In Summary
  • Back from the brink. Motherhood is a blessing. It is most, if not, every woman’s desire, and for many couples, having babies happens easily and naturally.
  • Not so for others. But with science, many of the factors that have been an impediment to motherhood are becoming a thing of the past.
  • In Uganda where assisted reproduction is still limited, many would-be mothers go through hell in their search to a child, often pushed by stigma from society where childlessness is treated like a curse. Florence Kiza attests to this in her story to Henry Lubega

I first met my husband in 1988 and in 1997 we officially became husband and wife at the Church of Uganda in Nakulabye, a city suburb. Four years into our marriage with no child, he put me under pressure; he wanted [a child] though he already had children from other women.

Starting the hunt
In 2000, I went to Mulago hospital for a checkup and I was told I had fibroids. The following year – 2001 – I went back and I was operated to remove them. After a week in Mulago, I was discharged but on reaching home, I was bleeding too much. The doctors told me it would stop with time and indeed, it stopped. After, I started experiencing very painful menstruation; during that time I could hardly even walk or do anything. Sometimes they were so severe that I cried. I got concerned as I had not conceived a year after the operation. With advice from some women friends I started looking for a solution away from the hospitals. The search saw me go deep in Masaka and as far as Bududa.
I funded my trips to anyplace I was told I would find a solution to my problem. I was ready to go an extra mile to meet my husband’s demand to have a child. I was vending tea to raise money. Ours was a struggling family; we were staying in Kasubi in a one-bedroom house. I used to move in different markets preparing tea; that is how I was earning. It is that meagre saving that I had to collect and go to the native doctors. I drank all sorts of herbs but in vain.
In 2005, I went to a witchdoctor in Masaka, who told me that my mother had been bewitched while I was in her womb, and that the curse was following me. To be cleansed, I had to walk through a dead anthill located in a cemetery in the dead of the night while naked. After his ritual, he gave me one month to conceive. A month passed but nothing changed. I moved to different places all in vain until I was directed to another one in Bududa.

Visiting shrines
In Bududa, I was made to sit on a fresh banana leaf while naked at 4am in the road to be cleansed. Afterwards, I was given a slippery green herb to drink and [the witch doctor] also gave me one month to conceive, but nothing happened.
In between I moved to so many other traditional healers and herbalists in and around Kampala. When my savings from tea vending could no longer fund my search for a baby, I sold my four cows in the village. To raise more funds, I convinced my sisters and we sold the land our father bequeathed us. I got my share of the money, which I spent on herbalists and traditional healers in the hope of having a child.
On top of dealing with my husband’s pressure, which now included being beaten, my in-laws joined in to make life hard for me. They mocked me as I went through my painful monthly sickness; they would say I was in labour pains and afterwards they would ask me for the sex of the baby I had presumably delivered.
When I ignored their insults, they resorted to bringing women to my husband. This went on for a number of years. In our one-bedroom house, I would get off the bed and sleep on the bedroom floor while he slept on the bed with the woman they have brought for him. Some would stay for weeks; others a month or more. During that time, I would cook and do laundry for them. They would insult me in case I did something they did not like or they would complain to my husband, who would then beat me. This went on for a number of years, but I was not ready to give up because he was my officially married husband until death did us part.
During that time, I had brought my brother’s two-year-old daughter to stay with me. When she was in Primary Two, my husband suggested that since I was not giving him children yet he had paid a lot in bride price, he wanted to take her as his wife. He had paid 10 cows and some goats as my bride price. I cautioned him not to dare unless he wanted to go to jail.
I thought he had ended it but during school holidays, I went with the girl to visit my brother. Behind my back, she told her mother how she was not going back with me. The girl told her parents that my husband would come to her bed and pass something on her private parts every night. And he always had a knife and promised her that if told me, he would cut off her head. I went back and confronted him; he denied doing such a thing, accusing me of being jealous because I was not capable of having children. That night, he went out and came with a prostitute from Kasubi. When I complained, I was beaten like never before. I was dragged on the ground and the skin of my hand peeled off. He threw me out of the house at 2am, not allowing me to take anything from the house. I called my brother in Ntinda who took me in for some time. My brother tried to arrange several meetings with my husband but he never honoured any. We tried to involve our best man as well.

Starting again
After several efforts to reconcile us failed, my brother rented for me a house in Bweyogerere and in 2005, he gave me a capital of Shs2m with which I started taking foodstuffs to Juba [South Sudan’s capital]. Unfortunately as soon as my first consignment reached South Sudan, rebels attacked and took everything save for the Irish potatoes and onions. Fortunately, the five bags of Irish and onions were able to bring back the capital. When I returned to Uganda, my brother did not want me to go back but I did not have anything to do here, so I found a way of going back.
When I returned to Juba, I started washing dishes in restaurants, where I met people working with Gemtel, a cellular company. I asked them to get me a job and a few months later, I was given a job as a company chef, earning $200 [about Shs730,000] a month. I worked with the cellular company for some time but even then, my problem (of very painful periods) had persisted.
In 2010, I came to the Women’s hospital in Kampala on recommendation of a friend. With my savings from Juba, I came to seek treatment. The doctors checked me and found that I had severe fibroids, but I did not have the money to be operated on. I returned in 2012 and a bucketful of fibroids was removed from my uterus.

