The fertile grounds of reproductive activism in The Gambia: A qualitative study of local key stakeholders’ understandings and heterogeneous actions related to infertility
Autoři:
Susan Dierickx aff001; Gily Coene aff001; Megan Evans aff003; Julie Balen aff003; Chia Longman aff002
Působiště autorů:
Centre of Expertise on Gender, Diversity and Intersectionality (RHEA), Vrije Universiteit Brussel, Brussel, Belgium
aff001; Centre for Research on Culture and Gender, Ghent University, Ghent, Belgium
aff002; School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
aff003
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0226079
Souhrn
Introduction
While several studies have focussed on the experiences of women living with infertility, there is a paucity of information related to understandings, representations and actions of key stakeholders (i.e. organisations and individual actors involved in activities or professional care surrounding infertility) when it comes to infertility in Sub-Saharan Africa. This ethnographic study conducted in The Gambia, West Africa, focuses on how key stakeholders in the country understand infertility, and on their activities to improve the lives of people with infertility.
Methodology
This ethnographic study draws on primary and secondary data for thematic analysis. Primary qualitative data were collected using in-depth interviews, observations, informal conversations and group discussion with various stakeholders (i.e. health care providers and representatives of non-governmental, governmental and international organisations). Sources of secondary data included government and non-governmental reports and media outputs.
Results
Results illustrated that most key stakeholders had a good understanding of the cultural frameworks and social realities of women living with infertility, with less focus on, or awareness of, men’s experiences of infertility. We distinguished three different positions of these actors and organisations, first, the infertility supporters, i.e. those who despite political challenges and a lack of funding, initiated activities to raise awareness about the problems people with infertility are facing and aim to increase access to infertility services. The second are moderate supporters, i.e. those who recognise the problems infertility poses and whose organisations target some of the perceived causes of infertility (i.e. lack of health education and harmful cultural practices). A third group of neutral or moderate opponents consist mainly of formal health care providers who do not consider infertility a current priority, given many competing demands in the resource-constrained healthcare system.
Conclusion
While international donors still largely neglect the emotional and social implications of infertility in Sub-Saharan African countries, some local stakeholders are working to bring services closer to people with infertility. The efforts of these local stakeholders require support and integration, and should include engaging with different groups for widespread sensitisation to reduce stigma and promote attendance to health centres for reproductive health challenges.
Klíčová slova:
Culture – Female infertility – Global health – Health care providers – Health education and awareness – Infertility – Male infertility – Gambia
Zdroje
1. de Kok BC. Infertility and relationships: the importance of constructions in context. Fam Relationships Soc. 2013;2: 23–42. doi: 10.1332/204674313X664680
2. Gerrits T, Shaw M. Biomedical infertility care in sub-Saharan Africa: a social science review of current practices, experiences and view points. Facts, views Vis ObGyn. 2010;2: 194–207. Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4090591&tool=pmcentrez&rendertype=abstract
3. Hough CA. Loss in childbearing among Gambia’s kanyalengs: Using a stratified reproduction framework to expand the scope of sexual and reproductive health. Soc Sci Med. Elsevier Ltd; 2010;71: 1757–1763. doi: 10.1016/j.socscimed.2010.05.001 20965107
4. Sundby J. A rollercoaster of policy shifts: Global trends and reproductive health policy in The Gambia. Glob Public Health. Taylor & Francis; 2014;9: 894–909. doi: 10.1080/17441692.2014.940991 25203251
5. Domingues Figueira De Faria I. Therapeutic Navigations: National and transnational quests for fertility among Mozambican women and men. Universiteit van Amsterdam. 2016.
6. Inhorn MC, Patrizio P. Infertility around the globe: New thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update. 2015;21: 411–426. doi: 10.1093/humupd/dmv016 25801630
7. Fledderjohann JJ. “Zero is not good for me”: Implications of infertility in Ghana. Hum Reprod. 2012;27: 1383–1390. doi: 10.1093/humrep/des035 22357772
8. Ombelet W. Global access to infertility care in developing countries: a case of human rights, equity and social justice. Facts, views Vis ObGyn. 2012; 7–16.
9. Dierickx S, Rahbari L, Longman C, Jaiteh F, Coene G. ‘I am always crying on the inside’: A qualitative study on the implications of infertility on women’s lives in urban Gambia. BMC Reprod Heal. Reproductive Health; 2018;15: 1–11. doi: 10.1186/s12978-018-0596-2 30208896
10. Gerrits T. Social and Cultural Aspects of Infertility in Mozambique. Patient Educ Couns. 1997;31: 39–48. doi: 10.1016/s0738-3991(97)01018-5 9197801
11. Inhorn MC, Van Balen F, editors. Infertility around the Globe. New thinking on childlessness, gender and reproductive technologies. London: University of California Press; 2002.
