"My mother in-law forced my husband to divorce me": Experiences of women with infertility in Zamfara State of Nigeria

Experience of infertility-related stigma in Africa: a systematic review and mixed methods meta-synthesis

Infertility is a significant reproductive health issue with high prevalence rates in Africa, where it is often stigmatized. This systematic review characterizes the experience of infertility stigma in Africa. A systematic search of relevant studies was conducted across PubMed, MEDLINE, CINAHL, PsycINFO, Global Health, Scopus and Web of Science, covering publications from their inception to March 2025. The search incorporated subject headings and keywords related to 'infertility' and 'stigma' in combination with terms specifying all African countries. A mixed methods approach was employed for data analysis, using the convergent thematic QUAL synthesis method. A total of 1987 records were identified, with 48 studies ultimately meeting the inclusion criteria. The analysis revealed four overarching themes in the experience of infertility stigma: mechanisms of stigma-factors that drive or perpetuate stigma surrounding infertility; stigma marking-the social markers and identifiers that distinguish individuals as stigmatized; manifestations of stigma-the varied forms through which stigma is expressed; and consequences-the psychological, behavioural, relational and health-related repercussions for individuals experiencing infertility stigma. Infertility stigma was widespread, with a prevalence as high as 64%. However, no interventions were developed and implemented to mitigate this issue. Infertility stigma in Africa is deeply embedded within cultural norms and social structures, significantly impacting the lives of those affected. This review emphasizes the critical need for culturally tailored interventions to alleviate stigma and enhance access to reproductive health services.

Navigating child adoption decision among women with infertility in Southern Ghana

The traditional Ghanaian society is pro-natal, with childbearing as the ultimate purpose of marriage. However, infertility may impede this purpose, leading to the need for child adoption among couples. This study explored child adoption decisions among women with infertility in Southern Ghana. A qualitative descriptive exploratory design was used. Purposive and snowball sampling techniques were used to recruit eligible participants. Overall, 14 women with infertility were interviewed. Analyses of the data were conducted using content analysis after audio-recorded interviews were transcribed verbatim. The findings suggested that to navigate the decision to adopt a child in Southern Ghana, there are key factors and environmental factors influencing the decision of these women. The study revealed that child adoption is associated with stigma, and some cultural beliefs, which were described as impediments to their decision-making process. The findings suggest that discrimination, stigma, and cultural beliefs, are the obstacles to child adoption in Southern Ghana. As a result, there is a need for community engagement, particularly with traditional and religious leaders, on child adoption issues in Ghana.

Design of Conceptual Model of Psycho-Social Burden in Infertile Couples Undergoing Assisted Reproductive Treatments: A Study Protocol for a Mixed Method Study

Background and Aims

The multifaceted consequences of infertility impose a significant psycho-social burden on the couples involved and necessitate design a valid conceptual model to identify them. Therefore, this study aimed to design of conceptual model of psycho-social burden in infertile couples undergoing assisted reproductive treatments.

Methods

This study will be conducted in four phases using a mixed method and the sequential exploratory approach. In the first phase, a qualitative study will be carried out through the content analysis approach with the aim of identifying the components of psycho-social burden in infertile couples who are candidates for assisted reproduction treatment (ART). In the second phase the initial version of the infertility psycho-social burden questionnaire will be compiled. Face and content validity will be evaluated quantitatively and qualitatively. In the third phase, a cross-sectional study will be conducted on 150 infertile couples who are candidates for ART in Isfahan, Iran. The construct validity of the prepared questionnaire will be evaluated using exploratory factor analysis with varimax rotation. After psychometrics evaluation of the infertility psycho-social burden questionnaire, sampling will continue on 150 couples. Participants' mental health will be evaluated using the 28-item general health questionnaire, and its correlation with the extracted psycho-social burden components will be evaluated. Based on the results of the third step, in the fourth phase, a conceptual model of psycho-social burden will be designed and confirmatory factor analysis of the conceptual model will be performed.

