The fertile grounds of reproductive activism in The Gambia: A qualitative study of local key stakeholders' understandings and heterogeneous actions related to infertility.

INTRODUCTION: While several studies have focussed on the experiences of women living with infertility, there is a paucity of information related to understandings, representations and actions of key stakeholders (i.e. organisations and individual actors involved in activities or professional care surrounding infertility) when it comes to infertility in Sub-Saharan Africa. This ethnographic study conducted in The Gambia, West Africa, focuses on how key stakeholders in the country understand infertility, and on their activities to improve the lives of people with infertility. METHODOLOGY: This ethnographic study draws on primary and secondary data for thematic analysis. Primary qualitative data were collected using in-depth interviews, observations, informal conversations and group discussion with various stakeholders (i.e. health care providers and representatives of non-governmental, governmental and international organisations). Sources of secondary data included government and non-governmental reports and media outputs. RESULTS: Results illustrated that most key stakeholders had a good understanding of the cultural frameworks and social realities of women living with infertility, with less focus on, or awareness of, men's experiences of infertility. We distinguished three different positions of these actors and organisations, first, the infertility supporters, i.e. those who despite political challenges and a lack of funding, initiated activities to raise awareness about the problems people with infertility are facing and aim to increase access to infertility services. The second are moderate supporters, i.e. those who recognise the problems infertility poses and whose organisations target some of the perceived causes of infertility (i.e. lack of health education and harmful cultural practices). A third group of neutral or moderate opponents consist mainly of formal health care providers who do not consider infertility a current priority, given many competing demands in the resource-constrained healthcare system. CONCLUSION: While international donors still largely neglect the emotional and social implications of infertility in Sub-Saharan African countries, some local stakeholders are working to bring services closer to people with infertility. The efforts of these local stakeholders require support and integration, and should include engaging with different groups for widespread sensitisation to reduce stigma and promote attendance to health centres for reproductive health challenges.

Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia.

BACKGROUND: In many low-and middle-income countries women with infertility are often in polygynous marriages. From a human and women's rights perspective, the practice of polygyny is commonly understood as harmful. Studies indicate that polygyny aggravates negative life circumstances of women with infertility with respect to their health and social well-being. The purpose of this qualitative study is to explore how women with infertility experience polygyny and to understand their decision-making regarding these marriages. METHODS: An explorative qualitative study was conducted among women with infertility in the urban communities of the West Coast region of The Gambia using in-depth interviews (30). Data analysis involved an emergent and partially inductive thematic framework and was carried out using NVivo 11. RESULTS: With the exception of some women with infertility who described positive experiences within polygynous marriages, most women emphasised conflicts that exist within polygynous households and reported financial and emotional difficulties. Thematic analysis identified several strategies of women with infertility to cope with and resist polygynous marriages, including overcoming childlessness, addressing conflict, spending time outside the compound, looking for social support, kanyaleng kafoolu, living separately and initiating divorce. Moreover, the experiences and decision-making power of women with infertility when it comes to polygynous marriages was found to be closely related to their socio-demographic background. CONCLUSION: This work highlights how women with infertility in polygynous marriages are in a precarious situation in urban Gambia. Women utilize a mix of compliance, coping and resistance strategies to navigate the challenges of polygynous marriages in a structurally constraining context.

'We are always desperate and will try anything to conceive': The convoluted and dynamic process of health seeking among women with infertility in the West Coast Region of The Gambia.

