January 3, 2020
Fertility Treatment in Zimbabwe Helps Women Overcome Shame and Secrecy, But is Still Out of Reach for Most
January 3, 2020
Until in vitro fertilization was introduced in Zimbabwe in the late 1980s, medical fertility treatment was scarce here. Though pricey, the treatment is more accessible now, but for women who face cultural stigma and risk of ridicule, cost may be the least of their concerns.
HARARE, ZIMBABWE — In traditional Zimbabwean culture, infertility is a sensitive topic. Women tend to bear the brunt of the blame as they face pressure to conceive and deliver healthy babies soon after marriage. The subject is often addressed behind closed doors, so as not to bring shame or ridicule to the families involved.
Until recent decades, the steep price tag made fertility treatment difficult to access in Zimbabwe. But in the late 1980s, the introduction of in vitro fertilization restored hope to women who had lost faith in having a child of their own.
“I could not open up to most of my family, as I felt I would be judged for not being able to do what I was created to do,” says S.M., a 38-year-old woman from Cameroon who lives in Harare and asked that only her initials be used. “I used to wonder what was different about me, why could other women do it so easily, yet I could not.”
Like many women around the world who struggle with infertility, SM suffered in silence as she tried to get pregnant shortly after marrying in 2013.
She had been trying to have a child for six years when she was diagnosed with polycystic ovarian Syndrome or PCOS, a common hormonal disorder among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods, among other symptoms, and have an excess of male sex hormones, or androgens. PCOS can make it difficult to conceive children.
For SM, the longing for motherhood led her across the continent to the IVF Zimbabwe clinic, where dozens of women and their families take advantage of the in vitro fertilization process and receive help to get pregnant and successfully deliver their babies.
Dr. Tony Robertson, an obstetrician and gynecologist from the UK, introduced IVF treatment to Zimbabwe in the late 1980s, but the facility closed in 2000 due to economic hardship.
In 2016, when obstetrician and gynecologist Dr. Tinovimba Mhlanga re-opened the facility, Zimbabwe joined a growing list of African nations that provide infertility treatment. The increased access stems in part from greater awareness of infertility’s impact on women and families worldwide.
According to a study published in the Human Reproduction Open Journal in 2018, “Evidence overwhelmingly shows that childlessness is highly stigmatized in [resource-poor areas where fertility rates are high], and that women who are unable to bear children suffer significant social and psychological consequences. The World Health Organization has recommended that infertility be considered a global health problem.”
Since IVF Zimbabwe re-opened, the clinic has helped bring about 60 successful live births.
Mhlanga says the majority of his patients are local Zimbabweans, and treatment costs between $3,800-$4,000 US dollars, a hefty sum considering the average monthly salary is $253 USD. The public health sector is severely under-resourced, and private health care is pricey. Fertility is not seen as an emergency, which is why health insurance companies do not cover fertility treatment. In Zimbabwe, this fee covers all aspects of the procedure, including embryologist and gynecologist appointments, medication and hospital bills.
While IVF treatment in other countries, like India, may cost less, most Zimbabwean couples can’t afford the transportation and accommodation on top of the IVF treatment. Mhlanga says costs are kept relatively low so more people can access treatment: “Most of the people do not know about us, so if we start at a higher margin, it would mean we would attract less people. We want to make our name known, and our results speak for themselves.”
But for families desperate to conceive, the cost is sometimes the easiest part of the journey. The burden of culture and tradition can take an even greater toll.
Prince Mutandi, director of ZINATHA School of Traditional Medicine, says procedures like IVF are at odds with Zimbabwean tradition because anything to do with sex and reproduction is usually handled in private.
“There was a traditional protocol when it came to these issues. A protocol which began when people reached puberty,” Mutandi says. “Aunties and grandmothers would educate and advise young women, and uncles and grandfathers would do the same for young men.”
Young men were subject to certain rituals to determine their stamina and strength in preparation for marriage. “For boys, there were certain things like peeing contests that were held between men, to see if a young man can shoot urine over his head and urinate behind himself. If he failed to do so, he was given certain roots to chew or certain foods to eat to increase his stamina.”
Some cultures, for example, believe that infertility occurs when a bride price has not been paid, Mutandi says. Other culprits include curses, an avenging spirit or witchcraft.
Faced with these familial obligations and rituals, many women who undergo IVF treatment choose to do so in secret. SM’s stress was multiplied because her husband’s family did not know about it.
“Sometimes I could spend up to six months without having my menses, so it was difficult to plan,” SM says. She began the IVF process in Cameroon, then was referred to Cape Fertility Clinic in Cape Town, South Africa, in July 2018.
While there, she underwent painful cycles of IVF treatment to produce enough eggs to be retrieved.
“The first time, they harvested 15 eggs, but the embryos were not good. The doctor told me that they were not good, but they would implant them anyways,” SM said. Ten days after she returned to Zimbabwe, she started bleeding. Heavily.
“There was no need to test,” she said, looking forlorn. “I already knew.”
But her desire to give birth never faded. SM returned to Cape Town in March 2019 to try again. The two trips to South Africa cost $14,000 US dollars and required significant time off from her job.
“They harvested 15 eggs, and 12 embryos were good. And of those 12 we picked 10,” she says. “Two were implanted, and eight were frozen. But even for those two, they didn’t take.”
When the expense of traveling to and from Cape Town got too high, SM asked around and heard about IVF Zimbabwe. On July 6, she underwent her third implantation at IVF Zimbabwe’s clinic. That proved to be the charm.
“Ten days after the procedure, I took the test, and I couldn’t believe my eyes,” she gushes. “The test was positive.” SM heard the baby’s heartbeat for the first time six weeks later.
“I was over the moon. I am grateful and prayerful that it goes well,” she says.
Another woman, 46-year-old GM, who also didn’t want her name used, tried to conceive for 10 years before successful IVF treatment in 2017. “I was married in 2007, and although I was hopeful, I had trouble having a child. I tried tablets, I tried traditional methods, apostolic churches, everything. Nothing worked,” she says.
Eventually, GM was diagnosed with fibroids and had them removed. Then she learned about IVF. After she connected with Mhlanga, GM says she had success quickly, after her eggs and a donor’s hormones were combined with her husband’s sperm. “Not a lot of people knew that I was undergoing IVF treatment, because people don’t understand it,” she says.
But as she gazes lovingly at her sleeping 15-month-old infant, GM says she would not hesitate to have another child. “As soon as I have enough funds, I want to go back and do another round of IVF.”