1.0 Introduction
1.1 Background of Study
Infertility is a global health issue that affects millions of individuals and couples of reproductive age. According to the World Health Organization (2021), infertility is defined as a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Globally, it is estimated that about 48 million couples and 186 million individuals live with infertility, with the burden disproportionately affecting those in low- and middle-income countries (Mascarenhas et al., 2012). In many African societies, including Nigeria, infertility is often perceived as a personal tragedy and a social stigma, especially for women, despite medical advancements and increasing awareness.
The consequences of infertility extend beyond the physical inability to conceive, often leading to severe psychological and emotional distress. Women attending fertility gynaecological clinics frequently experience feelings of grief, depression, low self-esteem, marital strain, and social exclusion (Ojo & Fasubaa, 2019). These psychological effects are often compounded by societal pressures that define womanhood and marital success in terms of childbearing. Men are also affected, though cultural norms may cause them to suppress emotional responses or avoid seeking help altogether.
Fertility, defined as the natural capability to conceive children, is a crucial aspect of human reproduction. According to the World Health Organization (WHO, 2021), infertility is characterized as the inability to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. The inability to conceive can be emotionally and psychologically distressing for individuals and couples, leading many to seek medical assistance from gynaecological clinics.
Infertility is perceived as a problem across virtually all cultures and societies and affects an estimated 10-15% of couples of reproductive age (Bovine, Bunting, Collins & Negron, 2017). It has been viewed differently in different cultures. The population in the developed and developing countries hold different attitudes regarding infertility. In developing countries, infertility may be linked to an act of God, punishment for sins of the past, prolonged use of contraceptives, and the result of witchcraft which is causing childlessness, whereas people in developed countries view infertility as caused by biological and other related factors like excessive alcoholism, lack of cooperation between the man and the woman during sexual intercourse (Bovine, Bunting, Collins & Negron, 2017). No matter the culture, infertility is viewed as an enormous problem by couples everywhere.
According to Dhont, Van der Wijgert, Coene, Gasarabwe & Temmerman, (2010) children are seen as blessings of marriage and in some societies of the world; it is even believed that they are symbols of God's approval and blessings on marriages. Under normal circumstances, it is the choice of each individual and couple, within their own sense of conscience, to determine if they intend pregnancy and if so, the size of their family unit and the timing of when to have a child or children. However, in many African cultures, married couples who are unable to bear children shortly a few years after marriage are faced with all forms of unfriendly pressure from the family and social groups which could lead to unnecessary frustration, resentment and depression.
Apart from the rare cases when couples deliberately decide not to have children, inability to bear children has been the cause of many failed marriages and even destroyed many homes. It affects the self-esteem of a man, dampens his sense of control and also throws a woman into total confusion, frustration and anxiety. It is therefore an issue that should not be taken lightly by both the man and the woman. Many women believe that without children, life is without hope (Marida & Ulla, 2014).
World Health Organisation, 1987 as cited in Tabong & Adongo, (2013) defined infertility as failure to conceive after one year of regular unprotected sexual intercourse in the absence of known reproductive pathology. However epidemiological studies have revealed that in a normal population of heterosexually active women who are not using birth control methods, 25% will become pregnant in the first month, 63% within six months and 80% within one year. By the end of the second year, 85% to 90% will have conceived (National collaboration centre for women and children heath, 2012). Because some couples who are not infertile may not be able to conceive within the first year of unprotected sex, World Health Organization (WHO) therefore recommends the epidemiological definition of infertility, which is the inability to conceive within two years of exposure to pregnancy (WHO, 1987 in Tabong & Adongo, 2013).Individuals who are thought to be infertile are generally relegated to an inferior status, and stigmatized with many labels. As a result, childlessness has varied consequences through its effects in the society and on life style of individuals. Though in some cases, the childless life style enhances life satisfaction for some individuals, yet it is diminishing for others for whom parenthood is a personal goal (Aysel & Gul, 2015).
Graham (2015) noted that, parenthood is one of the major transitions in adult life for both men and women. The stress of the non fulfilment of a wish for a child has been associated with emotional related problems, sexual dysfunction and social isolation. Couples passing through the stress of infertility challenges experience stigma, sense of loss, and diminished self esteem in the society. Among couples with infertility challenges in general, women show higher levels of distress than their men partners. They experience sense of loss of identity and have pronounced feelings of incompleteness and incompetence.
