Breaking Barriers: Why Reproductive Health Equity Matters
Mariam is a 19-year-old newlywed. In her culture, women are expected to have a child within the first year of marriage. But as her anniversary approaches, Mariam still isn’t pregnant. The whispers begin—calling her “barren” and accusing her of wrongdoing before marriage. Every gathering becomes painful, so she stops showing up altogether. She goes to the market and straight home, avoiding her friends and community because the shame feels too heavy to carry.
Even at home, she finds no peace. Her husband begins hinting that he might take another wife if she doesn’t conceive soon. Months pass, and Mariam’s body starts to change—she gains weight, her periods become unpredictable, and coarse facial hair begins to grow. People assume she’s finally expecting, but every test says otherwise. The gossip grows crueler, calling her “manly” and “cursed.” She lives in constant pain from long, heavy periods and feels trapped in a body she doesn’t understand.
When she finally visits a doctor, she receives no clear answers. The tests are inconclusive, and her symptoms are dismissed. Eventually, her husband remarries, leaving her heartbroken and blaming herself. Years later, she gives birth to one child—the only one she would ever have—still never knowing why her body had “failed” her.
Mariam’s experience is not unique. What she never knew was that she had Polycystic Ovarian Syndrome (PCOS)—a hormonal disorder that affects millions of women of reproductive age.
The main symptoms of PCOS include:
Irregular periods
Excess of male hormones (androgens)
Cysts on the ovaries
How the symptoms can manifest:
Infertility
Acne
Hair loss
Weight gain
Painful and/or absent menstrual cycle
According to the Cleveland Clinic, the exact cause of PCOS remains unknown¹. However, researchers point to high levels of male hormones that prevent ovulation, insulin resistance (which can lead to obesity and diabetes), and chronic inflammation as possible factors. Because these causes are interlinked, it’s difficult to determine whether PCOS leads to insulin resistance—or vice versa. Untreated, the condition can cause complications such as miscarriage, high blood pressure, and preterm birth.
What makes this issue even more concerning is how it plays out in under-resourced regions of Africa, where healthcare access is limited, and stigma around reproductive issues runs deep. Africa currently has some of the highest rates of stillbirths in the world, and reproductive disorders like PCOS likely contribute to this burden. Yet, as of 2023, there have been no substantial systemic studies on PCOS in Sub-Saharan Africa. This lack of research means that countless women suffer in silence, often labeled as infertile or “cursed,” without ever receiving a diagnosis.
Globally, PCOS affects an estimated 8–13% of women of reproductive age², but experts believe the true number is much higher, especially in areas where women rarely seek or have access to care. Up to 70% of women with PCOS remain undiagnosed, meaning millions are living with symptoms they don’t have a name or explanation for³.
PCOS exposes a major gap in women’s health equity. In many West African communities, conversations about reproductive health are silenced by stigma, lack of education, and cultural expectations. Infertility is often seen as a woman’s failure, not as a medical condition. This silence isolates women like Mariam and prevents them from getting the care and support they deserve.
Across much of Africa, reproductive health is one of the least discussed yet most impactful areas of public health. The lack of education surrounding conditions like PCOS allows misinformation and shame to thrive. Women are often discouraged from speaking openly about their bodies. When they do seek help, they’re met with limited healthcare resources, untrained professionals, or systems that fail to take their symptoms seriously. As a result, conditions that could be managed through early diagnosis and treatment instead go unnoticed until they cause irreversible damage.
This isn’t just a medical issue—it’s a social and economic one. When women are unable to access proper care, it affects every aspect of their lives: their ability to work, raise families, and participate fully in their communities. Poor reproductive health outcomes contribute to cycles of poverty, inequality, and emotional distress that extend far beyond the individual.
PCOS represents the broader need for investment in women’s health infrastructure and education across Africa. Strengthening health systems, training providers to recognize hormonal and reproductive disorders, and creating safe spaces for discussion can transform outcomes for millions of women. Equally important is challenging cultural stigmas that frame infertility as shameful or divine punishment. By normalizing conversations about reproductive health, societies can replace silence and judgment with understanding and compassion.
References
Mayo Clinic Staff. (2022, March). Polycystic ovary syndrome (PCOS) — Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
Yasmin, A., Roychoudhury, S., Choudhury, A. P., Ahmed, A. B. F., Dutta, S., Mottola, F., Verma, V., Kalita, J. C., Kumar, D., Sengupta, P., & Kolesarova, A. (2022). Polycystic ovary syndrome: An updated overview foregrounding impacts of ethnicities and geographic variations. Life, 12(12), 1974. https://doi.org/10.3390/life12121974
World Health Organization. (2025, February 7). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
