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Kataria D, Rani B, Punia A, Jha SK, Narendran M, Singh J. Reproductive Risk Factors Associated with Female Infertility in Sonepat District of Haryana: A Community Based Cross-Sectional Study. J Hum Reprod Sci 2023; 16:204-211. [PMID: 38045508 PMCID: PMC10688274 DOI: 10.4103/jhrs.jhrs_82_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
Background Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Aims The aim of this study was to estimate the prevalence of infertility and its association with reproductive risk factors amongst women of reproductive age group (18-49 years) in district Sonepat, Haryana. Settings and Design This observational community-based cross-sectional study was conducted amongst 444 reproductive age group (18-49 years) women residing in district Sonepat, from August 2021 to May 2022. Materials and Methods A simple random sampling technique was used to select the study subjects. After taking written informed consent, all the participants were interviewed using a pre-designed, pre-tested semi-structured questionnaire for desired information. Statistical Analysis Used Mean and standard deviation (SD) were calculated for quantitative data. Percentages and proportions were calculated for qualitative data. Results Out of 444 study population, majority of women were fertile (88.7%), while 6.3% of women were secondary infertile and 5% of women were primary infertile. Most women were aged between 30 and 39 years. The difference of occurrence of infertility in relation to genital discharge (P = 0.049), genital ulcer/sores (P ≤ 0.001), groin swelling (P ≤ 0.001), warts (P = 0.015), menstrual cycle duration (P ≤ 0.001) and menstrual flow amount (P = 0.048) was statistically significant. The mean age of menarche for the female with infertility was 14.34 years (standard deviation = 1.40). Conclusion Almost all of the symptoms of sexually transmitted infection/reproductive tract infection were high amongst infertile females. Awareness generation about the preventable risk factors and provision of infertility care services at primary healthcare facilities will be of use in addressing infertility in Sonepat.
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Affiliation(s)
- Deepika Kataria
- Department of Community Medicine, BPS GMC (W), Sonepat, Haryana, India
| | - Babita Rani
- Department of Community Medicine, BPS GMC (W), Sonepat, Haryana, India
| | - Anita Punia
- Department of Community Medicine, BPS GMC (W), Sonepat, Haryana, India
| | - S. K. Jha
- Department of Community Medicine, BPS GMC (W), Sonepat, Haryana, India
| | - M. Narendran
- Department of Community Medicine, BPS GMC (W), Sonepat, Haryana, India
| | - Jagmohan Singh
- Department of Community Medicine, BPS GMC (W), Sonepat, Haryana, India
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Bornstein M, Huber-Krum S, Norris AH, Gipson JD. Infertility and perceived chance of conception among men in Malawi. HUM FERTIL 2023; 26:504-511. [PMID: 36942485 PMCID: PMC10511657 DOI: 10.1080/14647273.2023.2190042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/16/2022] [Indexed: 03/23/2023]
Abstract
Infertility is a common experience among individuals and couples worldwide, but few studies focus on men's reports of infertility or perceived chance of conceiving, particularly in high-fertility, pronatalist contexts where infertility is highly stigmatized. Using data from the fourth wave of the Umoyo wa Thanzi (UTHA) cohort study in rural Central Malawi (2017-2018), we examine the relationship between self-reported infertility, the perceived chance of conceiving within one year, and sociodemographic characteristics among men (N = 484). While 13% of men reported that they had experienced infertility, just 4% of men perceived that they were unlikely or there was no chance they would conceive with their partner within one year of having sex without contraception. In multivariable logistic regression models, older age was associated with experienced infertility (AOR: 1.06, p < 0.05) and higher parity was associated with lower odds of reporting that conception was unlikely or there was no chance of conception (AOR: 0.08; p < 0.05). We argue that additional research on infertility focusing on men is critical in gaining a more holistic and gender-equitable understanding of infertility. Including men in infertility research may also contribute to destigmatizing infertility among both women and men by acknowledging men's roles in infertility.
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Affiliation(s)
- Marta Bornstein
- Ohio State University College of Public Health, Columbus, OH, USA
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Alison H. Norris
- Ohio State University College of Public Health, Columbus, OH, USA
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Oskowitz SP, Rwiyereka AK, Rurangwa T, Shepard DS, Rwamasirabo E, Isaacson KB, van der Poel S, Racowsky C. Infertility services integrated within the maternal health department of a public hospital in a low-income country, Rwanda. F S Rep 2023; 4:130-142. [PMID: 37398610 PMCID: PMC10310971 DOI: 10.1016/j.xfre.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To describe the initiation, integration, and costs of reduced-cost infertility services within the maternal health department of a public hospital in a low-income country. Design Retrospective review of the clinical and laboratory components of patients undergoing in vitro fertilization (IVF) treatment in Rwanda from 2018 to 2020. Setting Academic tertiary referral hospital in Rwanda. Patients Patients seeking infertility services beyond the primary gynecological options. Interventions The national government furnished facilities and personnel, and the Rwanda Infertility Initiative, an international nongovernmental organization, provided training, equipment, and materials. The incidence of retrieval, fertilization, embryo cleavage, transfer, and conception (observed until ultrasound verification of intrauterine pregnancy with fetal heartbeat) were analyzed. Cost calculations used the government-issued tariff specifying insurers' payments and patients' copayments with projected delivery rates using early literature. Main Outcome Measures Assessment of functional clinical and laboratory infertility services and costs. Results A total of 207 IVF cycles were initiated, 60 of which led to transfer of ≥1 high-grade embryo and 5 to ongoing pregnancies. The projected average cost per cycle was 1,521 USD. Using optimistic and conservative assumptions, the estimated costs per delivery for women <35 years were 4,540 and 5,156 USD, respectively. Conclusions Reduced-cost infertility services were initiated and integrated within a maternal health department of a public hospital in a low-income country. This integration required commitment, collaboration, leadership, and a universal health financing system. Low-income countries, such as Rwanda, might consider infertility treatment and IVF for younger patients as part of an equitable and affordable health care benefit.
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Affiliation(s)
- Selwyn P. Oskowitz
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Rwanda Infertility Initiative (RII), Los Angeles, California
| | - Angélique K. Rwiyereka
- Rwanda Infertility Initiative (RII), Los Angeles, California
- Schneider Institutes for Health Policy and Research, Institute for Global Health and Development, Heller School of Social Policy, Brandeis University, Waltham, Massachusetts
| | - Théogène Rurangwa
- Rwanda Infertility Initiative (RII), Los Angeles, California
- Department of Obstetrics and Gynecology, Rwanda Military Hospital, Kigali, Rwanda
| | - Donald S. Shepard
- Rwanda Infertility Initiative (RII), Los Angeles, California
- Schneider Institutes for Health Policy and Research, Institute for Global Health and Development, Heller School of Social Policy, Brandeis University, Waltham, Massachusetts
| | - Emile Rwamasirabo
- Rwanda Infertility Initiative (RII), Los Angeles, California
- Rwanda Accreditation Agency for Quality Healthcare (RAAQH), Kigali, Rwanda
| | - Keith B. Isaacson
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Rwanda Infertility Initiative (RII), Los Angeles, California
| | | | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
- Rwanda Infertility Initiative (RII), Los Angeles, California
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch, Suresnes, France
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Bittaye H, Mooney JP, Afferri A, Balen J, Kay V. Introducing assisted reproductive technologies in The Gambia, a survey on the perspectives of Gambian healthcare professionals and medical students. BMC Health Serv Res 2023; 23:203. [PMID: 36855053 PMCID: PMC9979844 DOI: 10.1186/s12913-023-09171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Infertility remains a global reproductive health burden with the highest prevalence in low and middle-income countries. In sub-Saharan Africa, the ability to procreate holds great societal importance. Couples, and particularly women, with infertility can face devastating challenges, leading to social stigma, isolation and/or divorce. However, attention to addressing infertility is lacking in sub-Saharan Africa. In The Gambia, where this study is based, little is known about the potential for introduction of assisted reproductive technologies (ART) in the public health sector. METHODS A quantitative survey was conducted using detailed questionnaires on infertility services available, staff knowledge, perceived barriers, and personal motivation to support assisted reproductive technologies. Data was collected electronically between April and June 2021 from healthcare providers (n = 70) in eleven health facilities throughout the country, as well as from medical students (n = 55) enrolled at The University of The Gambia. RESULTS Basic infertility services were found to be lacking in the rural areas. Furthermore, 39% of staff (n = 27) providing fertility care had not receive any formal training on the topic. However, 91% of staff (n = 64) showed interest in acquiring additional knowledge and had a positive attitude towards supporting the introduction of ART. Perceived challenges of doing so included: (i) the competing importance of other health priorities; and (ii) religious and cultural barriers. CONCLUSION This survey highlights that expansion of infertility services is needed, especially in rural areas. Staff perceived the introduction of ART as important, but this should be coupled with specialized training, as most medical staff had not received any formal infertility training. Future care providers (current medical students) showed both interest in ART and reported having received some basic training in infertility management. Given the reported lack of infrastructure and services, additional targeted investment in infertility care, including ART, will be needed to improve reproductive health for all, countrywide.