Conclusion

Extracted conceptual models will assist psychological counselors, social workers, and psychoanalysts in gaining an in-depth understanding of the factors affecting the mental health of infertile couples. Moreover, the psychosocial burden of the infertility scale can be presented as a screening tool for couples at risk of psychological issues related to infertility.

Knowledge, awareness and perception of Natural Procreative Technology (NaProTechnology) among pharmacy undergraduate students in Nigeria: a pre-post educational video intervention study

OBJECTIVE

The study assessed the knowledge, awareness and perception of NaProTechnology as well as the effect of an educational video intervention among pharmacy undergraduate students.

DESIGN

The study design was a pre-post educational video intervention using a cross-sectional questionnaire-based survey.

PARTICIPANTS AND SETTING

The study was done among undergraduate students of a school of pharmacy in South-eastern Nigeria.

INTERVENTION AND OUTCOME MEASURES

At baseline, the knowledge, awareness and perception of the students were assessed using a 17-item questionnaire: five questions for knowledge, five questions for awareness and seven questions for perception, followed by the administration of an educational video on NaProTechnology which was prepared by one of the authors, a gynaecologist and also an expert in NaProTechnology. A post-intervention survey was done with the same pre-intervention questionnaire to assess the effect of the educational intervention. The correct (knowledge) or positive (awareness and perception) responses for each question were reported as percentages.

RESULTS

There were 410 and 350 students in the pre- and post-intervention surveys, respectively, with a relatively equal number of males and females. The majority were between 18 and 29 years old. The average proportion of the participants with correct responses on the knowledge assessment of NaProTechnology was 13.2% and 75.7% in the pre- and post-intervention surveys, respectively (p<0.0001).

CONCLUSION

An educational video intervention was effective in improving the short-term knowledge, awareness and positive perception of NaProTechnology among pharmacy students.

"Community members question me and flaunt their children before me": A call for psychosocial support for women with infertility in Northern Ghana

Infertility is a major health issue that poses threats to women's lives, marriages, and health. Yet little is known about psychosocial support for women with infertility in Northern Ghana. This study aims to understand the psychosocial challenges faced by women with infertility and evaluate the availability and effectiveness of social support systems in East Mamprusi Municipality, Northern Ghana using a qualitative interpretive descriptive design. In-depth interviews were conducted using a semi-structured interview guide. Ethical approval was received from the Institutional Review Board of Ghana Health Service, Accra. Women who visited the health facility desiring to conceive were recruited and interviewed. Thirteen (13) women were interviewed, with each interview lasting 45 min to an hour. The interviews were audiotaped after obtaining permission from the participants, which were transcribed verbatim and analyzed using content analysis. The findings revealed that women faced numerous mental and social problems. Some of these problems include emotional, behavioural, marital instability, the high cost of infertility treatment, and a strong desire to have children. Although the women reported some social support from the community, they lacked strategies to sustain this support. Women with infertility face numerous mental and social challenges. They lack support systems to improve their mental and social health. Health professionals are required to constitute peer support groups for these women and advocate for external assistance to sustain these support groups.

Epidemiological characteristics of infertility, 1990-2021, and 15-year forecasts: an analysis based on the global burden of disease study 2021

BACKGROUND

Infertility, defined as the inability to achieve pregnancy after 1 year of regular unprotected intercourse, affects approximately 186 million people globally, with consistent prevalence across different income levels. Globally, the rising infertility rates are impacting population growth and individual quality of life. Infertility is not just a personal issue but also a public health concern, with social and economic implications, including stigmatization, marital discord, and mental strain. The COVID-19 pandemic has further exacerbated mental health issues among individuals with infertility, underscoring the need for research into the mental health impacts and access to fertility services. Economically, infertility poses a significant financial burden, especially in regions where Assisted Reproductive Technology (ART) costs can be up to 200% of the GDP per capita. Understanding the complexities and spread of infertility is essential for guiding policy decisions and program rollouts, with studies analyzing infertility issues based on the Global Burden of Disease (GBD) database.

