Understanding the impact of gendered roles on the experiences of infertility amongst men and women in Punjab

Muslim Women's Experiences with Infertility: A Literature Review

OBJECTIVE

Infertility affects one in six women worldwide, playing a large role on an individual's psychosocial wellbeing and quality of life. The purpose of this review was to examine the experiences of Muslim women with infertility.

METHODS

A Prisma-guided literature review was conducted in Scopus, CINAHL, PubMed, Embase, PsychInfo, and Google Scholar. Sample inclusion criteria included research that examined the psychosocial consequences of infertility in women, used a qualitative design, were from a Muslim majority country or specified participants were Muslim, and were published in the English-language since 2013. Thematic analysis was used to synthesize the findings into themes.

RESULTS

Fourteen qualitative studies that explored the experiences of Muslim women with infertility were included for analysis. Women's responses were categorized into three focus areas: (1) emotional responses, (2) interpersonal relationships, and (3) social relationships. From these focus points, six overarching themes were identified that illustrated the challenges faced by Muslim women experiencing infertility: (1) identity crisis, (2) low self-esteem and depression, (3) abuse and harassment, (4) a weakened marital bond, (5) stigma, and (6) social exclusion and isolation.

CLINICAL IMPLICATIONS

Review of the literature provided an initial entrée into understanding the experiences of Muslim women with infertility. Understanding the unique role of infertility within a religious community equips nurses and other providers with the knowledge that discussions surrounding infertility must be conducted with cultural sensitivity. Further research should be conducted to explore and offer culturally tailored educational materials that align with the religious preferences of Muslim women.

Factors affecting self-esteem and disease acceptance in patients from infertile couples

Introduction

Infertility has been diagnosed in millions of people around the world and is described as a complex medical, mental, and social problem that affects many aspects of life. The aim of the study was to extract the determining factors and the level of self-esteem and the degree of acceptance of the disease in infertile patients and to find differences between women and men in this aspect.

Methods

A total 456 patients (235 women and 221 men) from infertile couples participated in a cross-sectional study. To collect data a Personal Information Form (PIF), Rosenberg Self-Esteem Scale (SES), and Acceptance of Illness Scale (AIS) were used.

Results

The overall self-esteem score for the whole sample was 30.50 (15 ± 30) points and for acceptance of the disease 32.4 (8 ± 40) points. In the study group, men obtained a slightly higher level of self-esteem than women (31.00 vs. 30.04 points). Additionally, men had a higher level of acceptance of the disease (33.12 vs. 31.80) than women. Socio-demographic factors such as age and level of education had impact on scores SES and AIS. Clinical factors did not determine the results of SES and AIS, both in the overall sample and in the female and male groups.

Conclusion

Self-esteem in patients from infertile couples increases with age and level of education. There are also significant differences between women and men, i.e., positive correlations between the level of education and self-esteem in men and the degree of acceptance of the disease in women.

COVID-19 vaccine hesitancy and attitudes in Pakistan: a cross-sectional phone survey of major urban cities

BACKGROUND

COVID-19 mass vaccination is the only hopeful savior to curb the pandemic. Vaccine distribution to achieve herd immunity is hindered by hesitance and negative attitude of the public against COVID-19 vaccination. This study aims to evaluate the vaccine hesitancy and attitudes in major cities in Pakistan as well as their determinants.

METHODS

A cross-sectional telephonic survey was conducted in June 2021 in major cities of Pakistan including Karachi, Lahore, Islamabad, Peshawar, and Gilgit, from unvaccinated urban population aged 18 years or older. Random Digit Dialing through multi-stage stratified random sampling was used to ensure representation of each target city and socio-economic classes. Questionnaire collected information on socio-demographics, COVID-19-related experiences, risk perception of infection, and receptivity of COVID-19 vaccination. Multivariate logistic regression analyses were performed to identify key determinants of vaccine hesitancy and acceptance.

