Coping Strategies of Clients With Fertility Challenges Attending Obstetric and Gynaecological Clinic of University of Maiduguri Teaching Hospital, Borno State
CHAPTER ONE
Objective of Study
- Ascertain the use of escape/avoidance coping strategy by clients with fertility challenges.
- Determine the use of self-controlling coping strategy by clients with fertility
- Determine if clients with fertility challenges use seeking social support as a coping strategy.
- Assess if clients with fertility challenges use positive reappraisal as a coping
CHAPTER TWO
LITERATURE REVIEW
This chapter presents the review of literature on the topic under conceptual review: concept of infertility and coping strategies, theoretical (Kubler-Ross model of grieving) and empirical reviews. It also highlights the summary of literature.
Conceptual Review Concept of Infertility
Infertility refers to the biological inability of a person to contribute to conception. It also refers to the state of a woman who is unable to carry a pregnancy to full term (Mogobe, 2010). The World Health Organisation (WHO, 1987 as cited in Tabong & Adongo, 2013) defines infertility as the inability to conceive a child. A couple may be considered infertile if, after two years of regular intercourse, without contraception, the woman has not become pregnant. There are two types of infertility, primary and secondary. Primary infertility is infertility in a couple who had never been pregnant while secondary infertility is failure to conceive following previous pregnancy (WHO, 2013). The use of the ability of the female to conceive as a measure to differentiate between primary and secondary infertility is however problematic as it places couple infertility on the doorstep of the female partner (Tabong & Adongo, 2013).
Inhorn (2012) noted that, infertility is not often seen as an issue in the developed countries. This is because of assumption about overpopulation problem and hyper fertility in developing countries, and perceived need for them to decrease their population and birth rates. Lock & Nguyen (2011) explained that fertility treatments, such as treatment for sexual transmitted infections that cause infertility, are therefore not usually made available to individuals in these countries. Despite this, infertility has profound effects on individuals in developing countries, as the production of children is often highly and socially valued and is vital for social security and health network as well as for family income generation.
For many individuals and couples, infertility is undeniably a major life crisis and psychologically stressful (Holstein, Christensen & Bovin, 2011a). It has been reported to cause depression, pain and the promise of often unfulfilled dreams in women. It is a lonely place for individuals and couples because “infertility is often a silent and solitary crucible, since it is not visible, life threatening or disfiguring” (Caroll, Robinson, Marshall, Callister, Olsen and Dyches, 2011).
When a client is diagnosed with infertility, they commonly experience a variety of stressors. These stressors include, but not limited to, disruptions in personal life and relationships with others, changes in quality of individual’s emotional and sexual relationship, and alterations in relationship with co-workers, family and friends. Further, fertility challenges the infertile person’s life expectations (Schmidt, 2009). As infertility is an unplanned and unexpected stressor, individuals typically lack the knowledge and skills sets to adequately manage infertility stress. As a result, they engage in a variety of coping strategies in an attempt to regain control over their lives and rebalance the disruptions they have experienced in their personal, marital and social relationships (Schmidt, Christensen & Holstein, 2010b).
In Africa women perceive infertility as the most important sexual and reproductive health problem and have made efforts to position infertility as an important issue within discourses on gender and sexual and reproductive health rights (Okonofua, 2010). The fear of infertility has been put forward by several advocates and social science researchers in Africa to explain the current low contraceptive prevalence rates in some African countries, as women frequently avoid contraception for fear that it may cause infertility in later life (Castle, 2014).When couples encounter a barrier for having a child, which is linked with fertility problems, the distressful, anxious and psychological stressful conditions may arise. After this, they may look for alternative patterns for the purpose of having children (United Nations, 2004).
Esima, Orji & Lasis, (2014) reported that, most studies have investigated the prevalence of female infertility and very few have studied male infertility. However, it has been suggested that males and females contribute equally to infertility. Nevertheless, report from various part of Nigeria have reached different conclusion. While some showed equal contribution of male and female partners, others showed a disproportionate contribution of male and female partners. More so, it is difficult to accurately determine the contribution of males and females to infertility, as fertility is relative and may manifest differently in different couples.
CHAPTER THREE
RESEARCH METHODS
This chapter describes the research design, area of study, population of study, sample and sampling technique, instrument for data collection, validation of instrument, reliability of instrument, procedure for data collection, ethical consideration and methods of data analysis.
