Abstract
This study explores cultural attitudes toward fertility and infertility among African Christian women, focusing on Tsonga culture. It examines the challenges Tsonga Christian women face in their daily lives, the pressures that lead some to leave churches, and the forms of oppression they experience within religious and cultural contexts. Adopting an interdisciplinary perspective rooted in theology and socio-cultural theory, the article highlights how these women navigate infertility, often without adequate pastoral care. It argues that the lack of theological response is influenced by Tsonga cultural beliefs that shape limited understanding of infertility within faith communities. The study recognises that human beings are inherently cultural and shaped by deep-seated belief systems that extend beyond religion. Using a literature review and analytical approach, it investigates how cultural and theological factors contribute to the marginalisation of infertile women in the church. The findings reveal that unaddressed infertility concerns reinforce stigma and feelings of inadequacy among women. The study calls for contextually sensitive pastoral interventions that integrate cultural awareness and spiritual care to support women experiencing infertility and to promote holistic healing within African Christian communities.
Contribution: This essay advocates for practical theology to adopt a more pragmatic approach in addressing infertility among Tsonga women. The religious and spiritual aspects of infertility have been largely overlooked, despite a growing corpus of studies addressing its medical, psychological, social, and cultural impacts. We assert that medical professionals addressing women’s fertility issues must include all facets of holistic care, as infertility is a multifaceted problem leading to various losses.
Keywords: infertility; theology; women; African; Church; culture; Tsonga.
Introduction
Infertility is described as ‘a disorder of the reproductive system characterised by the inability to attain a clinical pregnancy after 12 months or more of consistent unprotected sexual intercourse’ (Zegers-Hochschild et al. 2009). Millions of individuals globally of reproductive age contend with infertility. Infertility impacts 80 million individuals globally (Abedi Shargh et al. 2015; Batool & De Visser 2016; Bhamani et al. 2020; Casu & Gremigni 2016; Donarelli et al. 2016; Greil et al. 2010; Karaca et al. 2016; Lakatos et al. 2017; Li et al. 2020). Infertility, a disorder impacting the male or female reproductive system, is characterised by the failure to conceive after 12 months or more of consistent, unprotected sexual intercourse. This article will, however, focus on infertility among women. Primary infertility is the complete inability to conceive, whereas secondary infertility is the inability to conceive after a previous successful pregnancy. The World Health Organization’s (WHO) International Classification of Diseases contains detailed information on the numerous primary and secondary causes of infertility in both genders. According to WHO data, the number of infertile couples, also known as marital infertility, has increased to 48 million in recent decades, while the total number of people affected by infertility has risen to 186 million.
The psychological pressures that many couples experience in their pursuit of progeny can be astonishing. Male, female, a combination of both genders, indeterminate circumstances may all contribute to infertility. Religious and spiritual beliefs might assist women in navigating challenging periods and discovering purpose and hope among their pain. The article examines religious literature. It addresses the challenges faced by women with reproductive disorders within churches, along with religious and spiritual care as an integral aspect of comprehensive treatment.
Literature review
This literature review provides a thorough examination of infertility and the challenges that African Christian women experience in the church context. Infertility should be diagnosed when conception does not occur after 1 year of unprotected sexual intercourse in a couple intending to conceive (Davajan 1999:18). Okonofua (2000:208) divides infertility into two categories: primary and secondary infertility. Primary infertility is a situation in which a couple has never conceived. Secondary infertility occurs when a couple has had at least one previous conception (Westerfield 2012:498). According to Tagwai (2018:39), the negative experiences of infertile couples in most African cultural settings are unpleasant to hear. All the time, couples (usually the woman alone) are made to feel ashamed of themselves by society as a result of their condition because of societal stigma caused by cultural expectations that undermine their human dignity. In most cases, the woman is left to suffer alone, raising the possibility that the gods are punishing her for her wrongdoings. The first reference of infertility in the Bible is in Genesis 11:30, which states, ‘Now Sarai was barren; she had no children’. Among other verses, 1 Samuel 2:5, Job 3:7, Isaiah 49:21, and Proverbs 30:16 address the topic of barrenness or infertility. The ability to bear many children was considered proof of heavenly approbation and blessing in ancient Hebrew culture (Ekeke & Uchegbue 2014:201). Infertility has become a dreadful cankerworm, stealing the joy of countless couples throughout the world. This issue has reached a tipping point among Christians, prompting many to question God’s power and capabilities. When women encounter infertility, they may have an identity crisis, marital problems, loneliness, increased anxiety and depression, and social stigma (Ghafouri et al. 2016; Kaya & Oskay 2019; Kim, Moon & Kim 2020). Monga et al. (2004:126) state that childbearing is a significant part of most marriages. Most couples expect to have children as a result of their sexual connection. The infertile couple may experience psychological distress as a result of societal and parental demands to propagate the family name (Maroufizadeh et al. 2017).
