RÉSUMÉ
Fertility is affected by many different cultural, environmental, and socioeconomic factors, especially in developing countries where poverty and infections are commonplace. Environmental factors play a major role in infertility in Africa. One of the most important health problems in sub-Saharan Africa is the high rate of infertility and childlessness. The African society has a strong traditional heritage, and the study of the patterns of infertility in this part of the world would be incomplete without consideration of the sociocultural and environmental factors. The most cost-effective approach to solving the infertility problems in Africa is prevention and education. In Mexico, problems of reproductive health are associated with pregnancy in adolescents, sexually transmitted diseases and genitourinary neoplasms. Infertility affects 10% of couples, usually as a result of asymptomatic infection. Education, poverty, nutrition, and pollution are problems that must be tackled. The government has taken positive action in the State of São Paulo in Brazil, where gender discrimination is a major factor affecting women's health and reproductive outcomes. The implementation of new policies with adequate funding has resulted in marked improvements.
PIP: The impact of cultural, environmental, and socioeconomic factors on reproductive health and infertility are discussed in general terms. Conditions in sub-Saharan Africa, Kenya, Mexico, and Brazil are described. In Mexico, high levels of arsenic in drinking water pose a major environmental hazard affecting reproductive health. Chronic arsenic poisoning in Comarca Lagunera, Mexico, contributes to male infertility and birth defects. Additional problems are adolescent pregnancy, sexually transmitted diseases (STDs), congenital malformations, genitourinary neoplasms, malnourishment, and poverty. The example of Sao Paolo's investment in the well-being of women shows how effective government policy can accomplish rapid improvement in women's health. Infertility in Africa is around 30-40%. Infertility in the US is only 8%. The African cultural emphasis on women's status and childbearing makes infertility a major concern. African infertility is related to disease. In the Cameroon, over 50% of infertility is accounted for by pelvic inflammatory disease. Prevention programs should include improvement in diagnosis and treatment of sexually transmitted diseases (STDs), sex education for men and women, expanded family planning (FP) services, and better obstetric care. Infertility in Zaire, Cameroon, Gabon, and Uganda is high compared to other non-African countries. Infertility is geographically and ethnically variable within each country. Politics and government FP policy, traditional attitudes, polygamous relationships, and induced abortion all impact on infertility. Traditional practices, such as female genital mutilation, result in infections during the healing process; infections also occur during childbirth. Vesico-vaginal fistula and incontinence are problematic and can be corrected through surgical methods. Illegal abortions contribute to morbidity and mortality. STDs are a main cause of infertility in Kenya. Cultural beliefs place the blame on females. In both Africa and Mexico, men account for 30% of couple infertility.