CHAPTER ONE

1.0 INTRODUCTION:
Worldwide, couples view infertility as a tragedy which carries social, economic
and psychological consequences. WHO, (2008)

In 2006, the United Nations general assembly adopted the secretary-general’s

report recommending the inclusion of the target to achieve Universal access to
reproductive health under the millennium development goals five (5) to improve
maternal health.

The department of reproductive and research recognize that infertility is a problem

in both developed and developing countries. Report had it that one in four (1:4)
married women of reproductive age in most developing countries are infertile
because of primary or secondary infertility. (WHO comparative report, 2006)

Additionally, 7% of married couples in which the women are of reproductive age

reported that they had not use contraceptive for twelve (12) months and the women
had not become pregnant (National Survey of family growth, 2004)

The World Health Organization (WHO) in 2004, define female infertility as the in
ability of a woman of reproductive age to conceive and carry pregnancy to birth
within two (2) years of exposure to the risk of pregnancy.

There are two (2) types of infertility thus; primary and secondary infertility.
Infertility is not always a problem of woman because 40% causes are from woman,
another 40% are due to man and remaining 20% from both parties or unknown.

BACKGROUND OF THE STUDY:

It has been discovered that childlessness has led many couples into the valley of
conflict, bondage of polygamy, ocean of confusion, mountains of obstacles and
eventually into the cell of divorce. That is why many women trying to conceive for
1
the first time panic if their menstrual periods continuous for even three to four
months of marriage without knowing the standard definition of infertility, which is
unsuccessful conception after an entire year of regular unprotected sexual
intercourse. Monday Adishi, (2009)

Furthermore, several studies indicated that Africa had extremely high rates of
female infertility and it produces social consequences for African couples, and
these consequences are particularly pronounced on women as compare to men
regardless of the causes of infertility. Women received more blames for
reproductive setback and also suffer personal grief and frustration, social stigma
and serious economic deprivation. Adetero et al, (2009)

In our society today, there are broken homes and these women are also pushed out
of their husband’s houses without granting them access to their husband’s
properties because they cannot bear children for their husbands. Inhorn, (2011)

Many of these women are sent back to their fathers’ houses where they are given
all sorts of names such as; man-woman, fellow man, abortionist, fruitless tree,
barren fig etc in order to destabilize them. In facts, some parents even re-marry for
their sons in order to provoke their daughter’s in-law.

Fido et al, (2004) examined the psychological distress among the Kuwaiti women
having infertility problems and also they explored the causes of infertility. Arabic
version of hospital anxiety and depression scale was used to inspect the
psychological condition of 120 infertile Kuwaiti women and 120 healthy pregnant
women. Healthy women were used as control group. Results of both women were
compared and it was found that the infertile women had significantly higher
psychopathology in all parameters. The infertile women had high scores of
hostility, anxiety, self-blame, tension, and suicidal tendency. Illiterate group of
infertile women thought that their infertility is due to evil spirits, witchcraft and
God’s retribution. On the other hand infertile educated women blamed marital,

2
dietary and psycho sexual factors for their infertility. Illiterate women preferred
faith healers for treatment while educated women opted for infertility clinics.

STATEMENT OF PROBLEMS;
Female infertility is global health concern that is often ranked as the most
distressing life crisis in the life of women worldwide, and it is described as the
most important reproductive health concern of Nigerian women which accounts for
between 60-70% of gynecological consultations in our tertiary institutions.
Ekunfua et al, (2010).

The World Health Organization (WHO, 2012) has calculated that over 10% of
women are affected despite modern methods of prevention and treatment of
infertility, making women to suffer from one psychological problem to another and
are equally stigmatized.

In some cases, childless women have been excluded from some important social
activities and ceremonies. Sandelowski and Jones, (2006) Included situations
where participants were:

“Forced to tell” about their fertility problems in order to explain their childless
state.

As a result of that, the group of these women developed depression and low self
esteem.

It is on this recognition that the researcher is motivated to find out the

psychological impacts of infertility on women of child bearing age.

OBJECTIVE OF THESTUDY.
1. To identify the causes of infertility among women of child bearing age.

3
 2. To determine the psychosocial impacts of infertility on women of child
bearing age.

3. To enlighten the public on female infertility.

4. To describe the preventive measures/treatments of female infertility.

RESEARCH QUESTIONS.
1. What are the causes of female infertility?

2. What are the psycho-social impacts of infertility on women of child bearing

age?

3. Does the public have adequate knowledge and awareness of female

infertility?

4. What are the treatment and preventive measures of female infertility?

SIGNIFICANCE OF THE STUDY

The result of this study will be of immense benefit of producing the useful
information on the impact of female infertility on the productive women.

It will help the women to understand the sign of female infertility. And the study
will help to educate this group of women on the causes and possible remedies of
these problems. The study will also help to reduce individuals’ misconception on
the causes of female infertility. The study will equally help to increase the
women’s self-esteem. For the researchers, it will serves as a basis for further
studies.

4
SCOPE AND DELIMINATION OF THE STUDY.
This research intends to study the psychosocial impacts of infertility on
women of child bearing age within the scope of gynecology clinic murtala
Muhammad specialist hospital. It will cover female within the age of fifteen
to forty five years (15-45 years) who come to the clinic with complain of
primary or secondary infertility. Their problems would be identified and
give solution proffer to them.

OPERATIONAL DEFINITION OF TERMS

1.7.1 INFERTILITY:
In ability to naturally conceive a child within one year of unprotected sexual
intercourse. (Centre for disease control, 2016)
1.7.2 FERTILITY:
Is the natural capability to produce offspring. (Jorge Chaverro, 2009)
1.7.3 AMENORHOEA:
Absence of menstrual flow.(Elsevier Sauders, 2011)
1.7.4 IMPACT:
An outcome, result, effects, aftermath or consequences produced by action.
(Online Dictionary by Doglas Harper, 2010)
1.7.5 WOMEN OF CHILD BEARING AGE:
An adult female within the age of 15 – 44 years. (Tamim H, 2010)
1.7.6 PSYCHOSOCIAL:
Relating to the interaction of social factors and individual thought and
behaviours. ( American Heritage English Dictionary, 2013)
1.7.7 MENOPAUSE:
Absence of menstrual period about 12 months after last menstrual period and
marks the end of menstrual cycles. (Mayoclinic, 2008)
5
1.7.8 MENARCH:
Is the first menstrual cycle or the first menstrual bleeding in females. (The Free
Medical Dictionary by Farlex, 2015)
1.7.9 MENSTRUATION:
Is a woman’s monthly bleeding through the vagina. (Teen Health, Nemours
Foundation, 2014)
1.7.10 FERTILIZATION:
(also known as conception) In human is a fusion of male and female gamete to
initiate the development of a new individuals organisms. (Angier Natalie, 2007)
1.7.11 ABORTION:
The expulsion or removal of an embryo or foetus from uterus at a stage of
pregnancy when it’s incapable of independent survival (i.e. at any time between
conception and the 24th weeks of pregnancy). (Grimes et al, 2010)
1.7.12 BONDAGE:
The state of being another person’s slave. (Advernced learner’s Dictionary 2 nd
edition, 2005)
1.7.13 POLYGAMY:
Practice of having more than one wife. (Longman Pocket Dictionary, 2008)
1.7.14 DIVORCE:
To end the marriage by an official or legal process. (Longman Pocket
Dictionary, 2008)

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 CHAPTER TWO
LITERATURE REVIEW

2.0 INTRODUCTION
Related literatures from textbooks, journals, magazines were reviewed under the
following sub-headings:

Concept of infertility, causes of female infertility, clinical manifestations of female

infertility, psychosocial impacts of infertility on women of child bearing age,
public knowledge of infertility, preventive measures/treatment of female infertility
and theoretical framework.

2.1 CONCEPT OF FEMALE INFERTILITY

Female infertility is a global public health concerned that often ranked as the most
distressing life-crises in the life of women worldwide. (Okunfua et al, 2007). The
author further described it as the most important reproductive health concern of
Nigerian women which accounts for between 60-70 percent of gynecological
consultation in our tertiary health institutions. It is a stressful experience that
affects a woman’s life; her religious faith, self-esteem and even her occupation.
The common psychological symptoms reported among infertile women are
depression, anxiety and suicidal ideation. (Fido, 2006)

According to Sherman, (2009) in tertiary health institution, most women that come
to see the doctors because of infertility problems were typically in their late 30s.
Most of them tend to have some kind of ovulatory problem or a problem with egg
quality because they are getting to menopause. This group observed that if you

7
look at the population at large, the most common cause of infertility is some kind
of tubal blockage, which is caused by an infection in the fallopian tube gotten
either from a sexually transmitted disease or from a prior pelvic surgery. The
second leading cause of infertility is lack of ovulation called polycystic ovary
syndrome (PCOS), in which women do not ovulate.