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Affiliation(s)
| | - Jason P. Mooney
- grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Anna Afferri
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julie Balen
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Vanessa Kay
- grid.8241.f0000 0004 0397 2876School of Medicine, University of Dundee, Dundee, UK
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Pratt MC, Owembabazi M, Muyindike W, Kaida A, Marrazzo JM, Bangsberg DR, Bwana MB, Psaros C, Turan J, Atukunda EC, Matthews LT. 'I still desire to have a child': a qualitative analysis of intersectional HIV- and childlessness-related stigma in rural southwestern Uganda. CULTURE, HEALTH & SEXUALITY 2023; 25:143-158. [PMID: 35015604 PMCID: PMC9271525 DOI: 10.1080/13691058.2021.2023761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
This study explored the intersecting forms of stigma experienced by HIV-serodifferent couples with unmet reproductive goals in rural Uganda. The parent mixed-methods study, which included 131 HIV-exposed women with plans for pregnancy, offered comprehensive HIV prevention counselling and care over a nine-month period. In-depth interviews were conducted with 37 women and seven male partners to explore care experiences and the use of safer conception strategies. This secondary analysis explored how challenges conceiving informed pregnancy plans and HIV prevention behaviours. The following themes were developed (1) partnership conflicts arise from HIV- and infertility-related forms of stigma, contributing to gender-based violence, partnership dissolution and the pursuit of new partners; (2) cultural and gender norms pressure men and women to conceive and maintain partnerships, which is complicated by the stigma directed towards serodifferent couples; (3) frustration with low partner participation in safer conception strategies led to the decreased use of these methods of HIV prevention; (4) health care provider support promotes continued hope of conception and helps overcome stigma. In HIV-affected partnerships, these intersecting forms of stigma may impact HIV prevention. Seeking to fulfil their reproductive needs, partners may increase HIV transmission opportunities as they engage in condomless sex with additional partners and decrease adherence to prevention strategies. Future research programmes should consider the integration of fertility counselling with reproductive and sexual health care.
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Affiliation(s)
- Madeline C. Pratt
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jeanne M. Marrazzo
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David R. Bangsberg
- School of Public Health, Oregon Health Sciences University – Portland State University, Portland, OR, USA
| | | | - Christina Psaros
- Department of Psychiatry, Behavioural Medicine Program, Massachusetts General Hospital, Boston, MA, USA
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Lynn T. Matthews
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Mukamana D, Gishoma D, Holt L, Kayiranga D, Na JJ, White R, Nyblade L, Knettel BA, Agasaro C, Relf MV. Dehumanizing language, motherhood in the context of HIV, and overcoming HIV stigma - the voices of Rwandan women with HIV: A focus group study. Int J Nurs Stud 2022; 135:104339. [PMID: 36088732 DOI: 10.1016/j.ijnurstu.2022.104339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stigma is an underlying cause of health inequities, and a major barrier to HIV prevention, care, and treatment. Experiences of HIV stigma have been shown to reduce engagement in care across the HIV care continuum, from testing and diagnosis to long-term retention in care and anti-retroviral therapy adherence. In Rwanda, approximately 130,000 women are living with HIV, representing a prevalence rate (3.7%) which is substantially higher than Rwandan men (2.2%). Both the national Rwanda and City of Kigali HIV and AIDS strategic plans identify stigma as a key concern for reducing the burden of HIV. OBJECTIVES The first objective of this study was to understand the sources of HIV-related stigma among women living with HIV in Rwanda. The second objective was to understand the cultural, linguistic, and contextual context of HIV-related stigma and the intersection of HIV-related stigma to the HIV care continuum (engagement in care, medication/treatment adherence) among women with HIV in Rwanda. DESIGN This study used a cross-sectional, qualitative design. SETTING AND PARTICIPANTS Three-three women from urban and rural settings in Rwanda were recruited from public HIV treatment and care centers to participate in this study. METHOD Focus groups discussions, guided by a structured interview guide, were used to collect qualitative data. Framework analysis was used to analyze the data, which was collected during July 2018. RESULTS The participants in this study highlighted that Rwandan women with HIV experience all forms of stigma - enacted, anticipated, perceived, and internalized - associated with HIV as well as structural stigma. Further, three major themes - dehumanizing language, importance of motherhood in the context of HIV, and overcoming HIV stigma - emerged from the data. CONCLUSION The results of this study are among the few to give voice and perspective to the stigma experiences of Rwandan women with HIV. The women with HIV participating in this study shed light on the pervasive and culturally constructed effects of stigma that continue to exist. Further, the findings from this study highlighted the significant intersection of the role dehumanizing language experienced by Rwandan women with HIV. Additionally, the intersectional identities of being a woman with HIV and a mother and their relationship to societal and cultural norms and expectations must be considered concurrently. Finally, the beneficial effects of support groups was identified as key in helping Rwandan women with HIV to accept self.
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Affiliation(s)
- Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda
| | - Darius Gishoma
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda; University Teaching Hospital of Kigali, KN 4 Ave, Kigali, Rwanda
| | - Lauren Holt
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA
| | - Dieudonne Kayiranga
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda
| | - Jieun Julia Na
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA
| | - Rebecca White
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, KG 11 Ave, 47, Remera, Kigali, Rwanda; University of Illinois Chicago, College of Nursing, 845 S. Damen Ave, Chicago 60612, IL, USA
| | - Laura Nyblade
- RTI International, 701 13th Street NW, Suite 750, Washington 20005-3967, DC, USA
| | - Brandon A Knettel
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA; Duke Global Health Institute, Duke University, 3110 Trent Drive, 27710, NC, USA
| | - Charity Agasaro
- Duke University, 2080 Duke University Road, Durham 27708, NC, USA
| | - Michael V Relf
- School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham 27710, NC, USA; Duke Global Health Institute, Duke University, 3110 Trent Drive, 27710, NC, USA.
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Zhu C, Yan L, He C, Wang Y, Wu J, Chen L, Zhang J. Incidence and risk factors of infertility among couples who desire a first and second child in Shanghai, China: a facility-based prospective cohort study. Reprod Health 2022; 19:155. [PMID: 35804377 PMCID: PMC9270756 DOI: 10.1186/s12978-022-01459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background With the implementation of the two-child policy in China, more couples have expressed the desire to have another child. We conducted this study to evaluate the incidence of infertility and risk factors in couples intending to have a first and second child. Methods From 2013 to 2017, a prospective cohort study was conducted at the pre-pregnancy center of the International Peace Maternal and Child Health Hospital. The participants were selected by screening and random sampling couples who came to the pre-pregnancy center. Data regarding patient sociodemographic characteristics, reproductive and gynecological history, male disease history, and laboratory and imaging examination results were collected. Couples were followed up every 3 months until pregnancy or for 12 months, whichever came first. Multi-factor logistic regression was used to analyze risk factors for infertility. Adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors. Results The overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338), respectively. This study found great differences in both infertility rate (P < 0.001) and risk factors between the two groups. Risk factors for “first child intention” infertility included advanced age (> 35 years) (aOR = 1.70, 95% CI 1.27–2.28), abnormal body mass index (BMI) (aOR = 1.58, 95% CI 1.31–6.26), longer menstrual periods (aOR = 4.47, 95% CI 2.25–8.88), endometrial polyps (aOR = 2.52, 95% CI 1.28–4.97), polycystic ovarian syndrome (PCOS) (aOR = 6.72, 95% CI 1.79–7.39), salpingostomy (aOR = 3.44, 95% CI 1.68–7.07), and history of mycoplasma (aOR = 1.54, 95% CI 1.09–2.40). However, in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma (aOR = 5.60, 95% CI 1.06–29.76), and higher age (> 40 years) (aOR = 7.36, 95% CI 1.01–53.84). Conclusion The overall infertility rate in Shanghai is similar to that of other large cities in China. Marriage at advanced ages has become increasingly common. As such, the government must consider subsidies to encourage childbirth at childbearing ages, which can improve fertility levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01459-x. Infertility is defined as pregnancy failure after at least 12 months of regular unprotected sexual intercourse. Few researchers have investigated the infertility rate in Shanghai in the past 15 years, and little attention has been paid to the infertility of couples hoping to have a second child. We conducted a prospective cohort study in Shanghai to evaluate infertility incidence and risk factors in couples intending to have a first or second child. The investigators administered a questionnaire survey to the participants and followed them for 1 year. Finally, 1839 couples intending to have a first child and 338 couples intending to have a second child were included in this study. The overall infertility incidence was 16.95% (369/2177). However, the infertility incidence of the “first child intention” and “second child intention” groups was 19.30% (355/1839) and 4.14% (14/338), respectively. Risk factors for “first child intention” infertility included advanced age (> 35 years), abnormal body mass index (BMI), longer menstrual periods, endometrial polyps, polycystic ovarian syndrome (PCOS), salpingostomy, and history of mycoplasma; in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma and advanced age (> 40 years). Since studies have shown large differences in infertility risk factors between the two groups, early and targeted intervention for couples in different high-risk groups can help reduce infertility.
