Infertility in Nigeria: Ending the stigma and expanding access to fertility care

By Olawuyi Mariam Damilola

In Nigeria, the question often comes before the congratulations: “When are you having a child?” For couples struggling to conceive, what may appear to be an innocent question can reopen wounds that are already difficult to explain. At family gatherings, religious meetings and social celebrations, the absence of a child can become a subject of speculation, unsolicited advice and, in some cases, outright humiliation. For many, the struggle to conceive does not end in the privacy of the home; it follows them into the community, where parenthood is often treated as an expectation rather than a personal journey. Buy Maps

Behind this social pressure lies a reproductive health challenge that deserves far greater public attention. Infertility affects both men and women, yet the burden of blame in many Nigerian communities continues to fall disproportionately on women. Some face questions about their femininity, accusations from relatives and pressure within their marriages, while the possibility of male infertility is overlooked or dismissed. The result is a culture in which a medical concern can become a source of shame, emotional distress and social exclusion.

But infertility is not a moral failure, a punishment or proof that a person has failed in marriage. It is a medical condition that warrants appropriate assessment, evidence-based treatment where available, and compassionate support. Until Nigeria confronts the stigma surrounding infertility alongside the financial and healthcare barriers that limit access to fertility services, countless individuals and couples will continue to endure their struggles in silence.

The question, therefore, is no longer simply why some couples struggle to have children. It is why a society that places such a high value on parenthood continues to make the experience of infertility even more painful for those living through it.

Infertility Is a Public Health Issue, Not a Personal Failure

Infertility is generally defined as the inability to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse. It can result from several factors affecting either partner, both partners, or, in some cases, causes that remain unexplained despite medical investigation.

In women, contributing factors may include ovulatory disorders, blocked fallopian tubes, endometriosis, age-related changes in fertility and certain reproductive infections. In men, problems involving sperm production, sperm movement, hormonal function and the reproductive tract can affect fertility. Some couples experience a combination of male and female factors, making a comprehensive assessment essential.

Despite the medical explanations available, infertility is still frequently interpreted through cultural assumptions, religious beliefs and misconceptions. Some couples may be told that their inability to conceive is evidence of a spiritual problem, a lack of faith or a consequence of past wrongdoing. Although individuals have the right to their personal beliefs, such explanations can become harmful when they discourage medical assessment, encourage blame or expose vulnerable people to exploitation. Check Fertility!

Recognising infertility as a public health concern does not diminish its personal significance. Rather, it acknowledges that the condition can affect emotional well-being, relationships, financial stability and social participation. It also reinforces the need for accessible healthcare, reliable information and supportive communities.

The Burden of Stigma and Social Expectations

In many Nigerian communities, having children is closely associated with marriage, family continuity and social acceptance. While these values may be meaningful to many families, they can create considerable pressure for couples who experience difficulties conceiving.

Women may face repeated questions about pregnancy, suggestions that their husbands should seek another partner, or accusations that they are responsible for a marriage’s inability to produce children. Some may experience hostility from relatives or fear rejection by their spouses. Others may be excluded from family discussions and social activities where childbirth and child-rearing are central themes.

Men are not immune to the emotional consequences of infertility. However, expectations surrounding masculinity can make it difficult for some men to acknowledge fertility problems or seek medical assistance. In settings where fatherhood is associated with virility and social status, a diagnosis of male infertility may be experienced as a threat to personal identity.

These pressures can take a serious psychological toll. Anxiety, sadness, isolation, relationship difficulties and declining self-esteem may accompany prolonged attempts to conceive. When couples feel compelled to hide their experiences, they may lose access to the emotional support that could help them cope.

Stigma can also influence healthcare decisions. Some people delay seeking medical advice because they fear being judged, while others pursue unverified remedies or expensive treatments in the hope of avoiding public scrutiny. Consequently, infertility stigma is not simply an issue of social etiquette; it can interfere with timely diagnosis, informed decision-making and appropriate care.

Why Are Women Still Blamed for Infertility? One of the most persistent misconceptions surrounding infertility is that it is primarily a woman’s problem. This assumption is medically inaccurate and socially damaging.

Male factors contribute substantially to infertility, either independently or alongside female factors. Conditions affecting sperm production, sperm quality, hormonal regulation and reproductive anatomy can all interfere with conception. Previous infections and certain medical conditions may also affect reproductive function.

Female infertility can similarly arise from a range of conditions, including disorders affecting ovulation, the fallopian tubes and the uterus. In other cases, both partners may have contributing factors, or investigations may not identify a definitive cause.

For this reason, fertility assessment should not automatically begin and end with the woman. Both partners should be encouraged to seek appropriate evaluation, with investigations guided by their medical histories and clinical circumstances.

This approach is not about transferring blame from women to men. It is about rejecting blame altogether. Infertility is a health concern that requires evidence-based investigation, shared responsibility and respectful treatment.

Healthcare professionals, community leaders and families have a role in correcting the misconception that a woman’s reproductive capacity determines her value or that a man’s fertility should never be questioned. Public education must make it clear that reproductive difficulties can affect anyone, regardless of gender, social standing or marital circumstances.

The Financial Barriers to Fertility Care: For many Nigerian couples, the decision to seek medical assistance is only the beginning of a difficult journey. Fertility investigations and treatment can be expensive, particularly when specialised services are required.

Consultations, laboratory tests, imaging, medications, surgical procedures and assisted reproductive technologies may place substantial demands on household finances. In vitro fertilisation (IVF), for example, can involve considerable costs, and some patients may require more than one treatment cycle before achieving pregnancy.

These expenses can be especially challenging for couples who must pay out of pocket while meeting other household responsibilities. As a result, some may postpone investigations, discontinue treatment or abandon their efforts because they can no longer afford the associated costs.

The financial burden can also make people vulnerable to misleading advertisements and individuals who promise guaranteed pregnancies or miracle cures. When hope is combined with desperation, couples may spend limited resources on interventions that lack reliable evidence or may delay appropriate medical evaluation.

Nigeria needs a reproductive healthcare system that makes accurate information, initial fertility assessment, appropriate referrals and counselling more accessible. Policymakers and healthcare institutions should explore practical approaches to reducing financial barriers, including stronger referral networks, transparent treatment costs, improved service availability and appropriate financial support for essential reproductive healthcare.

Improving affordability does not mean promising that every couple will achieve pregnancy. It means ensuring that financial circumstances do not unnecessarily prevent people from receiving appropriate medical advice and making informed decisions about their health.

The Role of Healthcare Professionals; Healthcare professionals are central to improving infertility care and reducing the stigma associated with it. Their responsibility extends beyond diagnosis and treatment to include communication, confidentiality, patient education and emotional support.

When couples seek assistance, they should receive respectful assessments based on their medical histories and individual circumstances. Depending on the clinical presentation, investigations may include assessment of ovulation, reproductive anatomy and semen quality. Further testing may be necessary where indicated, and treatment should be guided by the findings rather than assumptions.

Olawuyi Mariam Damilola is a Public Affairs Analys