What causes infertility in women
Many variables that influence or block the biological processes listed below may contribute to female infertility. Ovulation is the release of a mature egg from the ovary. Fertilisation occurs when sperm and egg unite in the fallopian tube after passing through the cervix, whereas uterus implantation occurs when a fertilised egg connects to the uterine lining, allowing it to grow and develop into a baby. Cigarette smoking, ageing, excessive alcohol consumption, being overweight, obese, or significantly underweight, and having certain Sexually Transmitted Infections (STIs) that might affect the reproductive system are all risk factors for female infertility. Infertility in women can be caused by a variety of medical disorders affecting the female reproductive system, including the following:
- Pelvic inflammatory illness (PID), polycystic ovarian syndrome (PCOS), hormonal imbalances, and ovulation issues.
- Endometriosis can cause uterine fibroids, premature ovarian death, and scar tissue from previous surgeries.
Infertility in the Africa church
Church is renowned as a place where people can go for comfort and direction, regardless of whether they are in good health. Focussing on women with infertility, we feel that the scriptures read there help us find peace inside ourselves and forget about our issues. Women who face difficulties such as infertility face judgement by the community. Surprisingly, the scriptures state that ‘do not judge, or you will be judged’ (Mt 7:1). Women who are affected find it difficult to settle in congregations where they are judged, and they eventually leave the church. Judging women who are suffering in this manner appears to be the norm in the majority of churches, both in the mainline and charismatic church in African society. Churches participate in activities such as immunising newborn babies, and some babies may be christened by sprinkling water on their heads. These practices may distress women who are attempting to have children but are unable to do so owing to infertility. Women may become emotionally overwhelmed by such actions when envisioning the joy and happiness of parents with children. Some couples are infertile today, just as they were in biblical times. According to the WHO (2020), the causes of infertility range from organic to functional. Baloyi (2009:1) asserts that childless marriages in Africa have always faced a diminished likelihood of endurance. Marriage and procreation are perceived as a means of unification, while infertility has historically been considered a stigma or disgrace among Africans. Kalu (2005:533) asserts that procreation is fundamentally significant in the African understanding of marriage. Baloyi (2009:5) posits that the African perception of infertility complicates acceptance of barrenness among the general populace, as societal norms dictate that reproduction is expected, rendering abnormality unanticipated. Because of the historical expectation for African marriages to produce offspring, childless unions often lead to polygamy (Schmidt et al. 2005:244). Numerous infertile couples encounter considerable challenges in their interpersonal connections, which becomes a way for pastoral correcting the problem that the couple is facing.
Pastors often claim that children are a blessing from God, which gives hope to individuals who are trying to have one; but how can they keep their hopes up when they are treated differently at churches, where they expect better treatment? to be Pastorally cared for, as church leaders, they are expected to understand and help with infertility issues, such as through counselling. While many churches routinely mention abortion, they rarely address these other losses in worship or congregational life. Women grieve alone more than men. The recommendation is for one to wait until the second trimester to announce a pregnancy is part of a culture of absence, a ‘forced forgetting’, a ‘veil of silence’, and infertility must be addressed and treated as any other sexual term.
Miscarriage and related complications ‘aren’t exclusively women’s issues’, despite the fact that they are seen as a ‘problem’ for women in most African societies. Miscarriage or infertility in African families is not only a private concern for the couple, but also for their extended family, who frequently enquire as to why there are no children in the marriage after a particular amount of time. It addresses family, marriage, and human issues. Because Africans are sometimes unable to express their pain, it eventually emerges as mental health difficulties and infertility. To encourage healing and a genuine knowledge of who God is, we must address these social issues. People do not know what to say when they experience or hear about infertility, thus churches and theologians rarely address this issue that women face, and preaching is frequently based on couples ‘multiplying’ as stated in scripture. African women with infertility challenges frequently live in fear of inappropriate comments, and grieving occasionally suppresses their experiences.
Insensitive comments concerning infertility are widespread. Stacey L. Edwards-Dunn, an ordained Church of Christ minister, founded a national support organisation for black women and couples experiencing infertility. ‘We feel more worse when individuals employ “God language” from a theological standpoint that contradicts who God is’, says Edwards-Dunn. People use sarcastic statements such as ‘God will provide a way’, ‘Maybe it’s a curse’, and ‘Maybe God doesn’t want you to have a baby’. These assertions fail to recognise our omnipotent God’s all-encompassing nature as a God of love, and as such, they should be seen as poor theology when dealing with infertility. This statement is actually damaging to women facing infertility instead of caring for those who are struggling.
In terms of how women with infertility are handled in church, it is worth noting that some churches sponsor or offer support groups for infertility or miscarriage. Others gather medical social workers and healthcare experts within their congregation to make relationships with hospitals, which is highly praised. Infertility patients are similar to the saints of old who did not immediately see the fruits of their faith on earth but remained faithful to God’s promises despite the circumstances (Heb 11:39). What gives us hope is that all of God’s children will be eternally happy when they are fully and completely joined with Christ. However, not all African churches provide this type of support, and some women in the church are uncomfortable expressing that they are struggling with infertility.