International Council on Fertility Information Dissemination, (2007) state that

female infertility is defined as the inability of a female to produce

ovum that can be fertilize by a fertile male for at least one year. Female infertility
is a contributing factor in about two third of fertility cases because female
reproductive system is less accessible than that of male, because of that diagnosis
and treatment in women are sometimes more difficult.

Infertility in women is conventionally defined as failure to conceive despite regular

sexual intercourse for a year, without using any contraceptive. Men produce
sperms throughout their reproductive years; however, women are born with a
specified number of eggs, whose number reduces with age, (Arpita, 2009).

According to the Centre for Disease Control and Prevention, (2007), Infertility is
becoming an increasingly common problem world-wide. It is estimated that one in
seven couples face fertility challenges, approximately 10% of women in the United
States have a hard time getting pregnant and this causes a lot of emotional problem
to the women.

8
Mayo Clinic Staffs (2009) also explained that infertility in women is referred to as
the biological inability of a woman to get conceived or to carry a pregnancy to full
term. To fertility experts, if you are under 35 years old and unable to get pregnant
after 1 year of steady and unprotected sexual intercourse (or 6 months if you are 35
or above), it is likely there is an infertility problem to deal with. It further stated
that infertility can be due to you or your partner or both.

2.2 CAUSES OF FEMALE INFERTILITY

The causes of female infertility may be classified as functional, anatomical, and
psychological causes, (Monday Adishi, 2009). Went further and broke it into
several categories which are as follows:

Ovulatory problems, cervical factors, pelvic and tubal factors, uterine factors,
reproductive conditions, physical barriers, hormonal imbalances, age-related
infertility, behavioral factors/lifestyle, environmental and occupational factors,
pelvic inflammatory disease and psychological problems, female infertility caused
by genetic problem .

All these causes are related to each other in different ways as we can see in the
explanation below:

2.2.1Ovulatory Problems
Ovulation is a complex event in which hormonal signals and physical events are
linked in a delicate balance, it is also stated that women ovulate most effectively in
their late teens and early twenties but by the age of 35-38 years, most women
experience a decline in the ability to ovulate effectively. Dyer et al (2006) stated

9
that ovarian problems also decrease the production of any one of the hormones that
regulate a woman’s reproductive cycle and may result in infertility. These
problems may inhibit reproduction and as such cause the ovarian follicle to remain
empty. Disruption also in the part of the brain that regulates ovulation can cause
low levels of the hormones that regulate this (luteinizing hormone (LH) and
follicle stimulating hormones FSH).

Ovulatory problem may also be caused by poor functioning of the fallopian tubes,
physical damage to the ovaries as in multiple surgeries;

There by causing the follicles not to mature properly and ovulation will not occur.
(Mayo clinic, 2009) According to fertility helper (2008) some women may develop
antibodies or immune cells that attack the man’s sperm, mistaking it for a toxic
invader.

2.2.2Cervical Causes
Cervical infertility involves inability of the sperm to pass through the mouth of the
uterus due to damage of the cervix, (Right health infertility, 2007).

Cervical factor in infertility can also be caused by the following:

Inadequate cervical mucus which acts as a filter that allows only the best sperm to
survive and fertilize an egg.

Cervical narrowing or stenosis and infections of the cervix with common sexually
transmit infections like Chlamydia, gonorrhea or trichomonas can also lead to
infertility in women. (Sherman, 2009)

10
2.2.3 Pelvic and Tubal Causes
According to Right health, (2007) pelvic causes include any disruption of the
normal pelvic anatomy. These include: Scar tissue or “adhesions”, endometriosis,
blocked, scarred, or distorted fallopian tubes and uterus.

The blockage or scarring of the fallopian tube may prevent the egg from traveling
from the ovary towards the uterus to meet with sperm, this can lead to infertility,
the pelvic adhesions are defined as bands of scar tissue that bind organs after
pelvic infection, appendicitis or abdominal or pelvic surgery. Frequent abortions
may also produce infertility by weakening the cervic or by leaving scar tissue that
obstructs the uterus. (Papreen, 2008).

Previous surgeries are important causes of disease and damage. Tubal damage may
result in a pregnancy but the fertilized egg will be unable to make its way through
the fallopian tube to be implanted in the uterus (ectopic pregnancy). This tubal
disorder affects approximately 25% of infertile couples and varies widely, ranging
from mild adhesions to complete tubal blockage. (Apirta, 2009)

2.2.4 Uterine Causes

Uterine causes of infertility are conditions in which there is adhesion between the
anterior and posterior uterine walls due to scar tissue formation. This makes it
difficult for the fertilized egg to implant. Anatomic problems like polyps, uterine
fibroid and abnormal shape of the uterus can also prevent fertility. (Right health
infertility, 2009).

11
Uterine muscles problems is another cause of infertility, in this condition, some
women may produce weak, infrequent or abnormal contractions in the uterus that
push the sperm away during ovulation. (Arpitta, 2009).

2.2.5 Reproductive causes

According to Monday Adishi, (2007) there are several causes of women infertility
related to the reproductive system that may be associated with disease that affect
the ovaries, uterus, fallopian tubes and other associated organs and this can
interfere with ovulation, fertilization or implantation in a number of ways. CDC,
(2008) further divided reproductive conditions into endometriosis and polycystic
ovarian syndrome.\ Endometriosis is a condition that occurs when segments of the
uterine lining or endometrium grow a structure outside the uterus. Endometriosis
affects women during their reproductive years; a woman may be at-risk for
developing it if there is a family history of the disease. (Ukpong, 2006).

According to center for disease control and prevention, (2010), Endometriosis is a

condition in which sections of the uterine lining are implanted in the vagina,
ovaries, and fallopian tubes or pelvic. These implants eventually form cysts that
grow with each menstrual cycle and may eventually turn into blisters and scars can
then block the passage of the egg within the tubes. According to Reproductive
health, (2008) polycystic ovarian syndrome (PCOS) is another leading cause of
female infertility, it is an endocrine condition that interferes with ovulation, due to
excess production of androgens (male hormones), and women with PCOS often do
not ovulate normally, polycystic ovary syndrome (PCOS)is also associated with
insulin resistance and obesity (Lancet, 2007) . Physical Barriers; Another common
12
cause of female infertility is a blockage or barrier in the fallopian tubes or uterus
that prevents the egg from coming into contact with sperm or implanting into the
uterine lining. Such a blockage may be due to a congenital abnormality, post-
surgical adhesions or any condition that produces scar tissue. Poor quality cervical
mucus sometimes serves as a barrier to sperm to enter the woman’s cervix and a
cervical infection may also be the cause. (Healthhints, 2007)

2.2.6 Hormonal Problem

A hormone is a chemical communication system used by the body to regulate
growth and other processes. When there is over or under- production of hormone
like in adrenal or thyroid deficiencies and excess production of prolactin can
prevent ovulation. (Mayo Foundation for Medical Education and Research, 2009)
Anderson, (2007) stated that in a luteal phase dysfunction, a woman’s corpus
luteum (the mound of yellow tissue produced from the egg follicle) may fail to
produce enough progesterone to thicken the uterine lining and when this occurs,
the fertilized egg may be unable to implant. The process of ovulation depends upon
a complex balance of hormones and any disruption in this process can hinder
fertility. The three main sources that can cause this problem are as follows: failure
to produce mature eggs which is characterized by a reduced production of FSH,
and normal or increased level of LH, oestrogen and testosterone, malfunction of
the hypothalamus where the hypothalamus fails to trigger and control this process,
immature eggs will result and malfunction of the pituitary gland. The pituitary
responsibility lies in producing and secreting FSH and LH. The ovaries will be
unable to ovulate properly if either too much or too little of these substances are

13
produced. This can occur due to physical injury, a tumor or if there is a chemical
imbalance in the pituitary. Right health, (2007)

