Q) What are the causes of the infertility among the Dinka and the Murle, and what can be done about it?
A) PID is number one–untreated pelvic inflammatory diseases, which scar the tubes at an early age. Without treatment of the earlier manageable stages of STD’s (and their clinic has been bombed away decades ago in the twenty two years of N/S civil war even before the current inter-tribal hostilities remained as the principle causes of casualties) the disease progresses to a scarred PID consequence of infertility during what would otherwise be reproductive years of life.
Hypothyroidism is number two–see the two references on this –one is the whole journal on “Metabolic Maladaptation:….” in the December 1999 “International Journal of Nutrition” and all editorials attached thereto. Also see Alberto Ahuka’s chapter in “Surgery and Healing in the Developing World” by Landes BioScience, which you can get just by googling my name.
Number three is the lack of what has become known in the Global Health Circles as “Safe Motherhood”–that is, the surgical means of assisting birth—1) C-section, 2) D& C for incomplete abortion, 3) Ruptured ectopic pregnancy, an emergency secondary to the PID referred to above.
Number four is general malnutrition of the kind called “Protein Calorie Malnutrition” formerly known as Kwashiorkor, but now better defined.
Number five: specific micronutrient deficiencies, namely Folic acid, Iodine (see “Hypothyroidism” above) Vitamin A and Iron (anemia of “Syndanemia” = 1) Malaria, 2) Parasitic worms [hookworm and soil transmitted helminths of the NTD] ) and 3) HIV.
Number six–and one that is overestimated, but now we have the brucellosis titer laboratory kits to prove/disprove this cause: Brucellosis. Brucella is a transmissible disease infecting the placenta among cattle culture people usually first known by causing spontaneous abortion among cattle. The fertility of the Dinka/Murle/Nuer cattle is devoutly sought even as much as for their human counterparts to whom the brucellosis can be transmitted–an attractive hypothesis, but I have only seen it confirmed once while in Jonglei Province (but that may be only because the lab capability of proving it only just arrived.)