title: 'Mama and papa nothing': living with infertility among an urban population in Kigali, Rwanda.
abstract: BACKGROUND
  Not being able to procreate has severe social and economic repercussions in resource-poor countries. The purpose of this research was to explore the consequences of female and/or male factor infertility for men and women in Rwanda.
  
  
  METHODS
  Both quantitative and qualitative methods were used. Couples presenting with female and/or male factor infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 312), were surveyed about domestic violence, current and past relationships and sexual functioning. In addition, five focus group discussions were held with a subsample of survey participants, who were either patients diagnosed with female- or male-factor fertility or their partners.
  
  
  RESULTS
  Domestic violence, union dissolutions and sexual dysfunction were reported more frequently in the survey by infertile than fertile couples. The psycho-social consequences suffered by infertile couples in Rwanda are severe and similar to those reported in other resource-poor countries. Although women carry the largest burden of suffering, the negative repercussions of infertility for men, especially at the level of the community, are considerable. Whether the infertility was caused by a female factor or male factor was an important determinant for the type of psycho-social consequences suffered.
  
  
  CONCLUSIONS
  In Rwanda, as in other resource-poor countries, infertility causes severe suffering. There is an urgent need to recognize infertility as a serious reproductive health problem and to put infertility care on the public health agenda.
authors.affiliation: International Centre for Reproductive Health, Ghent University, Ghent, Belgium. dhontnathalie@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Dhont
authors.forename: J
authors.initials: J
authors.lastname: van de Wijgert
authors.forename: G
authors.initials: G
authors.lastname: Coene
authors.forename: A
authors.initials: A
authors.lastname: Gasarabwe
authors.forename: M
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003906:Developing Countries; D017579:Domestic Violence; D005114:Extramarital Relations; D005195:Family Relations; D005260:Female; D017144:Focus Groups; D006785:Hospitals, University; D006801:Humans; D007246:Infertility / Q000150:complications* / Q000191:economics / Q000523:psychology*; D008297:Male; D012432:Rwanda; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000150:complications; D020018:Sexual Dysfunctions, Psychological / Q000150:complications; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health