Beyond the Wound: Nigerian women bearing the weight of infertility stigma

After nearly a decade of trying to conceive, Fatima Audu has become the subject of constant gossip in her circles. “I have been called barren more times than I can count,” said Mrs Audu, a 36-year-old teacher in a top Abuja school. “It feels like I carry a scarlet letter everywhere I go.”

In Nigeria, where children are often seen as the glue that holds families together, infertility is more than a medical issue; it is also a deep social wound.

The inability to conceive is met not with compassion but with suspicion, ridicule, and, often, rejection.

After marriage, there is almost an unspoken countdown: within nine months, a baby and sometimes, even twins or triplets, is expected to arrive. When that milestone passes without a child, the quiet pressure begins to creep in.

Oftentimes, in-laws begin to drop subtle remarks, neighbours ask probing questions, and friends exchange knowing looks that say more than words ever could.

And gradually, what ought to be a private journey of starting a family slowly turns into a community conversation, one that places the woman at the centre of scrutiny.

For some women, this quiet pressure soon gives way to open judgment. Mrs Audu knows this all too well.

Once outgoing and social, she now avoids gatherings where questions about children might arise. She recalls attending a cousin’s naming ceremony a few years ago, where a relative leaned close and whispered, “Don’t worry, your turn will come if you pray hard enough.”

Others exchanged glances as she forced a smile. “It was meant to comfort me, but it only reminded me that everyone was watching, waiting, judging,” she said.

At home, the strain follows her. While her husband stands by her side, she feels the unspoken disappointment of his family during visits.

Suggestions about herbal mixtures, fasting, prayers, and “trying again with more faith” come often, adding layers to the silent burden she carries.

Across Nigeria, countless women find themselves in similar situations, carrying the weight of stigma when a marriage does not produce children.

In many cases, the blame falls almost entirely on women, even though medical science shows that infertility affects both men and women.

Figures behind the pain

The World Health Organisation (WHO) describes infertility as a disease of the male or female reproductive system, defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.

Data from the WHO estimates that 48 million couples and 186 million individuals are living with infertility globally. This report, based on data from 1990 to 2021, estimated that approximately one in six people globally have experienced infertility at some stage in their lives, representing around 17.5 per cent of the adult population.

In Nigeria, exact figures are difficult to get, largely because many cases go unreported, but experts estimate that between 20 and 30 per cent of married couples are affected by infertility issues.

Studies also show that male infertility accounts for roughly 20-50 per cent of cases globally, including in Nigeria.

Lukman Omokanye, an expert in infertility management and minimal access to gynaecological surgeries, told PREMIUM TIMES that infertility may be caused by several different factors, in either the male or female reproductive systems.

Mr Omokanye explained that ovulation disorders are a leading cause of infertility in women, pointing out that these disorders can arise from various factors, including Polycystic Ovary Syndrome (PCOS), thyroid dysfunctions, and issues with the pituitary gland.

He noted that for men, low sperm count and poor sperm quality are frequent causes of infertility.

Mr Omokanye noted that chronic stress, excessive exercise, and some lifestyle factors can also lead to ovulation disorders in women and decreased sperm quality in men.

“In Nigeria, recent studies indicate that combined infertility factors in both men and women have risen from 30 per cent to between 40 per cent and 50 per cent,” he said.

Amanda Adeleye, an expert in reproductive endocrinology, explained that age can significantly impact fertility, particularly in women over the age of 35.

Ms Adeleye noted that as women age, the quality of their eggs deteriorates, which makes conception increasingly difficult.

“By the early to mid-40s, a woman’s chances of conceiving drop to between one and five per cent. While men also experience a decline in semen quality with age, it generally has less of an impact on their ability to conceive,” she explained.

Weight of Stigma

While doctors speak of hormones, egg quality, and even sperm counts, society rarely hears science. What people see is a marriage without children, and that is all it takes to fuel stigma.

Nigeria’s cultural and religious diversity also shapes how infertility is perceived. Stigma can vary dramatically between urban and rural areas, among Christians and Muslims, or across different ethnic groups.

In some communities, childlessness is seen as a curse, a punishment, or a failure of faith. Others interpret it as a sign of spiritual imbalance or familial disobedience. These beliefs intensify the stigma women like Fatima face daily.

