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- family planning service provision
- hormonal contraception
- sexually transmitted infections
Women’s concerns about infertility and return to fertility after using hormonal contraceptives are well documented and are often dismissed as ‘myths’. Yet in settings with uncontrolled epidemics of sexually transmitted infections (STIs) among young people, using contraceptives to delay childbearing may coincide with being infected with an STI. Chlamydia in particular is an important cause of tubal factor infertility.
The extent of STI prevalence has long been unmeasured in low-income and middle-income settings. Recent studies, however, have found a major uncontrolled chlamydia epidemic among young people in South Africa,1 2 suggesting that in other similar contexts there is also likely to be an unmeasured epidemic. This high prevalence of undiagnosed and untreated chlamydia is likely to be causing widespread fertility problems.
Fears about future infertility are some of the most widely cited reasons for avoiding highly effective contraceptives, and are often characterised in the literature as ‘misconceptions’ or ‘myths’ because the methods themselves are unlikely to cause infertility directly.3 Infertility is devastating anywhere in the world and for many can cause economic deprivation and social isolation as well as personal grief. For example, while pregnancy can confer adult status on women,4 studies from Nigeria4 and Tanzania5 report women who had never given birth being characterised as ‘useless’. Infertile women in Ghana can face severe social stigma, marital strain and a range of mental health difficulties. …
Twitter @cicely, @SuzannaCarterF1
Contributors CM conceived the idea for this article and drafted it. SCF contributed to conceptualisation, provided expert input and contributed to drafting. Both authors agree with and approve the final content.
Funding SCF received salary support from the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and also a part of the EDCTP2 programme supported by the European Union (MR/N023692/1; MR/K012126/1). The funders had no role in the development of this commentary.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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