A theological understanding of the challenge of infertility among Christian women
Although some may try to dismiss cultural activities as unchristian, it is critical to understand that culture is not inherently harmful. Nonetheless, certain cultural traditions are damaging to persons dealing with infertility. According to Ntiamoah (2018:33), one of the most important commands in the Old Testament is ‘be fruitful and multiply’. This commandment requires that particular rabbinic authorities limit the use of birth control until a couple has at least two children, preferably one of each gender. Hanna’s petition, which was presented long before the birth of the prophet Samuel, continues to be read during the synagogue’s daily prayer service (1 Sm 1:9–28). It is vital to emphasise that Hanna’s ordeal was just one of many instances of infertility in the Bible. Most couple lives shift into maturity when they have children.
Tagwai (2018:36) asserts that while infertility can be scientifically or medically validated, its implications, related challenges, and effects vary between societies and civilisations. Infertility is a common experience among couples and individuals, shaped by their socioeconomic circumstances. Infertility is regarded as a curse for couples, but fertility is viewed as a source of joy. This study illustrates how African societies seek to marginalise childless couples, disregarding their human value in the context of their relationships within society. Many childless women experience marital instability and its psychological repercussions because of derision and rumour from relatives and community members. An illustration of this discourse is ‘…there is no woman in that house, only two men–since she has no child’ (Mbiti 1991:10). Mbiti (1991:110) asserts that every typical individual is obligated to marry and procreate. A failure equates to a transgression of established norms and traditions. Because of the nature of this challenge, pastoral carers must assist those experiencing infertility.
How women with infertility cope in their marriages
Clearly, infertile couples in Africa face numerous obstacles, including abuse and marital infidelity. According to African traditional religion, the African sense of family is ideological, whereas the Western concept is biological. According to this concept, marriage is between two clans rather than two individuals (Anokye et al. 2017). An infertile individual endures personal adversity and is unable to contribute to the welfare of the broader community. In the African context, marriage is not the exclusive means of conferring legitimacy upon offspring. Preston-Whyte and Zondi (1992:237) contend that in African society, ‘bearing children is regarded as a fundamental aspect of womanhood and attaining success’. Research indicates that infertility may adversely affect marriage; however, it might also yield unforeseen advantages. More than half of the couples see benefits from infertility in their marriage, with 25% of women and 21% of men reporting that their marriage has strengthened and their bond has deepened as a result. Compounding the matter, some women have lost their husbands to fertile women who have had children with them, implying that their flaws are completely their own, causing deep sorrow among their spouses, extended families, and competition. Individuals with infertility frequently distance themselves to avoid encounters with pregnant women or families with young children (Loftus & Namaste 2011; Swanson & Braverman 2021).
Women who marry are effectively committing to having children because having children is considered the standard in society. As a result, infertility can lead to rejection from family and friends, as well as strong pressure to conceive. A total of 83% of couples face some form of pressure to become pregnant, usually from their partner, parents, or other family members, expectations from families, society, in-laws and acquaintances and for women to feel bad about their infertility. In addition, seeing a doctor can be time-consuming and costly. Infertility can sometimes be detrimental to the quality of a marriage. This effect is stronger in women, but it can also affect men. Infertility-related stress can worsen marital conflict, lower self-esteem, and decrease the overall quality of life and happiness. During his inquiry, Sewpaul (1999:744) revealed that one of the leaders of African traditional religion indicated that children, both boys and girls, signify security and wealth in African culture. In the more traditional type of polygamy, the only way to compete within the family was to have more children. Infertility stigmatises women, particularly in many African cultures, and can contribute to poverty because they stand to lose their pride and full adult status if they are infertile and are considered inferior in status to other fertile women, with societal consequences such as outright divorce or polygynous marriage from their husbands, stigmatisation from extended family members, and outright ostracism from the so-called fertile community. A study by Andrews, Abbey and Halman (1992), titled Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples found that the stress related with infertility was comparable to other forms of marital stress and conflict reported by men. Infertility, on the other hand, caused a unique type of stress in women that it firmly ingrained in their feeling of self-efficacy. In many cases, women desire children more than their partners and have a strong maternal identity. Infertility can cause stress in men, resulting in conflict and increased duties, but it often has a greater impact on women. Depending on the cause of infertility, some men may experience reduced sexual desire or performance issues. This may have an unfavourable effect on marital intimacy, as the man may feel pressured to ‘perform’ rather than enjoy the experience.
Certain couples encounter ‘mechanical’ intercourse, characterised by a singular focus on conception, devoid of intimacy and pleasure. This is merely an attempt to complete a task; it has lost its intimacy. The most distressing experience women endure in a sexual relationship is when their husbands lose interest in intimacy because of their inability to conceive. Some men overlook that sexual intercourse serves purposes beyond procreation. This is regrettable as women experiencing infertility are anticipated to depend significantly on their partners for support. The manner in which spouses discuss the issue significantly influences marital intimacy and satisfaction. Women, on average, exhibit a greater desire for children than their spouses and make more efforts to address infertility issues (Greil, Slauson-Blevins & McQuillan 2004). A male spouse’s heightened desire for a child correlates with more commitment to addressing infertility, including willingness to engage in discussions, so enhancing his wife’s sense of support. Wives often report an enhancement in their relationship because of infertility issues when husbands are prepared to communicate and engage accordingly (Greil, Zimmerman & McQuillan 2002).
