Merck More than a Mother Concept and Objectives

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Together we can create a culture shift

Dear Readers,
 
For many generations, taking on responsibility has been a characteristic element of the culture and the actions of Merck. Our commitment to society and scientific community is the cornerstone of our business. It is also an important driver of innovation. 
 
Therefore, I am very pleased to share with you the concept and objectives of “Merck More than a Mother” campaign as part of Merck Capacity Advancement Program (CAP).
 
This campaign is very important for Merck as the world leader in fertility management, it is also very important for Africa at large and for African women in particular.
 
Why?
 
As we might know, the differences between the developed and developing world are emerging because of the difference in availability of safe, effective and equitable infertility care and different socio-cultural values surrounding parenthood and procreation.
 
In many cultures, childless women suffer discrimination, stigma and ostracism.

 

An inability to have a child or to become pregnant can result in being greatly ostracized, isolated, disinherited or assaulted. This may result in denial of access to family traditions, divorce or physical and psychological violence. (1)
 

Together we can create a culture shift

Merck More than a Mother Concept and Objectives

 
According to WHO data more than 180 million couples in developing countries (which is one in every four couples) suffers from primary or secondary infertility. Infertility in Africa is caused by infections in over 85% of women compared to 33% worldwide which emphasizes the importance of prevention programs in Africa.
 
The social stigma of childlessness especially for infertile women still leads to isolation and stigmatization in many cultures.
Merck more than a Mother” initiative is very important for Africa, as it is well known that the consequences of infertility are much more dramatic in developing countries and can create more wide ranging social and cultural problems compared to western societies, particularly for women.
 
A central difficulty associated with infertility is that it can transform from an acute, private distress into a harsh, public stigma with complex and devastating consequences.
 
In some cultures, childless women still suffer discrimination, stigma and ostracism. An inability to have a child or to become pregnant can result in being greatly isolated, disinherited or assaulted. This may result in divorce or physical and psychological violence.
 
Through the “Merck more than a Mother” initiative, all stakeholders together including women leaders, policy makers, parliamentarians, academia, fertility experts, community and media will challenge the perception of infertile women, their roles and worth in society, both within and beyond the medical profession in order to achieve a systemic shift in the current culture of gender discrimination in the context of fertility care in African societies and address solutions for change of mind set and upgrading the health care services.
 
Objectives of “Merck More Than a Mother” Campaign
 
The Campaign will not only provide medical education and training for healthcare providers and embryologists but it will also support governments to define policies to improve access to awareness and safe, effective and regulate fertility care and address the need for interventions to reduce stigmatization and social suffering of infertile women and the necessity for a team approach to family building among couples.
 
Through this initiative key challenges will be addressed that are associated with resource constrained settings such as prevention of infertility, education and self-development, ART/IVF regulation, geographic barriers, and limited resources arguments.
 
Differences between the developed and developing world are emerging because of the different availability in safe, effective and equitable infertility care and different sociocultural value surrounding parenthood and procreation.
 
It is very important to take into consideration that accessible infertility treatment can only be successfully introduced in developing countries if sociocultural, economic essentials and needed skills are fulfilled and governments are ready to support their introduction.
 
In order to achieve this objective successfully, a discussion with the relevant authorities will be needed to discuss the strengthening of infertility services, education, auditing, regulation, community awareness and the need to integrate them with Mother and Child, HIV prevention and Family planning programs, which already exist in the health infrastructure.
 
The UN universal declaration of human rights, stated that access to adequate comprehensive reproductive health services, including infertility care, is a basic human right regardless of the economic circumstances in which individuals are born into. Therefore, "Merck More than a Mother” campaign will contribute to identifying and implementing strategies to improve access to effective, safe and regulated fertility care in Africa and to define interventions to decrease social suffering from infertility and childlessness.

Mothers or Nothing; A culture to be changed.
 
The agony of infertility in resource constrained settings and the social suffering:

 
The central difficulty associated with infertility in developing countries is that infertility transforms from an acute, private agony into a harsh, public stigma with complex and devastating consequences.
 
Although male factors contribute to about half of all cases of infertility, women are also overwhelmingly perceived as being the party responsible for a couple's infertility, and subsequently the social suffering associated with infertility tends to be greater for them than their husbands.
 
