Life in the Infertility Belt

With his tropical shirt unbuttoned to the fourth button and cigarette dangling from his lips, our French doctor looked like he was on a permanent vacation as he smeared cool gel onto my stomach. In silence, he moved the ultrasound sensor around for a couple minutes, then sighed, "Ce n'est pas bon" (It's not good). He wiped the gel off my stomach, and I quickly pulled my skirt back up. Exchanging looks, my husband and I followed him down the hall to his office, where he informed us that the baby wasn't there anymore.

 

We had spent a year and a half as a married couple in Texas before moving overseas. Since I'd been told to wait until I had a solid base in French before starting a family, we moved to Paris for a year, where I gained a rudimentary mastery of what I found to be an incredibly difficult language. We arrived in the equatorial country of Gabon, expecting to stay three to four years to help establish a Christian student ministry on the university campus. We lived in the capital city, Libreville, located a few miles north of the equator and right on the Atlantic coast. We could see the ocean from our apartment. This was a temporary assignment for us. A temporary home. A place for us to start a family and move on.

When we first met my French doctor, he said I was pregnant. We happily stuck the ultrasound picture of a black dot to our refrigerator and used a spotty dial-up Internet connection to send e-mails to share the good news with family.

Back in the doctor's office, we were bewildered. How does a developing embryo silently, painlessly disappear? Where had our black dot gone? Had we truly lost something or never had it to begin with? These were our questions, but we didn't voice them. Our doctor was too crass, too matter-of-fact, and seemingly bored by us.

Infertility. It took me by surprise. I'm the oldest of four children, my father one of eleven. I figured that I hailed from fertile stock. Early in our marriage, Scott had mentioned adoption a few times, but I brushed off the idea.

 

Catching a Pregnancy

In the 19th century, European explorers and colonial administrators noted high levels of infertility in central Africa. Princeton researchers later documented a large area of unusually low fertility in the center of the continent, including portions of the Democratic Republic of Congo, the Central African Republic, the Sudan, Cameroon, Niger, and our new home, Gabon.

In the weeks following the ultrasound, we asked around and found a new Gabonese doctor, a well-respected woman, a devout Catholic. I had now mastered the vocabulary for spotting, periods, and black dots on ultrasounds. After listening, the doctor asked, "So what do you want me to do?" She was businesslike, and I fumbled in my answer, but her twin boys, who would later be in my first grade class, had been conceived through fertility treatments. I figured that counted for something.

As we embarked on our quest to get pregnant, my Gabonese friends talked of young women catching pregnancies. "Elle a attrapé une grossesse." The French word attraper is the same word as "catch" and is also used when you catch a cold. I thought it was a strange way to describe the process by which one gets pregnant. Oops, she caught a pregnancy. These were all young women who didn't intend to get pregnant. The phrase didn't describe married, established women. Only accidents.

 

I met Germaine during her first year at Omar Bongo University, our second year in Gabon. She was quiet-spoken, with wide eyes and a bright red dress. She and her boyfriend were both from a small town in the north, home of Gabon's largest ethnic group, the Fang. One day as we shopped in the market, she told me that the Fang people refer to all others as blah blahs. I asked why.

"Because that's what all other languages sound like!"

I laughed with her. I, too, come from a people who prefer to stay put and stick with our own and group all others into a category that is distinctly other.

Germaine was worried about her boyfriend's drinking. She wanted him to come along to church and Christian meetings on campus. When he came, he usually arrived near the end and asked to borrow money from my husband, Scott. Sometimes, she told me that their families had an agreement. A bride price may not have been exchanged, but in the eyes of their families, they were engaged.

Germaine had taken years to finish high school and pass her entrance exam for college. So when she caught her first pregnancy, she was a little embarrassed. But, as she was already in her late 20s, she was thrilled to have "caught a pregnancy," in spite of the timing. She began to refer to her boyfriend/fiancé as her husband.