RESULTS

The prevalence of vaccinated population in this survey was 15%. Of the 2270 respondents, 65% respondents were willing to vaccinate, while only 19% were registered for vaccination. Factors significantly associated with vaccine willingness were older age (aOR: 6.48, 95% CI: 1.94-21.58), tertiary education (aOR: 2.02, 95% CI: 1.36, 3.01), being employed (aOR: 1.34, 95% CI: 1.01, 1.78), perceived risk of COVID-19 (aOR: 4.38, 95% CI: 2.70, 7.12), and higher compliance with standard operating procedures (aOR: 1.72, 95% CI: 1.26, 2.35). The most common vaccine hesitancy reasons were 'no need' (n = 284, 36%) and concerns with 'vaccine safety and side effects' (n = 251, 31%), while most reported vaccine motivation reasons were 'health safety' (n = 1029, 70%) and 'to end the pandemic' (n = 357, 24%).

CONCLUSIONS

Although our study found 35% hesitancy rate of COVID-19 vaccine, there were noticeable demographic differences that suggest tailored communication strategy to address concerns held by most hesitant subpopulation. Use of mobile vaccination facilities particularly for less mobile and disadvantaged, and implementation and evaluation of social mobilization strategy should be considered to increase overall COVID-19 vaccination acceptance and coverage.

“Am I Masculine?” A metasynthesis of qualitative studies on traditional masculinity on infertility

Background: The rate of infertility is increasing day by day. According to studies conducted worldwide, 30 million men are diagnosed with infertility. Cases of infertility are often associated with a failure to become male in society. Procreation and gender roles are often closely linked so that infertile men are often considered the second sex. Sometimes, this condition makes men question their masculinity.

Methods: We performed a systematic review and metasynthesis with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline procedure on qualitative studies on ten databases exploring the experience of infertile men and their association with masculinity.

Results: Twenty-four studies matched our question, and there are two major themes with eight subthemes that were obtained from the results of the metasynthesis of these studies. The impact of this gender issue is huge on men’s health and their social interactions. As a result, gender issues provide a space for debate and a burden on men. Sometimes, men develop mental health problems. The topic of masculinity and infertility is at odds with feminism and is susceptible to the societal stigma that results from the hegemonic conception of masculinity. Interestingly, the men must accept reality and follow the treatment process for infertility, although it affects their psychological well-being.

Conclusions: These findings provide insight for physicians, as treating infertility requires a multidisciplinary team that does not only address procreation issues. Social issues related to gender roles often bring patients into harmful and dangerous conditions. To address the gender issue in men globally in several dimensions, however, a large study in various populations is still required.

Women as Agents of Change: Exploring Women Leaders' Resistance and Shaping of Gender Ideologies in Pakistan

Despite a growing focus on processes to promote gender equity, women remain significantly underrepresented in leadership positions in the Global South. In the present study we focus on the role of familial experiences in shaping and contesting gender ideologies of Pakistani women in the workplace. We specifically examine the reciprocal ways in which women leaders and their family members shape each other’s gender ideologies regarding the workplace. Data collected and analyzed for this study were semi-structured interviews with eight women in positions of leadership in Lahore, Pakistan, and interviews with one family members of each of the women leaders (thus 16 interviews total). Using thematic narrative analysis, we identified three thematic phases: learning gender expectations, resistance, and familial transformation. These phases reflect the progression of developing, resisting, and influencing individual and familial gender ideologies. We document the manifestation of these phases in three specific domains: education, marriage and motherhood, and the workplace. We then discuss how these findings contribute to understanding the experiences of women leaders and perceptions of their family members regarding women’s role in the workplace. Findings from our research provide novel insights into the ways globalization and capitalism continue to shape the socio-cultural context for women leaders in the Global South.

Experiences of Mothers Who Relinquished Their Child for Adoption in Pakistan: A Qualitative Study