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Affiliation(s)
- Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Pre-Pregnancy center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Li Yan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Jiahao Wu
- Pre-Pregnancy center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Luting Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, China.
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, China.
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Wang Y, Fu Y, Ghazi P, Gao Q, Tian T, Kong F, Zhan S, Liu C, Bloom DE, Qiao J. Prevalence of intimate partner violence against infertile women in low-income and middle-income countries: a systematic review and meta-analysis. THE LANCET GLOBAL HEALTH 2022; 10:e820-e830. [PMID: 35561719 PMCID: PMC9115867 DOI: 10.1016/s2214-109x(22)00098-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 12/21/2022] Open
Abstract
Background Infertility and intimate partner violence (IPV) are of serious concern globally, yet the prevalence of IPV against infertile women has not been quantified at the regional or global level. We aimed to estimate the prevalence of IPV against infertile women and its variation in low-income and middle-income countries (LMICs). Methods We did a systematic literature search of 11 databases for articles published between database inception and Sept 30, 2021, and performed meta-analyses to estimate the pooled prevalence and 95% CI of IPV against infertile women in LMICs. We used subgroup analyses and meta-regressions to explore variation in the prevalence by study period (2010 and before vs after 2010), study region (Africa, west Asia, south Asia, and east Asia), type of infertility (primary or secondary), risk of bias (high, moderate, or low), sample size (continuous variable), and measuring tools (the modified Abuse Assessment Screen, the WHO Violence Against Women instrument, or the revised Conflict Tactics Scales). This study is registered with PROSPERO, CRD42021248448. Findings Of 2661 references identified (2637 via database searches and 24 via secondary searches), 120 full-text articles were reviewed, and we identified 30 relevant studies conducted in nine LMICs between 2000 and 2019. 25 studies met the inclusion criteria for meta-analysis, with a total sample size of 7164 participants. The 12-month prevalence of IPV among infertile women was 36·0% (95% CI 20·4–55·2), compared with a lifetime prevalence of 47·2% (31·7–63·3). The most common type of IPV was psychological violence, with a prevalence of 24·6% (11·3–45·6) over 12 months and 51·5% (38·8–64·0) over a lifetime (slightly higher than the pooled overall rate due to different data sources), respectively; followed by physical violence (11·9% [5·2–25·1] and 20·2% [12·1–31·7]); sexual violence (8·7% [2·6–25·0] and 11·5% [6·1–20·7]); and economic coercion (2·6% [0·4–13·7] and 9·8% [5·7–16·5]). Significant variations of lifetime prevalence estimates were presented by study period (R2=39·46%), region (R2=50·95%), and measuring tools (R2=54·27%). Interpretation A high prevalence of IPV against infertile women is evident despite heterogeneity across studies. IPV screening, counselling, and structural interventions should be tailored to address this urgent issue at multiple levels of society. Funding China Medical Board and WHO.
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Teklemicheal AG, Kassa EM, Weldetensaye EK. Prevalence and correlates of infertility related psychological stress in women with infertility: a cross-sectional hospital based survey. BMC Psychol 2022; 10:91. [PMID: 35392978 PMCID: PMC8988399 DOI: 10.1186/s40359-022-00804-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Psychological stress is commonly found among infertile women. Untreated stress can affect negatively the success of infertility treatment. Most of the available knowledge is generated from developed countries and is largely based on women undergoing In vitro fertilization (IVF) treatment. However, very little is known on infertile women from Ethiopia including other countries in East Africa. The aim of this study was to determine the prevalence of psychological stress and possible demographic-clinical correlates in Ethiopian women suffering from infertility. Method This cross sectional descriptive correlation study was conducted from May to August, 2021 involving 96 women undergoing a non-IVF treatment for infertility at Gandhi Memorial and Tikur Anbessa hospitals. The sampling was continuous and based on inclusion criteria that include infertility duration of a minimum one year, female sex and Ethiopian nationality. Data on Infertility related stress was collected using the Copenhagen Multi‐Centre Psychosocial Infertility-Fertility Problem Stress questionner administered by an interviewer. The socio demographic and clinical factors were collected using Amharic version of structured interviewer administered questionnaire and chart review. The analysis of relationship between infertility related stress and background variables was done with an independent sample t-test or one-way ANOVA statistics supplemented with effect size assessment. Results The prevalence of infertility related stress was overall 92.71% (95% CI, 87–98%). The personal, marital, and social subdomain mean scores (SD) were 2.74 (.80), 1.54 (.81) and 1.90 (.80), respectively. Infertility related stress was higher for those women who were: aged above 35, living in a cohabitation marital type, has no living children, and with 4–6 years duration of infertility (all P < 0.05). Whereas, there was insufficient evidence to suggest that infertility related stress varies by education, income, knowledge of cause of infertility or history of past treatment (all P > 0.05). Conclusions The prevalence of psychological stress among Ethiopia women having infertility was very high. The results provide preliminary evidence that infertility related stress is associated with age, marital status, motherhood status and duration of infertility. Responsible bodies need to avail psychological screening and services prioritizing women at higher risk of developing stress.
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Affiliation(s)
- Ashebir Getachew Teklemicheal
- Gandhi Memorial Hospital, Addis Ababa, Ethiopia. .,Department of Obstetrics and Gynecology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Eyasu Mesfin Kassa
- Department of Obstetrics and Gynecology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Men and infertility in The Gambia: Limited biomedical knowledge and awareness discourage male involvement and exacerbate gender-based impacts of infertility. PLoS One 2021; 16:e0260084. [PMID: 34843498 PMCID: PMC8629172 DOI: 10.1371/journal.pone.0260084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Infertility in Sub-Saharan Africa constitutes an important social and public health problem. Yet, there is a paucity of research on the experiences of men living with infertility, especially in West Africa. This study explored men’s aetiological knowledge, views and experiences of infertility in the West Coast region of The Gambia, West Africa. Methodology An explorative qualitative study was conducted among men living in the rural and urban communities of the West Coast region of The Gambia using in-depth interviews. Data collection and analysis were performed concurrently, and thematic data analysis was an iterative process carried out using NVivo 11 Analysis Software. Results Gambian men had generally poor knowledge of infertility, allocating it to God, spiritual powers and bodily (biomedical) factors. While societal norms meant that infertility was generally attributed to women, some men allocated male-factor infertility to poor sperm quality and impotence. Infertility threatened participants’ sense of masculinity and resulted in psychosocial distress, including stigma, feelings of isolation, and low self-esteem. Conclusion Normative gendered frameworks of infertility result in high levels of female responsibilisation in the Gambian context. Yet men diagnosed with infertility experience significant, often unrecognized, psychological and social distress. We therefore call for increased attention to male-factor infertility, and the promotion of male engagement with infertility-care and services, both of which are essential for successfully addressing infertility and it’s psychosocial consequences in The Gambia.
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Fledderjohann J. Self-reported fertility impairments and help-seeking strategies among young women in Malawi. Glob Public Health 2021; 17:2139-2155. [PMID: 34376104 PMCID: PMC8831643 DOI: 10.1080/17441692.2021.1965179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper analyses wave 4 the Tsogolo la Thanzi survey of n = 1349 Malawian women aged 16–26 to explore the prevalence and predictors of self-reported fertility impairments (difficulties conceiving and/or difficulties carrying a pregnancy to term) and help-seeking strategies. Using descriptive statistics, logistic regression models, and graphic displays, the correlates of self-reporting an impairment and patterns of help-seeking strategies are examined. Nearly 13% (n = 117) of those who had ever tried to conceive reported experiencing a fertility impairment. Age was positively associated with reporting an impairment, while there was a negative association with education and with parity. Of women who reported an impairment, 85.5% sought help. Visiting a hospital or clinic was the most common response, followed closely by going to a traditional healer. Around one-quarter employed multiple help-seeking strategies, highlighting the need for various help-seeking behaviours to be viewed in tandem rather than in isolation.
