This open-access article is distributed under 
Creative Commons licence CC-BY-NC 4.0. RESEARCH
‘I don’t experience any insults, but my wife does’: The concerns of 
men with infertility in Ghana
F Naab,1 PhD, MPhil, BA, RM, SRN; A A Kwashie,2  PhD candidate, MPhil, BSc, SRN
1 Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra
2 Department of Research, Education, and Administration, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra
Corresponding author: F Naab (florencenaab@yahoo.com) 
Background. African men with infertility appear to be concerned about the blame for male infertility falling on their wives. 
Objective. To explore the concerns of men with infertility about the blame for male infertility falling on their wives. 
Methods. Participants were recruited through their wives, who were receiving treatment for infertility from the obstetrics and gynaecology 
unit of a public hospital in Ghana. The men had been identified as having male factor infertility. A semi-structured interview guide was 
designed and used to conduct in-depth interviews. Each participant was interviewed twice. The first interview lasted ~20 - 30 minutes. The 
second was by telephone, for validation of the findings, and lasted ~10 minutes per participant. Each interview was transcribed verbatim 
for conventional content analysis. 
Results. The findings revealed that the men described three main concerns: traditional influences, emotional disturbances and pressure on 
wives. 
Conclusion. The men’s narrations of their experiences indicated that they were very concerned about the blame for male infertility falling 
on their wives. There is a need for health education on male infertility in Ghana.
S Afr J Obstet Gynaecol 2018;24(2):45-48. DOI:10.7196/SAJOG.2018.v24i2.1278
Although infertility affects both men and women, the experience the driver of this social regulation. Third, blame is believed to rely 
of infertility among men and women in Africa appears to on social recognition for its function, such that it is a judgement 
differ immensely. Globally, the evidence that women suffer more directed at a person who has violated a norm. Malle et al.[12] define 
consequences from infertility than men is overwhelming.[1-5] blame as arising from a negative event, where the person blamed is 
Similarly, many research reports suggest that women in Africa seen as the cause of the negative event.
suffer more negative consequences, such as depression and stress, Viewing infertility within the lens of these descriptions, it may be 
compared with men.[2,4,6] Nevertheless, research evidence suggests described as an undesirable outcome for couples, and the blame is 
that men equally suffer many psychosocial problems associated with obliviously socially directed at the woman as the agent of causality. 
infertility, especially when the infertility is known to be male-factor In the experience of infertility in Ghana, blaming the woman seems 
related.[7,8] In an intervention study in South Africa (SA), men with unavoidable, because of the culture of the Ghanaian people. Even 
infertility in the treatment group were reported to have high levels of though scientific evidence suggests that ~40 - 50% of infertility is 
distress when compared with men in the control group.[8] In Ghana, attributable to men, women are largely blamed by spouses, families 
men with infertility reported issues of depression, social isolation and society for the couple’s infertility.[10,11,14] The purpose of this study 
and stigma in a qualitative study.[9] These studies in Africa suggest was to explore the concerns of men with infertility, and particularly 
that infertility is a distressing experience for men with infertility. to address possible concerns about their wives being blamed for the 
It is therefore important to note that the experience of infertility couple’s infertility.
among men in Africa may be under-reported. In fact, because of 
the cultural connotations of infertility as being a female problem Methods
in Africa, male infertility appears to be a problem of secrecy. As a result, Study design
many women in Africa are blamed when a couple is infertile.[10,11] Women A descriptive exploratory qualitative design was used to explore the 
are under intense pressure to conceive, and those with difficulties concerns of men who were receiving treatment for infertility about 
conceiving may end up divorced as a consequence, and may be the blame for male infertility falling on their wives. 
ridiculed in society.[5,11] 
Blame may be described as a process of considering someone Participants
or something responsible for a misdeed, failure or undesirable Married men aged ≥25 years who were receiving infertility treatment 
outcome. Some psychologists describe three main categories of from a public hospital in Ghana were recruited via their wives. 
blame.[12] First, blame is described as being both cognitive and 
social, because the outcome of the two processes is a judgement Recruitment and data collection procedure 
made by people in society. Second, blame is sometimes used for a The Institutional Review Board of Noguchi Memorial Institute 
social regulation of human behaviour, in which cultural morality is for Medical Research at the University of Ghana provided ethical 
SAJOG • November 2018, Vol. 24, No. 2   45
RESEARCH
approval for the study. The management of the hospital granted  ‘It is society that makes things this way because in the western part 
permission for data collection. A semi-structured interview guide of the world, I think some people marry and they go to court to sign 
was designed, based on the study objectives, which was divided that they are not going to have children. What about that?’