The literature suggests long-term consequences and lack of support for birthmothers following relinquishment of their child for adoption (Memarnia in Listening to the experience of birth mothers whose children have been taken into care or adopted, 2014). But there was not any work done to study in-depth experiences of birthmothers after giving away their child in Pakistan. So, the purpose of the present study was to explore the experiences of mothers who relinquished their child for adoption. As the present study was intended to explore lived experiences of a particular group, the phenomenological research design was used to conduct this qualitative study. An interview protocol was devised to explore the experiences of birthmothers. The sample was comprised of five birthmothers who relinquished their child for adoption and fulfilled the criteria. Semi-structured interviews were conducted with the birthmothers, and all the interviews were audio-recorded and transcribed before analysis. Interpretive Phenomenological Analysis (IPA) was used to interpret the transcripts of interviews. Further, data verification was done through peer scrutiny, by debriefing sessions with the supervisor, and enriches the description of the phenomenon. Four main themes were emerged: Reasons to Relinquish, Psychological Distress, Coping Strategies, and Disenfranchised Grief. The study present that the experience of relinquishment has a negative impact on birthmother and highlights the need for proper measures to regulate the process of adoption and involvement of psychologists during the process of adoption. Moreover, it stresses the need for acknowledgment of the experience and psychological services for birthmothers who relinquish their child.

'With the kanyaleng and the help of god, you don't feel ashamed': women experiencing infertility in Casamance, Senegal

While the precarious situation of women with infertility in Sub-Saharan Africa is well documented, little is known about the ways in which such women show agency despite the challenges that infertility brings to their lives. This study provided a holistic understanding of the experiences of women with infertility living in a rural community in Casamance (Senegal), drawing attention towards both suffering as well as agency. Qualitative research methods were used, triangulating life-story interviews, participant observation and informal conversations. Findings showed that all women with infertility experienced emotional challenges. These emotional challenges were intertwined with social stigmatisation and troubled relationships with their families-in-law and within their marriages. However, women with infertility were not passive victims in these circumstances. The study identified several strategies used by women to cope with the challenges of infertility, including organising in kanyaleng groups, treatment seeking, fosterage, looking for religious and social support, becoming (financially) independent, avoidance and ignorance. These findings highlight the complexity of agency within a context of structural violence. Concrete measures to improve the lives of women with infertility should acknowledge the agency of women with infertility and involve such women while developing multi-component approaches addressing inequalities.

Men and infertility in The Gambia: Limited biomedical knowledge and awareness discourage male involvement and exacerbate gender-based impacts of infertility

Introduction

Infertility in Sub-Saharan Africa constitutes an important social and public health problem. Yet, there is a paucity of research on the experiences of men living with infertility, especially in West Africa. This study explored men’s aetiological knowledge, views and experiences of infertility in the West Coast region of The Gambia, West Africa.

Methodology

An explorative qualitative study was conducted among men living in the rural and urban communities of the West Coast region of The Gambia using in-depth interviews. Data collection and analysis were performed concurrently, and thematic data analysis was an iterative process carried out using NVivo 11 Analysis Software.

Results

Gambian men had generally poor knowledge of infertility, allocating it to God, spiritual powers and bodily (biomedical) factors. While societal norms meant that infertility was generally attributed to women, some men allocated male-factor infertility to poor sperm quality and impotence. Infertility threatened participants’ sense of masculinity and resulted in psychosocial distress, including stigma, feelings of isolation, and low self-esteem.

Conclusion

Normative gendered frameworks of infertility result in high levels of female responsibilisation in the Gambian context. Yet men diagnosed with infertility experience significant, often unrecognized, psychological and social distress. We therefore call for increased attention to male-factor infertility, and the promotion of male engagement with infertility-care and services, both of which are essential for successfully addressing infertility and it’s psychosocial consequences in The Gambia.

Marital Duration, and Fertility-Related Stress as Predictors of Quality of life: Gender Differences among Primary Infertile Couples

Context

Infertility is a global public health issue, and the current data suggest that the problem is growing. Various infertility-related issues are responsible for poorer mental health and well-being in couples with primary infertility.

Aim

The present study aimed to understand the gender differences of psychological factors related to infertility in couples with primary infertility. Furthermore, an attempt was also made to understand gender-specific associations that could interact with the fertility-related quality of life (FertiQoL).

Settings and Design

This cross-sectional hospital-based study included 100 married couples with the diagnosis of primary infertility, irrespective of the cause of infertility. The study was conducted at Infertility centers in the Eastern region of India.

Subject and Methods

One hundred men and women (n = 100 couples) with the diagnosis of primary infertility were recruited in the study. The fertility problem inventory and FertiQoL were used to measure the couples fertility-related stress and FertiQoL, respectively.

