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The following two case studies illustrate new forms of vulnerability faced by diagnosed men through the condensed in-depth narratives of men who discovered they had severe forms of male-factor infertility. He is single after the breakdown of his first marriage.

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Even affirmation of a suspected condition affects his sense of manhood. James James is in his late 20s; He completed secondary school and built a house, close to his relatives, of burnt bricks and glass windows roofed with iron sheets with income from skilled piece work and farming. He was married for four years. He endured taunts about their childlessness: Together they visited many herbalists.

After three years without a sign of a pregnancy they decided to go to the hospital encouraged by relatives of both sides. They suspected the man's low count could be the reason we are not bearing children. Sperm do not meet with the egg and some die on the way because they are very few. He tested again, reporting his count had not increased to normal levels. James describes his thoughts as unstable. He blames himself for his childlessness. He has no current plans to remarry, which makes him unusual among divorced men.

He explains he must first try to solve his problem. He dwells on her departure and the man he believes to be her boyfriend: When he apologised for any ill words at her natal home, her refusal to have sex with him convinced him she could not love him anymore.

He told her and her parents that marriages blessed by the church should not end in this way. He fears another woman will do the same and wonders if he should take another HIV test. Out of loneliness he spends little time at his house. Promise and Eliza Promise is in his late 30s, completed primary education and runs a small business with his second wife, Eliza to whom he has been married for a few years. Their home of burnt bricks annually thatched with grass is relatively far from his parents but close to hers and they live with her youngest child.

Promise was diagnosed with severe male factor infertility the preceding year, after encouragement from Eliza, his aunt and elder brother, They found out my sperm — the percentage with just a head is many. Without tails they do not have strength to open the egg of the woman … From there I knew there was no way I can have children — this is the problem. His diagnosis confirmed that the problem was his as he suspected: But there was no treatment available.

His first marriage of almost a decade deteriorated when both sought their chances of conception with other partners. Promise began his relationship with Eliza. His first wife became pregnant but a local man began claiming responsibility. In contrast, Promise cares for Eliza's children. In Eliza's words, he buys food, shoes and clothes, never shouts at them, and stays with her youngest as his own child.

Promise explained their father is poor, and it brings his wife peace of mind. He also fostered his brother's children. But he explained he has to be careful of his feelings, as their father may always call them back.

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Like several other infertile men and couples, he takes inspiration from the testimonies of healing of long-term infertility problems shown on popular Nigerian station, Emmanuel TV. These point to the lived reality of changing forms of masculinity and social strategies, enacted over time and in response to diagnosis Inhorn With respect to relationships in the community, childless men who privately knew they had a specific, reproductive impairment seemed to feel the pain of mockery from other men more deeply than men who receive a normal diagnosis.

Of the latter situation, a man described: Men's approach to marriage changed dramatically when they were diagnosed. James fears that any woman he marries will leave him and feels he must remain single unless he can increase his low sperm count. Perceiving a reproductive problem as shared or potentially their wife's, could support men's sense of themselves as loyal husbands, either choosing to distance themselves from husband-initiated divorce or polygyny or not over time.

This security is threatened by diagnosis. If pregnancy occurs, it may be complicated by the suspicion of infidelity, provoking anguish for either partner.

Women such as Eliza who had existing children, whose interests her infertile husband would advance, were more easily able to accept they would have no children in the marriage and could live untroubled by a husband's relatives or public gossip. Yet men's emotional investment and security as future fathers and senior men remained damaged.

Men, like many of those affected by childlessness whether diagnosed or unexplained, drew comfort from religious commitments and the possibility of prophetic healing. This community-based study in a predominantly rural area of Karonga District evidenced the spread of biomedical knowledge about male reproductive health, specifically male infertility, and explored the local impact of semen analysis implemented as part of a package of infertility services in Malawi.

It is unlikely to have accounted for the full range of responses of men who are diagnosed with male-factor infertility. However, the findings suggested that a serious diagnosis appears able to disrupt men's marriages, men's relationships with community members and a man's very sense of personhood as a future father.

The practice of semen analysis not only threatens men's self-worth at diagnosis but men's participation in the process provokes an emotional engagement on the part of men. Yet there are sufficient reasons for men to involve themselves in seeking biomedical infertility care. This focus on social change framed the analysis of the semen screening in rural northern Malawi in terms of the comparative ethnographic portrayal of the ways in which new forms of masculinity are experienced through interactions with new forms of medical technology Inhorn and Wentzell Relations with this diagnostic technique are conflicted in Malawi.

Health providers implementing policies on infertility and men's involvement in reproductive health emphasise the sharing of knowledge by partners and compassion in marriage. However, despite lifting some of the burden of infertility from women, the negative impacts of semen analysis on masculinity and gender relationships can leave men, just as they can leave women, in a vulnerable position, when there is no obvious treatment for their condition.

