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Neglect of STIs and infertility undermines family planning programmes
  1. Cicely Marston1,
  2. Suzanna C Francis2
  1. 1 Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
  2. 2 MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Professor Cicely Marston, Public Health, Environments, and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London WC1E 7HT, UK; Cicely.Marston{at}

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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. …

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