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Olamijuwon E, Odimegwu C, Chemhaka G. Involuntary Childlessness and Marital Infidelity Among Women in Sub-Saharan African Countries: An Assessment of the Moderating Role of Women's Education. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:601-614. [PMID: 32621140 DOI: 10.1007/s10508-020-01770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
A considerable number of married women in sub-Saharan African countries are childless and may be likely to engage in marital infidelity to avoid social stigma, economic insecurities, and other debilitating experience associated with being involuntarily childless. This study sought to investigate the relationship between involuntary childlessness and marital infidelity and how it may be moderated by women's educational attainment. Data were obtained from 23,847 women in their first union for at least 2 years and participated in the demographic and health surveys of five sub-Saharan African countries comprising Cameroon, Gabon, Lesotho, Liberia, and Sierra Leone. Data were analyzed using multivariate logistic regression, adjusted for socioeconomic, union, and partner characteristics. Involuntarily childless women in Cameroon (AOR: 2.34, 95% CI 1.62-3.39) and Sierra Leone (AOR: 2.22, 95% CI 1.42-3.49) were about two times more likely to engage in marital infidelity compared to non-childless married women. In Gabon, Lesotho, and Liberia, the odds of marital infidelity did not significantly differ between involuntarily childless and non-childless married women. Although involuntarily childless women with secondary or higher education reported higher levels of marital infidelity than non-childless women with a similar level of education, we found no statistical evidence in all the countries that the relationship between involuntary childlessness and marital infidelity was moderated by women's educational attainment. These findings suggest that involuntary childlessness is a critical factor potentially related to marital infidelity and may be an important target for intervention and prevention, particularly in settings with high levels of sexually transmitted infections.
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Affiliation(s)
- Emmanuel Olamijuwon
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa.
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni Campus, Kwaluseni, Eswatini.
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa
| | - Garikayi Chemhaka
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni Campus, Kwaluseni, Eswatini
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Boivin J, Carrier J, Zulu JM, Edwards D. A rapid scoping review of fear of infertility in Africa. Reprod Health 2020; 17:142. [PMID: 32928239 PMCID: PMC7488744 DOI: 10.1186/s12978-020-00973-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Fear of infertility (FOI) is often reported in studies about reproductive health but this literature not yet mapped. The aim of this rapid scoping review of qualitative studies was to describe the nature of FOI in Africa. Methods Eligibility criteria were qualitative data from Africa reporting views of women and men of any age. MEDLINE and CINAHL databases were searched for English language citations to February 2019 using keywords related to fear, infertility and Africa. Two independent reviewers screened texts for inclusion. Results Of 248 citations identified, 38 qualitative and six review papers were included. FOI was reported in diverse groups (e.g., men, women, fertile, infertile, married, unmarried, teachers, religious leaders). Two types of fears were identified: (1) fear of triggering infertility due to specific reproductive choices and (2) fear of the dire future consequences of infertility. Choices were perceived to affect fertility via internal accumulation and blockage (e.g., of menstrual blood), structural damage (e.g., burnt eggs), internal movement of contraceptive material, deliberate toxicity preventing population growth and behavioral effects impeding sexual activity. Diverse feared consequences of infertility were reported (e.g., polygamy, economic hardships). Fears were reported to affect reproductive behaviour (e.g., stopping contraception), help-seeking and social behaviour. Conclusion FOI is a phenomenon that should be studied in its own right. Fears could originate from genuine threats, incorrect knowledge, distortions of truths, or dissemination of false information. Rigorous studies are needed to better understand FOI and integrate it in health education, client counselling and family planning service provision.
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Affiliation(s)
- Jacky Boivin
- School of Psychology. College of Biomedical and Life Sciences, Cardiff University, 70 Park Place, CF10 3AT, Cardiff, Wales, UK.
| | - Judith Carrier
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
| | | | - Deborah Edwards
- Wales Centre for Evidence Based Care, School of Health Care Sciences, Cardiff University, Cardiff, Wales, UK
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Alabi OJ. Perceptions of Surrogacy Within the Yoruba Socio-Cultural Context of Ado-Ekiti, Nigeria. F1000Res 2020; 9:103. [PMID: 33732439 PMCID: PMC7921890 DOI: 10.12688/f1000research.20999.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Surrogacy might be a reproductive process that brings joy and fulfilment to many but it also brings with it numerous ethical and legal concerns; it raises questions about the fundamental human rights, welfare and wellbeing of women and infants especially within a context where it is barely regulated. This article examines the perception of surrogacy within the Yoruba socio-cultural context in Ado-Ekiti, Nigeria. It brings to the fore various socio-cultural concerns that questions the influence of surrogacy as a reproductive process on womanhood, motherhood and parenthood. It discusses by analysing the narratives of participants how surrogacy process is a dereliction of the sacredness and cultural sanctity of the family system, most especially in an African context. Methods: 15 stakeholders (traditional birth attendants and gynaecologists) were engaged in an in-depth interview to unravel the challenges surrogacy might or is encountering within the socio-cultural context of Ado-Ekiti. Results: There are various social, cultural and religious beliefs that police the reproductive sphere of the Yoruba socio-cultural group, which has grave implications on fertility treatment. These socio-cultural and religious factors do not provide a fertile ground for surrogacy to thrive within the study location. Hence, it is important that the socio-cultural framing of reproduction within this cultural context become receptive to medical reproductive solutions and innovations if at all the processes are to thrive or at least become less stigmatised. Conclusions: The process of surrogacy is very complex and people’s attitude towards the practice is greatly influenced by their culture, religion and social belief systems about what is considered appropriate for procreation. Also, it is important to have clear-cut policy regulating surrogacy and all forms of ARTs in Nigeria, as this will protect women and infants, as well as, ensure that they are not to exposed abuse, commercialization and exploitation.
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Affiliation(s)
- Oluwatobi Joseph Alabi
- Department of Sociology, University of Johannesburg, Johannesburg, Gauteng, 2006, South Africa
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15
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Naab F, Lawali Y, Donkor ES. "My mother in-law forced my husband to divorce me": Experiences of women with infertility in Zamfara State of Nigeria. PLoS One 2019; 14:e0225149. [PMID: 31856167 PMCID: PMC6922459 DOI: 10.1371/journal.pone.0225149] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Women with infertility have different experiences that determine the quality of their psychosocial health. Cultural constructions of infertility in Africa have made the experience of infertility among African women more burdensome. Yet, little is known about the psychosocial experiences of women with infertility in Zamfara State of Nigeria. The purpose of this study was to explore the psychosocial experiences of women with infertility in Zamfara. Materials and methods An exploratory qualitative design was used for this exploration. Individual in-depth interviews were conducted using a semi-structured interview guide. Ethical approval was received from the Institutional Review Board of the Nogouchi Memorial Institute for Medical Research in the University of Ghana. Women who were married and seeking treatment for infertility from a public hospital were recruited and interviewed. A total of 12 women were interviewed with each interview lasting 45 minutes. The interviews were audiotaped with permission from the participants, transcribed verbatim, and content analysed. Results The findings revealed that psychologically, majority of the women had experienced anxiety, stress and depression as a result of their inability to get pregnant. Socially, the women suffered self and social isolation, social stigma, social pressure and marital problems. Conclusion These women have psychosocial health problems that need the attention of health professionals to enhance their wellbeing.
