It is a polygamous society, and men may have several wives living in the family compound, all bearing children. A husband can divorce a woman who produces no children during the first seven years of marriage. Women who want to abstain from sex, space their pregnancies further apart, or practice safe sex to avoid sexually transmitted disease face many obstacles. It doesn't really cost him that much to have children. He can feed them from the land, there are no educational expenses, clothing expenses are minimal.
Infertility is therefore a major threat to a woman in Gambia.
According to a study by the World Health Organization, only 20 percent of the cases of infertility in developed countries are related to infectious diseases, whereas in sub-Saharan Africa infectious disease accounts for 80 percent of all infertility cases. Yet cultural practices and attitudes tend to inhibit Gambian women from seeking out health care services. Public Policy Implications Initiatives begun by the United Nations in the mid-1990s have drawn worldwide attention to the importance of providing reproductive health care services for women. We need to empower these women and make services more women friendly. In many regions, the culture of silence surrounding disorders of the reproductive organs is more likely to be broken if the focus is on the risks of infertility rather than the threat of acquiring AIDS, Walraven and his co-authors concluded.