2.2.7Age-Related Infertility
According to Sherman (2009), age can be a very big factor and is a cause of
infertility in women that cannot be avoided. Nowadays, many women are waiting
until they are in their mid-30s before trying to conceive but it is harder to conceive
at that age. The author further commented that fertility in women starts to decline
after age 27 and drops by 50% at 35 years and reduces to 20% by 40. Women over
the age of 35 often suffer from age-related infertility as their eggs resist declines
and hormonal changes make conception and pregnancy more difficult. Unlike
some types of female infertility, age-related problems are progressive. The longer
the patient waits before seeking treatment, the less likely that assisted reproductive
technology will be helpful. (Stanback, et al, 2006)

2.2.8 Behavioral Factors/Lifestyle

It is well-known that certain personal habits and lifestyle factors have impact on
health. Many of these factors may limit a woman’s ability to conceive. However,
many of these variables can be regulated to increase not only the chances of
conceiving but also one’s overall health. Equally, smoking by woman of child
bearing age reduces the chance of conceiving with each cycle, either naturally or
by IVF by one third. (American society for reproductive medicine, 2006)

Fertility plus, (2010) also stated that reproductive functioning requires both proper
diet and appropriate levels of exercise because women who are significantly
overweight or underweight may have difficulty becoming pregnant. Around 12%
14
of all infertility cases are because a woman is either underweight or overweight. In
over-weight women, their bodies produce a hormone called estrogen and too much
body fat (overweight) will lead to too much estrogen and the body will react to it
as if it is a birth control. Too little fat (underweight) also causes insufficient
estrogen and disrupts the menstrual cycle. When menstrual cycle is irregular,
ovulation is inadequate or even does not occur resulting in infertility.

2.2.9 Environmental and Occupational Factors

The ability to conceive may be affected by exposure to various toxins or chemicals
in workplace of the surrounding environment. Substances that can cause mutations,
birth defects, abortions, infertility or sterility are called reproductive toxins.
Disorders of infertility, reproduction and spontaneous abortion are among the top
ten work-related diseases and injuries of the present day. (Mayo clinic, 2007)

Despite the fact that considerable controversy exists regarding the impacts of
toxins on fertility, four chemicals are being regulated based on their documented
infringements on conceptions.

They are as follows:

Lead – This has been proven to have negative impact on female fertility.

Medical Treatment and Materials – Repeated exposure to radiation, ranging from

simple x- rays to chemotherapy, has been shown to contribute to a wide array of
ovarian problem.

15
Ethylene Oxide – This is the chemical used both in the sterilization of surgical
instruments and in the manufacturing of certain pesticides which has the potential
to provoke early miscarriage and cause infertility.

Dibromochloropropane (DBCP) – is a chemical found in pesticides, which can

cause ovarian problems, leading to a variety of healthy conditions like early
menopause that may directly have impact on fertility. (American Journal, 2012)

2.2.10 Pelvic Inflammatory Disease (PID)

PID is the most common cause of infertility world-wide it is an infection of the
pelvis or one or more of the reproductive organs, including the ovaries, the
fallopian tubes, the cervix or the uterus. Sometimes, PID spreads to the appendix
or to the entire pelvic area. It is usually caused by the same bacteria that cause
sexually transmitted infections, such as gonorrhea or Chlamydia. (Smeltzer and
Bare, 2008)

PID may also develop from bacteria that reach the reproductive organs through
non-sterile abortion, hysterectomy, childbirth, sexual intercourse, use of an
intrauterine contraceptive device (IUCD) or a ruptures appendix. (Anne and
Allison, 2006)

2.2.11 Psychological Problems

These include the condition in which there is failure of ovulation as a result of
stress or other forms of emotional instability usually this causes failure of
luteinizing hormone (L.H) to be released. (Dexeus institute, 2006).

16
Problem like marital conflict or family disagreement may prevent frequency of
intercourse, predisposing the couple to infertility.

Such problems probably account for relatively few cases of infertility. (Monday
Adishi, 2009)

2.2.12 Female Infertility Caused by Genetic Problems or an Illness

Turners Syndrome, a chromosomal abnormality, occurs in about 1 out of 2,500

live female births. The female is missing one of the X-chromosomes in most of her
cell and has a fragmented x in few other. According to the Turner’s syndrome
society (2010), most (90%) Turner syndrome individuals will experience early
ovarian failure. Although, most women with Turner syndrome are infertile because
of abnormal ovary development, the Cincinnati Children’s Heart Centre (2009)
reported that there have been cases reports of women with Turner syndrome
becoming pregnant on their own.

2.3 CLINICAL MANIFESTATIONS OF FEMALE INFERTILITY

Some or all of the following symptoms may be present, though, it is possible not to
experience any symptoms:

1. Inability to achieve pregnancy after one year of regular unprotected sexual

intercourse.

2. Irregular painless menses which may suggest an ovulation.

3. Fullness, heaviness, pressure, swelling or bloating in the abdomen.

17
4. An irregular menstrual cycle is a sign because it shows damage, blockage or
injury to some parts of the female reproductive system.

5. Absence of menses can also indicate infertility in the sense that there may be no
eggs being produces by the woman.

6. Dysmenorrhea, dyspareunia and waist pain suggest that there is retroversion of

the uterus.

7. Fluctuations in weight, irregular hair growth and acne over the age of puberty
are also signs of female infertility because these are sometimes caused by
hormonal imbalances which can affect the female reproductive system.

8. Painful menstrual cramps can signal endometriosis which can cause blockage or
damage to some part of a woman’s reproductive system.

9. Pain during intercourse is a sign of endometriosis as well as fibroid/tumors,

which can block passages in and around the reproductive system.

10. Irregular basal body temperature

11. There are other signs of female infertility which can be seen after the attending
physician has done some in depth tests to seek answers. (Medicine health, (2008),
Mayo clinic (2009), Fertility helper, (2008)

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2.4 PSYCHOSOCIAL IMPACTS OF INFERTILITY ON WOMEN OF CHILD BEARING
AGE
Infertility is an issue of profound human suffering particularly for women, it is a
human right issue, women in less developed countries do not have the economics
or job opportunity that are available in comparison to western nations. As a result
motherhood is a central point of identity and self worth. The inability to conceive a
child has a huge implication in terms of their ability to function in their societies,
Iris Waichler, (2012)

Women with infertility suffer from one form of abuse to the other as a result of
their infertility.

The commonest sources of the abuse were from neighbors’, spouse or spouse’s
relatives. (Matsubayasshi et al, 2008).

In Nigeria not having spousal support was observed to independently predict

psychological distress among infertile women. Lack of such support leaves the
women with infertility vulnerable to range of stressful events which may range
from domestic conflict to political violence. They also suffer personal grief,
frustration, social stigma and economic deprivation. The stress placed on the
infertile woman can be intense and impinge on her psychological and social well
being. (Ukpong, 2006)

Women carry the largest burden of suffering and the negative repercussions of the
infertility for men especially at the level of community. A marriage African
woman who has no child is living on borrowed time. The first threat in most cases

19
is outright divorce which is not negotiable. A woman acquires an identity through
marriage and most importantly when the marriage is fertile, if not she may be
returned by the husband to her parents at any moment in disgrace and shame.
(Monday Adishi, 2008)

In fact, women suffer from one form of abuse to another as a result of infertility,
according to Matsubayasshi et al, (2006) is from neighbors, spouses relatives etc.

