This lunchtime, as with most lunchtimes here in Dakar, when the blazing sun is at its height and the day’s chores are done, Ndim is watching television with her husband, Badera. The screen flashes in the dark room as he flicks to a cookery programme in which a smiling chef demonstrates the perfect thieboudienne (a dish made from fish, rice and tomato sauce). A child from the neighbouring compound ventures in and clambers on the bed. ‘Here at home, there are lots of kids,’ says Ndim. ‘They come and watch TV and play, and I ask myself why the good God hasn’t given me children like these of my own? It really, really hurts. Most of the time, I don’t cry, but I cry inside.’
This housekeeper and tailor were married in 2006, but despite 12 years of trying for a baby, they have no children together. After numerous miscarriages, Ndim, 35, was diagnosed with fibroids, uterine growths that Badera, 41, describes as like ‘a rat in her womb’. At more than CFA1,000,000 (£1,361) within a Senegalese medical system that garners no government support, the routine operation to remove the fibroids proved too expensive. Ndim stopped going to hospital. Now she saves every penny of her earnings for future treatment, but has, as this devout Muslim woman says, put herself in the hands of God, waiting for a miracle.
One might think this quiet household drama playing out behind closed doors is heartbreaking enough. Badera treats Ndim with palpable tenderness; a fleeting caress on her arm, a smile dropped her way as they recline on heart-print bed sheets. A man in love, by all accounts. All the more heartbreaking then, that along the corridor of this modest flat in the seaside district of Yoff, lives Badera’s second wife, his niarel, his deuxieme. That was 2016, and after the marriage, the second wife (who does not want to be identified) immediately fell pregnant with a daughter. Just turned one, she pops up around the house, the only glimmer of optimism between this trio of traumatised adults.
Badera’s shoulders droop when he talks about his decision. This man’s anger and regret is obvious; the tragedy of finding himself torn between his true love and his pride all too apparent. ‘Taking a second wife was vengeance,’ he says with passion. ‘People here in Senegal say things like: “But why haven’t you had a child after all these years. Are you ill?!” Then a relative accused me of being ill. I was so angry. I took a second wife to prove I wasn’t.’
‘When he took another wife it was the most painful thing that has ever happened to me,’ admits Ndim later, up on the roof, where a jigsaw of houses and washing lines run down to the sea. ‘But you know, my husband is a really amazing person. He’s always by my side. He could have rejected me, as others have done, but he’s always with me, consoling me.’
GIFTS FROM GOD
To some extent, Ndim’s story is not unusual. Thousands of women across the world suffer the physical, societal and psychological consequences of infertility – whether they are unable to conceive, or have miscarriages. In Europe the figures are startling – around one in seven couples in the UK, or 3.5 million people, have difficulties conceiving, according to the NHS. One in four UK pregnancies end in miscarriage, according to the charity Tommy’s, and around one in 100 women experience recurrent miscarriages. But in Africa there are apparently no published, significant, recent statistics. The issue exists below the surface, almost never talked about, a hidden taboo.
The effects of infertility run deep here in a part of the world where having a child not only defines a woman in her marital role, but also means financial and household support during one’s dotage. Children are a gift from God, as one Senegalese friend affirms.
As a result, infertility is considered a disability, says Dr Rokhaya Ba, a consultant gynaecologist who offers IVF and other infertility treatments from her smart clinic, stashed away in a wealthy enclave of Dakar. Infertile women are stigmatised, she explains, rejected and socially isolated. In many cases, their husbands will desert them.
‘The desire to have children is universal,’ explains Ba. ‘No matter who you are, rich or poor, a child is precious. But I do think that less wealthy people have an even deeper need for a child, because here in Africa, it’s the child who’ll look after his parents in old age. Parents who don’t work for a pension count on their children to look after them. Consequently, people who have no children are fearful of finding themselves alone, without any support when they’re older.’
Dr Ba’s clinic might be anywhere in Europe, all sparkling tiles, potted plants and marble statuettes. Two immaculate secretaries in headscarves and bright lipstick exude efficiency from behind the reception desk. But Ba’s patients aren’t just Senegalese super-rich. ‘There are people who sell their cars or take a loan to come for IVF,’ she says. ‘There’s such a social pressure here on people to have children, and women are so stigmatised if they can’t, that people will do anything. Most of the time I’m dealing with people who can’t read or write, so it’s more complicated to explain procedures and avoid errors. Consequently, when we take up this challenge and when, despite all this, we manage to obtain a pregnancy, follow it through to a positive conclusion and give the baby to its mother, it’s extraordinary.’
THE PUSH AND PULL
Dakar is a city in flux, just south of the Western Sahara, perched on the edge of the Atlantic Ocean and perched too on the brink of a social revolution. In the last ten years this pulsing Senegalese capital has spread its limbs outwards and upwards. Where once the Corniche was a wilderness dotted with dunes and coastal scrub, now shopping malls abound on the edges of the smooth tarmac roads running its length, as do upmarket hotels, fast food joints, trendy bars and restaurants, gyms, ice-cream parlours and fashion stores. Traffic is off the scale, with shiny black SUVs now replacing the scooters and horse-drawn carts of the 1980s and 1990s. Everywhere, apartment blocks and houses rise skywards. As the poor become middle-class, educated young couples are choosing to live not in the family compound with their parents, siblings and grandparents, but in flats of their own. And Senegal’s young women are finishing secondary school, going to university, forging careers – and leaving it later and later to marry and have children. Rising infertility rates are, as in Europe, also a consequence of social change.