It is likely that many women experience shame for engaging in this behaviour. The shame associated with the ‘I can’t’ category, such as ‘I can’t perform’ or ‘I can’t provide’, for men. Acknowledging your embarrassment is suitable. This is a complex issue, as there is some validity to the statement; nonetheless, it is essential to recognise that, although procreation is significant to many, our identity encompasses far more than our reproductive capabilities. Humanity encompasses more than mere reproduction or its absence; our identity extends beyond our reproductive capabilities. Understanding women’s dignity in connection to marriage and childbirth is particularly difficult since it implies that marriage is the only institution that confers dignity and respect on women (Segalo 2013:1–10). Women facing infertility have significantly higher levels of depressive symptoms (Domar et al. 1993) and anxiety (Downey et al. 1989) than their fertile counterparts. In one study, 11% of infertile participants met the criteria for a major depressive episode, compared to 3.6% of fertile respondents. In a separate trial of infertile women, 50% reported changes in sexual function and 75% experienced mood swings, including increased sorrow (Downey et al. 1989).
The anthropological and cultural challenges resulting from the cultural demands on childbearing
Humans are cultural beings, and their actions are largely reflections of their cultural belief systems. This article focuses on infertility as both a biological and cultural problem in dire need of intervention. Early scholarly notes on infertility in Southern Africa can be traced through the lens of historian-anthropologist, Junod (1912). Junod (1912) has observed that barrenness among Tsonga women, like other African communities, is often understood cosmologically, through cultural and spiritual frameworks, including beliefs in spiritual forces, witchcraft, ancestral displeasures, or curses, leading to consultation with spiritual healers for diagnosis and treatment through traditional rituals (Johnston 1974). While Tsonga communities hold specific beliefs, there are also shared cultural understandings of infertility across different African groups, emphasising the interplay between cultural beliefs, subjective experiences, and the search for solutions within traditional and Western healthcare systems (Makoba 2005).
In his ethnographic works on the Tsonga ethnic people, Junod (1912) explains that children are gifts from the gods, and that sterility is a treatable misfortune. The traditional treatment rite is conducted with the offering of a special sacrifice symbolised by the killing of a goat, whose skin is used to adorn the infertile woman. The sacrificial goat is dedicated to the gods, who are the givers of children (life). An infertile woman is despised and is labelled ‘mhika’ (Junod 1912:188), meaning one who does not bear children, or one who is barren. Even worse, the social stigma of being unable to bear children can lead to divorce (as also observed by Johnston 1974); but traditionally, the parents of the woman can send a sororal wife to the husband as a replacement for fertility purposes. In other worst-case scenarios, the social stigma of being infertile often leads to social isolation.
In a research article focused on ethnoveterinary medicine, Luseba and Van der Merwe (2006) are also in agreement with these assertions that infertility can have spiritual causes including magic. They also believe that ancestral spirits are at play, a parallel observed earlier by Junod (1912) when he asserted that children are God-gifted, and that special rites should be conducted to provide solutions and protection.
Further anthropological studies of fertility and infertility reveal a gender bias, with women presenting the challenges because they are responsible for bringing the child to full term. This is a serious issue in gender inequality, one that causes women to spiral into silence, guilt, and shame; hence they are depressed. While still focused on Southern Africa, a study on cultural perspectives of miscarriages from an unnamed context in Kenya, revealed that the phenomena focused on miscarriages as veiled in stigma and silence, resulting in emotions of shame, guilt, and isolation for individuals who have them. These misconceptions, which are frequently based on superstitions, as noticed by Junod (1912) and Johnston (1974) among Tsonga women, blame, or the assumption that miscarriage is a personal failing, can stifle honest conversation, impede access to assistance, and prolong the grief process. Furthermore, a miscarriage carries a shame for a woman, including the assumption that the lady either cheated on her husband or herself, or that her family had violated some customary taboo (Dillicour et al. 2013). Kiguli (2016) found that cultural and societal attitudes towards losing an unborn baby may involve prevalent beliefs in witchcraft and evil spirits. Some cultural beliefs ascribe miscarriages to the mother’s behaviour, infidelity, or breaching taboos, resulting in blame and social exclusion. Furthermore, a woman may feel inadequacy and failure as a mother in countries where maternity is revered and the inability to carry a baby to term is frowned upon and stigmatised.
Many cultures regard miscarriage as a private misfortune, resulting in silence and a reluctance to openly address the loss. This is also understandable from the perspective of Dellicour et al. (2013). According to Kiguli (2016), many women worldwide, particularly in sub-Saharan Africa, face stigmatisation, humiliation, and guilt. Sufferers are generally silenced and prevented from communicating their pain over the miscarriage.