Infertile women are also predisposed to a range of stressful events such as;
personnel grief, prostration, social stigma, economic deprivation, marginalization,
economic instability, depression, suicidal attempt, divorce, self guilt, anxiety
situation, sexual inadequacy, polygamy, low self esteem, marital conflict and
felling of hopelessness and unfulfilled dreams. Thomas Hilger, (2007)

2.5 PUBLIC KNOWLEDGE ON INFERTILITY IN WOMEN

The African society places passionate premium on procreation in any family
setting. The woman’s place in marriage remains precarious to confirmed through
child bearing. In the society, a woman has to prove her womanhood through
motherhood. Infertility therefore entails a loss of something even though
previously in existent is thought to be tangible and therefore impacts negatively on
women mental and social being. Okunfua, (2007)

Infertility causes a great worry and sorrow for many couples in Africa especially
for the women, medical evidence shows that men and women usually have the
same rate of infertility; yet African traditions view infertility as always the women
fault. In Nigeria generally, women are held responsible for most cases of infertility
20
even though male factors are known to be contributory in about 59% of all cases in
Nigeria. Infertile women are also believe by the public to have lived unhealthy past
with repeated cases of abortions and sexually transmitted infections (STIs)
precipitating their current condition. Dyer S. J, (2007)

In Africa, it is taboo to discuss male infertility that is something “to be concealed

at all cost”. In Zimbabwe for instance “covering up for men is usually done
through traditional practice called “Chiramu” which involves bringing in the
husband’s close relative (usually a brother ) to impregnate the wife, if that meeting
is not successful, then it is concluded that the wife is to blame and should be sent
back to her parent. The assumption that the wife is at faulty may lead to
polygamy. As one African woman wrote “To appease a childless husband and
desperate to save their daughter’s marriage, the parent of the infertile woman
sometimes marriage him a second wife. If they can’t afford to do so, they offer a
younger sister or a niece of the wife as a second wife. The wife is obligated to
protect the dignity of her husband yet no body protects her, not even her own
family.” Dora R. (2007)

Nigerians need re-education in regard to interpersonal sensitivity in many areas of

life circumstances especially infertility. They should know that marriage is for
lovers and children are the fruits of love, and so these women should not be
stabbed with songs of neighborhood. Even the pain of seeing other women
colleagues take maternity leave is a difficult thing to deal with. The re-education
strategy need not be focused in one area but could encompass a broader

21
perspective. Existing educational and intervention programs such as those on
HIV/AIDS prevention could for example include issues relating to infertility.
Youth programs could likewise incorporate material on fertility; such education
interventions should include a focus on gender sensitivity and confront cultural
prejudices that infertility as a female affair. Daniel K, (2009)

2.5 PREVENTIVE MEASURES/TREATMENT OF FEMALE INFERTILITY.

2.5.1 PREVENTIVE MEASURES OF FEMALE INFERTILITY.

Giving the poor prognosis of age- related infertility, it is appropriate that due
consideration be given to preventive strategies aimed at ensuring that women are
able to have children at a younger age without added complication of older age.
The basis of such prevention is that of public enlightenment campaign which have
to be as part of both general and reproductive health education. Godwin M, (2009)

According to San Francisco chronicle, (2007) the following are some of the
preventive measures of infertility in woman;

Reduce stress, do not delay parenthood, avoid too much exercise, maintaining a
normal weight, avoid alcohol and quit smoking, limit caffeine, practice safe sexual
life style because usually transmissible diseases (STIs) can lead to pelvic
inflammatory diseases (PID) which is a major cause of infertility. And have
regular sexual intercourse.

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2.5.2 TREATMENT OF FEMALE INFERTILITY
Infertility management is of utmost importance to the African woman than issues
of her physical health irrespective of whether such illness could precipitate further
morbidities. It is a complex disorder and so treatment involves significant
financial, physical, psychological and time commitment. Although, some women
need just one or two therapy(s) to restore fertility Treatment defend on many
factors including the age of the client, how long they have been infertile, personnel
preferences and their general state of health. Treatment options include;

1. Counseling; on the frequency of intercourse

2. Drugs; such as Ovulation inducing drugs which help to restore fertility by

regulating or inducing ovulation, they are the main treatment for women
who are infertile due to ovulation disorder in order to trigger ovulation. The
drugs are Clomifene citrate, Human Menopausal Gonadotrophin (HMG)
(Repronext), Follicle stimulating hormone FSH (Gonal-F), Human chorionic
gonerdotropine (Ovidrel) Bromocriptin. Progesterone deficiency require
progesterone replacement and antibiotics are needed for pelvic inflammatory
disease eg ofloxacin. Papreen et al, (2007)

3. Surgery; it is the use of surgical operation in treating infertility. For

example, in removing blockage or scar tissues from fallopian tubes, uterus of
pelvic areas. Minor surgery is the remedy defending on the location of the
blockage or scar tissues. Surgery may also be necessary to remove tumors

23
 located within or near the hypothalamus or pituitary gland. Monday adeshi,
(2009)

4. Assisted reproductive technologies; an assisted reproductive technology

(ART) had been developed over the years to assist women to achieve
pregnancy. ART procedures are those fertility treatments in which both egg
and sperm are handles in the laboratory for the purpose of establishing
pregnancy. Monday adeshi, (2009). There are many types but the practice
ones are in vitro fertilization (IVF) and Intracytoplasmic sperm injection
(ICSI). It is mostly done when other steps to achieve pregnancy failed.

5. Diet; the international council of fertility, (2007) stated that, female

infertility that is caused by over or under weight, the best remedy is dietary
change, involved an adequately and nutritious diet with plenty of fruit and
[Link] maintaining a body weight can also increase fertility.

2.6 THEORETICAL FRAMEWORK.

This chapter will examine infertility within a theoretical and developmental
framework. First, Eriksons stage of generativity vs. stagnation will be discuss
along with his emphasis on social and cultural aspects of ongoing identity
development. Second, Jean Bake Miller’s relational cultural theory will be discuss,
along with various other feminist writers. Emphasis will be placed on the impact
the experience of infertility has on relationships, and, in turn, the continuous
development of a sense of self. Finally the stigma theory will be reviewed,

24
addressing stigma’s unintentional yet painful presence in the life of an infertile
woman and it’s socio cultural impact.

2.6.1 Erik Erikson theory of identity formation and development

Erikson, (1959) was the first psychoanalyst to frame ego development and identity
formation as occurring over the course of a life time, and the first to stress
influence of culture and society on our ongoing opportunity for growth. It is a
useful theory within which to explore infertility, a major negative life event that
usually has a deleterious impact on the identity of women. Erikson’s, (1959)
epigenetic theory describes eight stages of development, each of which provides
opportunities for growth with various levels of success and failure. The seventh
stage is adulthood, where our developmental stage challenge is generativity vs.
stagnation the core of generativity lies in concern and raising the next generations,
most of often expressed through parenting or in some way caring for others. The
developmental lapse at this stage is stagnation, where one becomes self –absorbed
and emotionally stunted because of in ability to satisfy the need for generativity.

Identities remain stable as a result of continuity in roles within social networks;

alteration in identity are a result of a changes in relationship to an existing network,
caused by either internal or external factors. Marriage, divorce, and having
children are example of such factors. Stryker, (2007)

2.6.2 Jean Bake Miller’s relational cultural theory

The concept of disenfranchised grief is particularly salient when we consider its
impact on the relationships, and consequently lives and identities of infertile
women. Miller, (1976) addressed a different developmental line for women that
25
stressed the impact for relationship of identity formation and sense of self. In her
relational cultural theory, Miller stated that connectedness to and relationships with
others is vital to personnel growth, posits that healthy relationship require a sense
of feeling part of others by sharing ideas and feelings and emphasizes that people
do not live in isolation. According Miller “women stay with, build on, and develop
in a context of attachment and affiliation with others”, “women’s sense of self
become very much organized around been able to make, and then maintain,
affiliation and relationships,” and “eventually, for many women, the threat of
disruption to an affiliation is perceived not just as a loss of relationship but as
something closer to a total loss of self”. Miller, (1976)

2.6.3 Stigma theory.

Stigma theory help us to understand infertility as a cultural, societal, and existential
experience .Goffman (1963) define stigma as an attribute that is deeply
discrediting and further characterizes stigma as arising due to physical deformities,
individual character deformities, or from deviation from group identity. It is this
last piece-deviation from group identity- that is attached to infertility .Crocker
Major, and steel, (2006) examining from social psychological context, define it as
occurring when an individual is believe to possess an objective attribute that
conveys devalued social identity within a social context and is not located entirely
within the stigmatize person.

According to Whiteford and Gonzalez, (2007) the stigma of infertility is tend to

affect the social identity of the whole person, spoiling of her other
accomplishments and transform biological infertility into socially defined
26
inadequacy. The literature has well documented the emotion associated with
infertility, including shame, inadequacy, devaluation, failure, and incompleteness
that may contribute to the feeling stigmatize.

RELEVANCE OF THE THEORIES TO THE RESEARCH WORK

Each of the theories discuss above present a result of critical life stressor and the
potential for emerging change but intact with opportunities for mastering the stage
of generativity vs. stagnation with a healthy balance of positive and negative
outcomes. Infertility can be transformational experience when the loss has been
mourned. Central to a successful resolution of this loss is feeling validated in one’s
grief so that it is not disenfranchised and relationship have a better chance at
remaining supportive and intact. The infertile woman very much need friends,
family or a therapist to receive the gift of “the accepting, confirming, and
understanding women echo” Kohut, (2008). If there is no opportunity for this if a
woman struggling with infertility is not able to ask and receive what she
desperately need, growth is stagnant, thus heightening the developmental crisis of
generativity vs. stagnation. Going by the stigma theory many women who were un
able to conceive are psychologically traumatized and remain in low self esteem
and depressive throughout their life due to societal stigma and misconception.