For many couples, infertility is undeniably a major life crisis and psychologically stressful (Holstein, Christensen & Boivin, 2011a). It has been reported to cause depression, pain and the promise of often unfulfilled dreams in women. It is a lonely place for individuals and couples because “infertility is often a silent and solitary crucible, since it is not visible, life threatening or disfiguring” (Mogobe, 2010). Studies have found infertile women to be more neurotic, dependent and anxious than fertile women, experiencing conflict over their femininity and fear associated with reproduction. Others studies have similarly come to negative conclusions regarding the relationship between psychological factors and infertility (Noble, 2015).
Worldwide, more than 70 million couples suffer from infertility. In sub-Saharan Africa, the prevalence differs widely from 9% in the Gambia, 21.2% in north-western Ethiopia, 11.8% among women and 15.8% among men in Ghana and between 20 and 30% in Nigeria (National collaboration centre for women and children health, 2012). In African culture, the meaning of marriage is only fulfilled if the woman conceives and bears children as they are seen as sources of power and pride as well as assurance of family continuity. This study, therefore, aims to examine the coping strategies of clients with fertility issues attending gynaecological clinics.
1.2 Statement of Problems
Infertility is a deeply personal and emotionally challenging experience that affects not just physical health but also the psychological and social well-being of individuals. For many clients attending fertility gynaecological clinics, the journey is filled with uncertainty, fear, and societal pressure. In many cultures, particularly in African societies, the ability to have children is closely linked to identity, marital fulfillment, and social acceptance. When conception does not happen as expected, individuals especially women often face blame, stigma, and emotional trauma (Dyer, 2007).
Furthermore, the problem is not only the medical condition of infertility but the overwhelming emotional burden it brings. Many clients experience depression, anxiety, shame, and social isolation, which makes it difficult to maintain a sense of hope or balance in their daily lives (Greil et al., 2011). Relationships may become strained, and some individuals withdraw from social circles to avoid judgment or constant questions about childbearing. It is against the backdrop that this study seeks to address these problems by examining the coping strategies of clients with fertility issues attending gynaecological clinics.
1.3 Aim and Objectives of Study
The aim of this study is to explore and analyze the coping strategies employed by clients attending fertility gynaecological clinics in managing the emotional, psychological, and social challenges associated with infertility.
The specific objectives of the study are as follows:
- To identify the common coping strategies used by clients experiencing infertility.
- To examine the psychological and emotional impact of infertility on clients.
- To assess the role of cultural, religious, and social support systems in coping with infertility.
- To determine the effectiveness of different coping strategies on the mental well-being of clients.
- To provide recommendations for improving psychosocial support in fertility gynaecological clinics.
1.4 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What are the common coping strategies used by clients experiencing infertility?
- How does infertility impact the psychological and emotional well-being of clients?
- What role do cultural, religious, and social support systems play in how clients cope with infertility?
- How effective are the identified coping strategies in promoting mental and emotional well-being among clients?
- What measures can be recommended to enhance psychosocial support services in fertility gynaecological clinics?
1.5 Significance of Study
The findings of this research will be beneficial to healthcare professionals, particularly gynecologists, nurses, psychologists, and counselors, as it will inform them on the importance of integrating psychosocial support into infertility care. It will also guide them in developing more empathetic and patient-centered approaches to treatment.
Additionally, this research study will help policymakers and stakeholders in the health sector to recognize the need for supportive mental health programs within fertility clinics, and will advocate for improved services that address not only the physical but also the emotional needs of clients.
Furthermore, the study will provide future researchers with a foundational reference for further studies on infertility and mental health, particularly in culturally sensitive contexts where infertility is heavily stigmatized.
1.6 Scope of the Study
This study focuses on exploring the coping strategies adopted by clients attending fertility gynaecological clinics. It will involve clients receiving fertility treatment or counseling at University of Maiduguri Teaching Hospital (UMTH). The research study aims to examine the psychological, emotional, social, and cultural mechanisms clients use to cope with infertility challenges.
1.7 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- 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).
1.8 Definition of Terms
Coping Strategies: Coping strategies refer to the specific methods and behaviors that individuals use to manage stress, emotional distress, and challenges in difficult situations. in the context of infertility, coping strategies are the ways clients deal with the emotional and psychological strain caused by fertility problems (Lazarus & Folkman, 1984). These may include seeking social support, religious faith, problem-solving, or avoidance.
Fertility: Fertility is the natural capability to conceive children or offspring. When individuals or couples experience difficulty in conceiving after trying for an extended period, usually one year or more, they are considered infertile (World Health Organization [WHO], 2020).
Gynaecological Clinic: A gynaecological clinic is a healthcare facility specializing in the diagnosis, treatment, and management of women’s reproductive health issues, including fertility and infertility treatments (American College of Obstetricians and Gynecologists [ACOG], 2019).
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