Men's refusal of medicalisation of infertility may therefore also be framed in terms of the plural and shifting enactment of masculinities. Acknowledgements The author would like to express her sincere thanks to those who shared their experiences, and for the support of the Karonga Prevention Study, especially Green Kapira, Blessings Mwandosya, Aaron Ndovi and Dorothy Makoka for their invaluable research assistance.

Participants gave written informed consent. Malawi's national service delivery guidelines for the Management of Sexually Transmitted Infections using Syndromic Management Approach issued by the Ministry of Health MoHimplements the national policy on infertility.

This notes that the main causes of infertility include STIs resulting in Pelvic Inflammatory Disease in women and epididymo-orchiditis in men, complications of advanced syphilis or HIV infection. Other causes affecting men are given as: Preliminary investigations with respect to infertile couples should include: The guidelines states that all individuals or couples should undergo counselling for HIV testing. The practice of bridewealth and virilocal residence is attributed to the influence of patrilineal Ngoni invaders at the end of the nineteenth-century; the southern and central regions of Malawi remain matrilineal Morris ; Morris The study is based at a demographic surveillance site in the southern part of Karonga District, and incorporates narrative interviews, ethnography and population-based survey data.

The majority of male participants were recruited through the demographic surveillance system, except for eight supplemental men who had experienced childless marriages who were sensitively recruited by word of mouth from the same area. All names used in the text are pseudonyms. Schistosomiasis or bilharzias is a parasitic infection http: A history of urinary schistosomiasis causes some young men great concern regarding infertility.

The syndromic management approach does not rely on laboratory testing and is used to manage symptomatic STIs and provide same-day treatment using flow charts Vuylsteke In Malawi, van Dijk has described the growing success of an array of Pentacostal orientated organisations with regional transnational elements since the s as significant to personal healing East African Medical Journal.

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Women and Infertility in Sub-Saharan Africa: Marriage and Inequality in Classless Societies. Stanford University Press; Where are all the Men? Transnational Images of Pentacostal Healing: Comparative examples from Malawi and Botswana.

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G Westeditor. Brokering Therapeutic Resources in Southest Africa. Indiana University Press; J N Abrahams et al. Women's Experiences with Involuntary Childlessness. Male Infertility in Zimbabwe. Patient Education and Counseling. Social and Cultural Aspects of Infertility in Mozambique.

The Exceptional Case of the Macua. C Inhorn F van Baleneditor. Infertility Around the Globe: University of California Press; The Sex in the Sperm: C Mosegaardeditor. Reconceiving the Second Sex: Men, Masculinity and Reproduction. Journal of Religion in Africa. London and New York: Centre for Population Studies. Profiles of Infertility in Southern Nigeria: Women's Voices from Amakiri. Afr J Reprod Health. Larsen Motherhood in Sub-Saharan Africa: Focusing Male Infertility in Malawi: Kinship and Impacts on Biomedical Practice in Bamako.

Brockopp T Eicheditor. South Carolina University Press; Male Infertility and Stigma in Egypt and Lebanon. Male Infertility and Patriarchal Paradoxes in Egypt. Right to Assisted Reproductive Technology: Overcoming Infertility in Low-Resource Countries.

The New Arab Man: Emergent masculinities, Technologies, and Islam in the Middle East. Princeton University Press; F Baleneditor. Community service programs were available as alternatives to prison terms for first-time offenders with permanent addresses who were convicted of less serious crimes.

Victim support units attached to police stations in larger jurisdictions, such as Lilongwe, Zomba, and Mzimba, attended to the needs of vulnerable individuals, such as victims of trafficking and gender-based violence. Victims sheltered with police at other locations, however, had no protective measures in place.

During the year the government permitted domestic and international NGOs and the media to visit and monitor prison conditions and to donate basic supplies. Representatives of the Malawi Red Cross, the UN special rapporteur on the right to food, and foreign diplomats also visited prisons during the year. Arbitrary Arrest or Detention The constitution and law prohibit arbitrary arrest and detention; however, the government did not always observe these prohibitions.

The MDF commander reports directly to the president. The MDF and MPS stated that they were cooperating with corruption investigations by the Anti-Corruption Bureau but were not carrying out their own internal investigations. Investigators complained that the security services used national security as a justification for withholding information.

For example, a two-week sweep in July resulted in nearly arrests and, according to press reports, on September 12 and 13, the MPS and military conducted sweeps in Lilongwe that resulted in the arrest of 2, persons. The frequency of these sweeps and the role of the military in their execution increased throughout the year.

Police were inefficient, poorly trained, and corrupt see section 4. Impunity was a problem. The inspector general of police, however, remained committed to the professionalization of the MPS. The Internal Affairs Department of the MPS investigates police misconduct, including whether killings and other misconduct occurred in the line of duty and were justifiable.