12. Dierickx S, Coene G, Jarju B, Longman C. Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia. Reprod Health. Reproductive Health; 2019;16: 103. doi: 10.1186/s12978-019-0762-1 31307488
13. Ibisomi L, Mudege NN. Childlessness in Nigeria: perceptions and acceptability. Cult Heal Sex. 2014;16: 61–75. doi: 10.1080/13691058.2013.839828 24236953
14. de Kok BC. Constructing infertility in Malawi: management of interpersonal, normative and moral issues in talk [Internet]. The University of Edinburgh. 2006. http://search.ebscohost.com/login.aspx?direct=true&db=edsble&AN=edsble.561999&lang=ru&site=eds-live&authtype=uid
15. Hyder A, Syed S, Puvanachandra P, Bloom G, Sundaram S, Mahmood S, et al. Stakeholder analysis for health research: Case studies from low- and middle-income countries. Public Health. Elsevier Ltd; 2010;124: 159–166. doi: 10.1016/j.puhe.2009.12.006 20227095
16. Burgess R, Campbell C. Creating social policy to support women’s agency in coercive settings: A case study from Uganda. Glob Public Health. 2015; doi: 10.1080/17441692.2015.1005654 25748445
17. Chigudu S, Jasseh M, D’Alessandro U, Corrah T, Demba A, Balen J. The role of leadership in people-centred health systems: a sub-national study in The Gambia. Health Policy Plan. 2014; 1–12.
18. Tabong PTN, Adongo PB. Understanding the Social Meaning of Infertility and Childbearing: A Qualitative Study of the Perception of Childbearing and Childlessness in Northern Ghana. PLoS One. 2013;8. doi: 10.1371/journal.pone.0054429 23342158
19. Dyer SJ, Abrahams N, Mokoena NE, van der Spuy ZM. “You are a man because you have children”: Experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility in South Africa. Hum Reprod. 2004;19: 960–967. doi: 10.1093/humrep/deh195 15016772
20. Dierickx S, Balen J, Longman C, Rahbari L, Clarke E, Jarju B, et al. ‘We are always desperate and will try anything to conceive’: The convoluted and dynamic process of health seeking among women with infertility in the West Coast Region of The Gambia. PLoS One. 2019;14: e0211634. doi: 10.1371/journal.pone.0211634 30703136
21. Hultin N, Jallow B, Lawrance BN, Assan S. AUTOCRACY, MIGRATION, AND THE GAMBIA’ S ‘UNPRECEDENTED’ 2016 ELECTION. Afr Aff (Lond). 2017; 1–20. doi: 10.1093/afraf/adx007
22. Wright DR. The World and a Very Small Place in Africa: A History of Globalization in Niumi, The Gambia. New York: Sharpe; 2010.
23. Mcconnell BB. Music and health communication in The Gambia: A social capital approach. Soc Sci Med. Elsevier Ltd; 2016; doi: 10.1016/j.socscimed.2016.09.028 27721137
24. Touray I. Sexuality and women’s sexual rights in the Gambia. IDS Bull. 2006;37: 77–83. doi: 10.1111/j.1759-5436.2006.tb00306.x
25. Sundby J, Mboge R, Sonko S. Infertility in the Gambia: Frequency and health care seeking. Soc Sci Med. 1998;46: 891–899. doi: 10.1016/s0277-9536(97)00215-3 9541074
26. Walraven G, Scherf C, West B, Ekpo G, Paine K, Coleman R, et al. The burden of reproductive-organ disease in rural women in The Gambia, West Africa. Lancet. 2001;14: 1161–1167.
27. Hough CA. RE/PRODUCING MOTHERS: STRUCTURE AND AGENCY IN GAMBIAN KANYALENG PERFORMANCES. Ethnology. 2008;47: 257–269.
28. HEALTH IS WEALTH: Health policy framework. 2007.
29. Dem F. Day 2 Consultation on Islam, FGM ends without breakthrough. The Point. Banjul, The Gambia; 2017.
30. Bargalès C. Gambie: “Safe Haven”, une association de soutien aux femmes victimes d’infertilité [Internet]. RFI; 2018. http://www.rfi.fr/emission/20180107-gambie-safe-haven-une-association-soutien-femmes-victimes-infertilite
31. Speech dr. Mbowe. 2016.
32. President Jammeh to start diabetes cure soon. 2007.
33. 261 women turn to the President for their fertility problems. 2013.