Reïssa, 39, is part of this new generation. Clever, sophisticated, a successful accountant with a senior position at a company in Dakar and a mind and bank account of her own, Reïssa says that for a long time she just never met the right man and for years focused on building her career. ‘Nowadays here in Senegal we marry late in life; I was married at 35. I had boyfriends, but there was never anyone serious enough to enter into marriage, plus I really wanted a good job. To be honest, I never thought I’d wait so long to have a child – or that I wouldn’t have one.’
Yet Reïssa admits she is both modern and traditional, summing up the cultural push and pull of contemporary Senegal. She secretly finds Mother’s Day a challenge, and the boisterous baptisms of her friends’ babies traumatic. In modern Senegal, even a professional married woman is still to a great extent defined by her child-bearing abilities. ‘It’s not easy,’ Reïssa confesses. ‘Sometimes I snap, like everyone. I feel the loneliness, and tears flow. Why not me? What have I done in God’s eyes not to have children like others? I tell myself that it’s God’s will, but even if it’s just one child, I’ll do anything to have one.’
For Reïssa and her husband, an electrical engineer, IVF was a last resort after trying for five years to have the baby she so desperately wants: ‘A boy,’ she laughs, ‘who looks like me, a boisterous child who’ll make the house come alive!’ She and her husband had IVF this year at Dr Ba’s clinic, a step which felt radical – and expensive. ‘Frankly, it was all quite new. We were a little bit stressed. The success rate is so small, and you’re spending almost two million CFA. But we wanted to have a go. We said to ourselves that God exists, and he will be there for us.’
Reïssa, a devout Muslim, rose every night at 2am to say extra prayers for the pregnancy, and wore gri gris (talismans) from the marabout, a religious leader and teacher. ‘Here in Senegal, they say women who can’t have children are affected by les anges,’ she explains. ‘Bad spirits.’
In the end, the IVF treatment failed. Dr Ba, who due to her small team admits she operates not just as doctor for her patients, but as psychologist, confidante, marriage counsellor and sometimes even midwife, didn’t sleep before giving Reïssa the result. ‘We feel failures very badly. The day before a negative result, we think carefully about how to break the news. This is not necessarily the job of a doctor, but we do it nevertheless because we work alone. It’s not as comfortable doing this work in Africa as in Europe.’
The first IVF baby was born in Senegal in 1989, and several clinics now offer IVF treatment in Dakar as well as Cameroon, Nigeria and Togo. Since 2003, when Paris-trained Dr Ba established her surgery here, she has helped more than 100 bébés éprouvettes into the world. Yet because of the taboo surrounding infertility and IVF – perceived by some Senegalese as unnatural – most of Ba’s work is carried out in secret.
‘These are hidden babies,’ she says. ‘I can’t prove how many babies I’ve helped create, because the mothers won’t even show me photos. Infertility is such a taboo that, when a woman finally has her baby by IVF, she prefers to hide that fact, to demonstrate that she has managed to do it naturally. Because if it happens through “artificial means”, that proves that she hasn’t been capable of doing it on her own, so it’s a secret baby. The mothers even hide it from their own families, and, sometimes, when we deliver an IVF baby, they ask us not to tell the medical staff that the baby was conceived in this way. So it’s a really big secret, and we try to respect that, of course.’ Talking would do her patients a world of good, says Dr Ba, mentioning her wish to create a support group where women can come to share their stories. Many of them believe that bringing the subject of infertility into the open would help others deal with their trauma, and find treatment.
‘I think if the subject were discussed openly, it would help more couples,’ agrees Reïssa. ‘You coming here, it’s been wonderful to talk about it all, to know that I’m not alone.’
Arame Niang, 37, is a pharmacist who had IVF under Dr Ba. The treatment resulted in twins, now three years old. ‘A benediction from God,’ smiles Arame. ‘We tried for six years. I was losing hope of being a mother. We turned to IVF and went to Paris, where the treatment went wrong. It was horrible, horrible. I came back to Senegal and consulted Dr Ba, and the IVF was successful.’
That’s why Arame wants to talk. ‘I left my country to get what I thought would be better treatment,’ she says. ‘But that was not the case. The care, the amazing doctors, they were here in Senegal. Luck is everywhere, whether that’s in Europe or in Senegal. That’s what I want other women here in Africa to know.’
• This project was funded by the European Journalism Centre via its Innovation in Development Reporting Grant Programme (www.journalismgrants.org). Go to www.angels-documentary.com for more information and watch the film in full at geographical.co.uk. A crowdfunding campaign to help Ndim raise money for her fibroids operation can be found here: geog.gr/ndim.
This was published in the January 2019 edition of Geographical magazine