Ulla Larsen

Motherhood in sub‐Saharan Africa: The social consequences of infertility in an urban population in northern Tanzania

This paper examines the personal and social ramifications of infertility in an African urban population with low fertility. The study was conducted in Moshi, Tanzania, a multi‐ethnic community with relatively high levels of education and a well developed health services infrastructure. The major question to be addressed was whether in a low fertility urban population, both primary and secondary infertility bring about serious personal ramifications for women similar to those in rural areas. The methodology included a survey of 2,019 women and in‐depth interviews with 25 fertile and 25 infertile women. Of the 1,549 sexually active women in a regular union, 2.7% had never had a child in spite of trying to conceive for at least two years. Of the 1,352 women who had previously had a child, an additional 6.1% were subsequently infertile. The most important finding from the qualitative analysis concerns the major difference between childlessness and subsequent infertility (or primary and secondary infertility) in terms of implications for the effected women. These findings underline the importance of bearing a child in sub‐Saharan African populations.

GENDER INEQUALITY INCREASES WOMEN’S RISK OF HIV INFECTION IN MOSHI, TANZANIA

This study examined the hypothesis that multiple dimensions of gender inequality increase womens risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi, Tanzania. Three forms of HIV exposures were assessed reflecting gender power imbalance: economic exposures (age difference between partners and partners contributions to childrens expenses), physical exposures (coerced first sex and intimate partner violence) and social exposures (ever had problems conceiving). Behavioural risk factors included number of sexual partners for women in the last three years, partner had other wives or girlfriends, non-use of condom and alcohol use at least once a week in the last 12 months. Multivariate logistic regression analysis showed that a woman had a significantly elevated risk for HIV if she had a partner more than 10 years older (OR=2.5), her partner made low financial contributions to childrens expenses (OR=1.7), or she experienced coerced first sex before age 18 years (OR=2.0) even after taking into account the effects of risk behaviour factors. The association between ever had problem conceiving and HIV infection was explained away by risk behaviour factors. The findings lend support to the hypothesis that economic deprivation and experience of sexual violence increase womens vulnerability to HIV, providing further evidence for extending the behavioural approach to HIV interventions to incorporate womens economic empowerment, elimination of gender-based violence and promotion of changing attitudes and behaviours among men.

The problem of infertility in high fertility populations: Meanings, consequences and coping mechanisms in two Nigerian communities

This paper examines how socio-economic contexts shape local meanings of infertility, how the prevalence of infertility affects these meanings, and how the above affect community responses, life experiences and infertility treatment-seeking behaviors in two African communities. The paper is based on interdisciplinary research conducted among the Ijo and the Yakurr people of southern Nigeria that included a survey of approximately 100 infertile women and a matching sample of 100 fertile women, as well as in-depth ethnographic interviews with infertile and fertile women in two communities: Amakiri in Delta State and Lopon in Cross River State. In-depth interview results show that female infertility is more problematic among the Ijo in Amakiri, where kinship is patrilineal (traced through the fathers side), than among the Yakurr in Lopon, where kinship is double unilineal (traced through both parents). Childless women in Ijo society are not only disadvantaged economically but are prevented from attaining full adult womanhood. They therefore leave the community more often than other members. In Lopon there is also a strong preoccupation with fertility as a central fact of life, but infertile women receive support from maternal kin as well as voluntary associations serving as support groups. Our survey data confirm that there are significant differences between the life experiences of infertile and fertile women and between the infertile women of the two communities. The overall findings indicate that while there are variations in the extent to which infertility is considered problematic, the necessity for a woman to have a child remains basic in this region. Motherhood continues to define an individual womans treatment in the community, her self-respect and her understanding of womanhood.