27
 CHAPTER THREE
METHODOLOGY

3.0 INTRODUCTION.
This chapter deals with the method and procedure used for carrying out the study
as follows; Research design, Research setting, Target population, Sample size and
Sampling Technique, Instrument for data collection, Validity and Reliability of
instrument, method of data collection, Method of data analysis and ethical
considerations.

3.1 RESEARCH DESIGN

The descriptive survey research design was used in carrying out the study.

The descriptive survey enables the researcher to describe the psychosocial impact
of infertility on women of child bearing age base on response received by the use
of questionnaire.

3.2 RESEARCH SETTING

The study was conducted in murtala Muhammad specialist hospital kano, at
Muhammad abdullahi wase road/kofar mata road kano.

Murtala Muhammad special hospital is located at northern part of k/munincipal

Local Government Head quarter of Kano State, also is from the city of Kano at
Kano state central senatorial district. The Hospital comprises of the following
units;

Accident and Emergency, General Out Patient Department, Antenatal clinic,

ophthalmic clinic, Obstetrics and Gynaecology clinic, male medical ward, male
28
surgical ward, female medical ward, female surgical ward, pediatric ward, labor
ward, dental clinic, x-ray department, laboratory unit, works and services
department, medical record department, account and finance department and
pharmacy department.

The hospital is headed by a chief medical director who is a chief consultant

medical officer. The obstetrics and gynaecology clinic is run by consultant
obstetric and gynaecology docter, where female with obstetrics and gynaecology
problems attend to the clinic.

3.3 TARGET POPULATION

The target population used in this study is women within the age of 15-45 years
who attended the clinic with complaint of primary and or secondary infertility.

3.4 SAMPLE SIZE AND SAMPLING TECHNIQUE

Total of 50 participants were selected as a sample size, and non probability
convenience sampling technique was used by the researcher, because the clinic is a
general clinic for both obstetrics and gynaecology therefore, any woman within the
age of 15-45 years that come with complaint of either primary or secondary
infertility was chosen for the study.

3.5 INSTRUMENTS FOR DATA COLLECTION

A self-developed structured questionnaire was used. The questionnaire comprises
of five sections, section A has to do with demographic data of the respondents,
while section B deals with infertility and its causes, section C deals with

29
psychosocial impact of female infirmity, section D deals with public knowledge of
infertility, section E deals with preventive measures/treatment of infertility.

3.6 VALIDITY AND RELIABILITY OF INSTRUMENT

The researcher developed a questionnaire while the supervisor made sure that they
were valid before being administered, by making necessary corrections through
pre-test in order to be certain that it will elicit the data needed.

3.7 METHOD OF DATA COLLECTION

Questionnaires were distributed to the respondents by the researcher and research
assistant using non probability sampling method of collecting data. Fifty corrected
and approved questionnaires were distributed to the respondent, those who could
not read and/ or write had the questions interpreted to them by the research
assistant. All questions were properly filled and collected thereafter with no
missing questionnaire.

3.8 METHOD OF DATA ANALYSIS

The information gathered was analyzed and interpreted in percentage and
presented in tables with the number of respondents, frequency of percentages was
clearly indicated. This is because it is acceptable, reliable and easily understood.

3.9 ETHICAL CONSIDERATION

A letter of introduction from the school stating the purpose of the research was
taken to the hospital management of Tiga general hospital by the researcher in
order for permission to be granted before the distribution of the questionnaires. The
researcher saw the need to protect individual right therefore, adequate explanation
and information on the purpose of the research work was made to the participants
30
and they voluntarily accepted to be involve in the research. They were assured of
privacy and confidentiality of all information given; they were assured that all
information given will be use for the purpose of the research work only. He
acknowledged all direct quotations from any literature used to avoid plagiarism
and also adequate reference were given.

He made it clear to the participants that whoever wishes to withdraw from the
research can do without fear.

CHAPTER FOUR
DATA PRESENTATION/ ANALYSIS

4.0 INTRODUCTION
This chapter presents the result of the study base on questionnaire retrieved.
Responses of question were put in tables, based on research questions of the study,

31
and were converted into frequency from which percentage were drawn. The
researcher distributed 50 questionnaires and all were retrieved.
4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS
TABLE 4.1

VARIABLE NUMBER PERCENTAGE

(FREQUENCY)
AGE (IN YEARS)
15 – 25 10 20%
26 – 35 22 44%
36 – 45 16 32%
45 And Above 2 4%
Total 50 100%
RELIGION
Islam 44 88%
Christianity 6 12%
Others Nil 0%
Total 50 100%
MARITAL STATUS
Married 38 76%
Single 4 8%
Divorced 5 10%
Widow 3 6%
Total 50 100%
OCCUPATION
House Wife 36 72%
Civil Servant 6 12%
Business Woman 4 8%
Un-Employed 4 8%
Total 50 100%
32
TRIBE
Hausa 36 72%
Fulani 10 20%
Igbo 3 6%

Yoruba 1 2%
Others Nil 0%
Total 50 100%
EDUCATONAL
STATUS
Primary 10 20%
Secondary 4 8%
Tertiary 2 4%
Informal 34 68%
Total 50 100

Table 4.1 presents the socio-demographic characteristics of the respondents. Out of

50, 10 (20%) are between the age of 15-20 years, 22 (44%) are between 26- 35
years, 16 (32%) are between the age of 36 -45 % while 2 (4%) are 45 and above.
44 (80%) respondents are Muslims while the remaining 6 (12%) are Christians. 36
(72%) out of 50 respondents are fulltime house wife, while 6 (12%) are civil
servants, 4 (8%) are business women, 4 (8%) are unemployed. 38 (76%) out of 50
respondents are married, 4 (8%) are single, 5 (10%) are divorce while 3 (6%) are
widows. 36 (72%) of the respondents are Hausa by tribe 10 (20%) are Fulani, 3
(6%) are Igbo while the remaining 1 (2%) is Yoruba by tribe. 10 (20%) of the
respondents have attended primary level of education, 4 (8%) have secondary level
of education, 2 (4%) attended tertiary level while 34 (68%) didn’t have any formal
education, they only have informal education.

33
4.2 INFERTILITY AND ITS CAUSES
TABLE 4.2.1

VARIABLES FREQUENCY PERCENTAGE

At what age did you
marry?
11 – 20 years 20 40%
21 – 30 18 36%
31 – 40 12 12%
40 and above Nil 0%
TOTAL 50 100%
Have you ever heard of
infertility?
YES 50 100%
NO 0 0%
TOTAL 50 100%
If yes, what is your view?
is infertility
Failure to conceive after
one year of unprotected 34 68%
sexual intercourse

When a woman cannot

conceive and carry 12 24%
pregnancy to give birth
In ability of woman to
contribute to conception 4 8%

TOTAL 50 100%

34
From the above table, 20 (40%) of the respondents got married between 11 – 20
years while, 18 (36%) got married between 21-30 years, 12 (24%) marry at 31-
40years while none of the respondents got marriage at the age of 40 and above. All
50 (100%) respondents have knowledge about infertility. 34 (68%) of the
respondents from above table believe that infertility is a failure to conceive after
one year of un protective sexual intercourse. 12 (24%) are in the view that
infertility is when a woman cannot conceive and carry pregnancy to live birth,
while 4 (8%) are in the view that infertility is inability of woman to contribute to
conception.
TABLE 4.2.2
VERIABLES NUMBER PERCENTAGE
(FREQUENCY)
Which of the following is
the commonest cause of
infertility in woman?

Ovulation disorders 3 6%
Late marriage 2 4%
Pelvic inflammatory 10 20%
disease(PID)
All of the above 35 70%
TOTAL 50 100%
Which of the following is
the commonest cause of
infertility in couples?
Man 8 16%
Woman 14 28%
Both man and woman 28 56%

35
TOTAL 50 100%

From the above table 3 (6%) of the respondents agree that ovulation disorders are
the commonest causes of infertility in women, 2 (4%) of the respondents were in
the opinion that late marriage in the commonest cause of infertility in women,
while 10 (20%) of the respondents believe that pelvic inflammatory disease (PID)
is the commonest cause, but 35 (70%) of the respondents which are the majority
strongly believe that ovulation disorder, pelvic inflammatory diseases (PID) and
late marriage are all the contributory factors of the female infertility.

