ABSTRACT
The experience of infertility can greatly affect the couple’s general health, marriage, family relationships, job performance and social interactions. Added to the emotional and physical toll exerted by infertility is the financial burden carried by some couples seeking treatment for their disease. Approximately, one in ten couples experience primary or infertility. In Nigeria very little is known about the status of infertility and its associated factors. Therefore the objective of this study was to determine the prevalence of infertility and its associated factors of child bearing age 15-45 years, attending a given Model Primary Health Care using the nationally representative demographic 2022/23.
This paper used data from 2022-23 Nigeria Demographic Health Survey data and adopted a cross sectional study design. A representative sample of women who have had a child before, want another child and a have not had a child in the past five years was drawn. Descriptive analysis, binary logistic regression and Chi-square analysis were conducted to describe, test associations and establish the relationship between infertility and socio-economic, demographic as well as lifestyle factors. A multivariate logistic regression analysis was further conducted to ascertain the determinants of infertility.
Findings from this study showed that the prevalence of infertility in Nigeria was 14% and the factors associated with infertility were wealth index (AOR 0.47 CI: 0.223-0.975), a woman aged between 40-49 (AOR=0.46 CI: 0.208-0.856), the number of children she has had (AOR=0.55 CI 0.307-0.979), age difference between spouses (AOR=0.55 CI 0.307-0.979), living in a medium fertility belt (AOR =1.6 CI: 1.031-2.504), being HIV positive (AOR= 0.71 CI 0.578-1.042) as well as having a terminated pregnancy (1.53 CI:0.986-2.366) After adjusting for other factors (independent variables).
It is evident that infertility is very high in Nigeria and is influenced by socio demographic factors. Infertility is not merely an individual concern, it is a public health problem such that new interventions aimed at reducing the incidence and social implications of infertility are needed.
Key words: Infertility; socio demographic factors; Nigeria
CHAPTER ONE
Introduction
• Background of study
Infertility is a special reproductive health defect that is different from other diseases. It is not life threatening, but its detrimental influence to on patients, their families and the whole society should not be underestimated (Macaluso et al., 2010). Approximately, infertility affects between 60 million and 168 million people worldwide; generally, one in ten couples experience primary or infertility (Butler & Khanna, 2003; Vayena, Rowe, & Peterson, 2002). Worldwide rates of infertility vary dramatically corresponding to the incidence of preventable conditions leading to infertility, from 5 to 30% in sub-Saharan Africa (Daar & Merali, 2002; Vayena et al., 2009). A systematic analysis of infertility incidence in more than 190 countries and regions around the world showed that in 2010, women in age group 20–44 years suffered from infertility with an incidence of 10.5% (Mascarehas, 2013). Furthermore, infertility prevalence was highest in south Asia, sub-Saharan Africa, North Africa and the Middle East, central and Eastern Europe, and central Asia (Ibid). The "Infertility Belt" stretching across central and southern Africa has the world's highest rates of infertility (Butler & Khanna, 2003; Van Balen & Inhorn, 2002). The highest incidence is in some areas of sub- Saharan Africa, where rates of up to 50% have been recorded.
The World Health Organization (WHO, 2004) defines infertility as the inability to conceive a child. A couple may be considered infertile if, after two years of regular sexual intercourse, and without contraceptive use, the woman has not become pregnant. Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some of which may be bypassed with medical intervention (Makar & Toth, 2002). Infertility maybe primary or secondary. Primary infertility refers to couples who have never conceived whereas infertility refers to couples who are unable to conceive after one year of unprotected intercourse following previous pregnancy and not using any contraceptives (WHO, 1994). In this study infertility is defined as a woman who has had a live birth before, desires to have more children, has been in a union for at least five years, has not been on contraceptives and has not had any child in the same period.
• Consequences of infertility
Infertility exerts an enormous toll on both the affected individuals and on society. Couples in their most active and productive years are distracted by the physical, financial and emotional hardships of this disease (Safarinejad, 2007). For these couples, infertility is more than a disease; it is a devastating life crisis which can greatly affect the couple’s general health, marriage, family relationships, job performance and social interactions. Added to the emotional and physical toll exerted by infertility is the financial burden carried by some couples seeking treatment for their disease (Safarinejad, 2007). Infertility, whether primary or secondary, although affects couples, is an experience that strikes at the very core of a woman's life. Childlessness is found to result in perceived role failure, with social and emotional consequences for both men and women, and often has resulted in social stigmatization of the couple, particularly of the woman (Papreen et al., 2000).