METHODS

The study leverages data from the GBD 2021, encompassing 371 conditions or injuries and 88 risk factors across 204 nations. It examines prevalence, disability-adjusted life years (DALYs), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (ASDR) for infertility, categorized by sex, age, regions, and nations. The Social and Demographic Index (SDI), reflecting socio-economic levels, is used to analyze its correlation with infertility burden. The study employs decomposition analysis and frontier analysis methods to assess changes in infertility prevalence and DALYs, and Spearman's rank correlation coefficient to confirm relationships between age-standardized rates (ASRs) and SDI. The estimated annual percentage change (EAPC) of rates, with 95% confidence intervals (CIs), was calculated.

RESULTS

In 2021, it was calculated that the global ASPR for male infertility stood at 1354.76 cases per 100,000 individuals, with a 95% Uncertainty Interval ranging from 802.12 to 2174.77 cases per 100,000 individuals. For female infertility, the ASPR was recorded at 2764.62 per 100,000 individuals (95% UI: 1476.33-4862.57 per 100,000 individuals). Between 1990 and 2021, the EAPC in ASPR was observed to be 0.5% (95% CI 0.36-0.64) for males and 0.7% (95% CI 0.53-0.87) for females. In that same year, the global ASDR attributed to male infertility was 7.84 per 100,000 individuals (95% UI: 2.85-18.56 per 100,000 individuals), while for female infertility, it amounted to 15.12 per 100,000 individuals (95% UI: 5.35-36.88 per 100,000 individuals). The EAPC for ASDR linked to male and female infertility from 1990 to 2021 was assessed at 0.51% (95% CI 0.38-0.65) and 0.71% (95% CI 0.54-0.88), respectively. Among the 204 countries and territories in 2021, India ranked first in both the prevalence of cases and DALYs associated with male and female infertility, followed by China and Indonesia. Additionally, the investigation revealed a slight negative correlation between the ASPR and ASDR of infertility and the SDI. Decomposition analysis indicated that approximately 65% of the rise in the global burden of infertility could be attributed to population growth. Frontier analysis suggested that the variations in efficiency frontiers across specific SDI levels diminish as the SDI increases. Looking forward, the study projects a global rise in ASPR and ASDR for infertility between 2022 and 2036.

CONCLUSIONS

The worldwide prevalence of infertility has substantially increased between 1990 and 2021, largely as a result of population growth. This trend highlights the pressing necessity for better strategies concerning prevention, diagnosis, and treatment, particularly in low and middle-income nations. Strengthening healthcare infrastructures, enhancing access to high-quality medical services, and raising awareness about infertility are vital measures to tackle this issue. The results of the study offer essential information to help policymakers and health officials formulate targeted strategies for the prevention and management of infertility.

"We are not abnormal": experiences and management of stigma among Chinese women struggling with infertility

BACKGROUND

While numerous studies have highlighted the stigma experienced by women facing infertility, there is limited research that delves into the specific types of stigmas they encounter. Despite extensive discussions surrounding the Stigma Management Communication (SMC) theory and its application in managing stigma across various contexts, its utilisation in understanding and addressing the stigma experienced by women with infertility has been largely overlooked. This study seeks to bridge this gap by identifying forms of stigma that Chinese women experiencing infertility encounter and analysing the strategies they use to manage it.

METHOD

Eighteen one-to-one semi-structured in-depth interviews were conducted to gather comprehensive information. Reflexive thematic analysis was employed to analyse the data.

RESULTS

Chinese women experiencing infertility encountered structural, interpersonal and individual stigma. Regarding stigma management, participants employed three strategies: accepting personal stigma and acknowledging societal perceptions, accepting personal stigma while challenging societal perceptions, and challenging personal stigma while accepting societal perceptions.

CONCLUSIONS

Structural, individual, and interpersonal stigma were identified through the participants, expanding the understanding of stigma. The research underscored that personal emotions, government policies, and cultural norms were essential contextual factors in understanding SMC theory and highlighted the association between SMC strategies and consequences.