Amina Sule, a 38-year-old fashion designer in Kano State, experienced the harshest side of stigma. Married for four years without a child, her in-laws labelled her “barren” and even called her a “witch,” blaming her for the family’s misfortunes.

The constant verbal abuse and social isolation ultimately led to her divorce.

For Rachael Joseph, a 42-year-old businesswoman residing in Kaduna, the scars of battling infertility feel fresh every day.

Married for nine years without a child, she described how friends stopped inviting her to their kids’ parties. “It is as if I carry bad luck,” she said. “Sometimes I wonder if they even see me as a woman anymore.”

Mrs Joseph said she feels everyone is focusing on her marriage because she has yet to have children. “Whenever I step out of the house, I just think everyone is gossiping about me, my marriage, and just my life generally,” she said.

Narrating her story to PREMIUM TIMES, she said her mother-in-law often hints that her son should try again with another woman, so she can have her grandchildren before she dies.

For Mrs Audu, the Abuja-based teacher, even ordinary changes in her body attract scrutiny. “Anytime my stomach looks a little bloated, maybe from food or my monthly cycle, people start asking if I’m finally pregnant,” she said. “Some even rush to say, ‘congratulations’ before I can explain.”

She admitted that she now worries about gaining weight at all. “It sounds silly, but I’m scared of adding weight. Everyone will think I’m pregnant, and when they find out I’m not, the whispers start again.”

Also, the stigma of childlessness often leads to withdrawal from community life. Weddings, naming ceremonies, and even religious gatherings can become painful reminders of what society expects but cannot provide.

Temitope Oba, a fabric vendor in Ibadan, described the toll she had endured in her almost seven years of marriage. “I stopped attending naming ceremonies. Each time, someone would whisper behind my back, asking why I don’t have children yet. It became too much to bear.”

Akinnagbe Fernandez, a Consultant Obstetrician and Gynaecologist/Minimal Access and IVF expert at the University of Abuja Teaching Hospital, noted that stigmatisation is a common challenge among infertile couples across sub-Saharan Africa.

“Often, the blame is placed solely on women, even though infertility can result from either partner,” he explained.

“This stigma pushes couples away from proper medical care, as many first turn to religious houses or traditional healers. Such delays often worsen prognosis.”

Carrying the Blame

In Nigeria, where infertility is often interpreted through cultural and social lenses, women shoulder most of the blame. Even in cases where a man’s reproductive health is identified as the cause, suspicion and ridicule still fall heavily on the woman.

“People assume that if there are no children, the woman must be at fault,” said Janet, a Lagos-based banker who has been married for five years with no surviving children.

She described the assumption as ‘painful and unfair’, noting that both she and her partner are undergoing treatment.

Janet had been pregnant twice within this period, but unfortunately, she suffered miscarriages.

After four years of trying to conceive, Ronke Balogun, who lives in Keffi, Nasarawa State, remains without a child. This is despite years of consultations with doctors, visits to different clinics, and even prayer grounds.

In all these years, her husband, Moses, had not undergone any testing to assess if he was contributing to their inability to achieve pregnancy until a few months ago. “It was at this time we discovered that my husband’s sperm was having some issues,” she said.

Meanwhile, Mrs Balogun lived all these years thinking she was the problem, a situation that has taken a toll on her physical, mental, and social well-being.

Experts say this is not unusual.

Oladimeji Abraham, a urologist at the Federal Medical Centre, Ebute-Metta, Lagos State, explained that many Nigerian men are still reluctant to get tested for infertility, partly because of cultural attitudes that equate physical strength with good health.

Mr Abraham said this often leaves women carrying blame alone, even when male factors are at play.

“It’s an attitudinal issue,” he said. “Many men generally believe that when you are seemingly physically strong, you don’t have any medical challenges. Some also erroneously believe that it’s only women who have fertility problems. Thankfully, this is changing gradually.”

Men in the Shadows

While women bear the brunt of stigma, men are often untouched. They too struggle, though often in silence. In many Nigerian communities, admitting male infertility is unthinkable, as it challenges deep-rooted ideas of masculinity.

Across Nigeria, doctors say many men quietly struggle with infertility but rarely speak about it.

Men diagnosed with conditions such as low sperm count or poor sperm motility often keep it secret, leaving their wives to bear the blame publicly.

In many families, even when male infertility is identified, relatives continue to pressure the woman to “pray harder” or seek remedies, while the man remains shielded by silence.