Assisted reproduction
After the operation, Dr Tamale Sali told me that it was possible for me to have children if I wanted. But he cautioned that having children will not be instant as the scars on the uterus will need to heal for it to carry a baby.
The treatment for the scars took a year. During that time, I had fallen in love with a man in South Sudan and I told him my situation. Dr Sali assured me that once the uterus was cured, I would be in position to have children, but through IVF [In vitro fertilisation]. But I did not have the money, he instead told me to bring my husband, and the IVF process was started.
Fourteen days after the embryos had been transplanted, I returned for a checkup. When the Indian doctor who checked me told me I was pregnant I could not believe it. I ran out and sat in the middle of the road confused. I went back to the hospital to another nurse who I asked if the Indian doctor was telling me the truth or she was reading from another person’s papers. When she confirmed that I was pregnant, I was over the moon. The nurse told me what do and when to come back.
When I went back home that night, I was keen at noticing any movement in the stomach but there was nothing. By the time I returned for the scan after a month I had started experiencing morning sickness. The scan showed the baby; that was in 2015 and in early 2016; I gave birth to a baby girl I whom I christened Miracle.
Having a child is the best feeling in the world. I would rather sleep hungry or have nothing to cover myself but have a child. When my former husband and in-laws learnt that I had had a baby, they came looking for me to confirm. My child is now almost two years and she has totally changed my life. Unfortunately, her father was killed during the recent fighting in Juba. She will never get to know him. The good thing is that my late husband’s family loves my daughter very much and they are supporting us. At the moment, I am not working but I am positive that as a hard working woman, I will be able to slowly pick up my pieces again.

In the second part tomorrow, read about the trials of a woman, whose search for fertility treatment led her to a doctor who advised her to stop wearing underwear in order to conceive. We also explore the different infertility treatment options for couples.

Doctors make case for law on infertility treatment

As assisted reproduction takes root in Uganda, the practitioners involved decided to come together to accelerate regulation. Under their umbrella organisation, the Uganda Fertility Association, they are pushing to have a law in place.
The association president, Dr Robert Busingye, a consultant obstetrician/ gynecologist, says their body brings together all clinics currently practising fertility treatment and specialists that have an interest in infertility management. Other members are non-doctors involved in the treatment, such as embryologists, nurses and counsellors.
Although it is currently privately driven, government has realised there is a need for such treatment and wants to get involved.
“Specialised fertility treatment in Uganda started 15 years ago with one clinic, but the numbers have increased, with the most exciting one being in the women’s specialised hospital being constructed at Mulago,” says Dr Busingye.
He adds that there is a lot of myth about the causes and treatment of infertility. “Many people will go for alternative treatment for infertility such as herbs, places of worship and shrines as initial contact of medical care. At the fertility association, we are trying to reach out to the population to demystify infertility problems. This is easier done as an association than as individual clinics and people working on their own, and also to work with the different arms of government as we move towards a regulated medical service. Infertility has existed as long as medical practice but these treatments are limited. So, we are proud that we are way ahead of many other African countries in this field.”
Types of infertility
There are different causes of infertility; blocked tubes, hormonal imbalance, leading to eggs not growing well, immotile sperms for men, early egg exhaustion in women, and weak uterus, among others.
Dr Busingye says some of these cases are curable if detected early. “Women with hormonal imbalance can be given medicine and they ovulate and can conceive, while those with blocked tubes can have them flushed,” he says. “There are [those] who cannot be helped with basic infertility treatment. Women whose fallopian tubes have been previously cut, or had sterilisation and those who may have had very serious infections and got their fallopian tubes damaged or even removed,” he adds.
Some people have cases that are irreversible and no treatment can rectify their infertility. Some women are born without a womb or when it is too small and under developed, it would never be able to carry a baby. Some have their inner lining damaged, either because of previous infections, or during the cleaning of the womb, its surface is cleared off. Others have scars in the womb as a result of fibroids operation.
Unlike men, a woman has a finite number of eggs she can produce. Seven months in her mother’s womb, a baby girl has up to seven million eggs. At birth they have reduced to two million, and by puberty, they are 40,000, which should end in the late 40s. There are women who suffer from premature menopause or premature ovarian insufficiency; this is where the eggs are exhausted in their 20s. At 25, she is in her menopause and cannot have a baby. Such a person needs ART.
Uganda Fertility Association data shows that in about 50 per cent infertility cases, either the man is solely responsible or [the couple is] jointly responsible for the infertility. There are some identifiable causes of infertility among men that cannot be corrected such as undescended testis, where at birth the baby’s testis is not in the scrotum but in the abdomen or groin. If the child is not operated before two years, he will suffer from infertility.
Dr Busingye says investing in the sector is still hampering its reach as it requires both human and monitory capital.
“We do not have enough embryologists, who look after the eggs in the laboratory. Keeping the egg or the sperm outside the human body is a very delicate process. Fertility centers import embryologists when they are doing cycles and this makes the process very expensive. In Uganda, the cost of IVF process ranges between Shs15m and Shs30m per cycle.”