into two sections. Section A consisted of questions on demographic 
characteristics, while section B had open-ended questions on the Traditional influence was also reported from the perspective of the 
psychosocial experiences of infertility among the participants. patriarchal nature of Ghanaian society, in which men are described 
Participants were purposefully sampled to include only married men as the ‘heads of families’, and this notion was described as a result of 
aged ≥25 and receiving treatment for infertility. The sample size was the traditional influence as follows:
based on data saturation at the 12th participant. In-depth interviews ‘ We men feel that because we are the heads, we don’t need to be 
were conducted. Each participant was interviewed twice. The bothered in issues such as infertility.’
first interview lasted ~20 - 30 minutes, while the second interview 
lasted 10 minutes. The second interview was used for member A participant believed that this notion is an African problem more 
checking, that is, for validation of the findings by each participant. generally, rather than only Ghanaian:
Each interview was transcribed verbatim for conventional content  ‘They believe that in Africa, men dominate and control society and 
analysis. other things, so even if they have problems and they know very well 
that they have problems, they still wouldn’t like to come out and 
Data analysis would rather attribute such problems to their wives.’
Conventional content analysis  was conducted.[15] This is used when  
the researcher has no clear preconceived ideas of what categories Another aspect of traditional influence described by these men was 
will be present in the data to be analysed. As a result, soft copies of the concept of what makes a man in traditional Ghanaian society. A 
all twelve transcripts were retrieved and re-read for familiarity by participant reported:
both authors, and from this, codes were derived.  ‘In our traditional concepts, you are really considered a man when 
First, the exact words and phrases in each transcript that appeared you father a child and if you can’t, you are not respected in your 
to be describing an idea were highlighted for discussion. Next, each family.’ 
author made notes on the first impression about the highlighted  ‘Men in general we have some ego of superiority and we’ve heard 
words and phrases. Many codes were derived from the highlighted that we should be able to control everything.’
phrases, which were later organised into six categories. Later, similar  
categories were collapsed, and finally three main themes emerged Furthermore, the traditional influence on the experience of male 
from the six categories. In the final step, the three categories were infertility was linked to the purpose of marriage: 
defined and named, based on the content of each category.   ‘ The public believe that if you marry, within a year or two, you must 
have a child, and if it does not happen then they will start asking 
Results questions how and why.’
The three themes that emerged from the data were traditional  
influences, emotional disturbances and pressure on wives. In terms of using children as social security in old age, a participant 
The findings are presented as verbatim quotations from the reported that:
participants.  ‘You have to look after somebody to grow, so that the person will 
also look after you in old age.’
Demographic characteristics of participants
Twelve married men who were receiving treatment for infertility in A similar opinion was reported by another participant in this 
a public hospital, were interviewed. These included men with either manner: 
primary or secondary infertility, who were aged between 29 and  ‘I will definitely get old and in times of old age you might need some 
41 years, with various occupations, ranging from low to moderate help and you cannot go and call somebody’s child to come and assist 
income. The majority of the participants had lived with infertility for you.’
at least 2 years.  
These findings suggest that the experience of male infertility is 
Traditional influences influenced by traditional beliefs and practices.
Traditional influence was identified as a primary factor in the 
blame game of male infertility. In Africa, infertility is shrouded in Emotional disturbances of men with infertility
many beliefs and perceptions. The magnitude of the experience of Another factor that fuels the blame is emotional disturbances of 
infertility in Africa is different for men and women. In Ghana, it men with infertility. Four categories of emotional disturbance of 
is traditionally believed that infertility is a woman’s problem. This men with infertility were reported. These were worries/sadness/fear, 
belief was widely reported in the interviews, as narrated by the concerns for wives, pressure from family and friends, and mental 
participants: consequences. All the men were worried about their infertility 
‘ You know people have this in mind that it is always the women who status, as expressed by many:
don’t produce, they consider the women as barren and this is what ‘ Only the infertility is my worry. At times I feel bad but I just want 
they believe.’ to block that side of my sadness.’
 ‘I am worried because women have their time to give birth and if 
Some participants wondered why male infertility appears to be it passes that time, I would have placed my wife in a serious kind of 
acceptable in the western world, while this is not the case in Ghana: trouble.’ 
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Another participant similarly reported that: Other areas of emotional disturbance reported were varied issues of 
‘ If I am unable to find a solution to it and my wife gets beyond the functional status involving mental instabilities and sexual dysfunction: 
age of giving birth, that is where it is going to affect me plenty.’  ‘I felt like killing myself, but one of my friends told me this is not the 
end of the world.’
For some of these men, their sadness emanated from the fact that ‘ When I first got the information, it disturbed my performance when 
their wives tried to shield them from humiliation: i t comes to sex for some time before I came back to normal.’ 