"Michelle, back home, everyone sees us as married. We're really married." I certainly didn't judge. Getting married in Gabon is a years-long process involving family agreements, exchange of money and goods, a civil ceremony, and for Christians, a church ceremony. At what point a couple is actually married is subjective.

Germaine eventually rented a wooden shack off-campus and set up as best she could. Access was tricky, especially during the rainy season, as she had to balance on a wooden plank that served as a bridge over the stream to the collection of shanties. In time her boyfriend left her and the university, but not before she caught another pregnancy and struggled on her own to make ends meet.

I asked her if their families could intervene. The advantage of families being involved in the marriage process is that they have a vested interest in the couple and sometimes help reign in a wayward spouse. But this couple lived far from family, in the big city. He was out of reach. I helped however I could over the years. Germaine aged out of educational opportunities but didn't want to go back to her village for a life of sitting in the village market selling fruits and vegetables.

During our third year of trying, Nadine, another student friend, also caught a pregnancy. She refused to name the father, even once her baby girl was born. She moved from her dorm room back home, where we visited and cooed over the baby, dressed in pink. But another student's aunt worked at the clinic where Nadine had given birth. The aunt saw the father's name on the birth certificate and word got out. We knew all involved and were shocked. The father's fiancée was none too happy. Eventually, the spin was that Nadine had seduced Pierre. It was only one time. Reputations were tarnished, but not destroyed; these things happened.

But not to me. I began to fill pages with my morning temperature readings, length of monthly cycles, and days with spotting. There were months of fertility treatments where I waited, with bladder painfully full, for ultrasounds to monitor my lack of progress.

 

Our friends Denise and Sanders were an American/African couple with an open door policy. They had a house and a cook and cable television. On Saturdays, we and other young American volunteers low on funds played cards and ate the food that Pauline, their Beninese cook, had prepared.

Pauline was earning money in Gabon and sending it back home to build a house. Sanders had taught her to read and write. She cooked African food and used Denise's cookbooks to learn western recipes. When she watched television, there was no convincing her that everything happening was not real.

Ann, an American, was a good friend of Denise. She got pregnant. Ann wasn't aware of our infertility issue. Though we spent hours together playing cards and eating Pauline's food, we didn't know one another well enough, and I wasn't at a place where I could say, "Hey, would you mind carrying your baby to term, and giving it to us?" But I wondered. She went to our cigarette-smoking doctor for her abortion.

Because of widespread infertility in Gabon, pregnancies are generally happy events, no matter the circumstances. If a woman is unmarried, it's welcome proof that she's fertile, easing the way for marriage and a generous bride price. If she can't raise the baby, there is always another family member who will. The young Gabonese women I knew carried their babies to term, no matter the price.

A whole lot of women I knew were catching unwanted pregnancies even as we ran headlong, doing everything in our power to lay hold of something just out of our reach.

 

Gonorrhea

Gabon is a country of tropical rain forests, and the dirt roads in the interior become easily impassable during the rainy seasons. But during the dry season in July and August, the only travel issue is the red dust billowing up from the roads. One summer, Scott and I set off to explore. One of our stops was a mission hospital, Bongolo Hospital, near the town of Lebamba. Somewhere between Libreville and Lebamba, a billboard announces the equator. There's not much going on there but the sign, though sometimes a small man, likely of pygmy descent, is available to take your picture for a small fee.

At the hospital we stayed in a simple guest room, spent time with friends who worked as doctors and nurses and teachers, and learned a little about the practice of medicine in a very isolated location. Families accompanied their sick and provided services that we take for granted from western hospitals—things like cooking and giving suppositories. Much later, I would stay in Bongolo with my friend Denise when she needed a hysterectomy. As I wandered around and waited for her to regain consciousness in the recovery room, I saw what I figured was her uterus lying in a metal bowl on a table outside the operating room. I asked the nurse about it and was told that as a friend, it was my job to dispose of it.