Statistical Analysis Used

Descriptive statistics, independent t-statistics, Pearson correlation, linear regression, and mediation analysis were conducted.

Results

A significantly higher social and sexual concern of infertility and "need for parenthood" were found in women. Men had a significantly better quality of life compared to women. Significant negative predictors of quality of life were noted for both men and women separately. Fertility stress was a significant mediating factor between marital duration and global FertiQoL in men. However, women showed a direct negative association between marital duration and FertiQoL.

Conclusions

The study provides important insights into the couple's experiences with various infertility problems that may potentially be addressed during psychotherapy or during infertility counseling.

Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women

Background:

Infertility stigma is a phenomenon associated with various psychological and social tensions especially for women. The stigma is associated with a feeling of shame and secrecy. The present study was aimed to explore the concept of infertility stigma based on the experiences and perceptions of infertile women.

Materials and Methods:

This qualitative conventional content analysis study was conducted in Isfahan Fertility and Infertility Center, Iran. Data were collected through in-depth interviews with 17 women who had primary infertility. All the interviews were recorded, transcribed and analyzed according to the steps suggested by Graneheim and Lundman. The Standards for Reporting Qualitative Research (SRQR) checklist was followed for this research.

Results:

Eight hundred thirty-six initial codes were extracted from the interviews and divided into 25 sub-categories, 10 categories, and four themes. The themes included “stigma profile, self-stigma, defensive mechanism and balancing”. Stigma profile was perceived in the form of verbal, social and same sex stigma. Self-stigma was experienced as negative feelings and devaluation. Defensive mechanism was formed from three categories of escaping from the stigma, acceptance and infertility behind the mask. Two categories; empowered women and pressure levers, created a balancing theme against the infertility stigma.

Conclusion:

Infertile women face social and self-stigma which threatens their psychosocial wellbeing and self-esteem. They use defensive response mechanisms and social support to mitigate these effects. Education focused on coping strategies might be helpful against infertility stigma.

Infertility as seen by the infertile couples from a collectivistic culture

Infertility in collectivistic cultures is usually regarded as a matter of social stigmatization instead of a biomedical problem. It has adverse sociocultural consequences, especially for the female spouse. The current study, by involving 20 infertile couples, was a qualitative research focusing on the sociocultural experiences of the infertile couples about the nature, causes, and consequences of infertility. The findings of the current study clearly depicted the sociocultural factors involved in interpreting infertility as a matter of shame and bad reputation for the couple and its family. The study has filled a significant knowledge gap and will be useful in identifying and addressing the cultural barriers in the treatment of infertility.

Failure in Identity Building as the Main Challenge of Infertility: A Qualitative Study

BACKGROUND

The approach of considering the psychosocial consequences of infertility has become significant. Psychosocial outcomes of infertility are defined and shaped in the context of the particular social and cultural conditions. Childbearing, and raising a child are considered to be the core of "identity" in many collectivist cultures, and the status provided to individuals with children is accompanied with social acceptance and approval. In such societies, infertile people see their social identity seriously damaged. The purpose of this study was to comprehend the challenge of identity crisis of infertile people in Iran for helping to formulate support programs for policy makers.

METHODS

This qualitative study was conducted in 2016-2018, through semi-structured interviews conducted with 40 infertile clients of Avicenna Fertility Center. Data were analyzed by Strauss and Corbin coding paradigm.

RESULTS

The core of the phenomenon of psychosocial consequences of infertility was failure in identity building, which included the main categories of prevention from continuity and prevention of forming normative identity.

CONCLUSION

Challenge of identity crisis based on the experience of infertile people and the social construction of infertility in their minds affects not only internal, external, personal and structural factors, but it is also a kind of identity search in individuals. Regarding this fact, providing appropriate social services and training the skills needed to rebuild identity of infertile people and their social health will be very effective.

Threats to Feminine Identity as the Main Concern of Iranian Adolescents with Polycystic Ovary Syndrome: A Qualitative Study

PURPOSE

Polycystic Ovary Syndrome (PCOS) is a prevalent hormonal disorder in adolescents; this study seeks to elaborate the main concerns of adolescents with PCOS.

