Roselyne Sachiti Features, Health & Society Editor
Each day most Zimbabweans eat huge portions of starchy foods that include sadza, rice, bread, potatoes and pasta. Coupled with the lack of exercise, many become overweight oblivious to the implications this has on their reproductive health functions.
In many Zimbabwean communities, being overweight has for many years been linked to wealth or “good living” as many call it.
If anything, when a woman marries, society expects her to immediately gain weight as a sign that her husband is taking good care of her, and also as an indication that her womb has accepted his seed. The same applies to men. Society expects them to gain weight, an indication that the new wife is cooking for him.
Yet in some cases, being overweight has resulted in some couples having challenges when they want to have a baby.
Underweight women, too, face the similar challenge of having difficulty in conceiving.
According to the World Health Organisation (WHO), if the body mass index (BMI) equals to or is greater than 25kg/m2, it is considered overweight, whereas if the BMI equals to or is greater than 30kg/m2, it is considered obesity.
If a person’s BMI is below 18,5, this suggests that their weight may be too low.
According to the Turkish- German Gynaecological Association paper titled “Impact of Obesity on Infertility in Women”, co-authoured by Zeynep Özcan Dag and Berna Dilbaz, the relationship between obesity and reproductive functions has been an open secret for many years and it is still being explored.
“The negative effects of obesity on reproductive consequence are well known. However, it is difficult to describe the mechanism of how obesity affects the reproductive system because it is complex and multifactorial. Several mechanisms are involved in the relationship of fertility and obesity.
“The insulin resistance and leptin levels are increased and hyperandrogenemia occurs in obese women. Similarly, anovulation, changes in adipokine levels and the HPG axis, and steroidogenesis in obese women affects the reproductive system,” Zeynep Özcan Dag and Berna Dilbaz explain.
Director of Family Health in Zimbabwe’s Ministry of Health and Child Care Dr Bernard Madzima says being underweight and overweight have implications on fertility as both disturb ovulation.
“If underweight the body shuts out ovulation to conserve energy. In overweight, there is insulin resistance which results in failed ovulation,” he said.
He said being underweight does not affect male fertility. “Sperm production is resilient. However, if the underweight condition is due to ill health, the man might become potent,” he adds.
According to Dr Madzima, if extremely underweight, women can miscarry as the body conserves energy by getting rid of the excess demand, in this case, the pregnancy.
To increase chances of conceiving, he said, couples should make lifestyle changes.
“For women who smoke, tobacco has multiple negative effects on fertility, not to mention your general health and the health of your unborn baby. If you smoke and considering pregnancy, quit now.”
He adds: “There is also need to eat a balanced diet and maintaining a healthy weight as obesity is directly related to testosterone levels, which is a key hormone responsible for sperm production. Eating a balanced diet provides the necessary nutrients to optimise sperm function and minimise the effects of factors which may otherwise damage the sperm.”
Yet, in many societies, affected couples often lack information on how their weight has an impact on fertility. Women often face stigma as a result of their failure to have babies.
Such stigma and disempowerment faced by women over fertility issues are some of the reasons Merck Foundation through its “More than a Mother” campaign has been working with 15 First Ladies from various African countries appointed as ambassadors of the programme.
Working with Zimbabwe’s First Lady Amai Auxillia Mnangagwa, who is also the country’s health and child care ambassador, the “Merck More than a Mother” initiative aims at empowering infertile women through access to information, education and health and by changing mind-sets.
This important initiative supports governments in defining policies to enhance access to regulated, safe and effective fertility care.
In a message at the Merck Media Training in Harare on Monday, Dr Rasha Kelej, CEO of Merck Foundation and president of Merck more than a Mother emphasised: “After our committee meeting in March 2019 at Merck Foundation First Ladies Initiative (MFFLI) Summit, our programmes have started in partnership with Zimbabwe Government and we have already enrolled many doctors to our specialty training programmes for Two- Year Oncology Master and Fellowship, One-Year Online Diabetes Diploma and Fertility Specialist Training. Moreover, we are conducing today, the first health media training in Zimbabwe to educate media how to break the stigma of infertility through their valuable work.”
Amai Mnangagwa said the media has a huge and serious role in addressing issues of stigma relating to infertility.
“We want the media to bring out the message that infertility affects both men and women. This cannot be a blame game, yet we know in our societies that women bear the brunt of this problem.
“We want the media to bring out the fact that infertility is not a curse. “There can be a solution to situations when a couple comes face to face with this situation,” she said.
With such commitment, and availability of information, couples facing fertility challenges can make lifestyle changes that can improve their chances of having baby/babies.