Disproportionately having an effect on women, the burden of infertility is often assumed to fault the woman, as pregnancy and childbirth are manifested in the woman. (3)
 
Discrimination against the infertile woman may include that a girl will never pass into womanhood (regardless of age) if she never becomes pregnant, will no longer be marriageable and becomes viewed as a burden on families, communities or societies.
Violence: Intimate partner violence (IPV), gender based violence (GBV) and domestic violence have been shown to have significant associations with individuals and couples suffering from infertility. (1)
 
Mental Health: High rates of clinically significant symptoms of depression and anxiety, suicidal tendencies, and a strong conceptualization of grief affects infertile individuals.




Key Issues:
 
Lower levels of development are thought to be associated with higher levels of non-genetic and preventable causes of infertility such as poor nutrition, untreated sexually transmitted infections (STIs), unsafe abortion, consequence of infections caused by the practice of female genital mutilation, exposure to smoking and exposure to leaded petrol and other environmental pollutants. Hence Prevention Awareness is very important.
 
Public education on fertility awareness and prevention should be integrated within HIV prevention, family planning and mother care programs.
 
These programs have to include not only prevention of sexually transmitted diseases (STDs) and pregnancy related infections but also life style factors, iatrogenic infertility, environmental pollution and contamination.
 
Reproductive Rights:
Addressing “reproduction” within the public health sphere of reproductive health is important in order to fully address reproductive rights.
 
“People have the capability to reproduce and the freedom to decide if, when and how often to do so.”
As defined by the International Committee on Population and Development, ICPD.
 
Continuum of Care and Reproductive Rights:
Providing care to couples before and between pregnancies improves the chances of mothers and babies to be healthy. Pre-pregnancy, and specifically that associated with subfertility/infertility care, has been a crucial weak link in the continuum of care in reproductive health when addressing Universal Access to Reproductive Health (MDG5b) and long term maternal morbidities and disabilities. (5)
 
Motivations for parenthood and the perceived meaning of children vary among cultures:
In broad terms, in high income countries the desire for parenthood is expressed as a wish for personal happiness and fulfilment and children are said to be valued as they enhance the relationship and are enjoyable. (4)
 
In resource poor settings, additional reasons are identified for the wish to have children: the continuation of the family line, compliance with religious and societal expectations, and assurance of security in old age. (3)
In a review of studies relating to the value of children in African countries – insights from studies on infertility found that ‘children secure conjugal ties, offer social security, assist with labour, confer social status, secure rights of property and inheritance, provide community through reincarnation and maintaining the family lineage, and satisfy emotional needs.’
(6)
 
Next to interventions increasing access to biomedical infertility care, interventions to decrease stigmatization and social suffering from infertility and childlessness are needed.
 
“Merck More than a Mother” Highlights and Latest News

 
Join the conversation and reduce the stigma of infertility
 
Merck launched the Merck More than a Mother campaign in partnership with the Kenya Women Parliamentary Association, the University of Nairobi and the Kenya Fertility Society to address the need for interventions to reduce stigmatization and the social suffering of infertile women. The campaign was launched in June 2015 in Nairobi by Belén Garijo, CEO Merck Healthcare.
 
“Providing access to infertility care is important, but it is even more important to intervene to decrease stigmatization and social suffering arising from this condition,” said Belén Garijo during the launch of the campaign.
 
The initiative addresses key challenges that are associated with resource constrained settings such as prevention of infertility, education and self-development, assisted reproductive technology (ART) and in vitro fertilization (IVF) regulation, geographic barriers, reproductive rights and overpopulation and limited resources arguments.
 
The stigma that follows infertile women more often than not leads to complex and devastating consequences. These range from isolation, ostracism, discrimination, disinheritance, physical and psychological assault and even divorce.


                   


Front row: Prof. Koigi Kamau of the University of Nairobi, Belen Garijo, CEO Merck Healthcare, Joyce Lay Member of Parliament, Kenya, and Rasha Kelej (3rd right), Chief Social Officer, Merck Healthcare and international fertility experts during a session to contribute to building fertility care capacity at the University of Nairobi, Kenya

 Together with policy makers, academia, fertility experts, the community and media, the initiative aims to challenge the perception of infertile women, their roles and worth in society, both within and beyond the medical profession in order to achieve a systemic shift in the current culture of gender discrimination in the context of fertility care in African societies.


