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.

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).

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:

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.

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).

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:

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).

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).

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:

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.

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.