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Luo D, Zhouchen YB, Li L, Jiang YL, Liu Y, Redding SR, Wang R, Ouyang YQ. The Stigma and Infertility-Related Stress of Chinese Infertile Women: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1053. [PMID: 38891128 PMCID: PMC11171736 DOI: 10.3390/healthcare12111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES This study was conducted to investigate the stigma status of infertile women in China and to determine the influencing factors. METHODS 366 infertile women from the gynecological and reproductive departments of two tertiary hospitals completed socio-demographic questionnaires, the Infertility Stigma Scale (ISS) and the Mandarin Fertility Problem Inventory (M-FPI). RESULTS The scores of stigma and infertility-related stress in infertile women were (52.51 ± 17.74) and (150.03 ± 17.51), respectively. Multiple regression analysis found that location of residence, regarding children as the most important thing in life, talking to others about infertility and infertility-related stress were the main influencing factors of stigma in infertile women, which explained 17.3% of the total variance. CONCLUSIONS In the current study, the level of stigma in women with infertility was at the middle range. Location of residence, regarding children as the most important thing in life, whether to talk with others about infertility and infertility-related stress were the four main influencing factors of stigma.
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Affiliation(s)
- Dan Luo
- School of Nursing, Wuhan University, Wuhan 430071, China; (D.L.); (Y.-B.Z.); (Y.-L.J.)
| | - Yi-Bei Zhouchen
- School of Nursing, Wuhan University, Wuhan 430071, China; (D.L.); (Y.-B.Z.); (Y.-L.J.)
| | - Lu Li
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;
| | - Yu-Lei Jiang
- School of Nursing, Wuhan University, Wuhan 430071, China; (D.L.); (Y.-B.Z.); (Y.-L.J.)
| | - Yi Liu
- Zhongnan Hospital of Wuhan University, Wuhan 430071, China;
| | | | - Rong Wang
- Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yan-Qiong Ouyang
- School of Nursing, Wuhan University, Wuhan 430071, China; (D.L.); (Y.-B.Z.); (Y.-L.J.)
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Yanık D, Kavak Budak F. The Effect of Positive Psychotherapy-Based Training on Stigma and Self-Efficacy in Women Receiving Infertility Treatment. J Am Psychiatr Nurses Assoc 2024; 30:384-396. [PMID: 36113201 DOI: 10.1177/10783903221122801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infertility has increased in recent years. Infertility can cause many mental problems. The place of psychoeducation based on positive psychotherapy (PPT) is important in coping with mental problems. AIMS The aim of this study is to determine the effect of PPT-based training on stigma and self-efficacy in women receiving infertility treatment. METHODS This experimental study with randomized control group was completed with 64 women receiving infertility treatment. While the women in the experimental group received an 8-session PPT-based training, no intervention was applied to those in the control group. RESULTS A statistically significant difference was observed (p= .001) between the stigma and self-efficacy levels of the experimental group after the PPT-based training. CONCLUSIONS It was found that the PPT-based training was effective in decreasing stigma level of the women who received infertility treatment and increasing their self-efficacy level.
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Affiliation(s)
- Derya Yanık
- Derya Yanık, PhD, Batman University, Batman, Turkey
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Asante-Afari K, Nantomah B, Yendaw E, Borbor FM. Going through treatment: experiences of women who sought assisted reproductive technology treatment in five selected hospitals in Ghana. CULTURE, HEALTH & SEXUALITY 2024; 26:421-432. [PMID: 37083179 DOI: 10.1080/13691058.2023.2202725] [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: 05/05/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
Using a qualitative approach, this paper explores the accounts of 30 women who accessed assisted reproductive technology treatment in five fertility hospitals in Ghana. A semi-structured interview guide was used to collect data on women's experiences of the procedure. Findings indicated that most of the women sought ART treatment to save their relationships from collapsing, with pressure and demands from friends and in-laws as key motivating factors. Women complained of emotional imbalance and the high cost of ART treatment. They felt compelled to borrow money from friends, family and banks and, sometimes sold assets to pay for treatment costs. Health consequences such as depression, changes in menstrual flow, weight loss, body pain, breast tenderness, bleeding and disruption to daily activities and sexual life were reported as problems encountered by the women. While study findings are supportive of the inclusion of infertility treatment in the national health insurance scheme, more adequate counselling and education for women undergoing ART treatment is required.