In addition, WHO quotes the example of 44-year-old Larai, a chemist in Nigeria, who stated unequivocally:
Coping with my miscarriage was terrible. Even though I am a doctor, the medical professionals contributed significantly to my anguish. The other issue is a cultural mentality. Most individuals in traditional African societies believe that a curse or witchcraft can cause a baby to die. Child loss is stigmatised here because some people believe there is something wrong with a lady who has had recurring losses, that she may have been promiscuous, and that the loss is God’s retribution. (pp. 237–252)
Miscarriages appear to be dealt with silence because of custom and culture, causing women to suffer in silent. According to WHO, miscarriages might be confused with other health conditions that communities avoid discussing, including mental health, which is still a huge taboo subject. This taboo affects women regardless of their cultural background, education, or upbringing, as their friends and relatives refuse to discuss their loss. This appears inexorably linked to the pervasive silence surrounding the subject of mourning (WHO 2025). Kilshaw (2017) feels that because pregnancy loss is a regular aspect of women’s reproductive lives, there is a need to thoroughly understand how women process such loss across cultures. Such an understanding could provide insight into determining the underlying significance of the catastrophe. The silence around a pregnancy loss can be distressing for women who have lost their pregnancies because they need to talk about it with their friends and family. According to Kilshaw (2017), women express their loss through various means, including tattoos, social media posts, symbolic jewellery, and body markings because the prevailing narrative that has emerged depicts miscarriage as the death of a loved and treasured being that causes grief and trauma. Miscarriage typically involves grieving and rehabilitation (Kilshaw 2017).
A literature review conducted by Wallis, Heath and Spong (2024:6) identified the following themes: invalidation, feeling invisible grief, disenfranchised grief, silence, social and gender roles, deconstructing motherhood, femininity isolation, and the medicalisation of miscarriage. These themes suggest important recommendations for healthcare contexts. While men opt to maintain their stoic manly demeanour after losing a pregnancy, women go to their corners and grieve silently while being blamed for the loss. What is considered to be weird and harsh behaviours is when a woman is expected to conceive immediately after a miscarriage or face shame and ostracism (Ayebare et al. 2021).
The perception of infertility evident in the predominantly culturally dominated past generations
As previously discussed, previous generations maintained culturally dominant beliefs about infertility. Dillicour et al. (2013) argue that the pressure to reproduce persists regardless of the nature of civilisation. Whether in ancient or current times, the pressure is always on women, not men. When De-Whyte (2018:2) analyses infertility in the Ancient Near East (ANE), she argues unequivocally that women possessed power that could not be ignored, just as men did in a completely different environment. She claims that ‘fertility was the power and authority that ancient women wielded. As such, fertility was central to a woman’s identity in the ANE, but infertility was a devastating bodily and spiritual experience. An examination of selected Mesopotamian, Hittite, and Egyptian cultic materials, law codes, and proverbs reveals attitudes towards pregnant and barren women’. According to De-Whyte (2018), fertility in ancient times stretched beyond merely female reproduction to include fertility of the soil and livestock. Fertility was a cultic concept, with assigned gods overseeing fertility rites and ceremonies. Such cults included the purchase of fertility figures, which symbolised that childbearing was important to existence, and hence, a woman’s identity and place in society. Even back then, there were negative sentiments towards infertile women. Girls were even raised to be mothers; thus, an infertile woman was viewed as a lesser human being. Motherhood was a highly desired status in this environment. A woman who was unable to bear children brought shame to the entire extended family. A woman would marry to expand a man’s clan, with reproduction focusing on sons rather than daughters. According to De-Whyte, male offspring have traditionally been favoured above female children because of their labour potential and inheritance rights (De-Whyte 2018).
Behjati-Ardakani et al. (2016) examine the concept of myth and symbolism in fertility, claiming that fertility dates back to the beginning of creation and that people have a profound desire for reproduction. Reproduction and fertility were major concerns across the ANE, and women were often blamed for being infertile (Behjati-Ardakani et al. 2016). In an attempt to better understand infertility in couples, Vignozzi, Cipriani and Lippi (2024) delve into classical antiquity to uncover historical reasons that have contributed to gender inequity, allowing women to deal with infertility on their own. Their findings include blaming women for infertility, as well as the pressures on women caused by unfulfilled parenthood and cultural expectations (Junod 1912).