Knowledge of Male Infertility and Acceptance of Medical Assistance Reproductive Technology Among Fertile and Infertile Senegalese Men

Purpose

The objective of our study was to examine the knowledge of male infertility and the acceptance of assisted reproductive technology (ART) methods.

Patients and Methods

We conducted a descriptive, comparative, cross-sectional study from April 2023 to August 2023 in a center in Dakar. Included in the study were male patients aged 18 and older followed for male infertility (group 1) and fertile patients of the same age as those in group 1 (group 2). We designed a questionnaire assessing the sociodemographic characteristics of the respondents, their knowledge of male infertility, knowledge of ART, its acceptability, and the source of information about male infertility.

Results

Our sample size consisted of 119 respondents for each group. The average age of respondents in both groups was 41.24 ± 8.42 years. Fifty-eight percent of respondents in group 1 were referred by their wife's gynecologist. Fifty-four percent of respondents in group 1 had a good knowledge of male infertility, and 42.86% had average knowledge of male infertility. The majority of respondents in group 1 (42.9%) and group 2 (40.3%) did not know the duration that defines infertility. Fifty-seven percent of respondents in Group 1 and 81.5% of respondents in Group 2 did not know what assisted reproductive technology meant. Eighty-six percent of respondents in Group 1 agreed to use ART for procreation. The majority of respondents in Group 1 (54.6%) and Group 2 (58.8%) attributed a success rate of between 35% and 75% to ART.

Conclusion

Infertile men had better knowledge of male fertility than fertile men. Respondents in both groups, as well as the advanced age of men did not know the duration defining infertility. Poor knowledge of ART was also observed among respondents in both groups, and a better acceptance of ART methods was noted among infertile men.

Intimate partner violence in the context of infertility: voices from women seeking assisted reproductive technology treatment and clinicians' perspectives

BACKGROUND

The interplay between infertility and intimate partner violence (IPV) is a pressing global health issue, yet qualitative evidence on this phenomenon is limited. In order to measure and prevent IPV, it is pivotal to explore and integrate perceptions and experiences from those women with infertility themselves on IPV definition and its phenomenal manifestations in the context of infertility.

METHODS

This study is undertaken as part of a year-long ethnographic research based at a reproductive medicine center in Beijing, China from July 2022 to July 2023. Individual interviews with women attending ART outpatient clinics and with clinicians involved in infertility treatment were conducted. Grounded Theory methodology was used to guide data analysis, which entailed a three-step analytical approach.

RESULTS

A total of 37 women and five clinicians were interviewed. Incomplete conceptualization of IPV and high mental stress among patients were evident. IPV against women with infertility has been shown to be a specific and severe form of IPV. The phenomenal manifestation of IPV in the context of infertility often takes the form of psychological abuse, including stonewalling, threats of divorce, and non-compliance with ART treatment.

CONCLUSION

The study revealed that the burden of fertility disproportionately falls on women, often intensified by the involvement of other family and cultural norms, exacerbating gender inequalities and IPV risks. Findings from this study calls for an immediate and comprehensive response in healthcare practice. IPV screening, health education, and structural interventions should be introduced to prevent and mitigate this issue.

A scoping review of the psychosocial aspects of infertility in African countries

Infertility refers to the inability to conceive after 12 months of regular, unprotected sexual intercourse. Psychosocial aspects of infertility research are predominant in developed countries. A scoping review of psychosocial aspects of infertility research conducted in Africa between 2000 and 2022 was conducted. Twelve databases and grey literature were searched for articles. Studies were included if they were published in English and included findings from patients diagnosed with primary or secondary infertility. A total of 2 372 articles were initially found and screening resulted in 116 articles being included in the scoping review. Most of the studies (81%) were conducted in Nigeria, Ghana and South Africa. Psychosocial aspects explored included quality of life, barriers to treatment, attitudes and stigma, and sociocultural and religious aspects of infertility, among others. The review maps published psychosocial research in the context of infertility in Africa and identifies gaps for future research.