Research Design
Descriptive survey design was used. The design has the ability to describe coping strategies of clients with fertility challenges attending Obstetric and Gynaecological clinic in UMTH. The design was successfully used by Donkor and Sandall, (2013) in studying coping strategies of women seeking infertility treatment in Ghana.
Area of Study
The study was conducted at the Obstetric and Gynaecological clinic of UMTH. The clinic offers services to infertile clients. The clinic holds every Tuesday and Friday weekly. UMTH is located in Jere local government area of Borno state along Bama road. The hospital was established 1983 to serve the North Eastern states which includes Bauchi, Adamawa, Taraba, Gombe Yobe and Borno. The hospital also serves patients from neighbouring countries of Cameroon, Niger, and Chad in which Borno state share boundaries with them. The inhabitants of Maiduguri are mostly Kanuris and Hausas who are Muslims with a few Christians who are settlers that work in the university and the teaching hospital. The Muslim religion allows a man to marry more than one wife. This implies that, one of the wives may be infertile and the husband’s fertility may be proven by the other wives or a woman who has been divorced because of childless can prove her fertility by remarrying another man and bears children for him.
Population of Study
The target population consist of all clients with fertility challenges attending Obstetric and Gynaecological clinic of UMTH. From the available registered data in the clinic in 2015 it shows that an average of 57 clients with fertility challenges attend the clinic in a day. Thus in a week it will be approximately 114 since there are two clinic days in a week namely Tuesdays and Fridays. For the period of one month in which the data will be collected, the targeted population is estimated to be 114×4= 456.
CHAPTER FOUR
PRESENTATION OF RESULTS
This chapter dealt with presentation of results. Out of 232 questionnaires administered, 220 copies were correctly filled and retrieved giving a return rate of 95%
The result in table 1 shows that 109(50%) of respondents were aged between 30-39 years, 20-29 years were 60(27.3%), 40-49 years 43(19.5%) while those aged 50 and above were 8(3.6%). Majority 117(75.9%) of the respondents were females while 53(24.1%) were males. About 111(50.5%) had completed secondary school while 90(40.9%) had tertiary education. More than half 115(52%) of the respondents have been married between 1-5 years, 67(30.5%) had been in marriage for 6-10 years, 20(9.1%) for 11-15 years while 18(8.2%) had been married for 16 and above years. The table also shows that 142(85%) of females had secondary infertility while 25(15%) had primary infertility. On the other hand, 19(35.8%) of males have not impregnated a woman while 34(64.2%) have impregnated a woman before.
CHAPTER FIVE
DISCUSSION OF FINDINGS
This chapter dealt with discussion of major findings, limitations of the study, conclusion, recommendations, summary of the study, and suggestion for further studies.
Discussion of Major Findings
The major findings from the study were discussed with respect to the specific objectives and research questions set for the study. The discussion was done under the objectives for better understanding.
Demographic Variables of the Respondents
The result shows that, majority of the respondents were in the age grade of 30-39years with mean age of 33.6±7.04years. This shows that all the respondents were within reproductive age and still have hope of giving birth. A greater number of respondents had been married for almost 5years indicated by 115 (52.3%).This study finding is confirmed by Obeit, Hamlan and Callister (2014) where their respondents were within the reproductive age with a mean and standard deviation of 32±5.2years.
Majority of the female respondents had secondary infertility. Similarly, most male respondents had impregnated a woman in their life time. The finding shows that, secondary infertility was more prevalent than primary infertility among the respondents studied. These findings are similar to the findings of Obuna, Ndukwe, Ejikeme and Ugbonna, (2013) as well as Panti and Sununu, (2014) who reported in their studies that, majority of their respondents had secondary infertility 64.7%, primary infertility 35.3%, secondary infertility 67.2% and primary infertility 32.8% respectively.
Use of escape/avoidance coping strategy by clients with fertility challenges
The data analysed revealed that slightly above half (54.7%) of males and 31.1% of females drinks, smoke and indulge in drugs to forget they are childless with mean score and SD of 0.83 (0.893) for male and 0.35 (0.570) for female. What this means is that an average respondent fall between not used and used somehow. The higher mean value for male indicated that males used the strategy more than female. This is proven by the Fisher’s Exact statistical test which shows a significant difference as indicated by P = 0.000. Similarly, 61.4% of males and 46.1% of females are workaholic with mean scores and SD of 1.00 (0.981) for male and 0.59 (0.770). This means that average male respondents used the strategy somehow while an average female respondent fall between not used and used somehow. The higher male mean score of 1.00 is the evidence that they used this strategy more than females and supported by significant Fisher’s Exact test of P = 0.000. The findings support that of Pottinger et al (2006) and Audu, Ojua, Edem and Aeryi (2013) where the male respondents make self better by eating, drinking or smoking and keeping late nights.