Belén Garijo, CEO Merck Healthcare signs to show her support for Kenya’s IVF bill as Joyce Lay and Prof. Koigi Kamau look on


Rasha Kelej, Chief Social Officer, Merck Healthcare shows her support for the IVF bill in Kenya as Prof Koigi Kamau and Joyce Lay look on

Improving fertility care
 
“In addition to creating awareness to reduce stigma of infertility, Merck through this initiative is working with stakeholders to develop and implement strategies to improve access to effective, safe and regulated fertility care in Africa,” said Rasha Kelej, Chief Social Officer, Merck Healthcare.
 
The "Merck More than a Mother" Campaign is supporting the In- Vitro Fertilization (IVF) bill which is a very important step in the Kenyan healthcare system. The IVF Bill has been approved by the National Assembly of Kenya and will regulate IVF and infertility treatment for the first time in the country. Hon. Joyce Lay is one of the sponsors of IVF bill in the Kenyan Parliament.
 
From Kenya to Uganda: “Merck More than a Mother” campaign marks International Women’s Day


As the world was marking the International Women’s Day in February 2016 Merck launched its “More than a Mother” Campaign for the first time in Uganda to empower infertile women through improving access to information and healthcare and change of mind set.

Merck has also announced its African Embryologists Training Program with the aim to improve access to quality and safe fertility care across the continent.
 

“Merck More than a Mother” Campaign, a Pan-African initiative aims to build fertility capacity, raise awareness about prevention of infertility and male infertility. It also opens a dialogue to define interventions to reduce the stigma and social suffering of infertile women in Africa which includes discrimination and physical and psychological violence.

The campaign was first implemented in Kenya in 2015 and is being rolled out this year in Uganda, in collaboration with the Ministry of Health, Uganda Women Parliamentary Association (UWOPA) and Africa Fertility Society (AFS) and progressively rolled-out in more African countries.

Improving access to fertility care for women and couples in Africa

“Countless women in Africa face fear, abuse and discrimination every day simply because they are infertile,” said Belén Garijo, Member of the Executive Board of Merck and CEO Healthcare.

“After Kenya, we are proud to launch the “More than a Mother” Campaign in Uganda and work with the Ministry of Health, the medical community and parliamentarians to change perceptions and reduce the harsh social suffering of infertile women in Africa.”

Minister of State for Health for Uganda, Hon. Sarah Opendi emphasized during her speech: “We are happy to partner with reputable and innovative companies such as Merck. We believe that “Merck More than a Mother” Campaign addresses a very sensitive topic for the first time in Africa, we all know it is there but no one wants to talk about it. This initiative will help to empower infertile women by improving access to information and change in the culture and mind set.”

“Most Sub-Saharan African countries don’t have trained embryologists hence providing training to our embryologists will contribute significantly to improve the quality and accessibility to fertility care to couples in Uganda and Africa so that they can start their families,” she added.

According to the World Health Organization (WHO), lower levels of development are thought to be associated with higher levels of non-genetic and preventable causes of infertility such as poor nutrition, untreated sexually transmitted infections (STIs), unsafe abortion, consequence of infections caused by the practice of female genital mutilation, exposure to smoking and to leaded petrol and other environmental pollutants. Hence prevention awareness is very important.

“In some cultures, childless women still suffer discrimination, stigma and ostracism. As such, a central difficulty associated with infertility is that it can transform from an acute, private distress into a harsh public stigma with complex and devastating consequences. An inability to have a child or to become pregnant can result in being greatly isolated, disinherited or assaulted. This may result in divorce or physical and psychological violence. Therefore this campaign is very important for Africa,” said Rasha Kelej, Chief Social Officer, and Merck Healthcare.

“Merck More than a Mother” campaign provides training for African embryologists in Indonesia starting with candidates from Uganda and Kenya and will scale up to the rest of the continent. It will also provide education for healthcare providers which will improve basic fertility management and improve awareness about prevention and male infertility which is needed in Africa, Rasha Kelej added.

