Fertility in Eswatini

Fertility stress: effects on health and personal life

Health effects

• Increased anxiety and depressive symptoms, including persistent worry and mood changes
• Sleep disturbances (insomnia or disrupted sleep) and low energy
• Physical symptoms such as fatigue, headaches, muscle tension, and GI issues
• Exacerbation of preexisting conditions (e.g., migraines, high blood pressure, IBS)
• Possible hormonal or menstrual irregularities in some people, and overall reduced resilience to illness

Personal life effects

• Strained intimate relationships and communication gaps with a partner
• Changes in sexual desire or performance due to stress
• Social withdrawal, isolation, and reluctance to discuss fertility with friends or family
• Financial stress from fertility treatments and future planning
• Shifts in self-identity and self-esteem tied to fertility hopes

Coping and support

• Seek professional support: therapist or counselor experienced with infertility; couples therapy
• Join fertility-focused groups or digital groups (e.g., October) for peer support and coping strategies
• Practice stress management: mindfulness, breathing exercises, regular sleep and physical activity
• Communicate with employer/HR about flexible scheduling, time off for appointments, and workload adjustments; set boundaries to protect wellbeing

If you’re ever feeling overwhelmed or having thoughts of harming yourself, seek urgent help immediately.

Economic impacts of high fertility stress

• Lower productivity and higher absenteeism in the workforce due to caregiving responsibilities, fertility-related medical appointments, and associated mental health symptoms.

• Demographic shifts: potential changes in birth rates and age structure, affecting future labor supply, consumer demand, and long-run growth; in Eswatini, this interacts with a young population and unemployment context.

• Higher health care and mental health costs: increased demand for infertility treatment, maternal care, counseling, and treatment of anxiety/depression can strain households and public systems; access limitations in Eswatini can worsen financial burden.

• Household financial strain and inequality: reduced savings, increased debt, and disproportionate impact on lower-income families.

• Gender dynamics and female labor participation: caregiving burdens and fertility-related stigma can limit women's workforce participation, impacting productivity and GDP.

• Policy and business responses: need for reproductive health services, mental health support, and flexible workplace policies; digital programs like October can support employees through group sessions, assessments, and content.

• In Eswatini, expand voluntary reproductive health services (including contraception and HIV integration) with confidential counseling and easy rural access to reduce stress around fertility decisions.

• Build social and economic supports: paid parental leave, affordable childcare, and flexible work options to lessen financial pressure linked to childbearing.

• Promote education and gender equity: keep girls in school, empower women economically, and encourage men’s involvement in family planning to reduce stress and stigma.

• Integrate mental health care: routine screening for fertility-related stress in primary/reproductive health settings; fund digital resources (e.g., October) for group sessions and self-help, plus training for providers on emotional support.

• Provide accurate information and community engagement: public campaigns to dispel myths and validate diverse family choices; involve community/religious leaders and monitor policy impact to adapt strategies.

1. Destigmatize and normalize fertility stress

   • Promote open conversations, anti-stigma campaigns, and leadership examples; ensure confidentiality.

2. Flexible scheduling and leave for fertility care

   • Allow appointment time, flexible hours, compressed workweeks, and remote options where feasible.

3. Privacy-first policies and compassionate managers

   • Keep HR processes confidential; train managers to respond empathetically and avoid gender-based assumptions.

4. Financial and practical support for fertility care

   • Expand benefits to cover fertility treatments where feasible; offer subsidies, paid family planning days, and transportation/childcare help for clinic visits.

5. Manage workload and coverage

   • Monitor workloads, adjust deadlines, provide temporary coverage, and avoid punitive responses to seeking fertility care.

6. Accessible mental health resources and peer support

   • Provide EAP/counseling; offer digital programs (e.g., October) with fertility-focused content; ensure resources are available in English and siSwati.