This shows that males used escape coping strategy to cope with their fertility challenges more than females. This type of coping is a maladaptive coping mechanism where males avoid dealing with the problem (infertility challenges) and find solace in drinking, smoking and taking of drugs as well as being workaholic. By using this strategy, male will develop low self esteem as well as poor relationship with their partners. This findings should be consider appropriate because infertility issues are place in the door steps of women in Africa and men involving in maladaptive coping is acceptable in our society since they will not bear the blame.
Use of self controlling coping strategy by clients with fertility challenges
Findings from the study revealed that 73.6% of males and slightly above half (51.5%) of females avoid others from knowing how bad things were in their families with mean scores and SD of 1.23 (0.933) for male and 0.73 (0.835) for female. This means that an average male respondents fall between used somehow and used quite a bit while an average female respondents fall between not used and used somehow. The higher male mean score shows that, male used the strategy more than female as supported by significant statistical Fisher’s Exact test of P = 0.000. In the same vein, 79.2% of males and 50.3% of females avoid people who trouble them about pregnancy and children. The mean scores and SD is 1.47 (0.953) for male and 0.78 (0.959) for female. What this means is that an average male respondents fall between used somehow and used quite a bit while an average female respondents would fall between not used and used somehow. The higher male mean value indicated that men used the strategy more than the female. This is evidence by the significant Fisher’s Exact test of P= 0.000. The findings confirmed that of Pottinger et al (2006) where majority of men kept their feelings to themselves and as well kept others from knowing their pains. However, these findings contradict that of Donkor and Sandall (2013) where slightly above 90% of females, that is 91% kept their feelings to themselves, 96% kept others from knowing how bad things were and 95% refrained from discussing their problem with anyone except their husbands or partners.
Self controlling coping strategy is also a maladaptive coping mechanism which men deployed to use more than females. They regulate their feelings and actions in order not to let anyone know what they are passing through by avoiding others from knowing how bad things are in their families and the same time avoid people that trouble them about pregnancy and children. This is because our society stigmatised and relegates people who are childless to inferior status in the community as the men will be consider as “women” since they cannot impregnate their wives.
Whether clients with fertility challenges use seeking social support as a coping strategy
Analysis from the used of social seeking support by clients with fertility challenges shows that, 67.9% of males and 45.5% of females talk to someone to find more about the problem for them with mean scores and SD of 1.17 (1.051) for male and 0.66 (0.882) for female. This indicated that an average male respondents would fall between used somehow and used quite a bit while an average female respondents would fall between not used and used somehow. There was significant difference as proven by Fisher’s Exact test of P = 0.006 to support the fact that males used the strategy more than females. On the other hand, 75% of males and 92.2% of females ask people with similar problem for advice with mean scores and SD of 1.38 (0.931) for male and 1.62 (1.060) for female. This means that an average respondent would fall between used somehow and used quite a bit. There was no statistical significant difference in the use of coping strategy as proven by x2 = 20.562 and P > 0.05.The findings support that of Obeit, Hamlan and Callister (2014) where the participants reported receiving emotional support from extended family. However, the result is contrary to that of Donkor and Sandall (2013) where talking to others about fertility problems was not a common strategy that women used as 52% indicated that talking to someone to find solution about their inability to have children did not apply to them. Whereas 53% did not accept sympathy and understanding from people.
Seeking social support is a positive coping strategy which helps clients to find solution to their problem by talking to people who can help them find solution to their problem as well as ask people who have had similar problem in the past for advice. It also helps reduce the rate of stigmatization among clients with fertility challenges in the society as they received assistant and support from family, friends as well as co-workers to find solution to their problem.
