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215 ELEVEN Is Infertility an Unrecognized Public Health and Population Problem? The View from the Cameroon Grassfields Pamela Feldman-Savelsberg Many women in Cameroon, a sub-Saharan country located on the “hinge” between West and Central Africa, experience impediments to bearing healthy children. Results from the 1998 Demographic and Health Survey (DHS) demonstrate that despite recent decreases, 5.5 percent of married women between the ages of thirty-five and forty-nine still suffer primary infertility. In addition, 29 percent of Cameroonian women have had an “unproductive pregnancy” (i.e., miscarriage [22%], stillbirth [6%], or abortion [5%]) (Fotso et al., 1999, pp. 47–49). All of the approximately two hundred fifty diverse ethnic groups that constitute Cameroon’s population highly value children and women’s childbearing. Thus childlessness consistently causes emotional, social, economic, and sometimes physical suffering, particularly for women. Nonetheless, in Cameroon infertility receives only cursory attention as a public health concern. This lack of attention to infertility may seem surprising. Based on post– World War II sample surveys and censuses, demographers have identified an “infertility belt,” or geographic area of low fertility, in Central Africa, including Cameroon (Cordell & Gregory, 1994; Retel-Laurentin, 1974; for a fuller description, see chap. 10, this volume). Long before the infertility belt was identified, German, French, and British researchers and colonial administrators were concerned with low or decreasing fertility in Cameroon , especially in regions from which laborers were recruited for colonial public works projects (e.g., Cartron, 1934; Farinaud, 1944, p. 79; Ziemann, 1904, pp. 150–153).1 The most recent DHS, compared to earlier survey data, suggests declines in childlessness in Cameroon and other countries in the Central African infertility belt (Larsen, 1995; chap. 10, this volume). Nonetheless, fertility remains lower here than in the rest of sub-Saharan Africa. And sub-Saharan Africa, particularly Central Africa, still exhibits the 216 THE INFERTILITY BELT highest infertility rates in the world (Ericksen & Brunette, 1996; Larsen, 1994; Sciarra, 1994). Despite the documented prevalence of infertility, local and international governmental and nongovernmental organizations have identified “hyperfertility ” and birth spacing, rather than infertility and threatened reproduction , as “population problems” in Cameroon. These foci may grow from a demographic prejudice. Most demographers of sub-Saharan Africa have focused on its exceptionalism, its position as the only world region still characterized by high levels of fertility despite improvements in biomedical health care (e.g., Caldwell & Caldwell, 1987). The possibility of a nascent demographic transition has recently captured the attention of scholars and policy makers interested in population control (National Academy of Sciences , 1993; United Nations, 1998). Decreasing fertility is hailed as a success story, as the triumph of modernity, especially of the expansion of education and economic development, over a pretransition, “natural” pronatalism. The Bamiléké of the Cameroon Grassfields hold an important place in this fertility/infertility paradox. The Bamiléké, making up roughly 25 percent of the Cameroonian population, have higher rates of fertility than their average Cameroonian compatriots—6.8 Bamiléké versus 5.4 national average completed fertility (Wakam, 1994). The Bamiléké also exhibit lower rates of infertility than all other ethnic groups in Cameroon (4.9 % primary infertility and 22.2% secondary infertility; the Bamiléké combined infertility rate is 26%, whereas the national average combined infertility rate is 43.9%) (Akam, 1990, p. 180). Demographers note that Bamiléké fertility is higher than would be predicted by economic demographic models (Wakam, 1994). Folk demographic discourse in Cameroon also focuses on high Bamiléké fertility. The often-heard comment, “Central Hospital’s maternity ward is full of Bamiléké babies,” indicates a reputation for high fertility both among Bamiléké living in their rural homeland and the urban “exile” population of migrants and their descendants. Nonetheless, rural Bamiléké women fear infertility, and the social and psychological consequences of infertility are grave (Feldman-Savelsberg, 1999). Infertile and subfertile women in rural polygynous households may be less favored with access to land and material resources than their more fertile cowives. They risk divorce because they cannot contribute children to their husbands’ patrilineage, and their natal families may become resentful at the need to repay the bridewealth of a divorced infertile bride. In addition, an infertile woman has not contributed children to her mother’s matrilineage in the complex dual-descent kinship system (Feldman -Savelsberg, 1995). Infertility is a collective concern in the Cameroon Grassfields. Its cause is most commonly attributed to witchcraft practiced by envious peers in...

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