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Affiliation(s)
- Florence Naab
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Yakubu Lawali
- Department of Nursing Science, College of Health Sciences, Usmanu DanFodiyo University Sokoto, Sokoto, Nigeria
| | - Ernestina S. Donkor
- Department of Maternal and Child Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
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Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia. Reprod Health 2019; 16:103. [PMID: 31307488 PMCID: PMC6633655 DOI: 10.1186/s12978-019-0762-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022] Open
Abstract
Background In many low-and middle-income countries women with infertility are often in polygynous marriages. From a human and women’s rights perspective, the practice of polygyny is commonly understood as harmful. Studies indicate that polygyny aggravates negative life circumstances of women with infertility with respect to their health and social well-being. The purpose of this qualitative study is to explore how women with infertility experience polygyny and to understand their decision-making regarding these marriages. Methods An explorative qualitative study was conducted among women with infertility in the urban communities of the West Coast region of The Gambia using in-depth interviews (30). Data analysis involved an emergent and partially inductive thematic framework and was carried out using NVivo 11. Results With the exception of some women with infertility who described positive experiences within polygynous marriages, most women emphasised conflicts that exist within polygynous households and reported financial and emotional difficulties. Thematic analysis identified several strategies of women with infertility to cope with and resist polygynous marriages, including overcoming childlessness, addressing conflict, spending time outside the compound, looking for social support, kanyaleng kafoolu, living separately and initiating divorce. Moreover, the experiences and decision-making power of women with infertility when it comes to polygynous marriages was found to be closely related to their socio-demographic background. Conclusion This work highlights how women with infertility in polygynous marriages are in a precarious situation in urban Gambia. Women utilize a mix of compliance, coping and resistance strategies to navigate the challenges of polygynous marriages in a structurally constraining context.
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Ross R, Hess RF. Social Pressure for Pregnancy Scale: Its Development, Psychometric Properties, and Potential Contributions to Infertility and Depression Research. J Nurs Meas 2019; 27:5-15. [DOI: 10.1891/1061-3749.27.1.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundWomen with infertility in different cultures, especially those in West African countries, are viewed as inferior. They tend to experience discrimination and have suboptimal mental health outcomes. However, recent evidence shows that social pressure for pregnancy, not infertility, is a significant predictor of depression. Yet, instruments that measure social pressure for pregnancy are scarce. Existing instruments to measure social pressure for pregnancy show no evidence of psychometric properties.PurposeTo assess the psychometric properties of a new tool, the Social Pressure for Pregnancy Scale (SPPS), among Malian women in West Africa.MethodsExploratory factor analysis, and analyses of convergent validity, discriminant validity (known-groups technique), and reliability.Results and conclusionThe SPPS has good psychometric properties and can be used in future infertility studies especially in relation to depression.
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18
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'We are always desperate and will try anything to conceive': The convoluted and dynamic process of health seeking among women with infertility in the West Coast Region of The Gambia. PLoS One 2019; 14:e0211634. [PMID: 30703136 PMCID: PMC6355002 DOI: 10.1371/journal.pone.0211634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction In many Sub-Saharan African countries, women with infertility search relentlessly for treatment. Guided by the Partners for Applied Social Sciences model for health seeking behaviour and access to care research, this study aims to understand the health seeking behaviour of women with infertility in the West Coast region of The Gambia and the influence of aetiological beliefs on health seeking paths. Methodology A qualitative approach was used to generate both primary and secondary data for thematic analysis. The data collection methods included in-depth interviews (36), observations (18), informal conversations (42), group discussion (7) and made use of pile-sorting exercises. Sources of secondary data included government and non-governmental reports and media outputs. Results The health seeking approaches of women living in both rural and urban areas were extremely complex and dynamic, with women reporting that they looked for biomedical treatment as well as seeking indigenous treatment provided by local healers, sacred places and kanyaleng groups. While treatment choice was related to the perceived aetiology of infertility, it was also strongly influenced by the perceived effectiveness of the treatment available and the duration of the fertility problems. Other relevant factors were the affordability, accessibility and availability of treatment and respondents’ family and social networks, whereby access to the biomedical health sector was strongly influenced by people’s socio-economic background. Conclusion On the basis of this analysis and our wider research in the area, we see a need for health authorities to further invest in providing information and counselling on issues related to infertility prevention and treatment. The availability of locally applicable guidelines for the management of infertility for both men and women at all levels of the health system would facilitate such work. In addition, the public sphere should provide more space for alternative forms of social identity for both men and women.
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Hammarberg K, Trounson A, McBain J, Matthews P, Robertson T, Robertson F, Magli C, Mhlanga T, Makurumure T, Marechera F. Improving access to ART in low-income settings through knowledge transfer: a case study from Zimbabwe. Hum Reprod Open 2018; 2018:hoy017. [PMID: 30895258 PMCID: PMC6276666 DOI: 10.1093/hropen/hoy017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
It may be assumed that infertility is not a problem in resource-poor areas where fertility rates are high. However, evidence overwhelmingly shows that childlessness is highly stigmatized in these settings and that women who are unable to bear children suffer significant social and psychological consequences. The World Health Organization has recommended that infertility be considered a global health problem and stated the need for ART to be adapted to low-resource settings. This paper describes a model for improving access to ART in low-resource settings. Experienced ART health professionals from Australia and Italy representing medical science, embryology, nursing and counselling used knowledge transfer to support a clinician, a laboratory scientist and a nurse to establish an ART service in Harare, Zimbabwe. Support and mentorship provided between October 2016 and December 2017 included: hosting the clinician and the embryologist for the new service in established ART clinics for short periods and providing them with dedicated mentorship and training during their stay; funding an experienced embryologist to travel to Zimbabwe (three times) to oversee the setting up of the lab and provide hands-on embryology training; funding a scientist and a nurse to travel to Zimbabwe to troubleshoot and establish protocols for record keeping and psychosocial care; and contributing approximately AUD $15,000 to the purchase of some equipment. By 31 March 2018, the team at IVF Zimbabwe had performed 166 ART procedures, which at time of writing had resulted in 16 births and 4 ongoing pregnancies. This case study demonstrates that with mentorship and modest financial support from ART experts from high-income settings, health professionals in low-income settings can deliver affordable ART with successful outcomes.
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Affiliation(s)
- K Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - A Trounson
- Centre for Cancer Research, Monash University and Hudson Institute of Medical Research, Melbourne 3168, Australia
| | - J McBain
- Melbourne IVF, Melbourne 3002, Australia
| | - P Matthews
- Consultant Embryologist, Melbourne 3000, Australia
| | - T Robertson
- Retired Medical and Embryology practitioners, IVF Zimbabwe, Harare 263, Zimbabwe
| | - F Robertson
- Retired Medical and Embryology practitioners, IVF Zimbabwe, Harare 263, Zimbabwe
| | - C Magli
- SISMER, 40138 Bologna, Italy
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'I am always crying on the inside': a qualitative study on the implications of infertility on women's lives in urban Gambia. Reprod Health 2018; 15:151. [PMID: 30208896 PMCID: PMC6134751 DOI: 10.1186/s12978-018-0596-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is an increasing awareness that infertility in Sub-Saharan Africa constitutes a severe social and public health problem. Few of the existing studies on infertility explicitly take into account the differences between women. However, how women experience infertility is formed by their various social positions. This research explores the implications of infertility on women’s lives in urban Gambia and aims to provide an in-depth understanding of how this relates to gender and cultural norms as well as different social positions. Methods Qualitative data were collected through interviews (33), group discussions (13), participatory observations (14) and informal conversations (31). Purposive and snowball sampling techniques were used to identify participants. The data was analysed thematically using NVivo 11. Results Results showed that there was strong social pressure on urban women in The Gambia to procreate. Unable to conform to their gender role, women with infertility were confronted with financial problems, social stigma, as well as emotional and physical violence in their marriage. All women expressed feelings of trauma, stress and sadness. The intersectional approach used in this study highlighted how different positions influenced women’s experiences of infertility. Urban women with a high socio-economic status had a more powerful position within their marriages and the broader community, due to their financial position, professional career and, sometimes, their educational background. In contrast, women from a lower socio-economic background were more likely to be harshly confronted with the social stigma of infertility. Conclusion The lives of most women with infertility in The Gambia are characterized by social suffering resulting from gender and pro-natal norms, cultural beliefs and moral concerns, cultural practices and limited access to health care. An intersectional approach is an effective tool to inform public health and social policy since it highlights how, in specific situations, certain groups are more vulnerable than others.