From the above table 8 (16%) of the respondents believe that the cause of
infertility among couples is man while 14 representing (28%) agree that the cause
is woman, but 28 out of 50 (56%) believe that the cause is from both man and
woman.
4.3 PSYCHOSOCIAL IMPACTS OF FEMALE INFERTILITY.
TABLE 4.3.1

VARIABLES FREQUENCY PERCENTAGE

Have you been
maltreated for being
infertile?
Yes 48 96%
No 2 4%
Total 50 100%
If yes who maltreated
you?
Spouse 4 8.3%
Spouse relatives 42 87.5%
Neighbors 2 4.16%

36
Colleague in office - -
Total 48 100%
What are the abuses?
Divorce 6 12%
Polygamy 10 20%
Economics deprivation 4 8%
Insult 30 60%
Total 50 100%

The above table shows that 96% of the respondents have been maltreated for being
infertile while the remaining 4% have not experienced any form of maltreatment.

The table also shows that 87.5% of the respondents representing the majority have
been maltreated by their spouse relatives while 4.16% by their neighbors.

The table also shows that most of the respondents 60% were insulted for being
infertile, 20% suffer polygamy, 12% were divorced and the remaining 8% suffer
some form of economics deprivation.

TABLE 4.3.2
VARIABLES FREQUENCY PERCENTAGE
What is your reaction?
Frustrated 11 22%
Depressed 26 52%
Feeling inadequate 11 22%
Attempted suicide 2 4%
Total 50 100%
37
Is the loss of self esteem and self
worth among women with
infertility?
Yes 50 100%
No Nil 0%
Total 48 100%

The above table shows that 26 (52%) of the respondents were depressed in reaction
to the abuse, 11 (22%) were frustrated, also 11 (22%) had feeling of inadequacy,
while the remaining 2% attempted suicide.

Also the result from above table shows that the entire respondents representing
100% agreed that there is loss of self esteem and self worth among woman with
infertility.

4.4 PUBLIC KNOWLEDGE ON INFERTILITY

TABLE 4.4.1
VARIABLE FREQUENCY PERCENTAGE
Is motherhood the only
way woman can prove
her womanhood
Yes 47 94%
No 3 6%
Total 50 100%
What do you suggest

38
infertile woman should
do?
Adopt child 3 6%
Wait for God 30 60%
Go to herbalist 2 4%
Go to hospital 15 30
Total 50 100%
The table shows majority of the respondents 47 (94%), had agreed to the fact that
motherhood is the only way a woman can prove her womanhood, while remaining
6% says no.

Also the above table shows 60% of the respondents suggested that they should wait
for God, while 30% suggested going to the hospital, 6% said they should go for
adoption while 4% agreed to go to herbalists.
TABLE 4.4.2
VERIABLES FREQUENCY PERCENTAGE
Does your culture encourage divorce or
permit polygamy in couple who are
infertile?
Yes 40 80%
No 10 20%
Total 50 100%
Does your culture view infertility as
always the woman fault?

Yes 41 82%
No 9 18%
Total 50 100%

39
The above table shows that 40 (80%) of respondents belong to culture which
encourage divorce and or permit polygamy in couple with infertility, while the
remaining 10 (20%) belong to the culture that does not permit divorce or
encourage polygamy in infertile couples.

Also the result from above table shows that most culture view infertility as a
woman’s fault which is clearly seen as 82% of the respondents says yes while 18%
say no.
4.5 PREVENTIVE MEASURES / TREATMENT OF INFERTILITY
TABLE 4.5.1
VARIABLE FREQUENCY PERCENTAGE
In what way can we
prevent infertility in
women?
Marry at early age 6 12%
Prevention of sexual 8 16%
transmitted diseases
(STDs)
Maintain a normal weight 1 2%
All of the above 35 70%
Total 50 100%
Can creating awareness
and change in life style
prevent infertility in
women?

Yes 36 72%
No 14 28%
Total 50 100%

40
The result from above table shows that majority of the respondents representing
70% are of the opinion that early marriage, prevention of transmitted diseases and
maintaining a normal weight are some of the of preventing infertility, 16% agreed
with early marriage while 2% say by maintaining a normal weight.

Also from above table 72% of respondents forming majority agreed that creating
awareness and change in life style can prevent infertility, while the remaining 28%
disagreed.
TABLE 4.5.2
VARIABLES FREQUENCY PERCENTAGE
Is counseling a measure of combating
psychosocial impacts of infertility in
women?
Yes 44 88%
No 6 12%
Total 50 100%
The availability and accessibility of
treatment to victims is a measure for
combating the psychosocial impact of
infertility?
Yes 36 72%
No 14 28%
Total 50 100%
The table above shows that majority of the respondents 44 representing (88%)
agreed to the fact that the psychosocial impacts of infertility can be prevented
through counseling while remaining 12% disagreed.

The table also shows 72% of the respondents agreed strongly that availability and
accessibility of treatment to victims is a measure for combating psychosocial
impacts of infertility while remaining 28% says no.
41
TABLE 4.5.3
VARIABLES FREQUENCY PERCENTAGE
What treatment do you suggest to women
who have infertility?

Adoption 11 22%
Ovulation induction 3 6
Surgery 6 12%
Wait for God 30 60%
Total 50 100%
What is the role of government in
preventing of infertility in women?
Creating of on the dangers associate with 8 16%
sexually transmitted diseases (STDs)

Make investigation free for all women in 31 62%

government hospitals
Provide more fertility treatment centers 11 22%
Total 50 100%

The result above revealed that 60% of the respondents forming majority suggest
waiting for god’s time.22% suggest adoption, 12% options for surgery, while the
remaining 6%says they should undergo ovulation induction.

Also from the above table 31, (62%) of the respondents are in the opinion that
government should make the investigation free for women in all its hospitals,
(22%) suggested that government should provide more infertility centers while
(16%) are in the opinion of creating awareness on the dangers associated with
sexually transmitted diseases.

42
 CHAPTER FIVE
5.0 INTRODUCTION
This chapter discusses major findings, relationship with other studies, implication
for community health workers and student under training and recommendations
and suggestion for further study.
5.1 MAJOR FINDINGS
The following were the major findings of the study.

100% of the respondents have knowledge of infertility.

70% of the respondents are aware of the causes of infertility.

56% believe that the cause is from both men and women.

43
96% of the respondents have been maltreated for being infertile.

94% of respondents agreed that woman can only prove her womanhood through
motherhood.

88% of the respondents are aware that counseling is the best measure for
combating psychosocial impact of infertility.

82% of the respondents believe that their culture view infertility as woman's
faults.

62% are of the opinion of that government should make investigation free for
women with infertility in all government hospitals for prevention and early
treatment of infertility.
5.2 DISCUSSION OF FINDINGS
5.2. 1. Research question 1
1. What are the causes of female infertility?

With the reference to this question, finding shows that the common causes of
infertility are ovulation disorder, late marriage and pelvic inflammatory disease
representing (70%). Also (56%) of the respondents view infertility as a problem of
both men and women. This is in line with UK regulated fertility services (2009),
that 30% cause of infertility is from man, 30% from woman, 25% unexplained
10% combined and 5% unknown. Fertility helper (2008), also stated that the
causes of female infertility include ovulation problems, pelvic inflammatory
diseases and age related problems.
5.2. 2. Research Questions 2
What are the psychosocial impacts of infertility in women?

In response to the above question, (96%) of the respondents agreed that they were
maltreated for being infertile, another (87.5%) said that they were maltreated by
their spouse relatives, 52% were depressed in reaction to the maltreatment and the
44
entire respondents representing 100% said that there is loss of self esteem and self
worth in woman who are infertile. This is in relation to Matsubayashi et, al (2007),
who stated that there is psychological trauma to woman who are infertile due to
abuses or insult from their spouses, spouses relatives and neighbors which
predisposes them to social stigma emotional instability and depression.
5.2. 3. Research questions 3
Do public have adequate knowledge and awareness of female infertility?

