Infertility in the Gambia, 1994

The purpose of this study was to assess the magnitude of infertility in the Gambia and to understand the sociocultural factors that influence coping with and consequences of infertility. The frequency of infertility in rural and urban areas was estimated. Different social and marital variables influencing infertility and subfertility were identified, and infertility levels were compared across different types of backgrounds. Constraints to seeking health care for infertility and the health care system's burden of infertility patients were also investigated. In order to understand the problems of undesired infertility in a country where the desire for children and fertility is very high, a population based estimate of the frequency of sub-/infertility in the Gambia was undertaken. A survey method of assessment was used in a representative random sample of villages. The study also included a review of the problems faced and coping mechanisms employed by infertility clients and types of health care available for infertile couples in the different types and levels of the formal and traditional health system. Primary sterility was found to be fairly uncommon (around 3%), and secondary infertility to be more frequent (around 6%). Primary infertility is a feasible definition for a woman (couple) who have never been pregnant. Secondary infertility implies that the woman has been pregnant, but the result of the pregnancy could be either a live (or dead) child, or an abortion. Half of the infertile couples fail to seek formal health care, and they have to reach a certain level of care in order to be properly managed. Alternative care is often sought. Child fostering is also a frequent solution to childlessness. Childlessness in this context refers to both infertility and childlessness due to loss of children. Child mortality also contributes to childlessness. This is relevant in the Gambia. In-depth interviews revealed that traditional care like marabous are frequently consulted long before formal health care. This delay could be a problem in those cases where infertility is caused by infections. As outlined in the UN 1994 Population Conference in Cairo (ICPD), infertility management should be a part of a complete family planning program. To meet the needs of infertile couples for health care, it is important to strengthen and improve the competence of the formal health sector. In addition, there should be collaboration with, and training of, traditional healers to enable them to identify and refer relevant medical conditions for management at the formal health sector. In order to obtain a sample that would be fairly representative for the whole of the Gambia, the scientific review group developed a sampling frame based on the existing system of relatively equal size Enumeration Areas (EA) that were developed for the Gambia population census 1993, and which is very much up to date. This enables us to have a relatively good statistical base for our estimates. 24 EA's were then randomly drawn for the country as a whole and in order not to oversample the urban area, the randomization was weighted. This means that the results will have to be weighted to give representative results (the weights only account for a very small fraction of the variance). In the selected EAs our field interviewers visited every compound (or households if the compounds consisted of more than one household) and counted the number of people living in each compound or household within compounds.