DESIGN AND METHODS

This qualitative content analysis was conducted on 15 adolescents with PCOS using purposive sampling in 2018. Semi-structured in-depth interviews were held for data collection, and data saturation occurred when no new data were being obtained. Data were analyzed concurrently with data collection.

RESULTS

Fifteen adolescents with PCOS aged 13-19 years were enrolled into the study. Thirteen were single and two were married. The data analysis led to the extraction of "threats to feminine identity" as the main theme of this research, which was then divided into two categories: 1) concerns about attractiveness, with subcategories including fashion-related stress and the loss of physical beauty 2) concerns about femininity, with subcategories including the underlying issues of worrying about future marriage prospects, anxiety about infertility in the future and stress about menstrual abnormalities.

CONCLUSION

According to the results of this study, attractiveness and threat to femininity is the main concern of adolescents with PCOS that should be further considered in the management of their treatment.

IMPLICATIONS FOR PRACTICE

Understanding the main concerns of adolescents with PCOS can help healthcare professionals better manage this disease in this population subgroup.

Gender differences in factors associated with depression in infertility patients

AIMS

To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment.

DESIGN

A cross-sectional study.

METHODS

We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March - September 2016.

RESULTS

For women, ethnicity, the number of clinic visits, social concern, and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms.

CONCLUSION

Psychological counseling and intervention programs should be integrated into in-vitro fertilization treatments and interventions should be targeted based on gender differences.

IMPACT

The provision of treatment-related sexual knowledge by nurses is indispensable for infertile participants. Mental health policies should be developed to facilitate the implementation of psychological services. Psychological counseling and intervention programs should be integrated into in vitro fertilization treatment to help men and women with infertility cope with psychological distress.

Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia

Background

In many low-and middle-income countries women with infertility are often in polygynous marriages. From a human and women’s rights perspective, the practice of polygyny is commonly understood as harmful. Studies indicate that polygyny aggravates negative life circumstances of women with infertility with respect to their health and social well-being. The purpose of this qualitative study is to explore how women with infertility experience polygyny and to understand their decision-making regarding these marriages.

Methods

An explorative qualitative study was conducted among women with infertility in the urban communities of the West Coast region of The Gambia using in-depth interviews (30). Data analysis involved an emergent and partially inductive thematic framework and was carried out using NVivo 11.

Results

With the exception of some women with infertility who described positive experiences within polygynous marriages, most women emphasised conflicts that exist within polygynous households and reported financial and emotional difficulties. Thematic analysis identified several strategies of women with infertility to cope with and resist polygynous marriages, including overcoming childlessness, addressing conflict, spending time outside the compound, looking for social support, kanyaleng kafoolu, living separately and initiating divorce. Moreover, the experiences and decision-making power of women with infertility when it comes to polygynous marriages was found to be closely related to their socio-demographic background.

Conclusion

This work highlights how women with infertility in polygynous marriages are in a precarious situation in urban Gambia. Women utilize a mix of compliance, coping and resistance strategies to navigate the challenges of polygynous marriages in a structurally constraining context.

'We are always desperate and will try anything to conceive': The convoluted and dynamic process of health seeking among women with infertility in the West Coast Region of The Gambia

Introduction

In many Sub-Saharan African countries, women with infertility search relentlessly for treatment. Guided by the Partners for Applied Social Sciences model for health seeking behaviour and access to care research, this study aims to understand the health seeking behaviour of women with infertility in the West Coast region of The Gambia and the influence of aetiological beliefs on health seeking paths.

Methodology

A qualitative approach was used to generate both primary and secondary data for thematic analysis. The data collection methods included in-depth interviews (36), observations (18), informal conversations (42), group discussion (7) and made use of pile-sorting exercises. Sources of secondary data included government and non-governmental reports and media outputs.

Results

The health seeking approaches of women living in both rural and urban areas were extremely complex and dynamic, with women reporting that they looked for biomedical treatment as well as seeking indigenous treatment provided by local healers, sacred places and kanyaleng groups. While treatment choice was related to the perceived aetiology of infertility, it was also strongly influenced by the perceived effectiveness of the treatment available and the duration of the fertility problems. Other relevant factors were the affordability, accessibility and availability of treatment and respondents’ family and social networks, whereby access to the biomedical health sector was strongly influenced by people’s socio-economic background.