In this part of Africa, body parts can have spiritual implications. There are witch doctors and curses and fear, so the hospital avoided potential problems by allowing family members to take care of surgical waste. I let the nurse know that I would have nothing to do with my friend's uterus.

Next to the hospital, a large church seated hundreds. While Scott and I sat on a wooden bench during the Sunday morning service, an American doctor ran up and tapped Scott on the shoulder, whispering something urgent. Knowing Scott's fascination with biology, he had invited him to hurry over to the operating room to observe an emergency surgery.

As they ran to the operating room, the doctor explained that the patient was a woman whose ectopic pregnancy had just ruptured. When Scott saw her, she appeared to be very pregnant; her abdominal cavity had filled with blood. When the initial cut was made, this blood fountained up from her abdomen, covering the patient. The doctors saved her life; her family had gotten her there in the nick of time.

 

Ectopic pregnancies are very common in Gabon, and deadly if you live far from medical facilities. They're common in Gabon for the same reason that the infertility rate is high. Untreated gonorrhea and Chlamydia lead to pelvic infections, which can cause so much damage to the fallopian tubes that pregnancy becomes impossible. Infertility levels vary according to ethnic groups. In groups with high levels of sexual mobility—premarital sex and illegitimacy, divorce and remarriage, polygamy, extramarital sex, and prostitution—the infertility is high.

When we first arrived in Gabon, we displayed a picture of Scott's brother and wife at their recent wedding alongside our own wedding photo. Scott and his brother had the same hairline, beard, and wore glasses. I wonder how many guests believed that this was Scott's other wife without saying a word until someone finally said it aloud. We put the other photo in a box, leaving just our wedding picture up. Assumed sexual mobility.

We once visited a student in his village, Mouila. Though we had planned to stay with his family, he was worried about our comfort, so he asked an older, single woman missionary if we could stay with her. On her shelves, Esther displayed pictures of nieces and nephews but often had to explain that she was single and childless by choice. Many young African friends assumed that celibacy was physically impossible, and that these must be the children that she had conceived as a single woman in the U.S. before coming to Gabon.

In some ethnic groups, early sexual experience is encouraged. That weekend, the Mouila church youth group held a series of meetings about sexuality where we were invited to participate. I'm not sure that we were helpful; as Americans in Africa we might as well have been from another planet. Americans, whatever our beliefs and practices of sexuality, generally don't encourage early and varied sexual activity. I was told that mothers in some ethnic groups do. We talked with young men who believed that not engaging in regular sexual activity would cause illness. A priest or single missionary claiming lifelong sexual abstinence was assumed to be lying or about to be very, very sick.

In ethnic groups where required abstinence following the birth of a child ranges from 40 days to three years, men turn to other women and then bring STDs back to their home. Many women become infertile after a successful pregnancy.

I had no gonorrhea, no pelvic inflammation, but still, no pregnancy. And I didn't think that was fair.

 

Cursed

In the eyes of most, I was cursed. Not cursed as in unlucky, but cursed by a sorcerer. In animistic societies, everything happens for a reason. There are sorcerers in Gabon. Witch doctors. Spiritual practitioners. Within weeks of our arrival, I read in the daily newspaper, L'Union, about children's dead bodies found behind the home of a woman witch doctor.

When an unfortunate event occurs, it's important to ascribe blame, because someone is always responsible. At some funerals, a central part of the proceedings is the assigning of blame. Someone has to be responsible for death, and it is likely to be a family member or someone in the community. A university student told me about the time she was close to death because her uncle had put a curse on her. His family members watched warily as he became successful, and they ascribed their illnesses and deaths to him.

Ritually mutilated bodies washed up on the beach occasionally, once in the morning behind my principal's house. As I write, a campaign is underway to stop the mutilation and killing of children. Everyone in Gabon, white and black, keeps a closer eye on their children during election season, knowing that candidates are greedy for power, and the ritual sacrificing of a child is a sure way to get it.

People believed I was cursed. No one said it; I was white, after all, and didn't really understand these things. But, for many, it was the only explanation. Bad things don't just happen. I wondered if I was. Cursed, that is.

