‘At the hospital I learnt the truth’: diagnosing male infertility in rural Malawi

Abstract

This paper examines how men's reproductive bodies are problematised in rural northern Malawi as access to biomedically defined diagnoses of the health of men's sperm contribute to the visibility of male infertility. Ethnographic research with infertile and fertile men explored pathways into the sexual health and fertility services offered in district hospitals, men's clinical engagements and masculine imaginaries. The research suggested that men's willingness to be referred for semen analysis is an extension of intensive and persistent help-seeking for childlessness instigated by couples and encouraged by families. Within the laboratory, acceptable social arrangements for semen sample collection are negotiated between male clients and laboratory staff, which emphasise heterosexual and marital virility. Following diagnosis, counselling by clinical officers, without any significant therapeutic interventions, focuses on compassion in marriage. This paper considers: what is the role of semen analysis within public health facilities and why do men participate? How do men experience an infertility diagnosis and what do they and their partners do with this knowledge? In addition, how do these practices shape gendered relationships in families and communities? The analysis builds on Inhorn's (2012) concept of ‘emergent masculinities’ to better understand the connections between male subjectivities, medical technologies and the globalisation of male reproductive health, as they relate to men's lives in rural Malawi.

British Pakistani Muslim Masculinity, (In)fertility, and the Clinical Encounter

“…Similar findings about the gendered nature of infertility stigma have derived from studies across a broad geography (Inhorn and Van Balen 2002;Inhorn 2003;Culley and Hudson 2007). Tendencies to blame women can be disrupted by technologies that allow male factor infertility to be easily diagnosed (Parrott 2014), but this may be actively resisted. Health care systems that view male factor infertility diagnosis as a necessary stage in treatment protocols can assist more couples to access advanced treatments, but this too can be resisted in order to protect men (Bennett 2012).…”

A rapid scoping review of fear of infertility in Africa

“…The countries of origin primarily included Ghana (n = 8) [5,13,29,31,35,[38][39][40], Kenya (n = 4) [5,26,29,41], Uganda (n = 3) [14,19,20], Tanzania (n = 3) [25,28,34], South Africa (n = 3) [24,32,36]; Cameroon (n = 2) [8,43], Mozambique (n = 2) [15,42], Mali (n = 2) [18,33] and Nigeria [6,7]. One research study was also conducted in each of the following countries Madagascar [27], Congo [22], Ethopia [16], Malawi [45], Rwanda [30], The Gambia [10], Zimbabwe [37] and Botswana [44]; and one across Malawi, South Africa, Uganda and Zimbabwe [17]. See Fig.…”

“…Participants in the 'infertility consequences' studies were couples (n = 3) [30,38,39], women (n = 9) [10,[31][32][33][34][35][41][42][43], men (n = 2) [40,45] or combination thereof (n = 3) [36,37,44] Also represented were traditional healthcare professionals or healers [38,39,42], religious leaders [38,39] and managers of insurance schemes [38,39]. Participants were described as having fertility problems (diagnosed or not, in treatment or not) (n = 12) [10, 30-34, 37, 40-44] seeking treatment in gynaecological and obstetric clinics (n = 1) [35] or being childless (n = 3) [38,39,45]. Three studies also explored the perspectives of fertile women [34,42,44].…”

Infertility in Sub-Saharan Africa: A Woman’s Issue for How Long? A Qualitative Review of Literature

“…While the social burden falls disproportionately on women, infertile men are not excluded and may not be valued as adults by their communities if they are unable to have a child and in some societies if they only have girls [2]:…”

“…It is generally believed that more than 70 million couples suffer from infertility problem worldwide and this constitutes 15% of reproductive aged couples globally [1]. In Sub-Saharan Africa region, infertility problem prevalence varies from 9% in Gambia [2], 21.2% in northwestern Ethiopia [1] [3], between 20% and 30% in Nigeria [4] [5] and 11.8% among women and 15.8% among men in Ghana [6], however, men are mostly excluded in infertility discourse [7]. World Health Organization (WHO) demographic studies also show that in Sub-Saharan Africa, more than 30% of women aged 25 -49 years suffer from secondary infertility, the inability to achieve a subsequent pregnancy.…”