Kyrgyz Women Unfairly Blamed for Infertility Problems

When a Kyrgyz couple remains childless, it is generally the wife who is encouraged to seek fertility treatment. Husbands commonly reject suggestions they might be infertile, and some even remarry in the hope of having a child.



The state health information service in Kyrgyzstan says that in 2008, the last period for which comprehensive data are available, 5,000 women were on the records as having fertility problems compared with just 2,000 men. Yet doctors say that statistically speaking, the two figures for the population as a whole should be fairly close to each other.



There is some hope of change, however, as the 2008 figure for men was at least a dramatic rise on the 1,300 recorded in 2005, suggesting that more of them are actively seeking medical help.



Nurbek Sadyrbekov, head of the Urology Department at Kyrgyzstan’s National Hospital, told IWPR that the overall statistics for both sexes were understated as they only captured people seeking treatment in the state health system, not those who went private.



The discrepancy between male and female readiness to seek fertility treatment reflects deep-seated attitudes, experts say. Wives are under pressure to conceive and blamed if they do not, while men prefer to avoid the potentially embarrassing disclosure that they have problems fathering a child.



In an interview for IWPR, Professor Natalya Kerimova, head of the Department of Obstetrics and Gynaecology at the Kyrgyzstan State Medical Academy, said women conventionally get the blame when a couple is unable to conceive.



“The man sees himself as the stronger sex and believes he can’t be infertile,” she said.



Bishkek-based psychologist Venera Junusova agreed, sayting “Men think that going to see a doctor means losing their masculinity.”



There is strong social pressure on couples to produce children – traditionally as many as possible, including male heirs to continue the family line. A common toast to newlyweds is to wish them “lots of pairs of slippers” in their home.



In some cases, the man’s relatives urge him to divorce his wife if she does not conceive.



Rather than seek help, Junusova said, men “refuse to believe it to the very end, and start having affairs to prove the opposite”, adding that this was the cause of many marriage break-ups.



Sadyrbekov described a familiar pattern of events that follows when newlyweds have failed to conceive after a year or two, “He dumps his wife and marries someone else. He lives with his second wife but there are no children. Only then does he start wondering what’s going on.”



Esen, a businessman from Bishkek, told IWPR of his experience.



“My wife and I have been trying unsuccessfully to conceive since 2005. We underwent check-ups and were told it was down to me that we couldn’t conceive. Frankly, I think everything’s fine with me,” he said. “I’ve had a lot of women but none of them got pregnant, so I think it’s just matter of time.”



Esen said he had donated money to build a mosque, and believed God would help him and his wife to conceive.



By contrast, Janybek, a taxi driver in Bishkek, is undergoing treatment after putting it off for a long time.



His first marriage broke up because he and his wife did not have children. By this time he had already discovered he had a low sperm count.



Deterred by the cost of treatment, Janybek consulted a urologist only after he married for the third time.



The cost of medical help for either partner is high – IVF treatment can reach 4,000 US dollars, well beyond the reach of many couples, given that the average wage in Kyrgyzstan is about120 dollars a month.



Nazgul, a factory manager in Bishkek, has successfully persuaded her husband to seek treatment after several years of childlessness.



She said she felt under constant pressure from her mother-in-law to become pregnant, pointing out that in general, “if a woman doesn’t have a baby, then they [husband’s relatives] try to find another daughter-in-law who will bear a child”.



At first, Nazgul found it hard to convince her husband to go with her for a joint investigation into the possible causes of their infertility. However, when he saw her undergoing major treatment for gynaecological problems, “he realised it’s no joke, it’s serious”, she said.



Medical experts say male infertility can have a range of causes, including sexually transmitted diseases, STDs and undetected congenital conditions. These are compounded by low levels of public awareness and a lack of access to medical care.



Marat Rakishev, head of the emergency department at the City Gynaecology Hospital in Bishkek, says STDs are a major cause of infertility in Kyrgyzstan.



World Health Organisation figures from 2007, the most recent available, say the incidence of syphilis in Kyrgyzstan is 24 cases per 100,000 people, compared with most European Union countries where it is below five cases per 100,000.



Since Kyrgyzstan became independent in 1991, changing behavioural patterns have driven STD rates higher, and the Soviet-era practice of forcing sufferers to undergo treatment has been dropped.



Sadyrbekov said the results of Kyrgyzstan’s “sexual revolution” were apparent in the numbers of people made infertile by untreated infections like gonorrhea, syphilis, and chlamydia.



Sadyrbekov said congenital problems often went undetected because of the lack of check-ups for children and adolescents and the general shortage of doctors, especially in rural areas.



“Many patients could have been operated on as children, but when they reach an adult age it's already too late to do anything. Such cases are on the increase,” he said.



In Junusova’s view, three main areas need to be tackled to encourage more men to go for help – the quality, affordability and anonymity of the treatment on offer.



The Kyrgyz government recognises the problem exists, and has been running an annual Men’s Health Week since 2004.



The 2008 campaign, held towards the end of June, saw more than 1,500 men take up the offer of a free health check.



According to urologist Zufar Hakimhojaev, men are definitely becoming better informed about the issues.



“The situation has improved. Not that there are less infertile people, but now even men from remoter parts of the country are seeking specialist help. There’s an awareness that men, too, can be the cause of childlessness in the family.”



Taxi driver Janybek is philosophical about his own prospects of having a child, saying he is focusing on other things such as taking care of his elderly parents.



“When I first found out I might not be able to have kids, it was hard. But maybe that’s my fate,” he said.



Jennifer Croft is a freelance writer who has worked on development projects in Kyrgyzstan; Ainagul Abdrakhmanova is an IWPR-trained journalist in Kyrgyzstan.