Conclusion

On the basis of this analysis and our wider research in the area, we see a need for health authorities to further invest in providing information and counselling on issues related to infertility prevention and treatment. The availability of locally applicable guidelines for the management of infertility for both men and women at all levels of the health system would facilitate such work. In addition, the public sphere should provide more space for alternative forms of social identity for both men and women.

'I am always crying on the inside': a qualitative study on the implications of infertility on women's lives in urban Gambia

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.

British Pakistani Muslim Masculinity, (In)fertility, and the Clinical Encounter

The experiences of men facing fertility disruptions are understudied. For British Pakistanis, the impact of infertility is heightened for women because of normative pressures to bear children. But what of men? I present data from in-depth interviews in North East England with infertile British Pakistani Muslims and relevant health professionals. British Pakistani men’s level of participation in clinical encounters and responses to diagnoses of male factor infertility must be understood in the context of kinship, the construction of Pakistani ethnicity in the UK, and the subordinated forms of masculinity which accompany this identity.

Women's perceptions and experiences of the challenges in the process of male infertility treatment: A qualitative study

BACKGROUND

Despite the fact that both men and women are equally subject to infertility, it is usually women who bear the burden of treatment and its consequences, even in cases of male infertility. Therefore, it is more necessary to recognize their health problems in order to help them.

AIM

To explore women's perceptions and experiences of the challenges they face in the process of male infertility treatment.

METHODS

This qualitative study was conducted during 2014-2015 using content analysis. Thirty semi-structured interviews were conducted with women whose husbands suffered from male infertility. Purposive sampling was conducted until data saturation was achieved. All interviews were recorded, transcribed and analyzed using conventional content analysis adopted by Graneheim and Lundman.

RESULTS

From data analysis, the major category of "treatment-related stresses" and four subcategories of "high treatment expenses", "inefficiency of healthcare system", "being captive in the infertility treatment" and "treatment failure" emerged.

CONCLUSION

Experiences of women who face male infertility indicate their various concerns in the process of treatment. Therefore, it is required to develop emotional and financial support for the clients and to promote their quality of healthcare services. In addition, awareness of treatment challenges of these women can assist proper planning to promote the quality of services they need.

A systematic review and narrative report of the relationship between infertility, subfertility, and intimate partner violence

BACKGROUND

Infertility/subfertility could be a formerly unrecognized risk factor for intimate partner violence (IPV).

OBJECTIVES

To review the evidence on the association between infertility/subfertility in women and the risk of IPV.

SEARCH STRATEGY

Seven databases were searched for articles published in English or Spanish between January 2000 and July 2015.

SELECTION CRITERIA

Studies were included if they analyzed the relationship between infertility/subfertility and IPV in a quantitative manner.

DATA COLLECTION AND ANALYSIS

A systematic search was completed by one author, and articles meeting the inclusion/exclusion criteria were chosen by two authors. It was not possible to pool the data because of heterogeneity in the study design, the methods, and the definitions of IPV and infertility/subfertility found across the studies. Instead, a narrative report was completed.

MAIN RESULTS

Twenty-one papers met the inclusion/exclusion criteria. The available evidence indicated that infertility/subfertility is associated with IPV in low- and middle-income countries (LMICs).

CONCLUSIONS

Infertility/subfertility is associated with an increased risk of experiencing IPV in LMICs. Future research should focus on studies with a homogenous design, rigorous methodology, and appropriately selected study and control groups. Qualitative research would also be invaluable to assess the impact of relevant social variables on outcomes.

Cognitive emotional consequences of male infertility in their female partners: a qualitative content analysis

INTRODUCTION

Infertility, as a global phenomenon and one of the most important issues of reproductive health, affects women more often than men, even when the infertility is due to a male factor. The purpose of this study was to explore the cognitive emotional experiences of women faced with male infertility.

