"Access to reproductive medicine empowers women" - Dr Khatija Kadwa

Women withstand the worst of the social consequences of infertility, and Dr Khatija Kadwa hopes to make a difference to their lives by sub-specialising in reproductive medicine.

Sub-Saharan Africa has the highest rates of secondary infertility in the world. Experts ascribe this to high rates of sexually transmitted infections in men and women. The HIV pandemic also contributes to high rates of infertility.

"There are only three provinces in South Africa that offer fertility services in the public health sector - the Western Cape, Gauteng and the Free State," says Dr Khatija Kadwa, a gynaecologist and obstetrician who is sub-specialising in reproductive medicine.

Making infertility treatment accessible to all women

She hopes that her work will make infertility treatment more widely available to women in other parts of the country. Her parents wanted the best for her in life, and she wants to empower other women through her work.

The 43-year-old grew up in KwaZulu-Natal and matriculated from Durban Girls' High School. She studied medicine at the University of KwaZulu-Natal and later specialised in obstetrics and gynaecology at the University of Cape Town.

"My parents were my main inspiration. My mother, who came from a conservative family, didn't have the opportunity to finish her schooling. My father is a doctor. They instilled a work ethic in us and they were passionate about the fact that they wanted me to get a good education," Dr Kadwa says.

Early on in her medical career, she encountered the personal experiences of women who didn't have access to reproductive health services. She learned how unwanted pregnancies, infertility and other conditions could limit and challenge women's lives.

Reproductive health is a human right

"I developed a passion for reproductive medicine after witnessing women suffer from severe negative social consequences such as stigmatisation, ostracism, abuse, marital instability and economic deprivation that result from infertility," Dr Kadwa explains.

"Women dealing with infertility often face social isolation and scorn. The effective management of infertility, therefore, has a considerable impact on reproductive health and human rights in Africa," she adds.

The World Health Organization defines reproductive health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes".

For women, reproductive health issues include pregnancy and childbirth complications, as well as infertility, fibroids and endometriosis. Treatment for these conditions, especially in young women, should always be aimed at preserving fertility as far as possible. Inadequate access to modern contraception also has a huge influence on women's reproductive choices.

All women should have access to care

"Infertility treatment in the private sector is available only to those who can pay for it, and it costs four times as much as in the public sector," Dr Kadwa says.

She says infertility can be a complicated condition, and not one that can be treated on its own. "I hope that in the future there can be a collaborative partnership between the public and the private sector and that some form of low-cost fertility treatment can be made available to the South African population," she says.

How can her hope become reality? Dr Kadwa explains. "Emphasis on primary prevention of sexually transmitted infections, unwanted pregnancies and health education has been emphasised as the most cost-effective approach to the treatment of infertility in low-resource settings. This strategy, however, overlooks the emotional, relational and economic effects on couples who are already the subjects of involuntary infertility."

"This is especially important in communities where the identity of many women rests on the ability to reproduce," she adds.

With her Discovery Foundation Sub-Specialist Award, Dr Kadwa hopes to improve women's lives in the future by making infertility treatment more widely available to women in other parts of the country.

This article was created for the 2020 Discovery Foundation Awards and has been edited for the Discovery Magazine.