34. Fourth Batch of HIV/AIDS Patients start President Jammeh’s Treatment. 2007.
35. Ceesay A. Sixth batch of HIV/AIDS patients discharged. 2010.
36. Njie A. President Jammeh Takes on the Sixth Batch of Infertility Patients. Kanilai; 2011.
37. President Jammeh declares Gambia an Islamic Republic. 2015.
38. More hiv/aids patients to benefit from president Jammeh’s herbal medicine. 2007.
39. Njie A. Health Ministry Under The Microscope As Its New Minister is Sworn-in. 2011.
40. Ndow M. Batch Of Women Treated For Infertility Have Been Discharged. The Daily Observer. 15 Mar 2013.
41. Witsenburg C. The Problem of Infertility (Childlessness) in Africa Gambia no exception. The Point. Fajara, The Gambia; 2016. http://thepoint.gm/africa/gambia/article/the-problem-of-infertility-childlessness-in-africa-gambia-no-exception
42. 3RD BATCH OF 130 PATIENTS start INFERTILITY TREATMENT IN KANILAI. 2009.
43. 27 start hiv/aids treatment. 2007.
44. GAMBIANS MARCH IN SOLIDARITY WITH PRESIDENT JAMMEH IN HIS BREAKTRHOUGH OF HIV/AIDS CURE. 2007.
45. Jammeh YAJJ. ON THE CELEBRATION OF THE 1ST ANNIVERSARY OF THE HIV/AIDS BREAKTHROUGH [Internet]. The White House. Banjul; 2008. https://obamawhitehouse.archives.gov/the-press-office/2013/06/07/statement-president
46. Mbowe T. FOR THE CELEBRATION OF THE HIV/AIDS BREAKTHROUGH. 2008.
47. MacDouall-Gaya N. ON THE CELEBRATION OF THE HIV/AIDS BREAKTHROUGH ANNIVERSARY. Banjul, The Gambia; 2008.
48. Sanneh A. HEAD OF THE PRESIDENTIAL MEDICAL TEAM ON THE CELEBRATION OF THE HIV/AIDS BREAKTHROUGH ANNIVERSARY. Banjul; 2008.
49. Njie M. SECRETARY OF STATE FOR HEALTH AND SOCIAL WELFARE ON THE CELEBRATION OF THE HIV/AIDS BREAKTHROUGH ANNIVERSARY. Banjul; 2008.
50. Mbowe T. THE PRESIDENT’S ALTERNATIVE TREATMENT PROGRAMME: A SUCCESS OF HERBS CELEBRATED FOR THE 4TH YEAR. 2011.
51. Ceesay SM. FEATURE: Infertility stigmatization: Gambian perspective. The Point. 2018.
52. president jammeh’s aids cure is foolproof. 2010.
53. Sey O. MINISTER OF HEALTH AND SOCIAL WELFARE ON THE OCCAISION OF THE LAUNCHNIG OF NATIONAL TRADITIONAL MEDICINES DAY IN THE GAMBIA. Banjul; 2015. pp. 1–32.
54. National Medicine Day. 2015.
55. President Jammeh announces his decision to participate fully in the treatment of HIV. 2007.
56. PRESIDENT JAMMEH DISCHARGES 13 CURED HIV/AIDS PATIENTS. 2007.
57. president jammeh starts treatment for third batch of hiv/aids patients. Rabat; 2007.
58. El Aouad R. Letter Royaume du Maroc, Ministère de la santé Institute National d’hygiène. Rabat; 2007.
59. Jammeh’s breakthrough Significant achievement in President Jammeh’s cure for HIV/Aids [Internet]. 2007. http://health.gov.ie/blog/press-release/govt-approves-groundbreaking-legislation-to-tackle-alcohol-misuse-varadkar/
60. Njie A. Countdown to the 4th Anniversary of the President’s Herbal Breakthrough. 2011.
61. President Jammeh discharges the first and second batches of hiv/aids cured patients. 2007.
62. Darboe M. 42 Gambian Minors Crossed Med Sea in 2018- UNHCR. The Voice. 3 Apr 2018.
63. Ceesay A. Presidential Alternative Treatment Programme for hypertension on course. 2011.
64. president jammeh treats the second batch of hypertensive patients. 2007.
65. Marong OP, Jammeh AF. President Jammeh harps on same sex marriage. 2013.
66. Njie A. the President’s infertility treatment attracts more women. 2011.
67. President announces the discovery of speedy and efective treatments as latest HIV test results of the 3rd and 4th batches of patients were released. 2008.