METHODS

This qualitative study was conducted in 2014-2015 in Mashhad, Iran. The perceptions and experiences of healthy women whose husbands were diagnosed with primary male factor infertility were investigated using a qualitative content analysis approach. Participants were selected through purposeful sampling, and data collection was conducted using in-depth semistructured interviews. Data were analyzed using conventional content analysis with MAXqda software. Study rigor was verified via criteria proposed by Lincoln and Guba.

RESULTS

One main theme emerged through analysis entitled "cognitive emotional reactions confronting infertility diagnosis" with sub-themes of cognitive emotional reactions when confronted with male infertility diagnosis with subthemes of disbelief and denial, fear and apprehension, suffering and emotional distress, disappointment, frustration, confusion, and joy.

CONCLUSION

The diagnosis of male infertility was associated with important emotional cognitive consequences for their female partners. Emotional support, providing new insights into how to treat the issue, and trying to shorten the process of diagnosis are necessary for these women. This kind of support could reduce the psychological effects of confrontation with the diagnosis of male infertility, including social insecurity for women.

The Social Consequences of Infertility among Iranian Women: A Qualitative Study

BACKGROUND

Infertility may prevent couples to achieve the desired social roles and lead to some social and psychological problems. This study aimed to explain the social consequences of infertility in Iranian women seeking treatment.

MATERIALS AND METHODS

A qualitative content analysis was conducted based on 32 semi-structured interviews with 25 women affected by primary and secondary infertility with no surviving children. The participants were purposefully selected with maximum variability from a fertility health research center in Tehran, Iran, from January to October 2012. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method.

RESULTS

Our findings indicate that the consequences of infertility are divided into five main categories: 1. violence including psychological violence and domestic physical violence, 2. marital instability or uncertainty, 3. social isolation including avoiding certain people or certain social events and self-imposed isolation from family and friends, 4. social exclusion and partial deprivation including being disregarded by family members and relatives and reducing social interactions with the infertile woman and 5. social alienation.

CONCLUSION

This study reveals that Iranian women with fertility issues seeking treatment face several social problems that could have devastating effects on the quality of their lives. It is, therefore, recommended that, in Iran, infertility is only considered as a biomedical issue of a couple and pay further attention to its sociocultural dimensions and consequences.

Prevalence and factors associated with use of herbal medicine among women attending an infertility clinic in Uganda

Background

Infertility is a public health problem associated with devastating psychosocial consequences. In countries where infertility care is difficult to access, women turn to herbal medicines to achieve parenthood. The aim of this study was to determine the prevalence and factors associated with herbal medicine use by women attending the infertility clinic.

Methods

This was a cross-sectional study of 260 women attending the infertility clinic at Mulago hospital. The interviewer administered questionnaire comprised socio-demographic characteristics, infertility-related aspects and information on herbal medicine use. The main outcome measure was herbal medicines use for infertility treatment. Determinants of herbal medicine use were assessed using multivariable logistic regression.

Results

The majority (76.2%) of respondents had used herbal medicines for infertility treatment. The mean age of the participants was 28.3 years ± 5.5. Over 80% were married, 59.6% had secondary infertility and 2/3 of the married participants were in monogamous unions. In a multivariable model, the variables that were independently associated with increased use of herbal medicine among infertile patients were being married (OR 2.55, CI 1.24-5.24), never conceived (OR 4.08 CI 1.86-8.96) and infertility for less than 3 years (OR 3.52 CI 1.51-8.821). Factors that were associated with less use of herbal medicine among infertile women were being aged 30 years or less (OR 0.18 CI 0.07-0.46), primary and no education (OR 0.12 CI 0.05-0.46) and living with partner for less than three years (OR 0.39 CI 0.16-0.93).

Conclusions

The prevalence of herbal medicine use among women attending the infertility clinic was 76.2%. Herbal medicine use was associated with the participants’ age, level of education, marital status, infertility duration, nulliparity, and duration of marriage. Medical care was often delayed and the majority of the participants did not disclose use of herbal medicines to the attending physician. Health professionals should enquire about use of herbal medicines. This may help in educating the patients about the health risks of using herbal medicine and may reduce delays in seeking appropriate care. Collaboration of health professionals with herbal medicine practitioners would help identify the common herbal medicines used for infertility treatment, their potential benefits and harm.