Infertility places women at risk of social and familial displacement, and women clearly bear the greatest burden of infertility as motherhood is seen as a supreme achievement for a woman and demonstrates her physical and psychological adequacy (Chowdhury, 2009). In many parts of the world, including Nigeria, only a woman is thought to be responsible for producing next generation and the blame for absence of desired number and sex of children is unquestioningly placed on her.
The inability to reproduce desired number and sex of children results in catastrophe that negatively impacts a woman’s relationships not only with her husband but also with other family members leading to destabilization of her social status. Interactions with her husband, friends and family are altered and therefore lead to an altered experience of self loathe (Neelofar and Taeem, nd). Studies have revealed that severe emotional harassment is experienced by a large number of such women in their marital homes in the form of ostracism from family celebrations, taunting and stigmatization, negative attitude as well as beating, withholding of food and health care (Bentley and Mascie-Taylor, 2000).
The incidence of infertility in a population has important demographic and health implications as well. High infertility has a dampening effect on overall fertility and the rate of population growth and improvements in the ability to bear children may impede efforts to lower the fertility rate. For example, it has been estimated that a reduction in infertility in sub-Saharan Africa to “normal” levels would increase fertility in the region by 15% (Frank, 1983). Similarly, Bongaarts, Frank, and Lesthaeghe (1984) found that infertility accounts for 60% of the variation in total fertility in 18 sub-Saharan countries and that fertility decreases by one birth for each increase in 9 percentage points in the proportion of women age 45 to 49 who have no children.
• Difficulties in assessing the occurrence of infertility
There are however multiple difficulties inherent in assessing the occurrence of infertility. First, assessment and measurement is complicated by the fact that the condition is generally experienced by a couple, not as an individual. There is also a social bias in identifying infertility. Finally, no objective test or universally accepted definition for the condition exists. This is also compounded by inconsistencies in definitions of infertility (Bongaarts, Frank, Lesthaeghe (1984)). However, there is general consensus that rates of infertility are underestimated because of difficulty in measuring prevalence, potentially flawed methods for measurement, and cultural biases which create hidden categories of the condition (Daar & Merali, 2002).
Comparative studies of infertility are hampered by the fact that different definitions of infertility are being employed in epidemiological and demographic research. Mascarenhas et al (2012), pointed out that epidemiological definitions are oriented towards early detection of individual patients with the aim of starting treatment while the demographic definition attempts to measure infertility on a population level so that there is clear understanding of the magnitude, distribution and trends of the infertility problem.
Demographers have modified the epidemiological definition of infertility, and define infertility as the inability of a non-contracepting sexually active woman to have a live birth (Pressat, 1985). Demographers have also shifted the endpoint from conception to live births, because it is difficult to collect data about conceptions in population based studies. Furthermore, demographic analyses of infertility are often based on secondary data such as Demographic Health Surveys that contain complete birth histories but no information about miscarriages and still births (Larsen, 2000).
Larsen and Menken (1991), recommend, based on simulation, to use 7 years of exposure to measure primary infertility i.e. infertility of nulliparous women and 5 years of exposure to measure infertility i.e. infertility of parous women. Demographic estimates of infertility are based on relatively long periods of exposure (5 and 7 years) because it is difficult to assess exposure i.e. regular sexual intercourse of non-contracepting women, in population based of survey data. Estimates of primary infertility need longer periods of exposure because it is in particular difficult to assess onset of sexual activity from population based surveys. For analysis age was truncated at 25+ to circumvent the difficulties of separating adolescent’s subfertility from infertility (Ulla, 2009).
It should be noted that the focus of this study is on women experiencing infertility as opposed to primary infertility because the estimates of the prevalence of secondary are three times higher than those of primary infertility. The psychological, social, economic, and biological trauma of infertility are similar to those who experience primary infertility. In Nigeria very little is known about the status of infertility; however, infertility is not merely an individual concern but also a public health concern as the experience of infertility is a stressful condition itself. This study is an approach to find out the prevalence of infertility and its associated factors among married couples aged 24-49.
