Wednesday, 22 February 2012

Infertility as a Public Health: The Intersection of Person and Society

Infertility is both an individual and social condition. An individual suffering from unwanted childlessness suffers from an ailing body, an unfulfilled human identity, and disrupted relationships with direct social, political and
economic impact. Lack of acknowledgement of infertility as a social concern confines the condition to the realm of private, usually feminine, suffering. These attitudes, as well as pervasive vertical approaches to family planning provision and STI management ultimately disconnect the goals of reproductive health care, with infertility services inevitable falling behind. The effects of infertility leave no doubt as to its harms. Infertility interacts with a complex network of kinship, social relationships, cultural expectations, and societal needs; it is both a medical and social issue. Ultimately, a reduction in the ability to reproduce ourselves imperils the continuation of society. Infertility is failed biological reproduction, but when enough individuals are unable to bear children the reproduction of society is threatened as well.

As a health-focused social science, public health highlights the intersection of personal and societal issues. Public health is concerned with the social effects of health issues and infertility affects both the individual and the society in which they live. The current emphasis in public health on an individual's relationship with their complex social and physical environment is an excellent lens through which to investigate the issue of infertility.

One of the most disturbing ways in which infertility could have a social effect is a broad decrease in fertility due to environmental pollutants. There is growing concern over environmental toxicants contributing to widespread decrease in fertility, especially a decline in sperm counts. In an analysis of 61 studies published between 1938 and 1990, Carlsen et al. found a significant decline in mean sperm concentration and volume. Although this study suffered from several methodological limitations, a re-analysis of the original data with new methods did find evidence of reduced sperm quality over a fifty year period. Furthermore, the decline was not geographically uniform indicating that further research needs to be done to investigate factors that contribute to differences in fertility.

The mere fear of infertility has the power to exact severe societal consequences. In March 2004, the northern Nigerian states of Kanu, Niger, Bauchi and Zamfara suspended a WHO polio immunization campaign targeting 60 million children following reports from Muslim clerics that the vaccine was contaminated with anti-fertility agents as part of a United States plot to render Muslim women infertile. The WHO denies the claims of these clerics and is seeking an alternative source of vaccines. Meanwhile, polio has radiated out from northern Nigeria and has infected people in at least six other west and central African states.

Infertility is a personal health problem; additionally it is linked to unachieved social expectations, interrupted cultural perpetuation, and ultimately, the failure of society to reproduce itself. Fear of infertility is powerful, and there is evidence to suggest that a global reduction in fertility has occurred over the last half a century. As an issue with multiple levels of personal and social significance, infertility is a public health concern.

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