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Affiliation(s)
| | - Bismark Nantomah
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Elijah Yendaw
- Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Upper West Region, Ghana
- Centre for Environment, Migration and International Relations, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Upper West Region, Ghana
| | - Frank Mawutor Borbor
- Faculty of Social Sciences, Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Akhter-Khan SC, van Es W, Prina M, Lawrence V, Piri I, Rokach A, Heu LC, Mayston R. Experiences of loneliness in lower- and middle-income countries: A systematic review of qualitative studies. Soc Sci Med 2024; 340:116438. [PMID: 38016310 DOI: 10.1016/j.socscimed.2023.116438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
Loneliness is understood as a subjective experience resulting from unmet social relationship expectations. As most loneliness research has been conducted in higher-income-countries, there is limited understanding of loneliness in relation to diverse cultural, economic, and socio-political factors. To address this gap, the present review systematically synthesises existing qualitative studies on the experience of loneliness and social relationship expectations in lower- and middle-income countries (LMICs). Between June and July 2022, six online databases (Embase, Ovid Medline, APA PsycINFO, Global Health, Web of Science, Google Scholar) were searched for peer-reviewed studies from LMICs on loneliness using qualitative methods. There were no restrictions on publication date, language, or study setting. Studies that solely focused on social isolation or were conducted with children (<16 years) were excluded. Risk of bias was assessed with the Critical Appraisal Skills Programme. After deduplication, a total of 7866 records were identified and screened for inclusion, resulting in 24 studies published between 2002 and 2022. The included studies represent data from 728 participants in 15 countries across West Africa (Ghana, Nigeria, Niger, Mali), East Africa (Uganda, Kenya), North Africa (Egypt), West Asia (Iran), South Asia (India, Pakistan, Sri Lanka) and Southeast Asia (Myanmar, Cambodia, Indonesia, Philippines). Data were analysed combining inductive and deductive coding, summarised using narrative synthesis, and examined by geographical region. Common features of loneliness included rejection, overthinking, and pain. Loneliness was related to depression across regions. Whereas loneliness tended to be distinguished from social isolation in studies from Africa, it tended to be related with being alone in studies from Asia. Poverty and stigma were common barriers to fulfilling social relationship expectations. This review illustrates how loneliness and expectations are contextually embedded, with some expectations possibly being specific to a certain culture or life stage, having implications for assessment of and interventions for loneliness worldwide.
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Affiliation(s)
- Samia C Akhter-Khan
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom.
| | - Willemijn van Es
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vanessa Lawrence
- Department of Health Service & Population Research, King's College London, London, United Kingdom
| | - Ilayda Piri
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Ami Rokach
- Department of Psychology, York University, Toronto, Canada
| | - Luzia C Heu
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Rosie Mayston
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom
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5
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Kuug AK, James S, Sihaam JB. Exploring the cultural perspectives and implications of infertility among couples in the Talensi and Nabdam Districts of the upper east region of Ghana. Contracept Reprod Med 2023; 8:28. [PMID: 37076914 PMCID: PMC10114423 DOI: 10.1186/s40834-023-00225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Infertility remains a major clinical and social problem, affecting approximately one in every 10 couples. It is a reproductive health condition that is silently experienced with deep repercussions in the essence of self. In Ghana childbearing is considered a social prestige, where the couples are unduly pressurized to bear children for purposes of genealogical continuity. PURPOSE This study explored the cultural perspectives and implications among males and females experiencing infertility in the Talensi and Nabdam districts of the Upper East Region of Ghana. METHODS This study used an ethnographic design to explore the perspectives of couples on socio-cultural beliefs about infertility on 15 participants made up of 8 male and 7 female couple units. Participants were selected using a purposive sampling technique while semi-structured interviews were used to explore the cultural implications on male and female couple units. The data were analysed using Tesch's method of analysing qualitative data. RESULTS Two broad themes and five subthemes emerged from the data analysis regarding the cultural implications of infertility. The major themes and subthemes include: (1) Varying cultural perceptions of infertility (Cultural beliefs and perceptions regarding causes of infertility, cultural consequences of infertility and traditional remedies for infertility), and (2) family dynamics stemming from infertility (abuse from family members, and parenthood as a standard for family inheritance). CONCLUSIONS This study adduces evidence of the cultural implications of infertility in rural Ghana. Considering the cultural inclination of most Ghanaian communities, especially the current study setting, it is imperative that policymakers and public health practitioners should consider fertility interventions that are culturally sensitive. Also, culturally sensitive intervention programs that are targeted at increasing the awareness of the rural population on fertility and its treatment should be considered.
