Middle East & AfricaJul 21st 2018 edition
A bad place to be barren
Nigeria has a high fertility rate. Why are infertility clinics booming?
Treatments range from modern IVF to prayers and blessed water
IN A rough-and-ready church in Ifo, on the northern fringe of Lagos, Prophet Emmanuel Akanni and Prophetess Foluke Akanni do extraordinary things. During moments of religious ecstasy, Mr Akanni receives visions that indicate which of his congregants are struggling to conceive children. By holding a chicken's egg over a woman's belly, he claims to be able to spy into her womb. Then he uses herbs and prayers to effect a cure. "There is nothing God cannot do," adds Mrs Akanni.
The fertility rate in Nigeria is estimated to be 5.4, implying that the average woman can expect to have that many children during her life. Yet many Nigerians experience infertility. Chelsea Polis of the Guttmacher Institute, a think-tank, and her colleagues estimate that 31% of Nigerian couples fail to conceive a child after 12 months of unprotected sex—a rate at least as high as in the West. In a country where a woman's worth is defined largely in terms of her ability to bear children, there is a growth market for fertility treatments of all kinds.
When Richardson Ajayi created the Bridge Clinic in 1999, in vitro fertilisation (IVF) was still a novelty in Nigeria. He had to fly in doctors and send blood samples abroad for hormone analysis. Today the technology is widespread, and private IVF clinics are popping up in wealthy parts of Lagos. "You buy an incubator, you go on television, and if you're good-looking, you'll get patients," says Dr Ajayi, disapprovingly. Mr and Mrs Akanni face similarly strong competition from other religious healers. "Jesus gives miracle babies here," reads a placard on a nearby church.
Many Nigerian women struggle to conceive because they have been harmed by sexually transmitted diseases such as chlamydia, or by infections picked up during unhygienic abortions or previous deliveries. Others have infertile partners. One study of 246 couples seeking fertility treatment in a Lagos hospital found that 52% of the men had a low sperm count or another problem that made it hard to conceive.
Few men, however, will countenance the idea that the problem lies with them. Infertility is "a one-sided thing", says Kemi Ailoje, who founded the Lifelink Fertility Clinic in Lagos two years ago. The notion that barrenness is a female malady is so strong, she says, that many women are obliged to pay for treatment out of their own pockets. They often turn up in her clinic in their early 40s, because it is only at that stage of life that they have amassed enough money.
Women have good reason to spend their savings. One study in Kano, a northern city, found that 38% of women seeking fertility treatment in a hospital had been physically or verbally abused. Just 7% of pregnant women said the same. Other women are abandoned or displaced. Dr Ajayi says that many men in childless marriages will remarry. It is only after they fail to impregnate their second or third wives that they seek medical help. As a result, almost all the men who enter his clinic turn out to have fertility problems.
Medical treatment can be expensive, especially when both partners have problems. A single IVF cycle in a Lagos clinic costs around 1m naira ($2,800), which is cheaper than in the West but far out of reach of the average Nigerian. Because so many clients are in their 40s, treatment is often unsuccessful. Dr Ailoje says that many infertile couples could have been treated fairly easily and cheaply had they sought help earlier. But many are unaware of the science of fertility, and neither the Nigerian government nor aid agencies have tried hard to educate them.
So the pastors and the traditional healers thrive. In Sango Ota, another town on the outskirts of Lagos, Prophet Okanlawon Mayowa of the Cherubim and Seraphim church sees between one and three new clients per month. He charges 50,000-100,000 naira for treatments that include saying prayers over water, which infertile couples then drink. He also uses herbs. Your correspondent asks which ones. Why, jokes Mr Mayowa—is he thinking of getting into the fertility business, too?
This article appeared in the Middle East & Africa section of the print edition under the headline "A bad place to be barren"