Merck has joined hands with Indonesian Fertility Experts to provide advanced embryology training for African candidates starting with Kenya and Uganda and expanding to the rest of Africa. 

Dr. Ivans Sini, President of Indonesian Reproductive Science Institute (IRSI) emphasized: We are very happy to partner with Merck to provide this high technology training to develop African embryologists to be able together to improve access to quality and safe fertility care in Africa, it is a great idea and we are very proud to be part of it. We are very excited to meet them next month.”

Hon. Betty Amongi, Chairperson of Uganda Women Parliamentary Association emphasized: “We will partner with Merck and Ministry of Health to define policies to improve access to safe and effective fertility care, address the need for interventions to reduce stigmatization and social suffering of infertile women and raise awareness about male infertility and the necessity for a team approach to family building among couples”.

Dr. Oladapo Adenrele Ashiru, President of Africa Fertility Society explained: “In Nigeria where I practice, infertility is caused by infections in over 85% of women, like in the rest of Africa, compared to 33% worldwide which emphasizes the importance of prevention programs in Africa. Therefore, our partnership with Merck is very essential to address this sensitive topic for the first time in the continent”. “We are going to host this important campaign in Nigeria and many other African countries this year,” he added.

Sarah Opendi appointed Ambassador of “Merck More than a Mother” for Uganda

During the event, Merck announced the appointment of Hon. Sarah Opendi, Uganda’s Minister of State for Health, to be the Ambassador of “Merck More Than a Mother” Campaign in Uganda in recognition for her support and efforts to reduce the stigma of infertility and raise awareness about the condition in the country.


Rasha Kelej, Chief Social Officer, Merck Healthcare presents a certificate appointing Sarah Opendi as the “Merck More than a Mother” Campaign Ambassador for Uganda as other guests look on
 

At the launch event, Merck awarded Berna Amullen, a Ugandan woman, who openly shared her story of stigmatization and suffering for being infertile. The award was in recognition of her courage in creating awareness and sharing her devastating experience so that no other woman would suffer the same.

Hon. Joyce Lay, a Member of Parliament and Ambassador of the Campaign in Kenya, has joined hands with Uganda Ministry of Health and Uganda Women Parliamentary Association to raise awareness about prevention of infertility and male infertility. Lay emphasized: “In order to improve access to safe and effective fertility care, a discussion with the relevant authorities will be needed to discuss the strengthening of infertility services, education, auditing, regulation, community awareness and the need to integrate them in programs which already exist in the local health infrastructure.”
 
Empowering Berna - A new initiative of “Merck More than a Mother” to mark CSW60
 
“Merck More than a Mother”, in partnership with African Fertility Society, African Alliance for Women Empowerment (AFRAWE), and International Federation of Business and Professional Women (BPW), marked the 60th Session of the Commission on the Status of Women- CSW60 with the theme ‘fighting violence against women and girls’.

Through the “Merck More than a Mother” initiative, women leaders and parliamentarians, Africa Fertility Society, ministers of gender, healthcare providers and media were invited to define interventions to raise awareness about infertility prevention and management. They sought to build fertility care capacity, support government to improve access to regulated, safe and effective fertility care, decrease the social suffering and stigmatization of infertile women and fertility at large in order to achieve a systemic shift in the current culture of gender discrimination in the context of fertility care in African societies.



During the event, they announced the start of a new initiative as part of “Merck More than a Mother” called‘Empowering Berna’. Berna Amullen is a Ugandan woman who suffers from infertility as a result of an untreated sexually transmitted disease (STD). Berna was diagnosed too late to be given proper treatment and she lost the hope of being a mother and leading a happy life.


In her video, Berna shares her devastating story of mistreatment, discrimination and violence from her husband, family and community as a result of being infertile. She speaks about her attempt to commit suicide and how she was saved at the last moment.


Rasha Kelej (left) Chief Social Officer, Merck Healthcare introduces Berna Amullen (center) during the launch of the “Merck More than a Mother” campaign in Uganda in February 2016

“There are many cases like Berna’s out there and we cannot just leave them to suffer alone without any hope of a happy and independent life. We all have to believe that women are more than mothers,” Rasha Kelej, Chief Social Officer of Merck Healthcare emphasized.