Overcoming infertility
Infertility can have catastrophic consequences. Support groups could be valuable. According to Resolve, an infertility non-profit organisation, infertility-related pain is ‘similar to the sadness over losing a loved one, but it is unique since it is a reoccurring bereavement’. Most importantly, loved ones can support women enduring infertility by expressing their loss and pain. Before becoming pregnant with twins in 2015, Debra Kamin, 36, had three cycles of in vitro fertilisation. She reported that during the operation, heartfelt statements frequently had the opposite impact:
[P]eople sometimes feel forced, with the best of intentions, to say something to try to make things better, such as ‘Everything occurs for a reason’, or ‘You’ll get pregnant when the time comes’. (pp. 237–252)
However, she acknowledged that those comments were unpleasant because it can be difficult to accept such a broad perspective when going through a difficult operation. She said, ‘It feels like everything in the world hinges on the next call from the doctor’. So, the best course of action is to just admit that it must be difficult. The typical cultural and ecclesial narrative assumes that a woman and man fall in love, marry, and have biological children. Multiple therapy techniques may be necessary to treat female infertility. Female infertility treatment options include surgery, medications, and reproductive assistance such as assisted reproductive technology (ART). Although surgery has been used to treat female infertility in the past, it is becoming less common as alternative reproductive treatments develop. Surgery can improve fertility by removing fibroids, unblocking fallopian tubes, and correcting an irregularly shaped uterus. Reproductive aid procedures include intrauterine insemination (IUI) and ART. Intrauterine insemination, which occurs right before ovulation, involves the injection of millions of sperm into a woman’s uterus. While discussing the Christian response to infertility, Kunhiyop (2008:202) emphasised that when assisting couples, their families, and the community in dealing with the difficult situation of infertility, pastors and counsellors should emphasise the importance of understanding infertility in the light of scripture. According to Cox (2013:1), a theology of infertility is required to assist couples and the larger ecclesial community in understanding the theological consequences of infertility. According to Ekeke and Uchegbue (2014:201), infertility or barrenness among spouses has become a significant global concern. The rise in infertility has prompted biotechnology researchers to investigate new approaches to addressing the issue. This is why the concept of an artificial womb, which was previously only in fiction, is suddenly becoming a reality.
Conclusion
You may continue to pursue your reproductive ambitions following an infertility diagnosis. Numerous couples experiencing infertility may ultimately conceive, albeit it may require a considerable duration. Certain individuals will be capable of accomplishing it themselves, but others may require support. Infertility can be profoundly traumatic for couples. The variety of reproductive technologies accessible can lead to confusion. Selecting appropriate technologies requires considerable cognitive, emotional, and spiritual investment. Friends and family can assist couples navigating infertility in several significant ways.The aim is to motivate couples to acquire knowledge about the facts and thereafter explore the underlying causes of infertility. Infertility typically does not persist indefinitely. Some couples may have multiple years of infertility prior to conceiving children. Refrain from offering unwanted advice or disseminating outdated urban legends. Couples experiencing infertility may not derive solace from hearing about a relative or acquaintance who was previously infertile but has recently had a child. Numerous charities specialise in aiding infertile couples. The Scriptures contain numerous passages that can provide solace and encouragement to a believer in any circumstance they encounter in life. Pastoral carers must utilise this resource (the Bible) in their efforts to offer pastoral support to infertile couples through scriptural references.
Acknowledgements
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
CRediT authorship contribution
Hundzukani P. Khosa-Nkatini: Conceptualisation, Writing – original draft, Writing – review & editing. N’wa-Phaphama M.D. Mabale: Conceptualisation, Writing – original draft, Writing – review & editing. All authors contributed to the article, discussed the results, and approved the final version for submission and publication.
Ethical considerations
This article does not contain any studies involving human participants performed by any of the authors.
Funding information
The authors received no financial support for the research, authorship, and/or publication of this article.
Data availability
All data are available upon reasonable request from the corresponding author Hundzukani P. Khosa-Nkatini.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.
References
Abedi Shargh, N., Bakhshani, N.M., Mohebbi, M.D., Mahmudian, K., Ahovan, M., Mokhtari, M. et al., 2015, ‘The effectiveness of mindfulness – Based cognitive group therapy on marital satisfaction and general health in woman with infertility’, Global Journal of Health Science 8(3), 230–235. https://doi.org/10.5539/gjhs.v8n3p230
Andrews, F.M., Abbey, A. & Halman, L.J., 1992, ‘Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples’, Fertility and Sterility 57(6), 1247–1253. https://doi.org/10.1016/S0015-0282(16)55082-1
Anokye, R., Acheampong, E., Mprah, W.K., Ope, J.O. & Barivure, T.N., 2017, ‘Psychosocial effects of infertility among couples attending St. Michael’s Hospital, Jachie-Pramso in the Ashanti Region of Ghana’, BMC Research Notes 10, 690. https://doi.org/10.1186/s13104-017-3008-8
Ayebare, E., Lavender, T., Mweteise, J., Nabisere, A., Nendela, A., Mukhwana, R. et al., 2021, ‘The impact of cultural beliefs and practices on parents’ experiences of bereavement following stillbirth: A qualitative study in Uganda and Kenya’, BMC Pregnancy and Childbirth 21(443), 1–10.
Baloyi, M.E., 2009, ‘Critical reflections on infertility in black African Christian communities’, Practical Theology in South Africa 24(2), 1–17.
Batool, S.S. & De Visser, R.O., 2016, ‘Experiences of infertility in British and Pakistani women: A cross-cultural qualitative analysis’, Health Care for Women International 37(2), 180–196. https://doi.org/10.1080/07399332.2014.980890
Behjati-Ardakani, Z., Mohammad Mehdi, A., Homa, M. & Seyed Hasan, H., 2016, ‘An evaluation of the historical importance of fertility and its reflection in ancient mythology’, Journal of Reproduction & Fertility 1, 2–9.