Ethical implications of the widespread use of informal mHealth methods in Ghana

BACKGROUND

Informal mHealth is widely used by community health nurses in Ghana to extend healthcare delivery services to clients who otherwise might have been excluded from formal health systems or would experience significant barriers in their quest to access formal health services. The nurses use their private mobile phones or devices to make calls to their clients, health volunteers, colleagues or superiors. These phone calls are also reciprocal in nature. Besides, the parties exchange or share other health data and information through text messages, pictures, videos or voice clips. There are some ethical dimensions that are inherent in these practices that ought to be critically scrutinised by bioethicists.

OBJECTIVE

The author has argued in this paper that informal mHealth at large scale adoption in Ghana is associated with some bioethical challenges.

METHODS

This essay was largely based on an analysis of an empirical study published by Hampshire et al in 2021 on the use of informal mHealth methods in Ghana.

RESULTS

Widespread adoption of Informal mHealth in Ghana is associated with privacy invasion of both the nurses and their clients, breaches confidentiality of the parties, discredits the validity of informed consent processes and may predispose the nurses to some other significant aggregated harms.

CONCLUSION

The author affirms his partial support for a formalised adoption process of informal mHealth in Ghana but has reiterated that the current ethical challenges associated with informal mHealth in Ghana cannot escape all the debilitating bioethical challenges, even if it is formalised.

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study

INTRODUCTION

In the Global South, (in)fertility care is scarcely recognized as a priority, yet the government of The Gambia has recently included it as one of the key priorities in its reproductive health strategic plan. This inclusion appears to be the result of years of engagement between policy actors, academic researchers, and activists in the field of reproductive health and specifically of infertility. However, the operationalization of the strategic plan may be hampered by multiple factors. The research aims to identify and analyze challenges that may impede the effective implementation of the strategic plan, thereby providing policy action points and practical guidance into the operationalization of (in)fertility care in the context of The Gambia's health system.

METHODS

This is a mixed-methods study with data from a survey and semi-structured interviews collected between 2020 and 2021 in The Gambia that were separately published. In this paper, we present the triangulation of quantitative and qualitative data using a convergence coding matrix to identify relevant policy action points.

RESULTS

Six fertility care policy action points, driven by data, arose from the triangulation and interpretation process, specifically: (i) establishing and maintaining political commitment and national priority for fertility care; (ii) creating awareness and increasing the involvement of men in SRH and fertility; (iii) ensuring data-driven health policymaking; (iv) offering and regulating affordable IVF alternatives; (v) improving knowledge of and means for fertility care provision; and (vi) enhancing the collaboration among stakeholders and building links with the private healthcare sector.

CONCLUSION

This study found the implementation of the fertility care-related activities in the reproductive health strategic plan may face challenges that require careful mitigation through a holistic approach. Such an approach conceptualizes infertility not just as a biomedical issue but as a broader one that incorporates educational and socio-emotional aspects, including male and (not only) female involvement in sexual and reproductive health. Moreover, it is supported by a comprehensive health management information system that includes capturing data on the demand for, and access to, infertility services in The Gambia health system.

The Effect of Positive Psychotherapy-Based Training on Stigma and Self-Efficacy in Women Receiving Infertility Treatment

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.

Gender-based adjustment problems of divorcees in Hazara Division, Pakistan

INTRODUCTION

Divorce is one of the harshest realities in Eastern societies worldwide because it is an intact component of the elementary social institution of the family. Grievously, divorce rates are escalating with profound ramifications for divorcees in Asia, including Pakistan. Therefore, exploring the challenges after divorce with gender-based dimensions in the Pakistani context was necessary, particularly in Hazara Division.

RESEARCH METHODOLOGY

The study followed a pragmatic approach through snowball sampling and recruited 75 respondents. The data were collected through a semi-structured questionnaire and analysed using IBM SPSS 25. For descriptive statistics, frequencies of quantitative responses were determined using percentages, means, and standard deviations. Then Chi-Square Test of Independence, Principal Component Analysis, and Multivariate Analysis of Covariance were performed to find an association between the dependent and independent variables.

