per week, that is 20 cases. You are talking about 80 in a month. And that is more than 1,000 in a year. I think that is more like it.
What exactly do you say are the causes of infertility?
Like many things in medicine, the first thing we say is they are idiopathic; there is no reason for it. But oftentimes, you know, it takes two to tango. The cause may be from the man or the woman. Men contribute the same percentage of infertility of 40 per cent as women do. Both of them contribute 20 per cent. And from the men, sometimes, it is poor quality of sperm. There are men who have sperm without cells, they have the cell that are dead, they can’t fertilise an egg. So many things can cause this.
Smoking, a lot of alcohol, mumps. You know these mumps that children have can progress and result in problem in the area of spermatogenesis. There are people that sit on hot places; like long distance drivers, you know they sit on the engine. Wearing tight-fitting pants is also a problem. God is wonderful, he brought the scrotum out from the body and put it in a sac outside the body, to enable it have lower temperature. So, if you wear a tight nylon pant, it’s like you are now bringing it tight to the body and increasing the temperature. For the women, you also have a lot of factors that cause infertility. There is the tubal factor, a lot of infection destroying the tubes or the unhealthy practices of abortion. These can lead to tubal damage. Some women can’t ovulate. There is something we call polysistical which is very common on our environment. Here, a woman is big and her period is not coming regularly. There are other causes. But in some, after all investigations, you won’t even find any.
Are there illnesses that can cause infertility?
All venerable disease, like chlamydia in the woman, destroys the inside of the tubes. And once the tubes are not functioning as they should, you can’t get pregnant. Gonorrhoea is also there. So, history of sexually transmitted infection is very important. And that is why, to prevent infertility we advise young girls to abstain from sex or if you can’t, use condom. The condom is not just for preventing you from getting pregnant, it can also protect you from getting all these infections. So, even if you are a lady who likes taking pills and injections, to prevent pregnancy we also encourage you to use condom to prevent infections.
Do you have a fertility clinic here?
No, we have infertility clinic. As a public organisation, we don’t have the artificial reproductive equipment. Not yet in Abakaliki.
So what happens to the case you have?
We refer them to the centres around, like Enugu, Port Harcourt and other places. One funny thing is that if you have such a clinic in Abakaliki, most of your clients won’t come from Abakaliki, they prefer to go to a farther place, where people don’t know them. They stay there, get pregnant and then return home.