CHAPTER ONE

INTRODUCTION

1.1      BACKGROUND OF THE STUDY

Infertility is a worldwide public health issue, affecting 8%–15% of couples in their reproductive age. There is a large variation in the pattern of infertility in different parts of the world, being highest in the infertility belt of Africa, which includes Nigeria. Children are the fabric of any society, without which no meaningful social and economic progress is considered worthwhile especially in Africa. Infertility is defined as the inability of couples to attain conception despite frequent, unprotected sexual intercourse for one year duration and it is a condition which affects them in reproductive age (Belsey, 1976).  Infertility entails that there is a deficiency that does not compromise the physical integrity of the individual nor is it life-threatening within the field of reproductive health. However, such deficiency may negatively impact the development of the individual, bringing about frustration and weakening the personality, since most couples consider having children as a vital objective. World Health Organization (WHO) in 2012 estimated that between 8 and 12% of couples experienced some form of physiological condition during their reproductive lives, thus affecting 50 to 80 million worldwide, out of which 20 – 35 million couples in Africa are expected to experience this issue. This can be foreseen to be 3 - 4 million Nigeria couples suffering from infertility (Thomas 2010). However an estimate of infertile couples in Ile-Ife has been put at 19% by Okonofua in 2010, although authors in previous studies in the other parts of Nigeria gave ranging estimates. In Africa, its prevalence is particularly high in sub-sahara African ranging from 20% to 60% (Ogunniyi, 2015). Cultural beliefs are major determinants in the prevailing explanation of infertility from the lay perspectives. The divergence in the etiological explanation of infertility between the patient and the professional health care provider has implications for care provision and compliance of the patient to treatment. Infertility has psychosocial impacts on couples especially the women. This is more obvious in high fertility settings where children are highly desired and parenthood is culturally mandatory. In African settings, infertility is a socially un-acceptable condition; leading most infertile couples on a relentless “quest for conception”. Studies have shown that women not only are harassed by the family members but face various forms of marital instabilities. The extent of negative psychological impact of infertility may be affected by factors, such as their desire for a child/family, family relationships and support, diagnosis and cause of the problem, cultural and religious beliefs and fertility drugs and treatment outcome. Typical reactions to infertility may include shock, grief, depression, anger, and frustration, anxiety, psychiatric morbidity as well as loss of self-esteem, self-confidence and a sense of loss of control over one's destiny (Miller, 2013). Relationships between spouses or partners may suffer. They may struggle with anxiety-related sexual dysfunction and other marital conflicts. While medical interventions may offer much-needed help and hope, studies suggest that they may also add to the stress, anxiety and grief that patient are already experiencing from infertility itself (Miller, 2013). Infertility treatment is expensive; patients who can't pay for treatment may feel helpless and hopeless. Infertility medications may cause anxiety, sleep interruptions, depression, mania, irritability and thinking problems. When treatment fails, on the other hand, a new cycle of grieving and distress can be triggered (Sadler & Syrop, 2014). Psychological strain itself can also be a cause or aggravate infertility; it may prevent ovulation from its effect pulsatile release of gonadotrophin releasing hormones. High circulating stress hormones can interfere with the timing of ovulation and shorten the luteal phase. Reduced progesterone levels in the luteal phase post-conception lessen the likelihood of a successful implantation and could cause early pregnancy failure due to luteal phase defect mechanisms. A study noted that women with high stress levels released 20% less eggs during ovulation, had up to 20% fewer oocytes retrieved and fertilized during IVF cycles than women with low stress levels (Ebbesen, 2010).  Addressing and managing depression, anxiety, and stress will break the vicious cycle often formed and help increase the chances of giving birth to a child. Newton etal., 2013; Pahlavani, 1998; Deir & et al, 2008; Mahram and ahanchian, 2015; Shah abadi, 2016; Van Den Acker, 2015; Infertility as an important psychological and social problem with psychological and social problems Several factors, such as depression, anxiety, helplessness, divorce, social isolation, dissatisfaction with life, and marital incompatibility. Also, their studies have shown that psychological factors can both contribute to the development of infertility and can be considered as a consequence. In this regard, there is ample evidence that psychological problems caused by infertility can be a contributing factor in intensifying infertility (Kay, Chang, Rabbar and Soules, 2010; Dumar, Kelp and Slasby, 2013). Since infertility is a medical and demographic phenomenon in societies, there is still no scientific study of the social aspects of infertility in our society, more studies have been done in the field of medicine and psychology. On the other hand, infertility is the cause of some divorces and divorces, and since women are more exposed to the psychosocial consequences of infertility, and in private life and marital relationships with issues such as feeling frustrated, blaming, mistreatment, neglect, Social and economic deprivations, and physical and psychological harassment, recognizing the issues and problems of this group and paying attention to these couples in the program and policies of reproductive health is important and these points are important reasons to justify the need to address the subject of this research they are considered.