RESULTS

Results demonstrated that most divorcees face children-related issues followed by economic, social, and psychological issues that impede post-divorce adjustment of divorcees. Results showed that the immaturity of divorcees and gender-specific violence specifically for women make it challenging for them to cope with the situation and impede their growth after divorce. Results revealed that more than half of women and a few of men have custody of children after divorce; however, fight over custody of children is another major cause of delayed adjustment. Results presented that gender significantly influences women's intensity of post-divorce adjustment constraints.

CONCLUSION

Therefore, it is concluded that regardless of gender, ongoing conflicts with ex-spouses or in-laws made the post-divorce adjustment of divorcees difficult. Divorcees are in a constant tug-of-war between fighting internal dilemmas, pursuing individualistic ideals, and fulfilling societal norms, values, and expectations. This battle complicates and prolongs their adjustments after divorce. The study suggests that institutional, psychosocial, and family support is critical to proactively relieve divorcees from resources and their children.

Shared Decision-Making About Future Fertility in Childhood Cancer Survivorship: Perspectives of Parents in Uganda

Background: Despite a plethora of literature on barriers to addressing future fertility in childhood cancer survivors, the data are not representative of limited middle-income settings. Unique and context-specific factors may influence addressing future fertility care among childhood cancer survivors in Uganda. This study aimed to explore the experiences, attitudes, and perceptions of parents on their interactions with health providers about future fertility, as part of their child's cancer survivorship. Methods: Using grounded theory, semistructured interviews were conducted with parents of children diagnosed with cancer, <18 years of age, and not in the induction or consolidation phases of treatment. Transcripts were thematically analyzed. Results: A total of 20 participants were interviewed, with the majority identifying as female (n = 18). The global theme that arose was the importance of shared decision-making, and the key themes encompassing this were as follows: (1) importance of accurate information, (2) respect of autonomy, and (3) engagement and psychosocial support. Conclusion: In Uganda, parents of children with cancer value a multifaceted approach to satisfactory decision-making within the context of oncofertility.

Infertility services integrated within the maternal health department of a public hospital in a low-income country, Rwanda

Objective

To describe the initiation, integration, and costs of reduced-cost infertility services within the maternal health department of a public hospital in a low-income country.

Design

Retrospective review of the clinical and laboratory components of patients undergoing in vitro fertilization (IVF) treatment in Rwanda from 2018 to 2020.

Setting

Academic tertiary referral hospital in Rwanda.

Patients

Patients seeking infertility services beyond the primary gynecological options.

Interventions

The national government furnished facilities and personnel, and the Rwanda Infertility Initiative, an international nongovernmental organization, provided training, equipment, and materials. The incidence of retrieval, fertilization, embryo cleavage, transfer, and conception (observed until ultrasound verification of intrauterine pregnancy with fetal heartbeat) were analyzed. Cost calculations used the government-issued tariff specifying insurers' payments and patients' copayments with projected delivery rates using early literature.

Main Outcome Measures

Assessment of functional clinical and laboratory infertility services and costs.

Results

A total of 207 IVF cycles were initiated, 60 of which led to transfer of ≥1 high-grade embryo and 5 to ongoing pregnancies. The projected average cost per cycle was 1,521 USD. Using optimistic and conservative assumptions, the estimated costs per delivery for women <35 years were 4,540 and 5,156 USD, respectively.

Conclusions

Reduced-cost infertility services were initiated and integrated within a maternal health department of a public hospital in a low-income country. This integration required commitment, collaboration, leadership, and a universal health financing system. Low-income countries, such as Rwanda, might consider infertility treatment and IVF for younger patients as part of an equitable and affordable health care benefit.

Women's experiences of living with involuntary childlessness in Uganda: a qualitative phenomenological study

BACKGROUND

Involuntary childlessness is a global phenomenon that negatively impacts the couple, or the family involved. The experiences of women living with involuntary childlessness have not been well documented in the literature, specifically in the Ugandan context. The purpose of the study was to explore the experiences of women living with involuntary childlessness in Uganda.