 ‘I feel very bad when my wife tries to shield me from such 
humiliation and stuff like that.’ The majority reported these emotional disturbances as central 
problems in their lives. As a result, some of these men actually 
Peer comparison was another source of sadness for these men: contemplated having their wives engage in extra-marital affairs to 
‘ I worry because all my colleagues have children, some even have mitigate these emotional disturbances: 
four children and I am the only one who does not have children. It ‘ Sometimes some crazy things come to my mind that why not allow 
really makes me feel bad.’ her to go outside and bear her own child, and if she is willing to 
bring it home, I will father it.’ 
In addition to their personal emotional disturbances, these men 
had many concerns about their wives. They narrated their wishes to Pressure on wives
relieve their wives from familial and societal ridicule: Ironically, infertility in men is primarily identified via the female 
‘ I wish that I could satisfy my wife to have a child so that the family partner. Women are usually the first to go to hospitals, and do not 
problems will all be solved and nobody will be insulted.’ hesitate to undergo numerous invasive diagnostic procedures. 
‘ My concern is about the disturbance that the public is giving to my It is only when the woman is deemed to be fertile according to 
wife, because I see it that if not because of me she wouldn’t be going conventional assessment that the man may be assessed for infertility. 
through that trauma. That is my only concern but left to me myself, It appears that male infertility has always been a secondary, 
I am okay.’ clandestine health problem in Ghana, shielded by society, as reported 
by many participants: 
A participant passionately and sadly attested that his wife deserves ‘Everything is centred on the woman.’
better: ‘Society associates it with the woman.’
‘I just tell myself that she does not deserve this kind of treatment.’
Hence, women are blamed and they suffer the social consequences of 
Another area of emotional disturbance described was the pressure male infertility, as reported by many of these men as follows: 
from friends and family; participants attested to this pressure as the ‘T hey are not putting pressure on me, they are putting pressure on 
most common source of their emotional disturbance. One of the my wife.’
men had this to share about his family: 
 ‘Some family members ask me, they go like, my son what are you A participant narrated his wife’s ordeal as follows:
doing up to now? You have been married for almost 2 years and ‘I n less than 6 months after we married, they took her without my 
there is no child.’ consent, and later they called and informed me that because of so 
 and so we are taking your wife to a herbalist, and I was very angry.’
On the side of friends, participants shared similar experiences, as 
stated: Another participant simply put it this way:
 ‘When we meet as guys, they discuss about their wives and children. ‘I don’t experience any insults, but my wife does.’ 
For instance, some of them will say their wives are pregnant, others 
will say their wives have given birth and so on.’ Yet another participant was of the opinion that society and the wife’s 
 parents were the main offenders in the blame game. Consequently, 
Also, these men reported indirect pressure from their wives, in the some of the participants believed that negotiating with their wives 
form of attitudinal change when they have visiting friends and might salvage the situation: 
families with children: ‘I love my wife, so when I was told, I had to compromise with her.’
 ‘I see it more often when friends of hers or sisters come around with 
their children.’ Another participant said passionately about his wife:
  ‘It is hell, but she is managing. I will say she is a strong person and 
According to these men, on days when these indirect pressure sometimes when she comes [to me], I just have to console her.’
from their wives are experienced, there is usually disunity and  
unhappiness in their homes, as evidenced by these quotes: On the other hand, some participants reported that: 
 ‘My family is troubled with anger and quarrels in the house,  ‘Some men try their luck outside [the marriage], so that if he  
sometimes, something that is not supposed to bring about anger, succeeds he puts the blame on the woman.’ 
generates a fight.’
 ‘Sometimes she is overwhelmed with going to church for prayers and In summary, these findings suggest that the blame game of male 
the rest. In fact, the least mistake I make brings about problems in infertility is centred on traditional influences, emotional disturbances 
the house.’ among men and pressure put on their wives to conceive. 
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Discussion although male infertility exists in Ghana, its experience is shrouded 
The findings of this study suggest that it is traditional influences that in secrecy. There is therefore a need for public education on male 
lead to emotional disturbances among men with infertility. Although infertility in Ghana.
these men suffered many emotional problems, the patriarchal 
nature of Ghanaian culture appears to be a major contributor to Acknowledgements. We thank the participants for sharing their experiences of 
some of their emotions. For instance, all the men in this study infertility as men.
were informed about their medical infertility, yet it was common Author contributions. FN conceived the idea for the secondary analysis, de-
for their families to blame it on their wives. As has been found in signed and conducted the secondary analysis, drafted and revised all versions 
other African countries, the man is culturally considered to be of the article and gave the approval for the final submitted version. AAK co-
faultless.[11] Meanwhile, men suffer emotional problems as a result of analysed, reviewed, and provided feedback on all versions of the article.
infertility. Emotional problems such as worry, sadness and fear have Funding. Author-funded.
been reported among men in South Africa[8] and Zimbabwe.[13] The Conflicts of interest. None.
emotional problems among men in the present study were caused 
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from family, neighbours and society. These findings indicate that Accepted 4 August 2018.
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