Declining fertility among Kenyan young women: Here's why

An increase in infertility attributed to chlamydia, causing blockage of fallopian tubes in Kenya, is worrying fertility experts. [Istock]

An increase in infertility attributed to chlamydia, causing blockage of fallopian tubes in Kenya, is worrying fertility experts who singled out university students and young women of reproductive age as the most affected.

Prof Koigi Kamau of the Department of Obstetrics and Gynecology, University of Nairobi, says chlamydia is a sexually transmitted infection caused by a specific strain of bacteria known as Chlamydia Trachomatis.

According to Dr Ruth Masha, the CEO National Syndemic Diseases Control Council (NSDCC) increases in cases of Chlamydia is mainly are due to unsafe sex.

"If you go to fertility clinics today, and look at the queues, most of the girls have chlamydia, a worrying trend because this translates to more infertility in the future," says Dr Masha.

Prof Kamau explains that chlamydia is dangerous because its growth is insidious (slow) and not easily (imperceptible) detected.

Most patients are diagnosed at an adverse stage "unlike gonorrhoea when the pain comes it is severe and therefore easy to look for attention."

Though immunological tests can detect the antigens (components of chlamydia), they do not necessarily detect active disease.

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"Chlamydia has been marked by mystery, yet it is extremely common," says Prof Koigi. "It blows in the society without announcing its presence."

Word Bank data shows that Kenya's fertility rates have declined in the recent past, from 7.3 children per woman in 1960 to 5.1 in 2000. In 2020, it dipped to 3.3 children per woman.

The current fertility rate stands at 3.311 births per woman, a 1.55 per cent decline from 2021.

Take 37-year-old Brenda from Nakuru. The mother of one has unsuccessfully tried to conceive since 2013.

Doctors diagnosed her with blocked fallopian tubes, and neither modern nor herbal medicine has helped treat the condition.

"I did not present any symptoms of blocked tubes, a condition I learnt about as I tried to conceive unsuccessfully," rues Brenda adding that she can hardly afford IVF which requires upwards of Sh400, 000.

Though her medical records do not specify the cause of the blockage, experts observe it might be due to chlamydia.

According to the fertility expert, infertility due to tubal damage is the most common, with nearly 80 per cent, chlamydia being the leading cause of gonorrhoea and infections as a result of unsafe abortions, endometriosis, and adenomyosis.

Dr Fredrick Kareithia, a gynaecologist in Nairobi pegs cases of tubal blockage at 40 per cent of patients though the blockage is not specifically due to chlamydia.

He says at least 40 per cent of infertility is attributed to males and 40 per cent to females with 20 per cent due to unknown factors.

The gynaecologist notes the cases of chlamydia he has reviewed reported damaged and blocked fallopian tubes with the majority of patients being from the low-income bracket.

"I have treated infections, among them, those caused by chlamydia, but there is no credible data," adds Kareithia adding that the best way of preventing chlamydia is to have a monogamous relationship as "multiple partners risk contraction of chlamydia."

He adds that any pain or abnormal discharge after sexual intercourse needs check-up and treatment as " chlamydia can be treated easily, but if someone does not show up on time, it becomes complicated."

He also recommends condoms during sex.

However, Kenya is currently facing an acute shortage of condoms, with the Ministry of Health yet to allocate a budget for the free commodity.

But even as shortage bites, Dr Masha emphasizes the need to re-educate the general population on the need for protected sex, especially college students.

Prof Koigi observes that lack of condoms risks infections of more sexually transmitted diseases besides

According to him, infection strains emerge because of poor, wrong use of antibiotics, wrong diagnosis, and lack of information and misinformation.

According to a study in Thika last year, at least one in eight adolescents tested positive for chlamydia trachomatis, gonorrhea, chlamydia trachomatis, trichomonas vaginalis (TV), and vaginal gram stains.

Data by the Kenya Health Information System this March also revealed an increase in syphilis among pregnant women: out of 128,767 pregnant women who attended Antenatal clinic this January, more than 4,000 tested positive for syphilis.

To prevent STIs, Prof Koigi stresses the need to have public education besides including sex education into the curriculum.