In response to above questions, majority (94%) of the respondents have agreed to

the fact that woman can prove her womanhood through motherhood. Also 80% of
the respondents belong to culture which encourage and or permit polygamy in
couples with infertility. 82% of the respondents also belong to the culture that view
infertility as a woman faults. This is in line with Okunfua, (2007) which stated that
African society places passionate premium procreation in any family setting. The
woman’s places in marriage remains precarious to confirmed through child
bearing. In the society, a woman has to prove her womanhood through
motherhood.

Also Dora, R. (2007) stated that in Africa it is taboo to discuss male infertility that
is something to be concealed at all cost. In Zimbabwe for instance covering up for
men is usually done through traditional practices called ‘’chiramu’’ which involves
bringing in the husbands close relatives (usually a brother) to impregnate the wife,
if that meeting is not successful , then it is concluded that the wife is to blame and
should be sent back to her parents. The assumption that the wife is at fault may
lead to polygamy.

5.2. 4. Research question 4

What are the possible preventive measures/treatment of infertility in women?

45
With the reference to this question, 70% of the respondents are of the opinion that
prevention and treatment of sexually transmitted diseases, marrying at early age
and maintaining a normal weight can prevent infertility in women. 70% of the
respondents agreed that creating awareness and change in lifestyle can prevent
infertility. 72% suggested the availability and accessibility treatment to victims as
a measure of preventing infertility. While 62% of the respondents suggested that
investigation should be free for women in all government hospitals. Which is in
relation to the San Francisco Chronicle [2009], who stated some of the preventive
measures of infertility include, maintaining a normal weight prevention and
treatment of sexually transmitted diseases and to marry at early age.
5.3 IMPLICATIONS FOR COMMUNITY HEALT WORKER AND STUDENT
This implies that community health workers and student need to be
knowledgeable enough on infertility and its effects on women so as to health
educate the general public on the impact of this menace on victims and the possible
way of preventing its occurrence. Health education of the public on personal
hygiene in order to prevent pelvic inflammatory diseases that will eventually lead
to infertility and enlightenment on the general public on the causes of infertility so
as to create awareness that infertility is not always the women’s fault.
5.4 SUMMARY
The study was conducted in genecology clinic of murtala Muhammad specialist
hospital Kano, with the purpose of finding out psycho-social impact of infertility
on women of child bearing age (15 to 45 years). The methodology used was
descriptive research design. The total of 50 women were used as a sample size who
were selected through non-probability convenience sampling method, four research
questions were formulated and 26 items questionnaire was used for data collection.
Analysis of data collected was based on the responses of the respondent with the
use of table and percentage. The finding revealed that most of the respondents have
heard of infertility, the finding also shows that 94% of the respondents support the
fact that a women can only prove her womanhood through motherhood.

46
In view of that, infertility is generally regarded as woman’s fault.
5.5 CONCLUSION
Based on the findings of this study, the psycho-social impact of infertility on
woman include depression, frustration, feeling of inadequacy, low self esteem and
self worth to the extent some of them attempted suicide.

The general public needs more enlighten in order to reduce some of the
misconception about infertility in woman and prevent further maltreatment of
victims.
5.6 LIMITATIONS OF THE STUDY
Like all other research work, these results may not be generalizable to all women
that fit for eligibility criteria for participation due to the nature of the participants,
their ethnicity and tribe. Hence, transferability of this study may not be possible to
other tribes.

Another limitation in this study includes variables that are unable to be fully asses
in the context of qualitative study. These include; coping and stress management
styles, support system and mental health status.

An additional limitation in this study is self selection bias, an inherent issue in all
qualitative research. It is possible that those who chose to participate felt good
about their lives, had work hard through many of the issues raised by infertility
(including shame) and were therefore more open to disclosing highly personal
aspect of their history and current life.

Also another limitation of the study is the sample size and sampling technique, in
which only 50 participants were used as sample size, and non probability
convenience sampling technique was used due to nature of the research setting,
time and financial constraint, this may affect the generalization of the study.

47
Method employed in data presentation and analysis in which only table and
percentage was used due to limited time is another limitation of the study.
5.7 RECOMMENDATION
Based on the findings of this study, the researcher came up with the following
recommendations to the women, public and government in order to achieve a
possible reduction in the psycho-social impact of infertility on woman.

To women;

(A) Women should avoid late marriage as fertility decline with age.

(B) Women should avoid caffeine, smoking and alcohol consumption during their
reproductive age.

(C) Those with menstrual irregularities and pelvic inflammatory disease [PID]
should report to the nearest hospital for treatment.

General public;

(A) Any cultural belief that encouraged late marriage should be discourage.

(B) Traditional rulers should discourage divorce or and polygamy in couples who
are infertile as it is not always a woman’s faults.

Government;

(A) Public enlightenment campaign on the causes, effect, and prevention of

infertility should be made through mass media.

(B) Establishment of more infertility treatment centre and making medical services
free for women of child bearing age for easy diagnosis and treatment of
Gynecological conditions.

48
5.8 SUGGESTIONS FOR FURTHER STUDIES
For every problem there is always a remedy. In order to explore more on this topic,
the researcher suggested the following areas that are yet to be investigated for
further studies.

(A) Factors responsible for infertility in women of child bearing age.

(B) Determining the relationship between late marriage and infertility.

REFERENCES
Adesokon, F. O. (2011). Reproductive health for all ages Revised edition Bosen
publishers Nigeria limited Akure.

Agboola, A. (2006). Test book of obstetric and gynaecology for medical student.
Second edition

Anderson, R. A. Pandian, Z. (2011). Defining infertility. A systematic preview of

prevalence studies; (chuchilll-living stone). Edinburg.

Dane, M. Fraser (UK) margalet A copper, (UK) Ama [Link] (2009). Myles
test book for midwives African edition chuchill living stone Edinburg U S
A.

Khetarphal, A. singh, S, (2012). Infertility, why can’t we classify this inability as

disability? The Australian medical journal.
49
Maheshwari, A. (2008). Human reproduction Churchill living stone Edinburg

Monday Adishi. (2009). Hands on guide of infertility and remedies 5th edition.

Patricia S Jones (2007). Encyclopedia and dictionary of medicine, nursing and

allied health 7th edition, U S A.

R A hope, J M Long more (2008). Oxford hand book of clinical medicine, new
York.

Tanya A, meferran, (2009). A dictionary of nursing 5 th edition, clays limited Great

Britain.

Appendix
QUESTIONAIRE
School of health technology kano,

Sani marshal/club road kano.

[Link] 11549

kano state

Dear Respondent,

The researcher is a final year student of school of health technology kano at

community health department chew 37(diploma in chew programmed) currently

50
carrying out a research on the psychosocial impacts of infertility on women of
child bearing at Gynecology Clinic murtala Muhammad specialist Hospital Kano.

I hereby solicit for your honest and reliable information in filling the questionnaire.
All information gathered from your response will be treated with utmost
confidential and will be highly appreciated.

Thanks for your cooperation

Instructions; tick (√) or fill in the blank spaces

SECTION A: DEMOGRAPHIC DATA
1. Age:
a. 15- 25 { }
b. 26- 35 { }
c. 36- 45 { }
d. 45 and above { }
2. Religion:
a. Islam { }
b. Christianity { }
c. Others specify………….
3. Marital status:
a. Married { }
b. Single { }
c. Divorced { }
d. Widow { }

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4. Occupation:
a. House wife { }
b. Civil servant { }
c. Farmer { }
d. Business woman { }
e. Unemployed { }

5. Tribe:
a. Hausa { }
b. Fulani { }
c. Igbo { }
d. Yoruba { }
e. Others specify………….
6. Educational status:
a. Primary { }
b. Secondary { }
c. Tertiary { }
d. Informal { }
SECTION B Infertility and it’s causes
7. At what age did you marry?
a. 11 – 20 { }
b. 21 to 30 { }

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 c. 31 to 40 { }
d. 40 and above { }
8. Have you ever heard of infertility?
a. Yes { } b. No { }
9. If yes, what is your view is infertility?
a. failure to conceive after one year of regular unprotected sexual
intercourse { }
b. when a women cannot conceive and carry pregnancy to life birth { }
c. In ability of woman to contribute to conception { }
10. Which of the following is the commonest cause of infertility in woman?
a. Ovulation disorders { }
b. Late marriage { }
c. Pelvic inflammatory diseases (PID) { }
d. All of the above { }
11. Who in your view is the cause of infertility in a couple?
a. Man { }
b. Woman { }
c. Both A and B { }
SECTION C: THE PSYCHOSOCIAL IMPACT OF FEMALE
INFERTILITY
12. Have you been maltreated for infertile?
a. Yes { } b. No { }
13. If yes, who maltreated you?

