September 11, 2012
September 11, 2012
Barrenness is a delicate subject in Uganda, where the stigma attached to women who cannot bear children is strong. Uganda is considered to be part of the “African Infertility Belt.”
KAMPALA, UGANDA – For two decades Catherine Mubiru, 45, bore the derogatory nickname of “mugumba,” Luganda for a “barren woman,” because she could not bear a child.
“I have been labeled barren for many years,” says Mubiru, an administrative assistant with a local nongovernmental organization. “I got married at 19 and was not able to bear children for 21 years. My in-laws, workmates and even friends used to regard me as mugumba.”
She says the nickname followed her for so long that even she started to believe it.
“For so long, I was called barren and infertile by many that I, myself, started believing that I was never going to have children in life,” she says.
Mubiru says that women despised her and even insulted, her for her difficulty conceiving. She recalls one incident when a mother of two young children told her she would die with rust in her stomach.
She says she struggled to obtain approval from her in-laws as well.
“I tried my best to keep my marriage,” she says. “I loved my husband and in-laws. I welcomed them in the house and prepared for them the best meals I could in the home. One day, my sister-in-law, came to me and told me that even if I do marvelous things, they shall never see them unless I give them a baby.”
But Mubiru says that her husband always stood by her.
“My husband was supportive,” she says. “I thought he would divorce me at some point, but he did not.
Together, the two sought various remedies.
“At first, we sought the help of witch doctors,” she says.
Her mother would bring them home, and Mubiru and her husband did whatever the witch doctors told them to do.
“My husband and I did many things,” she says. “One of them told us to walk naked in the road very early in the morning before people wake up, and we did it.”
But the rituals yielded no results. Meanwhile, her husband, Chris Mubiru, fended off pressure to divorce his wife because of her difficulty conceiving.
“I felt I had to remain with my wife during this difficult time despite pressure from society to divorce her because we had wedded in church,” he says, “and I knew that the vows cannot be revoked.”
He says knew that her reproductive difficulties were not her fault, an idea that fuels the stigma here attached to childless married women.
“I had married her when she was just 19 and knew that she was innocent,” he says.
The stigma attached to infertility in Uganda is so strong that many women who struggle to conceive must deflect derogatory names, rejection by families and in-laws and divorce by their husbands. While some women seek help from witch doctors, others consult religious leaders, who recommend prayer. But doctors focus on the medical causes of infertility, with centers offering various treatments to women who can afford it. Although some women have lost hope, others remain optimistic that they will one day give birth to children of their own.
Uganda has one of the highest fertility rates in the world – 6.1 as of 2010 – according to the World Bank. But the World Health Organization notes a phenomenon in which infertility is most prevalent in areas with high fertility rates, including Uganda among the countries in the “African infertility belt.” WHO researchers attribute 50 percent of a couple’s difficulty conceiving to male infertility but say that society disproportionately assigns women the bulk of the blame.
Dr. Ssali Tamale, a fertility scientist and proprietor of Kampala Gynaecology and Fertility Centre, estimates that 10 percent of Ugandans are unable to have children.
“We estimate that there are about 3.5 million people in Uganda suffering from infertility,” he says. “Ten percent of these need to be assisted by reproductive therapy.”
Prudence Komujinya, a woman activist, says barrenness is a delicate subject in Uganda, and many blame the victims for their predicament. She says that people ostracize, snub and despise women who have been married for an extended period but have not been able to conceive.
Jackie Kigozi, 32, says she was married for six years before was able to have a baby. She suffered reproach from the community, and this affected her marriage.
“I got married in 2005 and did not get a child until this year,” she says. “For all that time, my in-laws were ridiculing me, telling me that I was just eating their son’s/brother’s food for nothing.”
She says that the societal pressure eventually weighed on her husband.
“One time, my husband even threatened to divorce me,” she says. “Even when I would go for functions, I would hear people asking when I was ever going to give birth.”
Farida Oketch, 46, an office attendant, says that her first husband did abandon her because of her challenge conceiving.
Oketch later remarried a widower with children. She treats them like she would her own.