METHODS

A qualitative phenomenological approach was used. Fifteen in-depth interviews were conducted among women experiencing involuntary childlessness attending a National Referral Hospital. Purposive sampling was, and data saturation determined the actual sample size. Thematic analysis was used for data analysis. The results are presented in the form of text and narrative quotes from participants.

RESULTS

Six themes emerged (i) Inadequate social support (ii) psychological torture (iii) continued grief (iv) marital instability (v) failure attributed to childlessness and (vi) financial constraints. Inadequate social support was in the form of having an unsupportive partner, altered social relation, and altered social status, while women experienced name-calling, emotional abuse, stigma, and blame under the psychological torture theme. Women experienced feelings of distress and grief, including anger, irritability, sadness, stress, and feelings of despair. Women with involuntary childlessness recounted experiencing unstable marriages characterized by infidelity, divorce, abandonment, and polygamous marriages. Some women coped positively, while others employed negative coping strategies such as social withdrawal and isolation. Women who their partners and families well supported coped positively. In contrast, those who did not receive as much support were stressed, sad, angry, and had lost hope of pregnancy.

CONCLUSIONS

In this study, women with involuntary childlessness lacked social support amidst experiences of marital turmoil, psychological torture, feelings of distress and grief, unfulfilled motherhood expectations, and financial constraints while seeking treatment, therefore, there is a need to screen the women for psychological / mental illness symptoms and provide empathetic care and counseling. The prevalence of involuntary childlessness is not well documented in Uganda and a study can be done to determine its extent.

University students' attitudes toward gender roles and infertility: A descriptive and correlational study

PURPOSE

To examine the relationship between university students' attitudes toward gender roles and infertility.

DESIGN AND METHODS

This descriptive and correlational study was conducted with 743 university students between September and December 2020. Data were collected using a personal information form, the Gender Roles Attitude Scale, and the Attitudes Towards Infertility Scale through online forms.

FINDINGS

It was found that attitudes toward gender roles and infertility could be influenced by some sociodemographic factors, for instance, students' sex, education, and family type. There was also a moderate and positive correlation between attitudes toward gender roles and infertility.

PRACTICE IMPLICATIONS

The present study contributes to a better understanding of the social construction and attitudes toward gender roles and infertility. For a better future, it is recommended that nurses help and support university students in raising awareness about such an important social problem.

Stigma predicting fertility quality of life among Chinese infertile women undergoing in vitro fertilization-embryo transfer

OBJECTIVE

To investigate stigma and fertility quality of life (FertiQoL) and identify predictors of FertiQoL in Chinese infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET).

METHODS

A descriptive correlational design was adopted to investigate the association between stigma and FertiQoL in 588 infertile women undergoing IVF-ET. The personal information questionnaire, Infertility Stigma Scale (ISS) and FertiQoL tool were used to measure study variables.

RESULTS

The mean scores of ISS and FertiQoL were 62.59 (SD = 21.58) and 63.64 (SD = 13.72), respectively. There were significant differences of ISS scores among participants with different educational level, residence, occupation, religious belief, financial condition, age group, duration of infertility and infertility treatment, while significant differences of the FertiQoL scores were found in participants with different insurance status, determinism of etiology, infertile type, duration of infertility treatment and cycles of IVF-ET. Pearson's correlation analysis showed stigma was negatively correlated with FertiQoL (r = -0.081 to -0.669, p < .05). The self-devaluation (β = -0.290, p < .001), social withdrawal (β = -0.237, p < .001), family stigma (β = -0.217, p < .001) and insurance status (β = 0.066, p=.035) were identified as the significant predictor of FertiQoL accounting for 43.5% of variance.

CONCLUSIONS

The stigma was significantly associated with FertiQoL in infertile women undergoing IVF-ET with higher level of stigma predicting poorer FertiQoL. More psychological support should be provided to infertile women to reduce stigma and improve FertiQoL.