The unit consisted of only three professional staff. Members of the National Police Disciplinary Committee met for the first time in two years in March to address disciplinary offenses, which mainly concerned desertion of post, failing to report for duty, and drunkenness on duty.

Sanctions for these offenses ranged from reprimand to reassignment or dismissal. Police continued to receive foreign assistance for training officials and procuring equipment. Arrest Procedures and Treatment of Detainees The law provides an accused person the right to challenge the legality of detention, have access to legal counsel, and be released from detention or informed of charges by a court within 48 hours of arrest; however, authorities often ignored these rights.

Most suspects were apprehended without a warrant if police had reasonable grounds. Only in cases involving corruption or white-collar crime were arrest warrants normally issued by a duly authorized official based on evidence presented. The use of temporary remand warrants to circumvent the hour rule was widespread. Police frequently demanded bribes to authorize police bail, which was often granted to reduce overcrowding of jails, rather than on the merits of the case.

Relatives were sometimes denied access to detainees. There were no reports that detainees were held incommunicado or held under house arrest. Detainees who could afford counsel were able to meet them in a timely manner. While the government is obligated by law to provide legal services to indigent detainees, in the vast majority of cases, such aid was provided only to homicide suspects. The Department of Legal Aid gave priority to women, children, the elderly, and those charged with capital offenses.

Legal aid often was delayed, since there were only 13 lawyers and 20 paralegals working as public defenders in the country as of September.

With financial assistance from the EU, the Department of Legal Aid visited most prisons in the country to assist prisoners in processing bail and appeal applications. The Center for Legal Assistance and Paralegal Advisory Service Institute, NGOs that assist prisoners with legal matters, provided limited free legal assistance to expedite the trials of detainees, with priority given to the sick, the young, and those subjected to long trial delays.

The law and constitution prohibit arbitrary arrest and detention. The government, however, used sections of the penal code pertaining to rogues and vagabonds, conduct likely to cause breach of peace, and obstruction of police officers to make arbitrary arrests.

For example, on September 12 and 13, police conducted a week-long sweeping operation under public and political pressure to respond to perceived increases in serious criminal activity.

In the operation the MPS reported the arrest of more than two thousand persons. As of October, of the total prison population of 12, persons, 1, or 16 percent, were in pretrial detention. Despite a statutory day limit on pretrial detention, authorities held most homicide suspects in pretrial detention for two to three years.

There was evidence some homicide detainees remained in prison awaiting trial for much longer periods, but reliable data on the exact number and situation of these detainees were unavailable. In September the chief commissioner of prisons reportedly stated there were murder suspects in pretrial detention. Camp courts expedite cases by bringing magistrates to the prison.

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Paralegals gather cases of pretrial detainees who have been held awaiting trial for excessive periods of time, are held unlawfully, or have been granted bail but cannot afford the terms set by the court. Magistrates, along with the court clerk and police prosecutor, work through the list, granting bail to some, reducing bail for others, dismissing cases, or setting trial dates. Denial of Fair Public Trial The constitution and law provide for an independent judiciary, and the government generally respected judicial independence.

The judicial system, however, was inefficient and handicapped by serious weaknesses, including poor recordkeeping; a shortage of judges, attorneys, and other trained personnel; heavy caseloads; and lack of resources.

The MDF conducts courts-martial but no military or security tribunals. Used more frequently than courts-martial is a nonjudicial procedure under which cases are dealt with summarily by senior officers without a formal trial process.

In both cases military personnel are entitled to the same rights as persons accused in civilian courts.

Trial Procedures Defendants are presumed innocent and have the right to a public trial, but not to a trial by jury. Jury trials were suspended indefinitely in due to a lack of funds and a backlog of cases awaiting trial. The constitution and laws provide for an accused to be informed of charges by a court within 48 hours of arrest in a language the accused understands.

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Defendants have the right to be present at their trial, to have an attorney, and, if indigent, an attorney provided at state expense. Such assistance, however, generally was limited to homicide cases. Defendants have the right to challenge prosecution or plaintiff evidence and witnesses, present their own witnesses and evidence, and access government-held evidence relevant to their cases.

By law they are not compelled to testify or confess guilt. The law does not specify a given length of time for the accused to prepare a defense, but the slow pace of trials affords defendants adequate time to prepare.

The law extends the above rights to all persons. All persons have the right of appeal; however, appeals often were delayed for years and sometimes never addressed by the higher court. The Office of the Director of Public Prosecutions in the Ministry of Justice was budgeted funds to clear of a backlog of homicide cases by mid As of October the office had cleared 30 cases.

It had 14 prosecuting attorneys and 20 paralegals, who served as lay prosecutors for certain cases in magistrate courts.

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Recruitment and retention of government attorneys remained a problem. Political Prisoners and Detainees There were no reports of political prisoners or detainees.