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Affiliation(s)
- Anthony Kolsabilik Kuug
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
| | - Sindiwe James
- Department of Nursing Science, Nelson Mandela University, Port Elizabeth, P O Box X77000, Gqeberha, 6013, South Africa
| | - Jardien-Baboo Sihaam
- Department of Nursing Science, Nelson Mandela University, Port Elizabeth, P O Box X77000, Gqeberha, 6013, South Africa
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Duran S, Can Öz Y. The Association Between Spirituality and Hope Among Turkish Women Undergoing Infertility Treatment. JOURNAL OF RELIGION AND HEALTH 2023; 62:764-777. [PMID: 36409430 DOI: 10.1007/s10943-022-01689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to determine the effect of spirituality on the levels of hope in women undergoing infertility treatment. This cross-sectional study was completed with the participation of 150 women undergoing IVF treatment at a university hospital in Kocaeli. In this study the women's spiritual well-being levels were high, and their hope levels were above the average score. Significant correlations were found between hope, spirituality, educational status, and age. Since attempts to boost hope will increase the chance of success in treatment, it is thought that factors affecting the level of hope should be determined and addressed. It is also thought that health professionals can apply hope therapy to women and take initiatives to provide spiritual support.
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Affiliation(s)
- Songul Duran
- Health Services Vocational College, Care of Elderly Program, Izmir Demokrasi University, Izmir, Turkey.
| | - Yüksel Can Öz
- Department of Psychiatric Nursing, Faculty of Health Sciences, Kocaeli University, Izmir, Kocaeli, Turkey
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Dube L, Bright K, Hayden KA, Gordon JL. Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis. Hum Reprod Update 2023; 29:71-94. [PMID: 36191078 DOI: 10.1093/humupd/dmac034] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates. OBJECTIVE AND RATIONALE This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach. SEARCH METHODS An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence. OUTCOMES There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge's g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07-1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate. WIDER IMPLICATIONS This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.
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Affiliation(s)
- Loveness Dube
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Katherine Bright
- Department of Outpatient Psychiatry, Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Department of Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Pharmacotherapy of infertility in Ghana: Why do infertile patients discontinue their fertility treatment? PLoS One 2022; 17:e0274635. [PMID: 36251650 PMCID: PMC9576038 DOI: 10.1371/journal.pone.0274635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
Background Globally, millions of people of reproductive age experience infertility. With that notwithstanding, most infertile patients undergoing pharmacotherapy withdraw from treatment before achieving the desired outcome. The reasons for their withdrawal, particularly in sub-Saharan Africa, have not been well examined, hence the need for this study. Objectives The aim of the study was to examine why infertile patients discontinue pharmacotherapy prior to achieving conception. Methods The study employed an exploratory qualitative design. Purposive sampling technique was used to recruit subjects into the study. Twenty infertile patients (fourteen females and six males) who discontinued their treatment, and eight attending health professionals who provided direct care to these patients were interviewed. Telephone and face-to-face interviews were conducted using a semi-structured interview guide. The data collected were transcribed, coded, and generated into themes using thematic content analysis. Results The major reasons for discontinuation of infertility treatment included lack of support from male partners, seeking alternative treatment, unmet outcome, poor medical services, distance, stigmatization, and relocation. Conclusions Patients and healthcare personnel shared both similar and diverse views on reasons for discontinuation of infertility treatment that reflect situations in a typical African setting, most of which are not reported in existing studies. The outcome of this study will provide insight for fertility therapists and policy makers in designing appropriate measures to facilitate maximum compliance and improvement in treatment outcome.