68. President Jammeh cures hypertension. 2007.
69. president JAMMEH TREATS MORE ASTHMA PATIENTS. 2007.
70. his excellency dr. alhaji yahya a.j.j. jammeh appointed honorary president of the west african natural traditional practitioners network. 2007.
71. President declares a ban on Female Genital Mutilation. 2015.
72. Jammeh’s Aids cure real …Sky News is wrong. 2007.
73. Kuyateh H. Veep, Others Stress Empowerment of Gambian women. The Voice. 3 Apr 2018.
74. Njie A. PATP DISCHARGES ANOTHER BATCH TREATED FOR INFERTILITY. 2011.
75. Twelfth batch of infertile women given hope of bearing children. 2015.
76. President Jammeh reacts to hiv results. 2007.
77. International Children’s Day of Broadcasting. The Gambia: Child Fund; 2018.
78. Speech of the hon minister on the commemoration of the national traditional medicine day. 2016.
79. Jammeh AF. President Jammeh calls for a retrospect as Africans at 9th Anniversary of Herbal Breakthrough. 2016.
80. 27 short listed for HIV treatment. 2007.
81. Ceesay H, Jeng N-Y, Jallow I, Gibba A. Consultation On Islam and Family Wellbeing: NEWSLETTER. 2017.
82. Ceesay H, Jeng N-Y, Jeng F, Sawaneh S. Consultation On Islam and Family Wellbeing: NEWSLETTER. 2017.
83. Witsenburg C. Planned parenthood & Child welfare: Assisted Reproductive Services, IUI: Patient information booklet. Jariatou Senghore; 2016. pp. 1–14.
84. Dimbayaa: Fertility for Africa (Eng). Brusubi;
85. Dimbayaa: Fertility for Africa. Brusubi;
86. The Gambia: Demographic and Health Survey 2013. Banjul, The Gambia; 2014.
87. Skilled and involved youth. Banjul, The Gambia;
88. Petersen I, Hancock JH, Bhana A, Govender K. Closing the treatment gap for depression co-morbid with HIV in South Africa: Voices of afflicted women. Health (Irvine Calif). 2013;5: 557–566.
89. Johnson KM, Fledderjohann J. Revisiting “her” infertility: Medicalized embodiment, self-identification and distress. Soc Sci Med. Elsevier Ltd; 2012;75: 883–891. doi: 10.1016/j.socscimed.2012.04.020 22647565
90. Hörbst V, Gerrits T. Transnational connections of health professionals: medicoscapes and assisted reproduction in Ghana and Uganda. Ethn Health. 2016;21: 357–374. doi: 10.1080/13557858.2015.1105184 26778613
91. Sandelowski MJ. Failures of Volition: Female Agency and Infertility in Historical Perspective. Signs (Chic). 1990;15: 475–499.
92. Hörbst V. “You need someone in a grand boubou”–barriers and means to access ARTs in West Africa. Facts, views Vis ObGyn. 2012; 46–52.
93. Hörbst V. ‘You cannot do IVF in Africa as in Europe’: the making of IVF in Mali and Uganda. Reprod Biomed Soc Online. Elsevier B.V.; 2016;2: 108–115. doi: 10.1016/j.rbms.2016.07.003 29892723
94. Ombelet W, Cooke I, Dyer S, Serour G, Devroey P. Infertility and the provision of infertility medical services in developing countries. Hum Reprod Update. 2008;14: 605–621. doi: 10.1093/humupd/dmn042 18820005
95. Morison L, Scherf C, Ekpo G, Paine K, West B, Coleman R, et al. The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey. Trop Med Int Heal. 2001;6: 643–653.
96. Sabbe A, Oulami H, Hamzali S, Oulami N, Le Hjir FZ, Abdallaoui M, et al. Women’s perspectives on marriage and rights in Morocco: risk factors for forced and early marriage in the Marrakech region. Cult Health Sex. 2015;17: 135–149. doi: 10.1080/13691058.2014.964773 25299768
97. Nour NM. Child Marriage: A Silent Health and Human Rights Issue. Rev Obstet Gynecol. 2009;2: 51–56. 19399295
98. Hampton T. Child Marriage Threatens Girls’ Health. Med News Perspect. 2010;304: 509–510.
99. Dhont N, Luchters S, Ombelet W, Vyankandondera J, Gasarabwe A, Van De Wijgert J, et al. Gender differences and factors associated with treatment-seeking behaviour for infertility in Rwanda. Hum Reprod. 2010;25: 2024–2030. doi: 10.1093/humrep/deq161 20573675
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