Bhamani, S.S., Zahid, N., Zahid, W., Farooq, S., Sachwani, S., Chapman, M. et al., 2020, ‘Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan’, BMC Public Health 20(1), 1607–1607. https://doi.org/10.1186/s12889-020-09706-1
Casu, G. & Gremigni, P., 2016, ‘Screening for infertility-related stress at the time of initial infertility consultation: Psychometric properties of a brief measure’, Journal of Advanced Nursing 72(3), 693–706. https://doi.org/10.1111/jan.12830
Cox, K.L., 2013, ‘Toward a theology of infertility and the role of Donum Vitae’, Horizons 40(1), 28–52.
Davajan, V., 1999, ‘Infertility and Reproductive Endocrinology’, in Clinical Gynecology, 3rd edn., pp. 18–22.
De-Whyte, J.P.E., 2018, ‘(In)fertility in the ancient near east’, in J.P.E. De-Whyte (ed.), Wom(b)an: A cultural-narrative reading of the Hebrew Bible barrenness narratives, pp. 24–52, Brill, Leiden, Boston, MA.
Dellicour, S., et al., 2013, ‘Exploring risk perception and attitudes to miscarriage and congenital anomaly in rural Western Kenya’, PLoS One 8(11), e8055.
Dillicour, S., Kambo, I., Delvaux, T., Bosso, P., Omondi, C. & Leye, E., 2013, ‘Exploring risk perception and attitudes to miscarriage and congenital anomaly in rural Western Kenya’, PLoS One 8(11), 1–8. https://doi.org/10.1371/journal.pone.0080551
Domar, A.D., et al., 1993, ‘Psychological impact of infertility: A comparison with patients with other medical conditions’, Journal of Psychosomatic Obstetrics & Gynecology 14(1), 45–52.
Donarelli, Z., Kivlighan, D.M., Allegra, A. & Lo Coco, G., 2016, ‘How do individual attachment patterns of both members of couples affect their perceived infertility stress? An actor–partner interdependence analysis’, Personality and Individual Differences 92, 63–68. https://doi.org/10.1016/j.paid.2015.12.023
Downey, J., Yingling, S., McKinney, M., Husami, N., Jewelewicz, R. & Maidman, J., 1989, ‘Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation’, Fertility and Sterility 52(3), 425–432. https://doi.org/10.1016/S0015-0282(16)60912-3
Ekeke, E.C. & Uchegbue, D.O., 2014, ‘Solving the problem of infertility among Christians: A bioethical appraisal’, American Journal of Social and Management Sciences 1(2), 201–208. https://doi.org/10.5251/ajsms.2010.1.2.201.208
Ghafouri, S.F., Ghanbari, S., Fallahzadeh, H. & Shokri, O., 2016, ‘The relation between marital adjustment and posttraumatic growth in infertile couples: The mediatory role of religious coping strategies’, Journal of Reproduction & Infertility 17(4), 221–229.
Greil, A., McQuillan, J., Benjamins, M., Johnson, D.R., Johnson, K.M. & Heinz, C.R., 2010, ‘Specifying the effects of religion on medical helpseeking: The case of infertility’, Social Science & Medicine 71(4), 734–742. https://doi.org/10.1016/j.socscimed.2010.04.033
Greil, A.L., Slauson-Blevins, K. & McQuillan, J., 2004, ‘Explaining differences in how women and men cope with infertility: Effects of appraisals’, Fertility and Sterility 82(2), 324–331. https://doi.org/10.1016/j.fertnstert.2004.01.032
Greil, A.L., Zimmerman, J.L. & McQuillan, J., 2002, ‘Differences between husbands’ and wives’ approach to infertility affect marital communication and adjustment’, Fertility and Sterility 78(2), 325–332. https://doi.org/10.1016/S0015-0282(02)03200-8
Johnston, T.F., 1974, ‘A Tsonga initiation’, African Arts 7(4), 60–62. https://doi.org/10.2307/3334849
Junod, H.A., 1912, The life of a south African tribe I: The social life, Imprimerie Atiner Afreres, Neuchatel.
Kalu, U.O., 2005, African Christianity: An African story, University of Pretoria, Pretoria.
Karaca, N., Karabulut, A., Ozkan, S., Aktun, H., Orengul, F., Yilmaz, R. et al., 2016, ‘Effect of IVF failure on quality of life and emotional status in infertile couples’, European Journal of Obstetrics & Gynaecology and Reproductive Biology 206, 158–163. https://doi.org/10.1016/j.ejogrb.2016.09.017
Kaya, Z. & Oskay, U. 2019, ‘Stigma, hopelessness and coping experiences of Turkish women with infertility’, Journal of Reproductive and Infant Psychology 38(5), 485–496. https://doi.org/10.1080/02646838.2019.1650904
Kiguli, J., 2016, ‘Stillbirths in sub-Saharan Africa: Unspoken grief’, The Lancet 387, 16–18. https://doi.org/10.1016/S0140-6736(16)00035-0
Kilshaw, S., 2017, ‘How culture shapes perceptions of miscarriage’, Sapiens, viewed 05 August 2025, from https://www.sapiens.org/biology/miscarriage-united-kingdom-qatar/.