• Statement of the problem
In Nigeria, fertility trends have been widely studied however, the prevalence of infertility has not been well-documented. There is very little is known information about the status of infertility and its. However, the problem is considered quite prevalent as the Government of the Republic of Nigeria through the Reproductive Health Policy acknowledges that “the rates of infertility in Nigeria are not known but gauging from the prevalence of Sexually Transmitted Diseases (STDs) alone, it is estimated that both primary and infertility rates are of concern” (MOH, 2008). STDs are among the major risk factors of infertility and the most common contributors of impaired fertility. Impaired fertility, variously described as infertility or sub-fertility, may be due to a relative or absolute inability to conceive, or to repeated pregnancy wastage (MOH, 2008). Approximately, infertility affects between 60 million and 168 million people worldwide; generally, one in ten couples experience primary or infertility (Butler & Khanna, 2003; Vayena, Rowe, & Peterson, 2002). The "Infertility Belt" stretching across central and southern Africa has the world's highest rates of infertility (Butler & Khanna, 2003; Van Balen & Inhorn, 2002). The highest incidence is in some areas of sub-Saharan Africa, where rates of up to 50% have been recorded. In 2017, infertility was estimated at 17.8% at the University Teaching Hospital, which is the national referral centre (Munalula and Vwalika, 2017).
The government has made efforts to ensure the provision of appropriate services for overcoming infertility barriers to the achievement of reproductive intentions by providing preventive and curative services for couples /individuals with infertility problems. However, these efforts have been inadequate in capping infertility as evidenced by the current National Health Strategic Plan that has no direct objective, programs or intervention in addressing infertility but mentions it indirectly as a reproductive health program and is thus lumped with other reproductive health problems. Infertility has been relatively neglected as a health problem in Nigeria, but is more significant in a country like Nigeria where children are accepted as an integral part of the cultural and social fabric (Munalula, 2017). Infertility risk increases with reproductive age group between 15-45 years are 4.1% of 15-24 years old, 31.1% of 25-35 years old, 21.4% of 35-44 years old (Kumar, 2007). Infertility is not merely a health problem, it is a matter of social injustice and inequality for all, as they are having high levels of child and maternal mortality and morbidity. Therefore the aim of this study was to estimate the prevalence of infertility and to determine its associated factors.
• Significance of the Study
Infertility is more than a disease and affects both men and women alike. It is a devastating life crisis which can greatly affect the couple’s general health, marriage, family relationships, job performance and social interactions. Added to the emotional and physical toll exerted by infertility is the financial burden carried by some couples seeking treatment for their disease (Safarinejad, 2007).
Infertility has been relatively neglected as both a health problem and a subject for social science research in Nigeria, as well as the developing world (Safarinejad, 2007). The findings of this study are significant and relevant as it will provide information on the prevalence of infertility and its associated factors as the general thrust of both programmers and research has been on the correlates of high fertility and its relation. Further the study will help in understanding the context of infertility, its causes and consequences in a pronatalist culture of Nigeria where the consequences of infertility for women are devastating. This information will also be cardinal for implementing successful programmes for dealing with infertility in Nigeria that will need to include both appropriate and effective sources for treatment as well as preventive measures for infertility.
It will also attempt to estimate the prevalence of infertility which still unknown in Nigeria. By putting a spot light infertility perhaps government and other stakeholders devise better mechanisms of identifying and addressing infertility, so e that people know some of the factors associated with infertility occurs in women and where best to seek care. It can also serve as a building block that further research on infertility can be built upon.
• Research Objectives
• General objective
• To investigate the determinants of infertility among married couples aged 25-49 in Nigeria.
• Specific objectives:
• To determine the prevalence of infertility among married couples aged 25-49 in Nigeria.
• To examine the influence of social, and demographic factors on infertility among married couples aged 25- 49 in Nigeria
• To determine the effect of lifestyle factors on infertility among married couples aged 25-49 in Nigeria.
• Research questions Main research
What are the determinants of infertility among married couples aged 25-29 in Nigeria?
Specific research questions
• What is the prevalence of secondary fertility among married couples aged 25-49 in Nigeria?
• What are the social, economic and demographic factors influencing infertility among married couples aged 25-49 in Nigeria?
• What are the effects of lifestyle factors on infertility among married couples aged 2549 in Nigeria.
For more Nursing Sciences Projects Click here
===================================================================Item Type: Project Material | Size: 54 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
===================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.