By Joyce Ojanji
Poor regulation and lack of transparency in Africa’s fertility industry leave sperm donors and recipients vulnerable to exploitation and unethical practices, including relatives unwittingly having children together, fertility experts warn.
Infertility is a growing concern in Africa, with the region having the highest global prevalence at 16 per cent, followed by the Western Pacific at 13 per cent, and European regions at 12 per cent, according to a 2019 study in the Journal of Global Health Reports.
While primary infertility – the inability to conceive a first pregnancy – is relatively uncommon in Sub-Saharan Africa, secondary infertility, where individuals struggle to conceive again after a successful pregnancy, poses a significant challenge.
To address these issues, many couples turn to assisted reproductive technology (ART), including in vitro fertilization (IVF).
However, ART operates in a largely unregulated environment in Africa, exposing donors and recipients to risks and ethical dilemmas, including the possibility of consanguinity, according to medical experts.
Anthony Kayiira, reproductive embryologist in Uganda, says that the unregulated sale of sperm to numerous families can lead to situations where offspring unknowingly form consanguineous relationships, leading to higher risk of genetic disorders down the family line.
“Without proper oversight, we create an environment where the risk of genetic disorders rises because donors’ sperm is used too widely without accountability. We need stricter regulations to protect donors and recipients,” says Kayiira.
Unlike in countries where strict laws limit the number of offspring per donor to reduce the risks of consanguinity(referring to where biological relatives conceive children together), many African nations lack such safeguards.
In Uganda, the industry operates with minimal regulation, despite having 14 sperm banks in operation, two of which are government-owned, according to Herbert Luswata, president of the Uganda Medical Association.
In many African countries, there is a lack of clear guidelines and regulations surrounding sperm donation, which can lead to inconsistencies and exploitation, experts note.
Clear regulations could limit the number of donations and offspring per donor to safeguard genetic diversity, prevent overreliance on a single donor, and reduce risks of accidental incest to protect the well-being of donors, offspring, and the broader gene pool.
To ensure ethical practices, experts stresses the importance of education and awareness-raising in holding organizations to account and promoting best practice.
“In many African cultures, large families are celebrated and societal attitudes towards fatherhood and community support can enhance the willingness of men to donate. By investing in education and training, governments and regulatory bodies can cultivate a culture of integrity and respect, ensuring that third-party reproduction is guided by compassion, transparency, and accountability,” they add.
In many African societies, infertility carries social stigma, leading couples to seek fertility treatments without fully understanding the long-term genetic and social implications.
In some communities, the concept of sperm donation itself is taboo, making it challenging to recruit diverse donors and avoid genetic overlaps.
This can narrow down the donor pool, increasing the likelihood of consanguinity.
Most governments adopt laws from higher-income countries, often referencing guidelines and recommendations from organizations such as the European Society of Human Reproduction and Embryology (ESHRE).
However, these imported frameworks may not address Africa’s unique social, economic, and cultural contexts, such as religious and societal taboos, according to analysts on the continent.
This lack of clear regulation and legal framework has sparked concerns around informed consent, donor exploitation, and the need for stricter oversight.
As in Uganda, a lack of comprehensive legislation governing sperm donation in Kenya leaves room for varying practices and potential exploitation, say experts in the sector.
They stress the urgent need for clear legal frameworks to protect both donors and recipients, ensuring ethical practices, transparency, and affordability.
In addition to this, the costs for recipients of sperm donations can be huge, while donors are barely compensated.
Meanwhile, sperm recipients pay between US$2,000 and US$4,000 for insemination, a price that excludes additional fertility clinic expenses.
Experts say most clients come from South Sudan, Ethiopia, and Eritrea.
Fertility Point Clinic in Nairobi charges Ksh 55,000 (about US$400) for a sperm donor, in addition to US$3,900 for the IVF procedure itself. These exorbitant costs place such fertility treatments out of reach for many Kenyans, raising concerns about equity of access to reproductive healthcare.
They note that the legislation that exists is not comprehensive enough to address the concerns raised adequately, or to deal with newer developments in this field.
Also, the lack of regulation creates an environment in which unscrupulous individuals can take advantage of vulnerable people.
Therefore, they say that there needs to be a concerted effort to strengthen regulations, improve informed consent, and ensure fair compensation
They believe that prioritizing the welfare of donors and recipients will ensure that sperm donation remains a safe and ethical option for those experiencing infertility.