Psycho-social experience of oocyte recipient women: a qualitative study

Background

Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The identification of these challenges during the treatment process is crucial to improve recipient mental health. Thus, the aim of this study was to gain an understanding of the experiences of oocyte recipient women.

Methods

This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation.

Results

Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial.

Conclusion

The results indicated that the process of treatment with donated oocyte is followed by the experiences of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women.

Plain English summary

Although associated with many successes, oocyte donation can lead to numerous psychological challenges in recipient women. The aim of this study was to gain an understanding of the experiences of oocyte recipient women. This research was conducted using a qualitative approach and inductive content analysis method. The data collection tool was in-depth interviews. Twenty women with the experience of receiving donated oocyte were selected and entered the study using purposive sampling method and considering the maximum variation. Three main categories of psychological challenges were extracted from patient interviews, specifically, distressing psychologic symptoms, social stigmatization, and negative coping mechanisms. The category of distressing psychologic symptoms was shaped based on the subcategories of self-esteem destruction, anxiety and stress, depression and spiritual discouragement. The category of social stigmatization included the subcategories of concern about disclosure, judgment of others, and conflict with religious teachings. And the category of negative coping mechanisms was formed based on the subcategories of aggression and denial. The results indicated that the process of treatment with donated oocyte is followed by experience of distressing psychologic symptoms, social stigmatization, and negative coping mechanisms in recipient women. As such, paying attention to the socio-cultural factors which affect this process seems necessary to maintain the mental health of these women.

Coping strategies mediate the association between stigma and fertility quality of life in infertile women undergoing in vitro fertilization-embryo transfer

BACKGROUND

The mediating role of coping strategies and its relationship with psychological well-being and quality of life has been considered in the literature. However, there is little research to explore the mechanism of coping strategies on stigma and fertility quality of life (FertiQoL) in infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET). The aim of this study was to examine the mediating effect of coping strategies on the relationship between stigma and fertility quality of life (FertiQoL) in Chinese infertile women undergoing In Vitro Fertilization Embryo Transfer (IVF-ET).

METHODS

In this cross-sectional study, a total of 768 infertile women undergoing IVF-ET were recruited from Assisted Reproductive Center of Shaanxi Province, China. The personal information, infertility stigma scale, coping strategy scale and FertiQoL scale were measured using a set of questionnaires. The multiple mediator model was performed using AMOS 21.0.

RESULTS

The model showed a significant negative direct effect between stigma on FertiQoL. There were significantly negative indirect effects of stigma on FertiQoL through active-avoidance, active-confronting and passive-avoidance, respectively. The meaning-based coping played a positive intermediary role. The model explained 69.4% of the variance in FertiQoL.

CONCLUSION

Active-avoidance coping strategy is the most important mediator factor between stigma and FertiQoL in infertile women undergoing IVF-ET treatment. Meaning-based coping strategy plays a positive mediating role between stigma and FertiQoL.

The association between early in marriage fertility pressure from in-laws' and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India

Background

Married adolescent girls are vulnerable to risky sexual and reproductive health outcomes. We examined the association of fertility pressure from in-laws’ early in marriage with contraceptive use ever, parity, time until first birth, and couple communication about family size, among married adolescent girls.

Methods

Data were taken from a cross-sectional survey with married girls aged 15–19 years (N = 4893) collected from September 2015 to July 2016 in Bihar and Uttar Pradesh, India. Multivariable regression assessed associations between in-laws’ fertility pressure and each outcome, adjusting for sociodemographic covariates.

Results

We found that 1 in 5 girls experienced pressure from in-laws’ to have a child immediately after marriage. In-laws’ fertility pressure was associated with lower parity (Adj. β Coef. − 0.10, 95% CI − 0.17, − 0.37) and couple communication about family size (AOR = 1.77, 95% CI 1.39, 2.26), but not contraceptive use or time until birth.

Conclusions

Our study adds to the literature identifying that in-laws’ pressure on fertility is common, affects couple communication about family size, and may be more likely for those yet to have a child, but may have little effect impeding contraceptive use in a context where such use is not normative.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01116-9.