INTRODUCTION: In many Sub-Saharan African countries, women with infertility search relentlessly for treatment. Guided by the Partners for Applied Social Sciences model for health seeking behaviour and access to care research, this study aims to understand the health seeking behaviour of women with infertility in the West Coast region of The Gambia and the influence of aetiological beliefs on health seeking paths. METHODOLOGY: A qualitative approach was used to generate both primary and secondary data for thematic analysis. The data collection methods included in-depth interviews (36), observations (18), informal conversations (42), group discussion (7) and made use of pile-sorting exercises. Sources of secondary data included government and non-governmental reports and media outputs. RESULTS: The health seeking approaches of women living in both rural and urban areas were extremely complex and dynamic, with women reporting that they looked for biomedical treatment as well as seeking indigenous treatment provided by local healers, sacred places and kanyaleng groups. While treatment choice was related to the perceived aetiology of infertility, it was also strongly influenced by the perceived effectiveness of the treatment available and the duration of the fertility problems. Other relevant factors were the affordability, accessibility and availability of treatment and respondents' family and social networks, whereby access to the biomedical health sector was strongly influenced by people's socio-economic background. CONCLUSION: On the basis of this analysis and our wider research in the area, we see a need for health authorities to further invest in providing information and counselling on issues related to infertility prevention and treatment. The availability of locally applicable guidelines for the management of infertility for both men and women at all levels of the health system would facilitate such work. In addition, the public sphere should provide more space for alternative forms of social identity for both men and women.

'I am always crying on the inside': a qualitative study on the implications of infertility on women's lives in urban Gambia.

BACKGROUND: There is an increasing awareness that infertility in Sub-Saharan Africa constitutes a severe social and public health problem. Few of the existing studies on infertility explicitly take into account the differences between women. However, how women experience infertility is formed by their various social positions. This research explores the implications of infertility on women's lives in urban Gambia and aims to provide an in-depth understanding of how this relates to gender and cultural norms as well as different social positions. METHODS: Qualitative data were collected through interviews (33), group discussions (13), participatory observations (14) and informal conversations (31). Purposive and snowball sampling techniques were used to identify participants. The data was analysed thematically using NVivo 11. RESULTS: Results showed that there was strong social pressure on urban women in The Gambia to procreate. Unable to conform to their gender role, women with infertility were confronted with financial problems, social stigma, as well as emotional and physical violence in their marriage. All women expressed feelings of trauma, stress and sadness. The intersectional approach used in this study highlighted how different positions influenced women's experiences of infertility. Urban women with a high socio-economic status had a more powerful position within their marriages and the broader community, due to their financial position, professional career and, sometimes, their educational background. In contrast, women from a lower socio-economic background were more likely to be harshly confronted with the social stigma of infertility. CONCLUSION: The lives of most women with infertility in The Gambia are characterized by social suffering resulting from gender and pro-natal norms, cultural beliefs and moral concerns, cultural practices and limited access to health care. An intersectional approach is an effective tool to inform public health and social policy since it highlights how, in specific situations, certain groups are more vulnerable than others.

Working against many grains: Rethinking difference, emancipation and agency in the counter-discourse of an ethnic minority women's organisation in Belgium.

In this article, we aim to contribute to feminist academic debates about multiculturalism and secularism/religion by drawing upon an analysis of an ethnic minority women's organisation in Belgium that has been active since 1999: ella. The analysis focuses upon the way in which ella constructs notions of empowerment and emancipation by discussing structural inequalities, cultural-ethnic values and religious authority and identity. First, we look at how ella formulates its ideas about the emancipation trajectories of minoritised women and the potential role of religious belonging. Second, we look at ella's discussion of religious interpretation and gender/sexual diversity. Here, we explore assumptions about the relationship between religious authority and minoritised women's and LGBTQs' desires and pursuit for knowledge. We conclude by considering ella as an affirmative-critical actor of multiculturalism, and an implicit agent of religious reform.

Cet article vise à contribuer aux débats académiques féministes relatifs à la diversité culturelle et au rapport laïcité/religion par l'analyse d'une organisation de femmes de minorité ethnique en Belgique, connue sous le nom d'ella. Cette analyse se concentre sur la manière dont ella développe des notions de responsabilisation et d'émancipation en discutant des inégalités structurelles, des valeurs ethniques et culturelles ainsi que de l'autorité et de l'identité religieuse. Dans un premier temps, nous examinons comment ella formule ses idées sur les trajectoires d'émancipation des femmes mises en minorité et du rôle potentiel de leur appartenance religieuse. Dans un deuxième temps, nous analysons la manière dont ella envisage l'interprétation religieuse et la diversité des genres/diversité sexuelle. Nous concluons en considérant ella comme un acteur critique et affirmé du multiculturalisme et un agent implicite de la réforme religieuse.