“Therefore the ‘Empowering Berna’ initiative aims to empower unprivileged infertile women who can no longer be treated. The initiative will help them to establish their own small business and build independent lives” Kelej added.

“We will partner with “Merck More than a Mother” campaign to empower infertile women socially and economically through changing of mindsets and negative cultural aspects, elimination of violence against women and improving access to healthcare information and education,” said H.E. Julia Duncan-Cassell, Liberia Minister for Gender during the event.

During the event, Malawi Minister for Gender, Children, Disability and Social Welfare, H.E. Hon. Patricia Anne Kaliati highlighted: “We should partner with other ministers in health, education and economy to change our policies and regulation to empower our women by improving their access to information, knowledge and through capacity building to start their own business. Thus, they will be independent and able to contribute to our local and global economy. This is the only way they can comprehend their rights, roles and responsibilities and be more than mothers.”

H.E. Hon. Sarah Opendi, Uganda Minister of State for Health said: “We are happy to partner with reputable and innovative companies such as Merck. We believe that “Merck More than a Mother” campaign addresses a very sensitive topic for the first time in Africa; we all know it is there but no one wants to talk about it. This initiative will help to empower infertile women by improving access to information and change in the culture and mindset.”

“Most Sub-Saharan African countries do not have trained embryologists hence, providing training to our embryologists will contribute significantly to improve the quality and accessibility of fertility care for couples in Uganda and Africa so that they can start their families,” she added.

Participants at the meeting agreed to an affirmative action to create awareness about infertility prevention and management

All partners agreed to an affirmative action – creating awareness about male infertility, infertility prevention and management integration in the existing healthcare infrastructure such as HIV prevention, mother and child, family planning and maternity health programs.

“Moreover, also pushing bills that regulate fertility care such as the Assisted Reproductive Technique – (ART) bill that has been approved by the National Assembly of Kenya,” states Hon. Joyce Lay, Member of Parliament and Merck More than a Mother Ambassador of Kenya.

There are a lot of women in Africa like Berna and “Merck More than a Mother” will contribute to support and empower them. Stay tuned!

“Merck More than a Mother” will provide an Embryology Training Program in Indonesia since there are no African embryologists in majority of Sub-Saharan African countries. Merck has provided two embryologists from Kenya and Uganda with this opportunity to train for three months at the Indonesia Reproductive Sciences Institute (IRSI).
Stay tuned to watch our journey to improve access to fertility care in Africa.
 
Together we can create a culture shift.


Pauline Kibui, one of the Kenyan’s selected for the embryology training speaks about the anticipated benefits that the training will bring


 Join the conversation - Together we create a culture shift
 
Join the "Merck More than a Mother" social media campaign to reduce stigma, create awareness and define interventions to improve access to better fertility care in Africa.

Let your voice be heard on:

                   

 
 

Rasha Kelej
Chief Social Officer 
Merck Healthcare

 

For more information on the Merck More than a Mother initiative please visit: www.merck-foundation.com 

(1) Ombelet W.; Global access to infertility care in developing countries: a case of human rights, equity and social justice, ObGyn, 2012

(2) Dhont, S. Luchters, W. Ombelet, J.Vyankandondera, A. Gasarabwe, J. van de Wijgert, M, Temmerman. Gender differences and factors associated with tretment-seeking behaviour for infertility in Rwanda. Hum. Reprod. 2010

(3) Van Balen, H.M.W, Bos. Infertility, culture and psychology in worldwide perspective. J. Reprod. Infant Psychol. 2004; 22:245-247

(4) F.E. Okonofua, D. Harris, A. Odebiyi, T. Kane, R.C. Snow. The social meaning of infertility in Southwest Nigeria. Health Transition Rev, 1997; 7:2015-220

(5) S.Dyer. The value of children in African countries – insights from studies on infertility. J. Psychosom. Obstet. Gynaecol. 2007; 28:69-77

(6) S.J.Dyer, N. Abrahams, M. Hoffman and Z.M van der Spuy. Human Reproductive Vol. 17 No.6, 2002