Ulla Larsen

The event was part of the "Lectures on Population at Harvard" series, co-sponsored by the Office of the Provost, HSPH Office of the Dean, and the Harvard Center for Population and Development Studies.

So that she could use nationally representative data for the purposes of the talk, Larsen defined primary infertility as the absence of a birth within seven years of marriage. The couples in question have reached reproductive age and have sexual intercourse without contraception.

Westerners have historically seen Africa as overpopulated, and this view "has overshadowed the study of population in Africa," asserted Larsen. Africans, however, view the continent as "sparsely populated" and thus at a political and economic disadvantage.

Interest in infertility in sub-Saharan Africa has emerged slowly among researchers and policymakers, said Larsen. Suggestions of impaired fertility rates surfaced as early as 1974, with a study showing that 25 percent of women over the age of 40 in the Central African Republic were childless. A World Health Organization task force looked at the question and published its findings in a notable 1985 Lancet paper called "Worldwide Patterns of Infertility: Is Africa Different?"

The answer was apparently a qualified "yes." Infertile women in Africa tended to be younger, more likely to have had a history of sexually transmitted infections, and more likely to have had pregnancy complications than women in other regions. Infertile African men were more likely than men in other regions to have had a history of sexually transmitted infections.

Infertility in Africa is also associated with girls engaging in early intercourse and experiencing subsequent pregnancies, said Larsen. Having a child in early teenage years can result in "secondary infertility," defined as the absence of a birth within five years of a previous birth, due to increased risk of complications during delivery, she said.

Conversations about populations and reproduction in Africa must consider HIV/AIDS, said Larsen, and interventions that focus on condom use are complicated by strong cultural and social desires of both men and women to have children.

The main consequence of infertility for women is a potential decline in status and security, explained Larsen, as well as the loss of an opportunity to experience motherhood and raise children. A childless wife may be returned to her family and be deemed "unmarriageable." She may become part of a polygamous marriage, as her husband seeks a new, fertile wife. The wife may seek extramarital sexual intercourse if she suspects her husband is infertile. As a result, she increases her risk of exposure to HIV and other STDs and, as a result, may perpetuate the infertility cycle, said Larsen.

Larsen is currently principal investigator on two studies under way in Africa, one in the Moshi Urban District in northern Tanzania and the other among the Ijo and Yakurr communities of southern Nigeria. The Tanzanian study is taking an in-depth look at one local community, studying 2,019 women and their partners in order to provide an understanding of the prevalence, risk factors, local perceptions, and social and demographic implications of infertility, as well as behaviors for seeking health care and treatment.

The Nigerian study focuses on rural communities and investigates "local meanings of infertility as they are shaped by the larger social and cultural context, and the impact of the prevalence of infertility on these meanings," according to a study description.

--CC