1.2 STATEMENT OF THE PROBLEM

Infertility worldwide remains a major gynaecological problem with devastating psychosocial effect on women. It is observed that some women of child bearing age in Ose L.G.A in Ondo state do not have any children after a long period of their marriage despite that they did not use any contraceptive to prevent pregnancy. Infertility among women has led to broken homes, divorce, physical violence, stigmatization and discrimination especially to women, they are sometimes pushed out of their husband’s house without granting them access to their husband’s properties, most of women are sent back to their father’s house where they are cajoled and mocked by their sister in laws and given them all sort of names just to destabilize them. Many of them have visited various health care centres to seek for medical intervention for their childlessness, some of the health centre visited include both orthodox and traditional home. Some of the modern health centres visited includes governmental and private hospitals. Some of them have spent huge amount of money during this process that made some of them to become retched. Infertility has negative psychosocial consequences that do not limit or inhibit physical integrity but represent a crisis period for most couples. In many societies around the world, lack of pregnancy and the resulting childlessness are often highly stigmatizing, leading to profound social suffering for infertile couples. Infertility has been acknowledged as a serious public health problem globally and, especially in developing countries. In many societies around the globe, maternity provides a kind of social respectability for couples and lack of pregnancy is perceived as a humiliating condition. Infertility is considered a crisis with various biological, psychological, economic, ethical, and cultural consequences. As a result, infertility often leads to emotional stress, depression, anxiety, loss of self esteem and security, increased sense of guilt and self-blame, and relationship problems with partner, family, and friends. In African society, children are considered as assets and having many children is a symbol of high status. In the Nigerian context, giving birth is considered as a main purpose in life for couples. As children are assumed to be God’s blessings, life is meaningless for couples who fail to have children. Fertility has thus a great value in Nigerian context. Infertility as a social and personal problem is almost ignored. Despite the existence of a high fertility rate in the country, infertility as a social and personal problem has many dimensions. In view of this, the researcher carried out a study on the psychosocial causes of infertility on reproductive wellbeing of childbearing age women in Ose L.G.A, Ondo State.

1.3AIMS OF THE STUDY

The major purpose of this study is to examine perceived psychological causes of infertility among women of child bearing age. Other general objectives of the study are:

1.  To examine the awareness of infertility in among women of child bearing age in Ose L.G.A, Ondo state

2.  To examine the psychosocial challenges faced by infertile women in Ose L.G.A, Ondo state.

3.  To examine the impact of psychosocial causes of infertility on women of child bearing age in Ose L.G.A, Ondo state.

4.  To examine the social consequences of infertility among  women of  child bearing  age  in Ose L.G.A, Ondo state

5.  To identify the coping strategies childless women have to deal with infertility related problems in Ose L.G.A, Ondo state

6.  To examine the preventive methods of infertility among women of child bearing age.

1.4 RESEARCH QUESTIONS

1.  How is the awareness of infertility in among women of child bearing age in Ose L.G.A, Ondo state?

2.  What are the psychosocial challenges faced by infertile women in Ose L.G.A, Ondo state?

3.  What are the impacts of psychosocial causes of infertility on women of child bearing age in Ose L.G.A, Ondo state?

4.  What are the social consequences of infertility among women of child bearing age in Ose L.G.A, Ondo state?

5.  What are the coping strategies childless women have to deal with infertility related problems in Ose L.G.A, Ondo state?

6.  What are the preventive methods of infertility among women of child bearing age?

 1.5 RESEARCH HYPOTHESIS

H0: There is no impact of psychosocial causes of infertility on women of child bearing age in Ose L.G.A, Ondo state.

H1: There is a significant impact of psychosocial causes of infertility on women of child bearing age in Ose L.G.A, Ondo state.

1.6 SIGNIFICANCE OF THE STUDY

The result of this research work will be useful to the public. Because it will create awareness on the social consequences of infertility on women of child bearing age and the role it needs to play to curb this menace in our society. The women themselves will benefit from this research work as it will enable them to identify the problems associated with infertility which is not solely a medical problem because resultant psychosocial consequences such as anxiety, depression, marital difficulties, and societal stigmatisation have been reported. It will also benefit those in Public health because there is need for an intricate communal relationship between an individual and the environment and since infertility affects the complete living experience both qualitatively and quantitatively it goes beyond individual problems to a societal problem. The necessity to give women more attention and advocacy is obvious, therefore information from this study will be used by the policy makers and program managers in addressing the needs of women with infertility today and come up with effective interventions to help in the reduction of infertility among women of child bearing age. Findings of the study will also help focus attention on appropriate interventions responsive to the reproductive needs of women by strengthening friendly health services and promoting a safe and supportive social environment in which they can thrive. It will also show coping strategies in managing infertility among women and couples through guidance and counselling services.

1.7SCOPE OF THE STUDY 

The study is based on perceived psychological causes of infertility among women of child bearing age in Ose Local Government Area, Ondo state.

1.8 LIMITATION OF STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.9 DEFINITION OF TERMS

Infertility: Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” It can also be defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. The male partner can be evaluated for infertility or sub-fertility using a variety of clinical interventions, and also from a laboratory evaluation of semen.

Perceptions: Perceptions were defined as the attitudes towards infertility.

Psychosocial: Relating to the interrelation of social factors and individual thought and behaviour. The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is used in a broad range of helping professions in health and social care settings as well as by medical and social scientist.