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Maya ET, Guure CB, Adanu RM, Sarfo B, Ntumy M, Bonney EY, Lizneva D, Walker W, Azziz R. Why we need epidemiologic studies of polycystic ovary syndrome in Africa. Int J Gynaecol Obstet 2018; 143:251-254. [DOI: 10.1002/ijgo.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Ernest T. Maya
- School of Public Health; University of Ghana; Accra Ghana
- School of Medicine & Dentistry; University of Ghana; Accra Ghana
| | - Chris B. Guure
- School of Public Health; University of Ghana; Accra Ghana
| | | | - Bismark Sarfo
- School of Public Health; University of Ghana; Accra Ghana
| | - Michael Ntumy
- School of Medicine & Dentistry; University of Ghana; Accra Ghana
| | - Evelyn Y. Bonney
- Noguchi Memorial Institute for Medical Research; University of Ghana; Accra Ghana
| | - Daria Lizneva
- Department of Obstetrics & Gynecology; Augusta University; Augusta GA USA
- Division of Endocrinology, Diabetes and Bone Disease; Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Walidah Walker
- Department of Obstetrics & Gynecology; Augusta University; Augusta GA USA
| | - Ricardo Azziz
- Department of Obstetrics & Gynecology; Augusta University; Augusta GA USA
- The State University of New York System Administration; Albany NY USA
- Department of Health Policy; Management & Behavior; School of Public Health; University at Albany; Albany NY USA
- Department of Obstetrics & Gynecology; Albany Medical College; Albany NY USA
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Peterson ZD, Buday SK. Sexual coercion in couples with infertility: prevalence, gender differences, and associations with psychological outcomes. SEXUAL AND RELATIONSHIP THERAPY 2018. [DOI: 10.1080/14681994.2018.1435863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Zoë D. Peterson
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Sarah K. Buday
- Community Psychological Service, University of Missouri-St. Louis, St. Louis, MO, USA
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Hajizade-Valokolaee M, Khani S, Fooladi E, Peivandi S. Related factors of violence against women with infertility: A systematic review study based on an ecological approach. Electron Physician 2017; 9:5834-5843. [PMID: 29403627 PMCID: PMC5783136 DOI: 10.19082/5834] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/29/2017] [Indexed: 11/20/2022] Open
Abstract
Background and aim Infertility as a global problem, affects the different aspects of women’s health. Also, violence against infertile women affects their psychological wellbeing and treatment consequence. This study aimed at reviewing related factors to violence against infertile women, based on an ecological approach. Methods In this systematic review, the researchers conducted their search in electronic databases such as Google Scholar, and then in more specialized ones such as Medline via PubMed, Science Direct, Up-to-date, Springer, SID, Magiran, Iranmedex and Irandoc with the key words violence, infertility, women, risk factors, social environment, and individuality, from 1988 to 2016. The selection of papers was undertaken from 20–27 January 2017. The articles were selected based on the following criteria: 1), the articles focused on the research question 2), infertility and violence were included in the title of the articles, and 3) articles were published in online journals. Exclusion criteria were articles which focused on violence against the general population, pregnant women and female sex workers and articles that were not available in full text form or written in other languages (Not Persian or English). The quality of selected studies was appraised using a 16-item checklist adapted from Tao. This checklist consisted of 16 items which used a 0 or 1 scoring system (not eligible or eligible). If an article received a score of 75% (12–16 points), it was of high quality. A score of 50% to 74% (8–12 points) indicated moderate quality, and less than 50% (8 points) indicated low quality. The process of titles, abstracts and full-texts’ appraisal led to the selection of 16 articles, which were used to write this article Results Two of the articles based on 16-items of the check list had high quality score, 8 of them had moderate and the remaining articles had low quality score. Our findings were classified under three categories corresponding with the ecological approach: (1) Microsystem level “individual sociodemographic and infertility characteristics”, (2) Mesosystem level “interpersonal’ and husband sociodemographic characteristics” and (3) Macro system level considered ethnicity and cultural factors. Conclusion Violence against infertile women and the stress caused by it, would affect the consequences of infertility treatment. It is noted that various cultural-contextual factors cause violence in different societies. There is a need for the development of screening tools and applying counselors to identify infertile women at the risk of violence, and provide clinical services, counseling and social support.
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Affiliation(s)
- Maryam Hajizade-Valokolaee
- Student Research Committee, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soghra Khani
- Ph.D. of Reproductive Health, Assistant Professor, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ensieh Fooladi
- Ph.D. of Reproductive Health, Assistant Professor, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sepideh Peivandi
- M.D. Gynecologist, Associate Professor, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Polis CB, Cox CM, Tunçalp Ö, McLain AC, Thoma ME. Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data. Hum Reprod 2017; 32:1064-1074. [PMID: 28204493 PMCID: PMC5400046 DOI: 10.1093/humrep/dex025] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/24/2017] [Indexed: 01/12/2023] Open
Abstract
STUDY QUESTION Can infertility prevalence be estimated using a current duration (CD) approach when applied to nationally representative Demographic and Health Survey (DHS) data collected routinely in low- or middle-income countries? SUMMARY ANSWER Our analysis suggests that a CD approach applied to DHS data from Nigeria provides infertility prevalence estimates comparable to other smaller studies in the same region. WHAT IS KNOWN ALREADY Despite associations with serious negative health, social and economic outcomes, infertility in developing countries is a marginalized issue in sexual and reproductive health. Obtaining reliable, nationally representative prevalence estimates is critical to address the issue, but methodological and resource challenges have impeded this goal. STUDY DESIGN, SIZE, DURATION This cross-sectional study was based on standard information available in the DHS core questionnaire and data sets, which are collected routinely among participating low-to-middle-income countries. Our research question was examined among women participating in the 2013 Nigeria DHS (n = 38 948). Among women eligible for the study, 98% were interviewed. PARTICIPANTS/MATERIALS, SETTING, METHODS We applied a CD approach (i.e. current length of time-at-risk of pregnancy) to estimate time-to-pregnancy (TTP) and 12-month infertility prevalence among women ‘at risk’ of pregnancy at the time of interview (n = 7063). Women who were 18–44 years old, married or cohabitating, sexually active within the past 4 weeks and not currently using contraception (and had not been sterilized) were included in the analysis. Estimates were based on parametric survival methods using bootstrap methods (500 bootstrap replicates) to obtain 95% CIs. MAIN RESULTS AND THE ROLE OF CHANCE The estimated median TTP among couples at risk of pregnancy was 5.1 months (95% CI: 4.2–6.3). The estimated percentage of infertile couples was 31.1% (95% CI: 27.9–34.7%)—consistent with other smaller studies from Nigeria. Primary infertility (17.4%, 95% CI: 12.9–23.8%) was substantially lower than secondary infertility (34.1%, 95% CI: 30.3–39.3%) in this population. Overall estimates for TTP >24 or >36 months dropped to 17.7% (95% CI: 15.7–20%) and 11.5% (95% CI: 10.2–13%), respectively. Subgroup analyses showed that estimates varied by age, coital frequency and fertility intentions, while being in a polygynous relationship showed minimal impact. LIMITATIONS, REASONS FOR CAUTION The CD approach may be limited by assumptions on when exposure to risk of pregnancy began and methodologic assumptions required for estimation, which may be less accurate for particular subgroups or populations. Unrecognized pregnancies may have also biased our findings; however, we attempted to address this in our exclusion criteria. Limiting to married/cohabiting couples may have excluded women who are no longer in a relationship after being blamed for infertility. Although probably rare in this setting, we lack information on couples undergoing infertility treatment. Like other TTP measurement approaches, pregnancies resulting from contraceptive failure are not included, which may bias estimates. WIDER IMPLICATIONS OF THE FINDINGS Nationally representative estimates of TTP and infertility based on a clinical definition of 12 months have been limited within developing countries. This approach represents a pragmatic advance in our ability to measure and monitor infertility in the developing world, with potentially far-reaching implications for policies and programs intended to address reproductive health. STUDY FUNDING/COMPETING INTERESTS There are no competing interests and no financial support was provided for this study. Financial support for Open Access publication was provided by the World Health Organization.
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Affiliation(s)
- Chelsea B Polis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.,Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA
| | - Carie M Cox
- Department of Public Health,St. Catherine University, 2004 Randolph Ave., St. Paul, MN 55105, USA
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics,University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Marie E Thoma
- Department of Family Science,University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
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Abstract
Several policy initiatives support the empowerment of women to improve their reproductive health. Little is known, however, about the inverse effect that reproductive health might have on women's empowerment. Women are pressured to conform to their reproductive role, and an inability to do so might affect their empowerment, including control over their own body. Using a panel dataset of 504 married women in Northern Tanzania, we find that women who experienced a pregnancy loss show more tolerant views of partner violence and that child mortality lowers their perceived control over the sexual relationship with their spouse. The number of living children did not affect bodily integrity. These results confirm that women's bodily integrity is partly dependent on the ability to fulfill their reproductive role. They strengthen the case for policies and programs that improve women's reproductive health and underline the importance of counselling after pregnancy or child loss.