Use of positive reappraisal as a coping strategy by clients with fertility challenges
Regarding the respondents used of positive reappraisal as a coping strategy, 64.9% of males and 89.2% of females prayed to God to change the situation for them. The mean scores and SD were 1.51 (1.094) for male and 1.64 (0.877) for female. This means that an average respondent would fall between used somehow and used quite a bit. There was no significant statistical difference as indicated by Fisher’s Exact test of P = 0.087. Furthermore, 73.6% of males and 71.3% of females planned to go for assisted reproduction with mean scores and SD of 1.64 (0.870) for male and 1.58 (1.162) for female. What this means is that an average respondent would fall between used somehow and used quite a bit. There was also no statistical significant difference as proven by Fisher’s Exact test of P = 0.074. This is in consonance with the findings of Farzadi, Faezeh, Naeimeh and Alikhah, (2007) where 79.3% pray and trust in God. It also supported the findings of Donkor and Sandall (2013) where majority of women 99% pray to God and believed it was God’s will and if He choose, they will eventually conceived.
This findings can be consider appropriate as praying to God will rise the hope of the clients that one day they will conceive and have a child of their own. Clients used assisted reproduction as the last resort to have children when they cannot conceive on their own.
Finally, the magnitude in which the coping strategies were used were in the following order; escape/avoidance, social seeking support, positive reappraisal and self control.
Implication for the Study
Findings from the study revealed that, majority of the respondents were with the reproductive age thus raising their hope to conceive or impregnate a woman with time. Secondary infertility was prevalence in UMTH, Borno meaning majority of respondents had proven to be fertile before now.
As observed from the study, there was significant difference in the used of escape/avoidance as a coping strategies as males used the strategy more than females. This type of coping strategy is negative strategy which made the males to run away from their problem and refuse to look for solution.
The self controlling strategy is also a negative coping strategy and is used more by males in the study. This made the males not to open up or share their problem with people who can find solution to their problem. Thus, making them to continue to be in pains of infertility in silence.
However, the respondents seek social support from relatives and friends in order to solve their infertility problem. By using this strategy, they will not be stigmatized and relegated to the background while interact freely in their communities.
Positive reappraisal was used by respondents because it divert their energy to other useful activities and as well seek alternative solution to their problem.
Limitations of the Study
The study was conducted in UMTH and did not give room for generalization of findings to other part of the country. The researcher did not ascertain the religion of respondents as well as did not use educational qualification and type of infertility to test whether they have influence on coping strategy or not.
Conclusion
The outcome of the study suggest that all the respondents were within their reproductive age and still have hope of conceiving on their own. Secondary infertility was common among the respondents and most of them had secondary education. The males used escape/avoidance and self controlling coping strategies to cope than the females. Whereas there was no difference in the used of social seeking support and positive reappraisal by the clients.
Recommendations
Although findings shows that positive coping strategies(social seeking support and positive reappraisal) were used by most respondents, they should be encourage to be using it as it provide room to share their problem and get advice from others on how to tackle as well as find solution to the problem.
Clients should be attending clinic together so that any advice/treatment given by the physician should be share together.
Clients should be encourage to go for assisted reproduction to enable them have children of their own
Suggestion for further studies
The researcher suggests that; similar study should be carried out on other parts of the country on coping strategy of clients with fertility challenges. Study should be done on socio-cultural acceptability of assisted reproduction in our society.
Summary of the Study
This study was a descriptive survey that intended to determine the coping strategies of clients with fertility challenges. The study was limited to clients with fertility challenges attending Obstetric and Gynaecological clinic of UMTH. Relevant literatures were reviewed based on the objectives of the research study. Kubler-Ross model of grief was applied to the study.
Sample size of 232 was drawn from a target population of 456 using purposive sampling technique. Instrument for data collection was questionnaire adapted from Lazarus and Folkman ways of coping strategies which was administered by the researcher and two research assistants to the respondents. Only 220 questionnaires were filled returned and were analysed using descriptive and inferential statistics. The data generated were presented in tables and gender cross tabulated with coping strategies using Pearson Chi-square test and Fishers Exact test at significant level of 0.05. Results from the study shows that; the respondents were within their reproductive age and secondary infertility was prevalence among the clients. There were statistical significant differences in the coping strategies based on gender as males used higher amount of the coping strategies except is seeking social support and positive reappraisal where there was no statistical difference.
Limitation of the study was that it was done in UMTH, Borno state and cannot be used to generalised findings to other parts of the country. The researcher recommends the use of social seeking support and positive reappraisal as means of coping strategies for clients with fertility challenges.
Suggestions for further studies include; similar studies should be carried out in other parts of the country on coping strategies of clients with fertility challenges. Study should be done on socio-cultural acceptability of assisted reproduction in our society.
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