Mr Abraham, the urologist, noted that male infertility can sometimes be unknown or secondary to specific abnormalities.

“Most times, there’s impairment in the quality and/or quantity of semen,” he explained.

“This can result from varicocele, poorly treated sexually transmitted infections, testicular torsion, cigarette smoking, or even exposure of the testes to heat, radiation, and chemotherapy. Congenital abnormalities such as undescended testes or absence of the vas deferens, including hormonal and endocrine disorders, may also be responsible.”

The urologist noted that infertility treatment is not always straightforward, as patients are first evaluated based on clinical details, after which interventions may range from medications to surgery.

“In some cases, couples may eventually require assisted reproductive technologies,” he said.

Even Mrs Audu has felt the weight of this silence. After a medical test showed her husband’s sperm motility was low, she recalls how difficult it was for him to accept it.

“He wouldn’t talk about it,” she said. “Instead, his relatives kept telling me to pray harder, try traditional herbs, and be more patient. I was carrying the blame alone.”

This unwillingness to confront male infertility not only deepens women’s suffering but also prevents couples from accessing timely and effective care, Mr Abraham said.

The Price of Hope

For couples battling infertility, hope often comes with a heavy price tag. While medical solutions exist, they are far beyond the reach of most Nigerian families.

Findings by this reporter show that assisted reproductive technologies like In Vitro Fertilisation (IVF) cost between N2.8 million and N7.5 million per cycle, depending on the clinic. This amount is far beyond the income of the average Nigerian family in a country with a N70,000 minimum wage.

Without health insurance coverage, these medical solutions remain a luxury for only the wealthy few in the country.

Unlike in some developed countries where fertility treatments are partly covered by insurance or government health schemes, couples in Nigeria bear the full cost out of pocket.

Mrs Audu and her husband know this reality firsthand. Determined to try IVF, they pull resources together to raise money for their first IVF cycle. Unfortunately, it was unsuccessful.

“When it failed, I thought I would break,” she said tearfully. “It wasn’t just the money we lost; it was the hope, too.”

Mrs Oba, the Ibadan-based fabric vendor, has unfortunately suffered the same fate. She had undergone the IVF procedure twice, but both attempts failed.

WHO warns that infertility treatments can plunge families into what it calls a “medical poverty trap,” where couples exhaust life savings chasing a dream that remains out of reach.

“Millions of people face catastrophic healthcare costs after seeking infertility treatment, making this a major equity issue and all too often, a medical poverty trap for those affected,” said Pascale Allotey, director of Sexual and Reproductive Health and Research at WHO.

Mr Fernandez, the IVF expert, told PREMIUM TIMES that while IVF and other forms of Assisted Reproductive Technology (ART) “have become a reality in Nigeria and are here to stay,” accessibility remains a major hurdle.

“The cost of setting up IVF centres and treatment itself is still very high, making it out of reach for the majority of Nigerians,” he explained.

“However, established centres have recorded success rates of between 40 and 60 per cent, which is comparable to what is obtainable in most developed countries.”

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While couples wait

Infertility may remain a silent struggle for many Nigerian couples, but it does not have to remain an invisible one.

NGOs, support foundations, and peer-led groups are stepping into the gap, offering emotional succour, shared experiences, and sometimes even financial help during the long wait for diagnosis or treatment.

One strong example is the Merck Foundation’s “More Than a Mother” initiative. In Nigeria and other African countries, the foundation has supported training for fertility specialists and embryologists, organised awareness summits, used media/art to challenge stigma, and provided economic empowerment programmes for women battling infertility.

Also, the OARS Foundation, a charitable organisation, has demonstrated a commitment to helping couples realise their dream of having children. The Foundation offers grants to couples with financial challenges towards fertility treatment through the MART Medical Centre.

Similarly, the Fertility Support Professionals Association (FSPA Nigeria) organises peer groups and mentorship, so women do not have to struggle alone. The association said it is committed to providing comprehensive support, education, and advocacy for individuals and couples navigating the journey of fertility.

These interventions don’t erase the waiting, but they offer light in the shadows: companions who understand, spaces to share, and small but real avenues of relief.

For women like Mmes Audu, Sule, Balogun, and Oba, the journey is not just about having children. It is about reclaiming dignity in a society that too often defines womanhood by motherhood.

As Mrs Audu put it: “All I want is to be seen as a human being first, not just as a mother.”