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Mokwena K, Bogale YR. Fertility intention and use of contraception among women living with the human immunodeficiency virus in Oromia Region, Ethiopia. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2016.1254931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Kebogile Mokwena
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Yenealem Reta Bogale
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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Stellar C, Garcia-Moreno C, Temmerman M, van der Poel S. A systematic review and narrative report of the relationship between infertility, subfertility, and intimate partner violence. Int J Gynaecol Obstet 2015; 133:3-8. [PMID: 26797197 DOI: 10.1016/j.ijgo.2015.08.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/04/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Infertility/subfertility could be a formerly unrecognized risk factor for intimate partner violence (IPV). OBJECTIVES To review the evidence on the association between infertility/subfertility in women and the risk of IPV. SEARCH STRATEGY Seven databases were searched for articles published in English or Spanish between January 2000 and July 2015. SELECTION CRITERIA Studies were included if they analyzed the relationship between infertility/subfertility and IPV in a quantitative manner. DATA COLLECTION AND ANALYSIS A systematic search was completed by one author, and articles meeting the inclusion/exclusion criteria were chosen by two authors. It was not possible to pool the data because of heterogeneity in the study design, the methods, and the definitions of IPV and infertility/subfertility found across the studies. Instead, a narrative report was completed. MAIN RESULTS Twenty-one papers met the inclusion/exclusion criteria. The available evidence indicated that infertility/subfertility is associated with IPV in low- and middle-income countries (LMICs). CONCLUSIONS Infertility/subfertility is associated with an increased risk of experiencing IPV in LMICs. Future research should focus on studies with a homogenous design, rigorous methodology, and appropriately selected study and control groups. Qualitative research would also be invaluable to assess the impact of relevant social variables on outcomes.
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Affiliation(s)
| | | | - Marleen Temmerman
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
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Impact of Gender Infertility Diagnosis on Marital Relationship in Infertile Couples: A Couple Based Study. SEXUALITY AND DISABILITY 2015. [DOI: 10.1007/s11195-015-9417-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Langer A, Meleis A, Knaul FM, Atun R, Aran M, Arreola-Ornelas H, Bhutta ZA, Binagwaho A, Bonita R, Caglia JM, Claeson M, Davies J, Donnay FA, Gausman JM, Glickman C, Kearns AD, Kendall T, Lozano R, Seboni N, Sen G, Sindhu S, Temin M, Frenk J. Women and Health: the key for sustainable development. Lancet 2015; 386:1165-210. [PMID: 26051370 DOI: 10.1016/s0140-6736(15)60497-4] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Afaf Meleis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Felicia M Knaul
- Harvard Global Equity Initiative, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
| | - Jacquelyn M Caglia
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Jewel M Gausman
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Annie D Kearns
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Tamil Kendall
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Mexico
| | - Naomi Seboni
- International Planned Parenthood Federation Governing Council, London, UK
| | - Gita Sen
- Indian Institute of Management, Bangalore, India
| | | | - Miriam Temin
- Center for Global Development, Washington, DC, USA
| | - Julio Frenk
- Harvard T H Chan School of Public Health, Boston, MA, USA
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Jafarzadeh-Kenarsari F, Ghahiri A, Habibi M, Zargham-Boroujeni A. Exploration of infertile couples' support requirements: a qualitative study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:81-92. [PMID: 25918596 PMCID: PMC4410041 DOI: 10.22074/ijfs.2015.4212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 09/28/2014] [Indexed: 11/29/2022]
Abstract
Background Due to high prevalence of infertility, increasing demand for infertility
treatment, and provision of high quality of fertility care, it is necessary for healthcare
professionals to explore infertile couples’ expectations and needs. Identification of these
needs can be a prerequisite to plan the effective supportive interventions. The current
study was, therefore, conducted in an attempt to explore and to understand infertile couples’ experiences and needs. Materials and Methods This is a qualitative study based on a content analysis ap-
proach. The participants included 26 infertile couples (17 men and 26 women) and 7
members of medical personnel (3 gynecologists and 4 midwives) as the key informants. The infertile couples were selected from patients attending public and private
infertility treatment centers and private offices of infertility specialists in Isfahan
and Rasht, Iran, during 2012-2013. They were selected through purposive sampling
method with maximum variation. In-depth unstructured interviews and field notes
were used for data gathering among infertile couples. The data from medical personnel was collected through semi-structured interviews. The interview data were
analyzed using conventional content analysis method. Results Data analysis revealed four main categories of infertile couples’ needs,
including: i. Infertility and social support, ii. Infertility and financial support, iii.
Infertility and spiritual support and iv. Infertility and informational support. The
main theme of all these categories was assistance and support. Conclusion The study showed that in addition to treatment and medical needs, infertile
couples encounter various challenges in different emotional, psychosocial, communicative, cognitive, spiritual, and economic aspects that can affect various areas of their life
and lead to new concerns, problems, and demands. Thus, addressing infertile couples’
needs and expectations alongside their medical treatments as well as provision of psychosocial services by development of patient-centered approaches and couple-based interventions can improve their quality of life and treatment results and also relieve their negative
psychosocial consequences.
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Affiliation(s)
- Fatemeh Jafarzadeh-Kenarsari
- Nursing and Midwifery Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ataollah Ghahiri
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Habibi
- Family Research Institute, Shahid-Beheshti University, Tehran, Iran
| | - Ali Zargham-Boroujeni
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Hasanpoor-Azghdy SB, Simbar M, Vedadhir A. The Social Consequences of Infertility among Iranian Women: A Qualitative Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 8:409-20. [PMID: 25780523 PMCID: PMC4355928 DOI: 10.22074/ijfs.2015.4181] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/25/2013] [Indexed: 11/04/2022]
Abstract
BACKGROUND Infertility may prevent couples to achieve the desired social roles and lead to some social and psychological problems. This study aimed to explain the social consequences of infertility in Iranian women seeking treatment. MATERIALS AND METHODS A qualitative content analysis was conducted based on 32 semi-structured interviews with 25 women affected by primary and secondary infertility with no surviving children. The participants were purposefully selected with maximum variability from a fertility health research center in Tehran, Iran, from January to October 2012. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method. RESULTS Our findings indicate that the consequences of infertility are divided into five main categories: 1. violence including psychological violence and domestic physical violence, 2. marital instability or uncertainty, 3. social isolation including avoiding certain people or certain social events and self-imposed isolation from family and friends, 4. social exclusion and partial deprivation including being disregarded by family members and relatives and reducing social interactions with the infertile woman and 5. social alienation. CONCLUSION This study reveals that Iranian women with fertility issues seeking treatment face several social problems that could have devastating effects on the quality of their lives. It is, therefore, recommended that, in Iran, infertility is only considered as a biomedical issue of a couple and pay further attention to its sociocultural dimensions and consequences.
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Affiliation(s)
- Syedeh Batool Hasanpoor-Azghdy
- Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
| | - Masoumeh Simbar
- The Research Center for Safe Motherhood , Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti Medical Sciences University, Tehran, Iran
| | - Abouali Vedadhir
- Department of Anthropology, Faculty of Social Sciences, University of Tehran, Tehran, Iran
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Bahamondes L, Makuch MY. Infertility care and the introduction of new reproductive technologies in poor resource settings. Reprod Biol Endocrinol 2014; 12:87. [PMID: 25201070 PMCID: PMC4180834 DOI: 10.1186/1477-7827-12-87] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/01/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family. METHODS This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost. RESULTS There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child. CONCLUSIONS It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.
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Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP Brazil
| | - Maria Y Makuch
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP Brazil
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Pantoja M, Fernandes A. Indications for in vitro fertilization at a public center for reproductive health in Campinas, Brazil. Int J Gynaecol Obstet 2014; 128:14-7. [PMID: 25261108 DOI: 10.1016/j.ijgo.2014.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 07/09/2014] [Accepted: 08/22/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the sociodemographic profile and gynecologic and obstetric characteristics of women referred to a public reference center in Campinas, Brazil, for in vitro fertilization (IVF). METHODS Women referred between April 1, 2008, and October 31, 2009, were eligible for inclusion in a cross-sectional study. Participants were interviewed about sociodemographic characteristics, obstetric and gynecologic history, and etiologic factors resulting in the referral. Preliminary clinical examinations performed elsewhere were evaluated. RESULTS A total of 176 women were included, of whom 129 (73.3%) presented with tubal factor infertility. Tubal ligation had been performed in 66 (37.5%) women. Overall, 121 (68.8%) women were aged 30 years old or less, 110 (62.5%) had received more than 8 years of schooling, 123 (69.6%) had had infertility for up to 5 years, and 99 (56.3%) did not have any children. Moreover, 25 (14.2%) women had endometriosis and 25 (14.2%) had a male factor issue. A previous ectopic pregnancy was reported for 20 (11.4%) women and pelvic inflammatory disease for 49 (27.8%). CONCLUSION Tubal factor infertility was the most common indication for IVF. Preventive measures are required, in addition to policies that ensure access to high-complexity treatments in the public sector.