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Sant'Anna EM, Paiva SPC, Santos RP, Rodrigues AMS, Davis NA, Nery SF, Maia FP, Ferreira AVM, Reis FM. Mindfulness-based program to support lifestyle modification and weight loss in infertile women: randomized controlled trial. J Psychosom Obstet Gynaecol 2022; 43:136-144. [PMID: 32972271 DOI: 10.1080/0167482x.2020.1823962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We evaluated the short-term effects of a mindfulness-based program (MBP) on weight loss through lifestyle modification in infertile women who were overweight or obese. METHODS The participants were randomly assigned to 8 consecutive weekly sessions of MBP plus diet or diet alone. Both groups received a customized dietary plan. Body measures were taken and a questionnaire was applied to evaluate dietary habits at baseline and three months later. RESULTS The study was completed by 28 women in the MBP group and 24 in the control group. Body weight decreased 1.8 kg (2.1%) in the MBP group (p = 0.001, follow-up vs. baseline) and 1.7 kg (1.9%) in the control group (p = 0.035). There was an average reduction of 2.9 cm of waist circumference in the MBP group (p = 0.008) and 0.3 cm in the control group (p = 0.633). There was a significant reduction in the daily energy intake of the women attending the MBP (mean difference -430 Kcal/day, p=0.010) whereas no significant change was observed in the control group. CONCLUSION In the short term, this MBP did not affect weight loss in infertile women, but the MBP intervention contributed to reduce waist circumference, possibly due to a significant decrease in food energy intake. TRIAL REGISTRATION NUMBER RBR-7by76r.
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Affiliation(s)
- Edna M Sant'Anna
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sara P C Paiva
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raphael P Santos
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana M S Rodrigues
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nakita A Davis
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Simone F Nery
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda P Maia
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adaliene V M Ferreira
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Armah D, van der Wath AE, Yazbek M, Naab F. Development of Holistic Health Care Interventions for Women With Infertility: A Nominal Group Technique. Holist Nurs Pract 2022; 36:85-92. [PMID: 35166249 DOI: 10.1097/hnp.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Infertility care is often directed by a biomedical approach rather than a holistic approach, especially in African countries. This article explores the opinions of health care providers regarding holistic health care interventions in managing women with infertility in Ghana. Data were retrieved using a qualitative design and nominal group technique with a purposive sample of 12 health care providers in Ghana. Data were analyzed through thematic analysis. Health care providers explored various psychological, educational, spiritual, social, and medical interventions to ensure women diagnosed with infertility receive holistic treatment and attain optimal health.
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Affiliation(s)
- Deborah Armah
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa (Drs Armah, van der Wath, and Yazbek); and Department of Maternal and Child Health, School of Nursing, College of Health Sciences, University of Ghana, Legon, Accra, Ghana (Dr Naab)
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11
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Cox CM, Maya ET, Ali HM, Clayton L. Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana. QUALITATIVE HEALTH RESEARCH 2022; 32:491-503. [PMID: 34931573 DOI: 10.1177/10497323211060816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.
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Affiliation(s)
| | - Ernest Tei Maya
- School of Public Health, 260088University of Ghana, Accra, Ghana
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12
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Dube L, Nkosi-Mafutha N, Balsom AA, Gordon JL. Infertility-related distress and clinical targets for psychotherapy: a qualitative study. BMJ Open 2021; 11:e050373. [PMID: 34753757 PMCID: PMC8578979 DOI: 10.1136/bmjopen-2021-050373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES An estimated 30%-40% of women attending infertility tertiary care facilities experience clinically significant depression and anxiety. However, current psychological interventions for infertility are only modestly effective in this population. In this study, we aimed to identify the specific psychological components of infertility-related distress to assist in the development of a more targeted and effective therapeutic intervention. To our knowledge, this study is the first of its kind to include the views and opinions of mental health professionals who specialise in the field of infertility and the first to explore therapies currently used by mental health professionals. DESIGN A qualitative approach using semistructured individual interviews and focus group interviews with women who have experience with infertility and also mental health professionals specialising in the field of infertility. Thematic analysis was used to identify patterns and themes emerging from the data. PARTICIPANTS Twenty-one women (aged 25-41 years) struggling to conceive for ≥12 months and 14 mental health professionals participated in semistructured interviews about the psychological challenges related to infertility. RESULTS Five themes, each divided into subthemes, emerged from the data and these were developed into a model of infertility-related distress. These five themes are: (1) anxiety, (2) mood disturbance, (3) threat to self-esteem, identity and purpose, (4) deterioration of the couple and (5) weakened support network. In addition, therapeutic techniques used by mental health professionals were identified. CONCLUSIONS The results of this study suggest specific clinical targets that future interventions treating infertility-related distress should address.