“I got a new husband,” she says. “He was married and his wife died and left him with four children. We are looking after them. I get consoled that at least I have children to look after.”
Years later, Oketch is still hopeful she will one day have children of her own.
Some women therefore seek help from their churches, while those who can afford to, seek medical advice.
The Rev. Susan Nandelenga, 39, a Pentecostal pastor at Wonders Church, blames barrenness on ancestry. She says that some people’s ancestors dedicated their offspring to the gods, entering into covenants that included infertility.
“Some people have been sacrificed by their parents or great-grandparents, and agreements [were] made that they should not have children if the covenant is to stand,” she says.
Nandelenga says that serious prayers can avoid this curse.
“Many previously barren women have come to our church and been prayed for, and they got children,” she says. “Myself, I used to have miscarriages. But after being prayed for, I now have four babies.”
She says that she can now perform these prayers for others.
“I got the anointing to pray for barren women to have children,” she says.
But Nandelenga cautions that the affected women must also commit themselves spiritually – and avoid witchcraft.
“First, these women need to have faith that God can help them,” she says. “They need to forgive those who bewitched them, for sometimes the Holy Spirit reveals the cause, and it [is] witchcraft. They also need to be committed to God and not come to church for prayers at the same time going to the witch doctors.”
But doctors disagree.
Tamale attributes infertility to sexually transmitted diseases, as well as health issues like diabetes and high blood pressure that often result from a poor diet high in sugars and fats. He adds that infertility among couples could include men having low sperm counts, while women might have problems with their uterus, ovaries or fallopian tubes.
Dr. John Mutumba, the medical superintendent at the Women’s Hospital International and Fertility Center, says that there are various reasons that cause barrenness.
“For some women, their spouses cannot sustain an erection, produce abnormal sperms or even don’t produce sperms at all,” he says. “For women, some of their tubes may have been blocked either intentionally or unintentionally. Some women may not be ovulating, and for some, their uterus cannot hold babies.”
Mutumba says there are various treatments available for women who are unable to conceive.
“Most of our clients are women of about 35 years and older,” he says. “They usually come alone, tell the doctor their history, and from there, we can tell whether the problem is with the woman or the man.”
He says that the hospital carries out a number of procedures to try to help women to conceive.
“We do a number of procedures, including removing fibroids, repairing the pelvis when it is loose, or [if] the vagina is too big, we insert intrauterine insemination,” he says. “We have eggs and sperm donations for women who want children and have no men in their lives. We also carry out DNA testing.”
He says that the center’s ultimate goal is to make families complete and to make life better, adding other strategies.
“We also fertilize eggs outside the women,” he says. “We have women who can hold the baby for the couple if the women’s uterus can’t. We also carry out surgeries for those who need them. We introduce hormones in the vagina.”
Mutumba says the success rate of the operations they handle stands at 60 percent.
Kigozi says she was determined to remain a happy woman. She moved on with her career, pursued further studies and sought medical help at Kampala Gynaecology and Fertility Center. Eventually, she was able to conceive.
But not everyone can afford such treatments.
“Most of our clients belong either to the middle or upper class because the procedures are still on the expensive side,” Mutumba says.
He says the rates vary.
“They depend on the procedures to be carried out,” Mutumba says.
He also says that some cases are irreversible.
“For a woman who has no uterus or a woman whose uterus is damaged, we can’t do much so for such cases,” he says. “We don’t even try.”
Oketch has sought help from many sources, trying traditional, medical and religious routes. But she hasn’t been successful yet.
“I tried almost everything: witches, doctors and even going to different churches,” Oketch says.
Still, she remains hopeful.
“I can still have a child,” she says. “Some women who took long to have children finally did get children. I still have hope that one day I will get.”
Mubiru is one of those women.
After 21 years of being called mugumba, the Mubiru eventually gave birth to a baby boy named Isaac. Mubiru says her relationship with her in-laws has since improved.
“My mother-in-law and sisters-in-law were very excited when I got a baby,” she says. “They brought me many presents and these days visit me more than they used to.”