The Burden of Infertility: Global Prevalence and Women’s Voices from Around the World
The clinical definition of infertility provided by the World Health Organization is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” A number of factors including genetics, environmental exposures and infectious diseases have been linked to infertility risk. While infertility can affect both men and women, the majority of research on this topic focuses on women.
Global prevalence
Available data indicate that at least 50 million couples worldwide experience infertility. Importantly, studies estimating the global prevalence of infertility employ different methodologies, including different operational definitions for infertility, producing inconsistent results. Nevertheless, research has shown consistently that secondary infertility, which refers to women who have had at least one pregnancy and live birth previously, is more common than primary fertility, which refers to women without a biological child.
According to a systematic analysis of national health surveys, in 2010, approximately 10.5% of women around the world experienced secondary infertility, and roughly 2% experienced primary infertility. The prevalence of secondary infertility, in particular, varies widely by region and country, ranging from less than 6% to greater than 16% of women. The majority of researchers agree that infectious disease, which can lead to fallopian tube blockage, contributes largely to variation among populations and changes over time. Since infertility risk tends to increase with age, differences and changes in the age at childbearing likely play a role. Relatively little is known about the specific risk factors for and prevalence of male infertility around the world.
Cross-cultural experiences of stigma
In many cultures, women who do not have children suffer from stigmatization, discrimination and ostracism, even if the underlying cause lies in their male partners or husbands. Dr. Mahmoud Fathalla observed that the social burden of infertility “falls disproportionately on women…when a couple is unable to produce, the man may divorce his wife or take another wife if they live in a culture that permits polygamy.” Women’s experiences of stigma have been documented all over the world:
“Sometimes people will say, ‘ah, she’s like that, she doesn’t have children…you don’t have the feelings of a mothers so that’s why you say what you do.’” – Cameroon
“My brother-in-law said to us once without respect that we won’t know how to teach children since we do not have any. We felt insulted.” – China
“Hmm the people in my community are real gossips. They talk too much. They gossip a lot about it. Sometimes I pass by some places and all that I see is people pointing fingers at me.” – Ghana
“I like to be alone at home and do not like to go anywhere. A woman who does not have a child must stay at home.” – Iran
“Our culture demands that, for a woman to be socially acceptable, she should have at least one biological child.” – Kenya
“Now whenever I go to any family gathering, right away they ask me this question. It feels very strange. When someone comes to meet me at my house they ask the same question. I feel very hurt that why do people say this thing.” – Pakistan
“My depression is [primarily] because of my neighborhood. Whenever I socialize, they ask me questions like, ‘Don’t you have a child?’… If I say that I am trying to get a tube baby, it will fly around immediately and we will become a subject of gossip.” – Turkey
“My maternal instinct is being denied. It’s a slap in the face. I feel like I’m isolated in a prison; I have no one who understands how horrible this is. People don’t know what to say to you … I think I’m alternatively dealt with as either someone who has died or that [I] have a handicap.” – United States
Access to treatment
Inequitable access to assisted reproductive techniques such as in vitro fertilization to treat infertility remains a challenge for those living in low-resource settings, especially in sub-Saharan Africa. Even if the services exist, they can be prohibitively expensive or poor quality. Unequal access to infertility services can be considered a human rights violation in that some people—namely, those who can afford these treatments—have more reproductive agency than others.
Connection to gender inequities
While the majority of research in this area is conducted among women, infertility is not just a woman’s issue. Currently, the data on global male infertility is lacking—both in terms of prevalence estimates and men’s experiences across cultures—simultaneously contributing to and reinforcing gender-related stigma. Global infertility represents yet another area of scientific inquiry requiring sex- and gender-based research, an important first step towards developing equitable programs and policies.
Graphs: Mascarenhas et al. National, regional and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLOS Medicine, 2012.
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