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 a. Spouse { }
b. Spouse relatives { }
c. Neighbours { }
d. Colleagues in office { }
14. What are some of the abuses?
a. Divorce { }
b. Polygamy { }
c. Economics deprivation { }
d. Insults { }
15. What was your reaction?
a. Frustrated { }
b. Depressed { }
c. Feeling inadequate { }
d. Attempted suicide { }
16. Is there loss of self esteem and self worth among women with infertility?
Yes { } No { }
SECTION D: PUBLIC KNOWLEDGE ON INFERTILITY
17. Is motherhood the only way woman can prove her womanhood?
a. Yes { } b. No { }
18. If yes what do you suggest infertile woman should do?
a. Appease the God { }
b. Wait for God { }
c. Go to herbalist { }

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 d. Go to hospital { }
19. Does your culture encourage divorce or permit polygamy in couples who are
infertile?
a. Yes { } b. No { }
20. Does your culture view infertility always woman’s fault?
a. Yes { } b. No { }
SECTION E: PREVENTIVE MEASURE /TREATMENT OF INFERTILITY
21. In what way can we prevent infertility in women?
a. Marry at early age { }
b. Prevention and treatment of sexual transmitted disease (STDs) { }
c. Maintaining a normal weight { }
d. All of the above { }
22. Can creating awareness and change in life style prevent infertility?
Yes { } No { }
23. Is counselling measure for combating the psychosocial impact of infertility in
women?
a. Yes { } b. No { }
24. Is The availability and accessibility of treatment to victim is a measure for
preventing the psychosocial impact of infertility?
a. Yes { } b. No { }
25. What treatment do you suggest to women who have infertility?
a. Adoption { }
b. Ovulation induction { }

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 c. Surgery { }
d. Wait for God. { }
26. What is the role of a government in the prevention of infertility in women?
a. Creating awareness on the dangers associated with sexual transmitted
diseases (STDs) { }
b. Make investigation free for women in all government hospital
c. Provide more infertility treatment centres { }

Contents
1.0 INTRODUCTION:................................................................................................................................1
BACKGROUND OF THE STUDY:................................................................................................................1
STATEMENT OF PROBLEMS;....................................................................................................................3
OBJECTIVE OF THESTUDY........................................................................................................................3
RESEARCH QUESTIONS............................................................................................................................4
SIGNIFICANCE OF THE STUDY..................................................................................................................4
SCOPE AND DELIMINATION OF THE STUDY.............................................................................................5
OPERATIONAL DEFINITION OF TERMS.....................................................................................................5
1.7.1 INFERTILITY:................................................................................................................................5
1.7.2 FERTILITY:...................................................................................................................................5
1.7.3 AMENORHOEA:...........................................................................................................................5
1.7.4 IMPACT:......................................................................................................................................5
1.7.5 WOMEN OF CHILD BEARING AGE:..............................................................................................5
1.7.6 PSYCHOSOCIAL:..........................................................................................................................5
1.7.7 MENOPAUSE:..............................................................................................................................5
1.7.8 MENARCH:..................................................................................................................................6
1.7.9 MENSTRUATION:........................................................................................................................6

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 1.7.10 FERTILIZATION:.........................................................................................................................6
1.7.11 ABORTION:................................................................................................................................6
1.7.12 BONDAGE:................................................................................................................................6
1.7.13 POLYGAMY:...............................................................................................................................6
1.7.14 DIVORCE:..................................................................................................................................6
CHAPTER TWO.............................................................................................................................................7
LITERATURE REVIEW................................................................................................................................7
2.0 INTRODUCTION.................................................................................................................................7
2.1 CONCEPT OF FEMALE INFERTILITY.....................................................................................................7
2.2 CAUSES OF FEMALE INFERTILITY.......................................................................................................9
2.2.1Ovulatory Problems.....................................................................................................................9
2.2.2Cervical Causes..........................................................................................................................10
2.2.3 Pelvic and Tubal Causes............................................................................................................11
2.2.4 Uterine Causes..........................................................................................................................11
2.2.5 Reproductive causes.................................................................................................................12
2.2.6 Hormonal Problem...................................................................................................................13
2.2.7Age-Related Infertility................................................................................................................14
2.2.8 Behavioral Factors/Lifestyle......................................................................................................14
2.2.9 Environmental and Occupational Factors.................................................................................15
2.2.10 Pelvic Inflammatory Disease (PID)..........................................................................................16
2.2.11 Psychological Problems...........................................................................................................16
2.3 CLINICAL MANIFESTATIONS OF FEMALE INFERTILITY......................................................................17
2.4 PSYCHOSOCIAL IMPACT OF INFERTILITY ON WOMEN OF CHILD BEARING AGE..............................19
2.5 PUBLIC KNOWLEDGE ON INFERTILITY IN WOMEN..........................................................................20
2.5 PREVENTIVE MEASURES/TREATMENT OF FEMALE INFERTILITY......................................................22
2.5.1 PREVENTIVE MEASURES OF FEMALE INFERTILITY.....................................................................22
2.5.2 TREATMENT OF FEMALE INFERTILITY.......................................................................................23

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 2.6 THEORETICAL FRAMEWORK............................................................................................................24
2.6.1 Erik Erikson theory of identity formation and development.....................................................25
2.6.2 Jean Bake Miller’s relational cultural theory.............................................................................25
2.6.3 Stigma theory...........................................................................................................................26
CHAPTER THREE........................................................................................................................................28
METHODOLOGY.....................................................................................................................................28
3.0 INTRODUCTION...............................................................................................................................28
3.1 RESEARCH DESIGN...........................................................................................................................28
3.2 RESEARCH SETTING..........................................................................................................................28
3.3 TARGET POPULATION......................................................................................................................29
3.4 SAMPLE SIZE AND SAMPLING TECHNIQUE......................................................................................29
3.5 INSTRUMENTS FOR DATA COLLECTION...........................................................................................30
3.6 VALIDITY AND RELIABILITY OF INSTRUMENT...................................................................................30
3.7 METHOD OF DATA COLLECTION......................................................................................................30
3.8 METHOD OF DATA ANALYSIS...........................................................................................................30
3.9 ETHICAL CONSIDERATION................................................................................................................31
CHAPTER FOUR..........................................................................................................................................32
DATA PRESENTATION/ ANALYSIS...........................................................................................................32
4.0 INTRODUCTION...............................................................................................................................32
4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS.........................................................32
4.2 INFERTILITY AND ITS CAUSES...........................................................................................................34
TABLE 4.2.2........................................................................................................................................35
4.3 PSYCHOSOCIAL IMPACTS OF FEMALE INFERTILITY..........................................................................36
TABLE 4.3.2........................................................................................................................................38
4.4 PUBLIC KNOWLEDGE ON INFERTILITY..............................................................................................39
TABLE 4.4.1........................................................................................................................................39
TABLE 4.4.2........................................................................................................................................39

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 4.5 PREVENTIVE MEASURES / TREATMENT OF INFERTILITY..................................................................40
TABLE 4.5.1........................................................................................................................................40
TABLE 4.5.2........................................................................................................................................41
TABLE 4.5.3........................................................................................................................................42
CHAPTER FIVE............................................................................................................................................44
5.0 INTRODUCTION...............................................................................................................................44
5.1 MAJOR FINDINGS.............................................................................................................................44
5.2 DISCUSSION OF FINDINGS...............................................................................................................44
5.2. 1. Research question 1................................................................................................................44
5.2. 2. Research Questions 2..............................................................................................................45
5.2. 3. Research questions 3..............................................................................................................45
5.2. 4. Research question 4................................................................................................................46
5.3 IMPLICATIONS FOR NURSING..........................................................................................................46
5.4 SUMMARY.......................................................................................................................................47
5.5 CONCLUSION...................................................................................................................................47
5.6 LIMITATIONS OF THE STUDY...........................................................................................................47
5.7 RECOMMENDATION........................................................................................................................48
5.8 SUGGESTIONS FOR FURTHER STUDIES............................................................................................49
REFERENCES..............................................................................................................................................50
Appendix...................................................................................................................................................51
QUESTIONAIRE......................................................................................................................................51

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