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Affiliation(s)
- Loveness Dube
- Department of Psychology, University of Regina Faculty of Arts, Regina, Saskatchewan, Canada
| | - Nokuthula Nkosi-Mafutha
- Department of Nursing Education, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Ashley A Balsom
- Department of Psychology, University of Regina Faculty of Arts, Regina, Saskatchewan, Canada
| | - Jennifer L Gordon
- Department of Psychology, University of Regina Faculty of Arts, Regina, Saskatchewan, Canada
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13
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Polis CB, Otupiri E, Hindin M, Chiu DW, Keogh SC, Aidoo C, Larsen-Reindorf R, Bell SO. Prevalence and Correlates of Perceived Infertility in Ghana. Stud Fam Plann 2021; 51:207-224. [PMID: 32964426 PMCID: PMC7539950 DOI: 10.1111/sifp.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Perceived infertility is an understudied phenomenon in low‐ and middle‐income countries, where biomedical infertility can have severe consequences, particularly for women. We conducted a nationally representative survey of Ghanaian women, estimated the prevalence of and reasons for perceived infertility, and assessed factors associated with higher levels of perceived infertility using a partial proportional odds model. Among 4,070 women, 13 percent believed they were “very likely” to have difficulty getting pregnant when they wanted to, 21 percent believed this was “somewhat likely,” and 66 percent believed this was “not at all likely.” Reasons for perceived infertility varied by whether the respondent was currently seeking pregnancy. In multivariable analysis, several factors were associated with higher levels of perceived infertility, while unexpectedly, women who reported ever using contraception were less likely to report perceived infertility. Acknowledging the need to address infertility globally and understanding the role of perceived infertility are important components in supporting people's ability to decide whether and when to have children.
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Affiliation(s)
- Chelsea B Polis
- Chelsea B. Polis, Guttmacher Institute, New York, NY.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Easmon Otupiri
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | - Michelle Hindin
- Suzanne O. Bell, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Easmon Otupiri, Cara Aidoo, Roderick Larsen-Reindorf, School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana. Michelle Hindin, Population Council, New York, NY
| | - Doris W Chiu
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Sarah C Keogh
- Chelsea B. Polis, Guttmacher Institute, New York, NY
| | - Cara Aidoo
- Doris W. Chiu, Sarah C. Keogh, Guttmacher Institute, New York, NY
| | | | - Suzanne O Bell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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14
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Kyei JM, Manu A, Kotoh AM, Adjei CA, Ankomah A. Beliefs about children and the psychosocial implications of infertility on individuals seeking assisted fertilization in Ghana. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 12:88-95. [PMID: 33898794 PMCID: PMC8053779 DOI: 10.1016/j.rbms.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 05/02/2023]
Abstract
Infertility presents challenges to individuals and couples, particularly in Sub-Saharan Africa. This study aimed to document beliefs about childbearing/children and the psychosocial implications of infertility in individuals seeking assisted fertilization in the Ghanaian context. The study had an exploratory descriptive qualitative design. Six males and 12 females were recruited purposefully from five private fertility centres in the Greater Accra Region. Face-to-face interviews were performed. In Ghanaian society, couples and individuals with infertility who are seeking assisted fertilization consider having biological children to be important. The quest to have children was broadly centred on the associated benefits of being a parent, including societal recognition, the role of family inheritance, and support. The inability of participants to have biological children was found to have a negative effect on their psychological and social well-being. Anxiety, worry, hopelessness, stigma and suicidal ideations were some of the effects identified. It is recommended that those seeking assisted fertilization should be supported through counselling to minimize the potential negative effects of childlessness.
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Affiliation(s)
| | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Agnes M. Kotoh
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Population Council, Accra, Ghana
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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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Ofosu-Budu D, Hanninen V. Living as an infertile woman: the case of southern and northern Ghana. Reprod Health 2020; 17:69. [PMID: 32434580 PMCID: PMC7240982 DOI: 10.1186/s12978-020-00920-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background Infertility is detrimental to the health of married couples, especially women. Despite the consequences associated with the condition, little is done to reduce the repercussions. This study throws more light on the lived experiences of infertile women and on how they can be helped to improve their own condition. Methodology We interviewed 30 infertile married women in the Northern and Ashanti regions of Ghana, 15 from each region. A qualitative method, phenomenological study design and thematic analysis was employed to explore their lived experiences. Results Due the huge stigma, some women reported that their loved ones encouraged them to try to conceive. Others revealed that, they were considering relocating from their current communities to reduce the insults, intense pressure, stress, and stigma. Though some revealed maltreatment from their husbands and in-laws, others stated their husbands disclosed their fertility status to their own family members to avoid these families pressuring these women. Conclusions To reduce the stigma, pronatalist societies urgently need education and sensitization. Would-be couples should be counselled to have a plan to deal with such occurrences should they experience them.