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Affiliation(s)
- Marcia Pantoja
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Arlete Fernandes
- Gynecological Division, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil.
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Dyer SJ, Sherwood K, McIntyre D, Ataguba JE. Catastrophic payment for assisted reproduction techniques with conventional ovarian stimulation in the public health sector of South Africa: frequency and coping strategies. Hum Reprod 2013; 28:2755-64. [DOI: 10.1093/humrep/det290] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Hindin MJ, McGough LJ, Adanu RM. Misperceptions, misinformation and myths about modern contraceptive use in Ghana. ACTA ACUST UNITED AC 2013; 40:30-5. [PMID: 23771916 DOI: 10.1136/jfprhc-2012-100464] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Ghana, like the rest of West Africa, has very low contraceptive prevalence and is one of a few nations that reports declines in contraceptive use over time based on two of the most recent national surveys. Fear of side effects is a leading cause of non-use of contraception, based on national surveys. The objective of this study was to gain a more holistic understanding of why Ghanaian women are not using contraception. METHODS We used focus groups with vignettes to elicit normative beliefs about contraception. We recruited 91 women from three different clinics within Legon Hospital in Accra, Ghana: the antenatal clinic, the student clinic and the child welfare clinic. Focus groups were homogeneous with regard to age group and union status. RESULTS We found that women were most concerned with the menstrual irregularities caused by hormonal methods. In addition, women believed strongly that the hospital was the best place to get contraception as blood tests were needed to match women with the appropriate method. Knowledge of how methods worked and of basic reproductive biology was low. CONCLUSIONS Poor knowledge of how to use modern methods combined with myths and misinformation should be the targets of programmes to increase modern contraceptive prevalence in Ghana.
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Affiliation(s)
- Michelle J Hindin
- Associate Professor, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Infertility in resource-constrained settings: moving towards amelioration. Reprod Biomed Online 2013; 26:189-95. [DOI: 10.1016/j.rbmo.2012.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/19/2012] [Accepted: 11/07/2012] [Indexed: 11/21/2022]
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Abstract
Infertility affects more than 10% of the world's population. In developing countries, there are severe social, psychological and economic consequences for infertile men and women. All of the cited references are compiled from primary peer-reviewed research articles that were conducted through one-to-one interviews or focus groups in countries of developing regions, such as Africa, Asia and the Middle East. The following paper seeks to raise awareness of the consequences of infertility in developing nations and identify infertility as an under-observed, but significant public health issue. It is proposed that education programmes tailored to each society's specific religious beliefs and grounded traditions must be implemented in order to reverse the social stigma, detrimental psychological effects, and loss of economic security that results from infertility.
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Affiliation(s)
- Brittany Rouchou
- St George's University, True Blue, St. Georges, Grenada, West Indies.
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Mumtaz Z, Shahid U, Levay A. Understanding the impact of gendered roles on the experiences of infertility amongst men and women in Punjab. Reprod Health 2013; 10:3. [PMID: 23317173 PMCID: PMC3562138 DOI: 10.1186/1742-4755-10-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/10/2013] [Indexed: 11/10/2022] Open
Abstract
While infertility is a global challenge for millions of couples, low income countries have particularly high rates, of up to 30%. Infertility in these contexts is not limited to its clinical definition but is a socially constructed notion with varying definitions. In highly pronatalistic and patriarchal societies like Pakistan, women bear the brunt of the social, emotional and physical consequences of childlessness. While the often harsh consequences of childlessness for Pakistani women have been widely documented, there is a dearth of exploration into the ways in which prescribed gender roles inform the experiences of childlessness among Pakistani women and men. The aim of this study was to explore and compare how gender ideologies, values and expectations shape women's and men's experiences of infertility in Pakistan. Using an interpretive descriptive approach, in-depth interviews were conducted with 12 women and 8 men experiencing childlessness in Punjab, Pakistan from April to May 2008. Data analysis was thematic and inductive based on the principles of content analysis. The experience of infertility for men and women is largely determined by their prescribed gender roles. Childlessness weakened marital bonds with gendered consequences. For women, motherhood is not only a source of status and power, it is the only avenue for women to ensure their marital security. Weak marital ties did not affect men's social identity, security or power. Women also face harsher psychosocial, social, emotional and physical consequences of childlessness than men. They experienced abuse, exclusion and stigmatization at the couple, household and societal level, while men only experienced minor taunting from friends. Women unceasingly sought invasive infertility treatments, while most men assumed there was nothing wrong with themselves. This study highlights the ways in which gender roles and norms shape the experiences associated with involuntary childlessness for men and women in Punjab, Pakistan. The insight obtained into the range of experiences can potentially contribute to deeper understanding of the social construction of infertility and childlessness in pronatalistic and patriarchal societies as well as the ways in which gender ideologies operationalise to marginalise women.
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Affiliation(s)
- Zubia Mumtaz
- School of Public Health, University of Alberta, 3-309 Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton AB T6G 1C9, Canada.
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Gupta J, Falb K, Kpebo D, Annan J. Abuse from in-laws and associations with attempts to control reproductive decisions among rural women in Côte d'Ivoire: a cross-sectional study. BJOG 2012; 119:1058-66. [PMID: 22676807 DOI: 10.1111/j.1471-0528.2012.03401.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To document the lifetime prevalence of abuse from in-laws (both nonphysical maltreatment and physical violence), the forms of in-law abuse and reproductive control, and the relationship between experiences of in-law abuse and reproductive control among partnered women in rural Côte d'Ivoire. DESIGN Cross-sectional study using baseline data (October 2010) from a randomised controlled trial examining socio-economic interventions on reduction of violence against Ivorian women. SETTING Rural Côte d'Ivoire. POPULATION A total of 981 Ivorian women aged 18 years and older who reported having a male partner and a current source of stable income. METHODS Bivariate and multivariable logistic regression. MAIN OUTCOME MEASURES Lifetime, in-law-perpetrated reproductive control. RESULTS More than one in four (27.0%) women reported experiencing lifetime in-law abuse. In adjusted logistic regression analysis, in-law abuse was significantly associated with in-law-perpetrated reproductive control (adjusted odds ratio 6.9; 95% confidence interval 3.9-12.2; P < 0.0001). Religion and having fewer pregnancies were also associated with reporting in-law-perpetrated reproductive control. CONCLUSIONS Increased efforts are needed to involve in-laws in programmes that seek to reduce gender-based violence against women and improve women's reproductive health.
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Affiliation(s)
- J Gupta
- Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06510, USA.
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Fisher JRW, Hammarberg K. Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically informed clinical care and future research. Asian J Androl 2011; 14:121-9. [PMID: 22179515 DOI: 10.1038/aja.2011.72] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Research concerning the psychosocial aspects of infertility and infertility treatment focuses more often on women than men. The aim of this review was to synthesize the English-language evidence related to the psychological and social aspects of infertility in men and discuss the implications of these reports for clinical care and future research. A structured search identified 73 studies that reported data concerning the desire for fatherhood and the psychological and social aspects of diagnosis, assisted reproductive technology (ART) treatment and unsuccessful treatment among men with fertility difficulties. The studies are diverse in conceptualisation, design, setting and data collection, but the findings were reasonably consistent. These studies indicated that fertile and infertile childless men of reproductive age have desires to experience parenthood that are similar to those of their female counterparts; in addition, diagnosis and initiation of treatment are associated with elevated infertility-specific anxiety, and unsuccessful treatment can lead to a state of lasting sadness. However, rates of clinically significant mental health problems among this patient population are no higher than in the general population. Infertile men who are socially isolated, have an avoidant coping style and appraise stressful events as overwhelming, are more vulnerable to severe anxiety than men without these characteristics. Men prefer oral to written treatment information and prefer to receive emotional support from infertility clinicians rather than from mental health professionals, self-help support groups or friends. Nevertheless, structured, facilitated psycho-educational groups that are didactic but permit informal sharing of experiences might be beneficial. There are gaps in knowledge about factors governing seeking, persisting with and deciding to cease treatment; experiences of invasive procedures; parenting after assisted conception; adoption and infertility-related grief and shame among men. Few resource-constrained countries have any data concerning male experiences of infertility.
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Affiliation(s)
- Jane R W Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic., Australia.
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Makuch MY, Simonia de Padua K, Petta CA, Duarte Osis MJ, Bahamondes L. Inequitable access to assisted reproductive technology for the low-income Brazilian population: a qualitative study. Hum Reprod 2011; 26:2054-60. [DOI: 10.1093/humrep/der158] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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