Trends in Infertility in Cameroon and Nigeria

Data from the 1978 World Fertility Survey (WFS) and the 1991 Demographic and Health Survey (DHS) for Cameroon and the 1981-82 WFS and 1990 DHS for Nigeria are used to examine infertility by age region and sexually transmitted diseases. The analysis includes only women who entered their first marriage at least five years before the survey. Data are weighted. The proportions childless are based on all women who were married at least seven years before the survey and weighted data. Findings indicate that infertility declined from 43% to 39% in Cameroon and from 36% to 33% in Nigeria. Age patterns of infertility were similar for both countries. It is ruled out that biases in level of infertility resulted from contraceptive use and sexual abstinence or lack of sexual activity or misrecording. In Cameroon prevalence of infertility was highest in the North. Infertility declined at all ages up to the age of 35 years in the Center-South Littoral and Southwest and West Regions. It remained the same or increased at older ages. Western Cameroon had the lowest infertility. Infertility declined regionally and by age in Nigeria. Infertility was lowest in the Southwest and highest in the Northeast and Northwest Regions. Infertility was the same in northeastern Nigeria and bordering northern Cameroon. Childlessness declined from 12% to 6% in Cameroon and from 6% to 4% in Nigeria. None of the infertile women had used contraception. Childlessness declined from 18% to 7% in the North Region of Cameroon and remained stable at 5% in the Littoral and Southwest Region. Childlessness in the Southeast and Southwest Regions of Nigeria was 1% or less. The Hausa in Nigeria were found to have higher levels of infertility than among other groups. Infertility was highest among women who initiated intercourse under the age of 13 years but even this population had declining fertility during the survey years. Desired number of children was higher than womens parity in both countries. Infertility prior to marriage or childbirth was higher in Cameroon.

Motherhood status and union formation in Moshi, Tanzania 2002–2003

Age at first union is increasing throughout much of sub-Saharan Africa at the same time that not all couples are waiting for marriage before their first sexual intercourse. We assessed the effect of a premarital first birth on entrance into a first union in an urban area in East Africa—Moshi, Tanzania. The data come from the Moshi Infertility Survey of 2002–2003. Women who spent less than a year in single motherhood were significantly more likely than childless women to enter into a first union, although the magnitude of this relationship was weaker for more recent cohorts. Women who had been single mothers for 5 or more years (about two-thirds of women with a premarital birth) were significantly less likely than women without children to enter into a first union.

The impact of childhood sexual abuse and intimate partner violence on sexually transmitted infections.

Childhood sexual abuse (CSA) and adult intimate partner violence (IPV) have both been found to be associated with sexually transmitted infections (STIs) independently, but studies of STIs have rarely looked at victimization during both childhood and adulthood. This paper examines the relationship between CSA, IPV and STIs using data from a nested casecontrol study of 309 women recruited from multiple health care settings. Overall, 37.3% of women experienced no violence, 10.3% experienced CSA only, 27.3% experienced IPV only, and 25.0% experienced both CSA and IPV. Having ever been diagnosed with an STI was associated with violence (CSA only, odds ratios [OR] = 2.8, 95% confidence intervals [CI] = 1.0–7.5; IPV only, OR = 2.2, 95% CI = 1.0–4.9; CSA and IPV: OR = 4.0, 95% CI = 1.7–9.4), controlling for demographic characteristics. Women who experienced CSA were younger when they were first diagnosed. Understanding how both childhood and adult victimization are associated with diagnosis of STIs is important to reducing the incidence and prevalence of STIs, as well as the associated consequences of STIs.

Sexual violence at first intercourse against women in Moshi, northern Tanzania: Prevalence, risk factors, and consequences

To explore the relationship between sexual violence at first intercourse and later sexually transmitted infections (STIs) in Moshi, Tanzania, we analysed data from a representative household survey that comprised face-to-face interviews with 1,835 women and tests for six STIs on biological samples from 1,235 of these women. Overall, 10.9 per cent report forced first intercourse and 15.3 per cent report unwanted first intercourse. Unadjusted analysis shows a relationship between forced first intercourse and STIs (OR: 1.72, 95 per cent CI: 1.19–2.51). Life-course variables mediate this relationship. Significant predictors of having an STI include older age, more sexual partners, and a partner who has children with other women. Coerced first intercourse appears to be associated with changes in the life course of women and with a heightened risk of contracting an STI.