Infertility is a health issue affecting about 5 to 8% of married couples globally, with the rate higher in sub-Saharan Africa. 10-30% of couples in Nigeria are affected.
According to the World Health Organisation, the causes of infertility vary among men and women but involve a delay in getting a fertile woman pregnant after at least 12 months of unprotected sex.
Unlike fertility, infertility has not been documented sufficiently to capture its real prevalence over time, but various cross-sectional studies have measured infertility rates over a lifetime or specific periods and the rates were determined by women at risk of pregnancy, married women, or those with a partner who have reported at least one child.
Around 2017, the prevalence of infertility was reported to be 31.1%, 17.7%, and 11.5% for married women who had not conceived after 12, 24, and 36 months of having unprotected sex—without use of contraceptives, respectively. This shows that a significant number of couples experience delays in childbearing for at least 12 months, with the rates decreasing over longer periods.
On the other hand, fertility—the average number of births per woman—has seen a relative decline in Nigeria over the past six decades. Despite World Bank data indicating that a woman in Nigeria still gives birth to at least five children, fertility rates dropped by 16.3% between 2000 and 2022.
In the same year, Nigeria ranked the lowest among the eight sub-Saharan African countries with the highest number of fertility rates, following countries like Angola and Mali, with a total of five births per woman in 2022.
The trend of ‘Baby factories’ in Nigeria
Nigeria’s high infertility rate has been linked to the emergence of baby factories that supply couples with children. This illegal operation, though solving a problem, often involves housing pregnant women who are contracted to bear children to sell to couples experiencing infertility.
This problem is compounded by societal pressures to bear children after marriage. Couples who fall short of this expectation explore several options to have children. Some desperate couples partronise the clandestine operation of baby factories across Nigeria.
In 2020, over 160 babies were rescued from unregistered orphanages in Abuja, the country’s capital. Some of them were whisked away from the back of their mothers.
Dataphyte’s analysis shows that the prevalence of reported cases of baby factories is higher in Southern Nigeria compared to Northern Nigeria. While this may not necessarily indicate higher infertility rates in the south, baby factories tend to be more prevalent in areas where fertility rates are lower.
Do contraceptives cause infertility?
In another analysis, findings reveal that the South West has the highest proportion of married women who use contraceptives to control their births, which is partly the reason for their low number of total births per woman compared to other regions.
Although it remains unclear whether contraceptive use directly causes infertility, data suggests that it has an impact on the total number of births per woman over time by reducing the opportunities for conception.
For instance, in 2018, the North Central region had the lowest contraceptive use at 5.7%, with an average of five births per woman. Meanwhile, in the South West, where contraceptive use is highest, the total number of births per woman is lower.
However, previous research has shown that birth control methods like contraceptive pills do not cause infertility. “Hormonal birth control temporarily delays fertility and prevents pregnancy,” one study reveals. “But fertility levels return to normal once the contraceptive is discontinued.”
Tadele Girum and Abebaw Wasie share the same sentiment as found in the previous research. According to their study, evidence on resumption of fertility after contraception use is inconclusive and practically fertility after termination of contraception remains a big concern for women who are using contraception.
Their conclusion is: “Contraceptive use regardless of its duration and type does not have a negative effect on the ability of women to conceive following termination of use.”
Expert shares their view
Dr. Ebunoluwa Soyinka, a medical officer, says that contraceptives are in different forms but generally, it does not directly cause infertility. “If at all it’d have an effect, it is only in rare cases would it have a long-term effect on fertility,” she said.
According to her, couples struggling with achieving conception have a number of legal options such as assisted reproductive techniques like IVF. Other options include legal adoption and surrogacy.
“Nobody should patronise baby factories. It’s inhumane because most times, those babies were taken forcefully from their mothers or young girls are lured and impregnated for the sole purpose of selling off the babies.”
Admitting that IVF can be expensive, Dr. Soyinka reiterates that the legal adoption process in Nigeria might be long and tiring but people still pull through.