High heels, barefoot driving and infertility: Experts warn of a silent reproductive health crisis

In Dubai, UAE 

Women who regularly drive barefoot may be at risk of infertility due to exposure to toxic heavy metals, a fertility expert has warned.

Prof Oladapo Ashiru, a Nigerian fertility expert who heads the Africa Reproductive Care Society, noted with concern that many women who love putting on high heels have a tendency of driving barefoot as it is more comfortable, a practice that may contribute to infertility.

Speaking at the Merck Foundation First Ladies Summit in Dubai, he said:  “According to latest research and medical examinations in Sub-Saharan Africa, many women who drive themselves have experienced miscarriages because they had antimony—a toxic metal found in car pedals -  in their bodies that affected their embryo.

“The toxic metal enters the human body via the skin overtime through contact with accelerator or brake pedals. It enters women’s bodies when they step on the pedals barefoot,” the expert highlighted. 

“"It is only until the antimony is removed from such patients that getting pregnant or carrying a pregnancy to term can take place,” he added.   

Antimony, he further explained, is a silvery-white, brittle metal found in the Earth's crust. It's commonly used to enhance the hardness of various alloys, particularly with lead in batteries and lead/copper/tin in machine bearings. Additionally, antimony is a component in automotive clutch and brake parts.“Comprehensive studies have shown that antimony along with other heavy metals are associated with infertility in women through interference with hormone function and disrupting the delicate balance of the endocrine system,” Prof Oladapo told delegates. 

Confront stigma

While agreeing with the Nigerian professor, Dr David Mwesigye, a consultant obstetrician- gynaecologist and director of Women’s Health and Fertility at the Specialised Clinic in Rwanda, called on the media, policymakers, and communities to confront infertility stigma, which he described as a silent crisis on the continent, with education, empathy and urgency.

“Infertility is not witchcraft. It’s not spiritual forces or God’s punishment, it’s a medical condition that deserves understanding, diagnosis, and treatment,” Dr Mwesigye said.

 He added that in sub-Saharan Africa, the societal expectation to marry and have children is deeply entrenched. 

“In many cases, women are disproportionately blamed when couples fail to conceive despite evidence that infertility affects both sexes almost equally,” Dr Mwesigye noted, adding that in many rural and urban communities, people still wrongly attribute infertility to bewitchment, punishment for religious conversion, past abortions, or the use of contraceptives.

The director argued that infertility, if ignored, can hinder social and economic development.

“No family can evolve without a child,” he stated.

In some communities, childless couples are denied access to land or inheritance, and their roles in extended family networks are diminished. 

This exclusion, he pointed out, leads to depression, poverty, and the breakdown of relationships.

He stressed that treating infertility should be seen as a public health priority, not a ‘cosmetic luxury’. 

Dr Mwesigye noted that infertility stems from diverse causes, affecting both men and women. They include infections, hormonal disorders, uterine abnormalities, low sperm count and lifestyle factors. In some cases, it is unexplained. The doctor added that fertility declines with age.

While causes of infertility in developed countries often involve hormonal disorders or structural issues like endometriosis and polycystic ovarian syndrome, the narrative is more troubling in Africa. “Here, the leading culprits are preventable infectious diseases—primarily sexually transmitted infections (STIs), post-abortion sepsis, and postpartum infections,” Dr Edem Hiadzi, a Ghanaian obstetrician-gynaecologist, highlighted while observing that many  of these infections damage fallopian tubes, preventing sperm and egg from ever meeting.

He added that male infertility in Africa is predominantly caused by preventable STIs such as chlamydia and gonorrhea, contrasting sharply with Western cases, which are more often linked to hormonal factors.

He also highlighted the devastating social stigma surrounding infertility in Africa and the disproportionately high prevalence of infertility compared to developed nations.

“In Africa, the stigma is often deadlier than the diagnosis. It’s time to talk.”

Dr Hiadzi, added that in Africa, infertility affects 20–30 per cent of couples, nearly three to five times higher than the six to 10 per cent seen in developed countries like the UK and US.

Also read: Causes and risk factors for male infertility

“Data indicate that in 40 per cent of infertility cases, male factors are solely responsible, while female factors are the sole cause in another 40 per cent of cases. Shared factors between both partners contribute to 15 per cent of cases, and the remaining five per cent remain unexplained.”

The expert further noted that infectious agents are significantly more prevalent in the reproductive fluids of infertile women compared to fertile women. These infections, when left untreated, lead to pelvic inflammatory disease, scarring, and tubal blockage—the most common cause of infertility in African women.

The expert also told delegates that unsafe abortions are a major contributor to infertility. In many communities, he explained, contraception are stigmatised as promiscuity—while unsafe abortions—far deadlier— are seen as less shameful. Women often undergo unsafe clandestine abortions, increasing their risk of uterine damage or Asherman’s syndrome, a condition where the womb lining is scraped excessively and scarred.
 
“Then there’s the issue of poor maternal health services. In under-resourced hospitals and rural settings, women endure prolonged obstructed labour, increasing the risk of repeated vaginal examinations, infections, and severe consequences like fistulas, where urine or feces leak through the vagina due to tissue death. Traditional birth attendants and faith healers, in the absence of formal healthcare, often handle deliveries without sterilised equipment, further increasing infection risk,” the Ghanaian expert said while urging African governments to pull up their socks. 

He added that tuberculosis, schistosomiasis, and efemale genital mutilation also contribute to the infertility burden. “These infections and injuries damage not only the fallopian tubes but also the ureters, disrupting the body’s reproductive and urinary functions.”

Dr Hiadzi stressed that infertility is not a woman’s issue alone.  

“It affects couples, and addressing it requires shared responsibility and mutual support. Yet cultural beliefs often place the burden—and shame—squarely on women. Men are frequently reluctant to be tested, hiding behind masculine pride, while women bear the emotional and social consequences, including stigma, abandonment, and abuse,” he noted while reminding that the crisis demands urgent attention. 

Despite USAid funding cuts, he said, health systems must improve access to contraceptives, safe abortion services, maternal care, and STI treatment.  

“Infertility may not kill, but in many parts of Africa, it destroys lives and marriages. Women are ostracized and communities blame the innocent—all while the real culprits go unchecked: infection, ignorance, and inequality. Until society confronts the root causes and dismantles harmful norms, infertility will remain not just a medical condition, but a silent epidemic rooted in injustice,” he told delegates. 

But thanks to science, there’s hope. 

Modern medicine now offers advanced options—from fertility drugs to assisted reproductive technologies like intrauterine insemination and in vitro fertilisation.

One emerging innovation, noted Dr Mwesigye, is egg freezing - a procedure where a woman's eggs are extracted, frozen, and stored for later use - which allows women to preserve their fertility while pursuing education or careers, or awaiting the right partner.

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