Kim, M., Moon, S. & Kim, J., 2020, ‘Effects of psychological intervention for Korean infertile women under in vitro fertilization on infertility stress, depression, intimacy, sexual satisfaction and fatigue’, Archives of Psychiatric Nursing 34(4), 211–217. https://doi.org/10.1016/j.apnu.2020.05.001
Kunhiyop, S.W., 2008, African Christian ethics, Hippo Books, Grand Rapids, MI.
Lakatos, E., Szigeti, J.F., Ujma, P.P., Sexty, R. & Balog, P., 2017, ‘Anxiety and depression among infertile women: A cross-sectional survey from Hungary’, BMC Women’s Health 17(1), 48–48, https://doi.org/10.1186/s12905-017-0410-2.
Li, X., Ye, L., Tian, L., Huo, Y. & Zhou, M., 2020, ‘Infertility-related stress and life satisfaction among Chinese infertile women: A moderated mediation model of marital satisfaction and resilience’, Sex Roles 82(1–2), 44–52. https://doi.org/10.1007/s11199-019-01032-0
Loftus, J. & Namaste, P., 2011, ‘Expectant mothers: Women’s infertility and the potential identity of biological motherhood’, Qualitative Sociology Review 7(1), 36–54. https://doi.org/10.18778/1733-8077.07.1.02
Luseba, D. & Van der Merwe, D., 2006, ‘Ethnoveterinary medicine practices among Tsonga speaking people of South Africa’, Onderstepoort Journal of Veterinary Research 73(2), 115–122. https://doi.org/10.4102/ojvr.v73i2.156
Makoba, L.T., 2005, ‘The experiences of infertile married African women in South Africa: A feminist narrative inquiry’, Unpublished MA (Clinical Psychology) dissertation, University of Pretoria, Pretoria.
Maroufizadeh, S., Omani-Samani, R., Almasi-Hashiani, A., Amini, P. & Sepidarkish, M., 2017, ‘Sociocultural determinants of infertility stress in patients undergoing fertility treatments’, Journal of Human Reproductive Sciences 10(4), 262–268.
Mbiti, J.S., 1991, Introduction to African religion, 2nd edn., Heinemann, Johannesburg.
Monga, M., Alexandrescu, B., Katz, S.E., Stein, M. & Ganiats, T., 2004, ‘Impact of infertility on quality of life, marital adjustment, and sexual function’, Urology 63(1), 126–130. https://doi.org/10.1016/j.urology.2003.09.015
Ntiamoah, D., 2018, ‘The role of religiosity and spirituality in healing infertility and psychological distress’, Journal of Philosophy, Culture and Religion 38, 32–37.
Okonofua, F., 2000, ‘Infertility in sub-Saharan Africa’, Contemporary Obstetrics and Gynecology 15(3), 208–215.
Preston-Whyte, E. & Zondi, M., 1992, ‘African teenage pregnancy: Whose problem’, in S. Burman & E. Preston-Whyte (eds.), Questionable issue: Illegitimacy in South Africa, pp. 237–252. Oxford University Press, Cape Town.
Schmidt, L., Holstein, B., Christensen, U. & Boivin, J., 2005, ‘Does infertility cause marital benefit? An epidemiological study of 2250 women and men in fertility treatment’, Patient Education and Counseling 59(3), 244–251. https://doi.org/10.1016/j.pec.2005.07.015
Segalo, P., 2013, ‘Gender, social justice and the psychology of women in Africa’, Agenda: Empowering Women for Gender Equity 27(2), 1–10.
Sewpaul, V., 1999, ‘Culture religion and infertility: A South African perspective’, British Journal of Social Work 29, 741–754. https://doi.org/10.1093/bjsw/29.5.741
Swanson, A. & Braverman, A.M., 2021, ‘Psychological components of infertility’, Family Court Review 59(1), 67–82. https://doi.org/10.1111/fcre.12552
Tagwai, Y.P., 2018, ‘Challenges confronting infertile couples in Africa: A pastoral care approach’, PhD thesis, Stellenbosch University, Stellenbosch.
Vignozzi, L., Cipriani, S. & Lippi, D., 2024, ‘Why couple infertility is historically a female-driven problem?’, Andrology 13(4), 675–680. https://doi.org/10.1111/andr.13716
Wallis, E.L.G., Heath, J. & Spong, A., 2024, ‘How do people story their experience of miscarriage? A systematic review of qualitative literature’, Sexual and Reproductive Healthcare 41, 1–7. https://doi.org/10.1016/j.srhc.2024.100997
Westerfield, R., 2012, Obstetrics and Gynecology Illustrated, 5th edn., 498.
World Health Organization (WHO), 2020, Infertility, WHO, viewed 20 January 2021, from www.who.int/news-room/fact-sheets/detail/infertility.
World Health Organization (WHO), 2025, Why we need to talk about losing a baby, WHO, viewed 05 August 2025, from https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-ababy#:~:text=Around%20the%20world%2C%20women%20have,are%20perceived%20to%20be%20unavoidable.
Zegers-Hochschild, F., et al., 2009, ‘The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology’, Human Reproduction 24(11), 2683–2687.
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