 

Infertility is no picnic no matter where you live, but it's particularly devastating for African women. In many places it is grounds for divorce. Among the Editi Yorubi of Nigeria, infertile women become outcasts, even in death, as their bodies are buried on the outskirts of town.

Here's a common story: A man, a successful man, an educated man, had a wife, whom he loved, but they had no children. So, he took up with a village woman. She had neither his education nor social level, but she did provide him with sons. They never married. The man lived with and loved his wife in the capital city. He also provided for his village family, eventually bringing them to the city and providing the mother of his children with a job, a house, and money.

Then the man died. We met the village woman when she rented the second floor apartment of her house to us. Except, of course, it wasn't fully hers. The man's estate was in a years-long dispute between his wife and his illegitimate wife.

When we knew her, the mother mostly sat drinking beer on her white plastic chair. Her fertility had earned her a way out of the village, into the city. And I wondered how the much-loved but infertile wife felt as the property dispute dragged on through the courts.

 

Facts and Figures

The nice thing about being infertile outside the U.S. is that medical treatment is cheap. The monthly fertility treatments cost one-fifth of the cost back home. After many failed months, my doctor, the devout Catholic, mother of twins, asked me if I was praying about this. The question seemed misplaced, out of context. She had always been pleasant but kept a professional distance and managed to oversee fertility treatments without getting too personal. I now wondered if she assumed my failure to conceive was because I wasn't knocking on heaven's door often or loud enough. That this was her version of Ce n'est pas bon. Yes, in addition to the temperature readings, the counting of days, the scheduling of shots, I was also praying, every day. I was doing everything right.

In hindsight, perhaps her question was less judgment of my spiritual handling of the matter and more her roundabout way of suggesting that it was time to stop. That I should pray about the pursuit, that there was nothing more she could do. Maybe the question was compassionate.

Recently, 20 years and two adopted children after our move to Gabon, I searched through our bookshelves and plastic storage crates until I found a journal that I had kept during this time. I pored through it for details, clues to what I was feeling and thinking. Within its pages, I am maddeningly opaque. There are tedious notes on my personal study of Jeremiah, a prophet in the Old Testament known as the weeping prophet, but nothing of my growing frustration and weariness. The journal ends with study notes from the New Testament book of Philippians, which Saint Paul wrote from prison.

One page catches my eye. Towards the end of the journal, three words are oddly spaced out. The word "baby' is written in the upper left corner, to the left of "vacation' and above "housing." The word floats on the page—unattainable. I can tell it took effort to write it down. It appears nowhere else in this yearlong record, our third, next-to-last year of trying to conceive.

The painful part of infertility wasn't knowing that my Gabonese friends not only felt sorry for me, but that they believed I was cursed. It didn't bother me if people assumed I had picked up an STD in my youth. I wasn't afraid that Scott would divorce me or find another mother for his children.

It was the necessity of maintaining some measure of hope as long as we were actively "trying." I needed hope in order to reach for the thermometer each morning, to lie still while I took my temperature and added it to the hundreds of days that came before. I needed hope to keep track of cycles that I never paid much attention to before, to schedule doctor's appointments in French, to show up day after day for ultrasounds, and shots, and sympathetic looks from the nurses who spent most of their days caring for pregnant women. We were either actively "trying," or not. It was emotionally and spiritually exhausting.

At the end of year three, we made a line in the sand and decided when the trying would stop. We stopped at the end of year four. My uterus was going to stay empty, as useless as Denise's buried or burned uterus in Bongolo. There was no miraculous opening of my womb, no lifting of a curse, no healing of disease.

I don't remember throwing away those notebooks with daily temperature readings. I'm sentimental and usually save important things, but one day, I must have decided that they weren't important. But those plastic trunks where I found my journal also contain my children's artwork and outgrown plastic toys. The children would come later, in another way, and they would one day run in the African sand.