1This collective work, edited by two anthropologists at the Paris Population and Development Centre, focuses on sterility and medical treatment of it in a region about which we know little in this connection: sub-Saharan Africa. With the exception of path-breaking studies by Marcia Inhorn on the Middle East and Elizabeth Roberts on the Ecuadorian Andes, social science research on these topics has primarily focused on Europe and North America. This is therefore a key study that provides a great deal of empirical information on sterility, treatments available for it in Africa, treatments used there, and collective and individual strategies for overcoming sterility, including biomedical techniques. Authors from three European countries and three disciplines (anthropology, education, and IT and communication sciences) analyse local ways of appropriating new reproduction techniques. Drawing on field surveys of sterile heterosexual couples and physicians in urban contexts and using communication analysis tools, the book’s fourteen chapters cover nine African countries: South Africa, Burkina Faso, Cameroon, Ivory Coast, Gabon, Ghana, Mozambique, Uganda and Senegal. Each country situation is positioned within the current international context, thereby creating globalized “reproscapes” in which individuals seeking reproduction assistance circulate together with different types of biomedical knowledge. The book concerns a region so diverse and with such particular political, policy, medical and social situations that it is difficult to present them in full here. However, the major features of assisted reproduction in the countries studied can be identified, together with the specificity of the African context.
2To begin with, the book shows that sterility in Africa is a combined public health and social problem. It is quite prevalent: 15% to 20% of couples experience problems of sterility in South Africa; 30% in Gabon. The main problems are STI-induced sterility or secondary sterility; that is, conceiving a second time after untreated or poorly treated complications of an earlier pregnancy, abortion, or delivery. However, sterility in the region is never thought of as a public health problem because the main preoccupation there is overpopulation and the problems it creates.
3Because the individual in Africa has a personal duty to ensure the perpetuation of the family, sterility there can be a source of stigma and marginalization. As Marie Brochard points out, individuals have “a symbolic debt to their family and lineage” (p. 169). Adoption and fosterage cannot stand in for “biological” procreation when it comes to perpetuating the lineage. The “injunction to engender” (p. 219) applies to both women and men. In becoming a mother, a woman acquires status within the family and community: reproduction is understood as an “empowerment mechanism” (p. 124) for women. Men too undergo social pressure, though of a more intimate and personal kind that concerns their reproductive performances (see chapter by Bonnet); this in turn often leads to denial behaviour around male sterility.
4The new reproduction techniques first appeared in sub-Saharan Africa in the 1980s but they have not been practiced much in the region, for a combination of political, economic and cultural reasons. Moreover, as there is very little in the way of public policy in this area the techniques are only available in a limited number of private clinics in large cities, leaving a considerable proportion of sterile couples without access to treatment and creating “stratified reproduction”, as illustrated by Frederic Le Marcis in his chapter on South Africa. The policy vacuum has another effect: physicians are the ones who decide on and manage medical practices and diffusion of information on them. To compensate for their lack of knowledge and practical competence, these same physicians go abroad to train, later adapting what they have learned to the specific context of their country in connection with a set of biomedical, economic and moral concerns and assumptions, the main objectives of which are to keep costs down and improve success rates (see chapter by Hörbst and Gerrits).
5Furthermore, biotechnologies are not democratically available in Africa due to socio-cultural representations of sterility suffused with urban legends and traditional beliefs about witchcraft. As Arielle Ekang Mvé explains, citing Margaret Lock, “a society’s cultural values are what determine how it uses biotechnologies” (p. 192). In the particular socio-cultural contexts studied here, couples wishing to improve their chances of conceiving and to minimise the social risks of using biotechnologies find solutions that illustrate both the constraints they are under and their ability to act (see chapter by Charmillot). One African specificity is a “hybrid” response to sterility: individuals draw simultaneously on traditional and biomedical treatments. Some decide to go abroad for treatment, either to another African country such as South Africa (chapter by Faria) or outside the continent, to the United States or Europe, where care is thought to be better and where they can gain access to techniques such as gamete donation. Finding solutions abroad is a way of ensuring that decisions and actions remain private and confidential; also in some cases a means of escaping family pressure, ritual constraints and recourse to witchcraft (chapter by Ekang Mvé). Meanwhile, socio-cultural representations of reproduction and biomedicine get tested in migration contexts (chapters by Epelboin and Duchesne). Véronique Duchesne identifies three paradoxes around anonymity, free treatment and representations of the female body that bring to light the discrepancies between the socio-cultural expectations of populations from Africa and the model found in France.
6Because assisted reproduction practices have not developed or become democratized in Africa there continues to be something taboo about them there and little information circulates. The new communication tools play a major role here. Clinics are now designing websites to make the procedures seem ordinary and accessible to potential patients, health professionals and the media. However, information is monitored and there is no possibility of exchanging with other users on clinic sites (see chapter by Massou). Discussion forums and blogs have therefore become the best means of acquiring and exchanging information. Emanuelle Simon shows how Ivorian women have used these resources to retake control of their lives and escape family pressure, at least to some degree. According to Brigitte Simonot, hosted blogs in South Africa enable women who have suffered personally and socially because of sterility to come to terms with that situation.
7Using various empirical approaches, this book has managed to collect the experiences and words of sterile couples and the physicians who treat them in the highly particular context of sub-Saharan Africa. It strengths are twofold. First, in studying the questions raised by assisted reproduction, it shows what Bonnet and Duchesne call in their conclusion the “silent changes” under way in African societies. Individual concerns now have a place alongside collective and community ones, gradually giving rise to an “Africa of individuals”. Children today are as much the incarnation of an African couple’s desire to have them as the demonstration that a duty to family has been accomplished. Second, above and beyond the case of Africa, the book shows and explains the many intertwined concerns underlying sterility problems and the use of biotechnologies in a particular context. It can therefore help us to better identify and understand current gender, family and health issues in the contexts of biomedicalization and globalization.
