Richard Smith: Managing infertility in Kenya

Richard SmithIvan Illich, the great critic of modern medicine, argued that it had displaced well the traditional cultural mechanisms for managing pain, sickness, and death with a false promise of eliminating all three. This is an abstract idea, but at a party in Cape Town last night I encountered an easily understood example. My Kenyan friends described to me how infertility is managed in their country.

The first thing to understand, they told me, is that a marriage without children is meaningless to Kenyans. The second important concept is that no man is infertile: it would be an impossible insult to his manhood to even entertain the idea.

So in Kenya infertility always arises because of the woman. The solution is for the infertile woman to select a second wife for her husband. The choice is hers not his, and the children that result from the second marriage will belong to her as well as to her husband and his second wife.

Now BMJ readers trained in modern medicine will see a flaw here. It could be in reality, you think, that the man might be infertile. Well, Kenyan culture has an answer to that as well: the community, the village, perhaps a brother will ensure that the woman becomes pregnant. How, you must not ask.

It’s unlikely that this Kenyan solution to infertility will catch on in Britain and other rich countries “blessed” with modern medicine, but the Kenyan method must have a much higher success rate than modern medicine. It’s also cheaper and less invasive. For me, it’s crazy that in a heavily overpopulated world we are spending billions of dollars on infertility treatments. Worse those methods often don’t work and because of their expense are not available to many couples. Or, as in Britain, couples may be offered a limited number of treatments, suffer all the uncomfortable interventions, and still remain infertile.

Perhaps Illich was right.

RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.