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Affiliation(s)
- Dorcas Ofosu-Budu
- Department of Social Science, University of Eastern Finland, Kuopio, Finland.
| | - Vilma Hanninen
- Department of Social Science, University of Eastern Finland, Kuopio, Finland
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Kong L, Shao Y, Xia J, Han J, Zhan Y, Liu G, Wang X. Quantitative and Qualitative Analyses of Psychological Experience and Adjustment of In Vitro Fertilization-Embryo Transfer Patients. Med Sci Monit 2019; 25:8069-8077. [PMID: 31656309 PMCID: PMC6836641 DOI: 10.12659/msm.916627] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to quantitatively analyze the psychosocial characteristics of in vitro fertilization-embryo transfer (IVF-ET) couples and normal couples, and to identify the influencing factors of psychological characteristics and pregnancy outcomes. MATERIAL AND METHODS There were 260 infertile couples undergoing IVF-ET and 277 healthy couples of childbearing age in Shengjing Hospital of China Medical University recruited into 2 groups. Psychosocial characteristics were compared to analyze the influencing factors of pregnancy outcomes after IVF-ET. In-depth interviews (n=11) and infertility-related forum posts (n=12) were adopted to obtain the data related to the psychological experience and adjustment. Nvivo 11 software was utilized to collect and analyze the data. RESULTS The levels of anxiety and depression in the IVF-ET group were significantly higher (both P<0.01), the total scores of marital quality scale and social support scale were significantly lower (both P<0.05), immature defense mechanism score was significantly higher (P<0.05), and mature defense mechanism score (P<0.05) was significantly lower than those in the control group. Bod mass index (BMI), family's rural residence, marital quality, and immature and mature defense mechanisms were influencing factors of depression in IVF-ET female patients (all P<0.05). Marital quality, mature and immature defense mechanisms, concealment factors, and Harm Avoidance (HA) score were influencing factors of depression in IVF-ET males (all P<0.05). The age of the female patient was an independent influencing factor of IVF-ET pregnancy success rate (P<0.01). CONCLUSIONS The mental health levels of IVF-ET patients were worse than those of fertile couples. The younger the female infertile patient, the higher pregnancy rate of IVF-ET.
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Affiliation(s)
- Lin Kong
- Department of Obstetrics and Gynecology, Assisted Reproduction Center, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yun Shao
- Department of Clinical Psychology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jing Xia
- Department of Clinical Psychology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jiyang Han
- Department of Clinical Psychology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yuhua Zhan
- Department of Clinical Psychology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Guo Liu
- Department of Clinical Psychology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xumei Wang
- Department of Clinical Psychology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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Çapık A, Aksoy M, Yılmaz E, Yılmaz F. Infertility Stigma Scale: A psychometric study in a Turkish sample. Perspect Psychiatr Care 2019; 55:328-335. [PMID: 30680737 DOI: 10.1111/ppc.12360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/27/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the present study is to conduct the Turkish validity and reliability study of the Infertility Stigma Scale (ISS). DESIGN AND METHODS This methodological study was conducted in an infertility polyclinic in Turkey. The sample consisted of 178 infertile women. FINDINGS The validity of the four-factor structure of the scale and the appropriateness of its fit indices were confirmed. The analyses of internal consistency indicated that the total score correlations of items were sufficient; test-retest, r = 0.948;P < 0.001; Cronbach's α = 0.93. PRACTICE IMPLICATIONS ISS could be used as a useful assessment instrument in investigating the stigma concerning infertility and making efficient related interventions.
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Affiliation(s)
- Ayla Çapık
- Department of Midwifery, Faculty of Health Science, Ataturk University, Erzurum, Turkey
| | - Meyreme Aksoy
- Department of Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
| | - Emine Yılmaz
- Department of Nursing, Faculty of Health Science, Bingöl University, Bingöl, Turkey
| | - Filiz Yılmaz
- Erzurum Regional Training and Research Hospital, Ministry of Health, Erzurum, Turkey
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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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