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ADOPTION AS A PATTERN OF INFERTILITY TREATMENT AMONG WOMEN ATTENDING GYNAECOLOGY CLINIC IN ENUGU STATE UNIVERSITY TEACHING HOSPITAL ENUGU

Project topic for Nursing Science department.

CHAPTER ONE

INTRODUCTION

Background to the study

Parenting is one of factor giving human beings a sense of wholeness and pregnancy and childbearing are among the principal changes in women’s lives (Behjati Ardakani, Navabakhsh, Ranjbar, Akhondi, and Mohseni, 2020). For this reason, infertility can be a barrier to self-acceptance in some women (Hasanpoor-Azghady, Simbar, Vedadhir, Azin, Amiri-Farahani, 2019). Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects) (Chowdhury, Cozma, Chowdhury, 2017). In humans, infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner.

Infertility is prevalent worldwide affecting about 5–8% of couples (Okonufua, 2017). Prevalence of infertility in sub-Saharan Africa is higher, with 10–30% of couples affected in Nigeria (Chimbatata, Malimba, 2017). It is one of the commonest reasons for women to seek gynaecologic consultation (Okohue, Onuh, Ikimalo. 2017). It’s a etiology in Nigeria was found to be mainly related to post infectious causes; sexually transmitted infections, post abortal and puerperal sepsis (Okohue, Onuh, Ikimalo. 2017). Being able to get pregnant is a big part of the marriage institution, especially in the African cultural context. Hence infertility is associated with a lot of negative psychosocial and other consequences such as stigma, deprivation and neglect, violence, marital problems and mental health issues (Okonufua, 2019). Despite this large burden, very few infertility-management programs exist (Omoaregba, James, Lawani, Morakinya, and Olotu, 2019). Fertility care, its development and access is limited in resource-poor countries (James, Taidy-Leigh, Bah, Kanu, Kangbai, and Sevalie. 2018) like Nigeria, overshadowed by competing and more important reproductive health issues (Patel M.) like high maternal mortality rates. Most times the burden of infertility lies squarely on the couple alone, with a greater burden on the woman. To satisfy their needs and end their suffering, infertile women may resort to different forms of treatment.

There are many causes of infertility, including some that medical intervention can treat. Estimates from 2019 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%. Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts (ESHRE 2019). In 10–20% of cases, no cause is found. The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods (NHC 2017). The most frequent cause of infertility today in occidental population is the delay of maternity, because the quality of oocytes decreases dramatically with age, especially after 35 years. Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity (WHO 2017). Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature.

Infertility is a public issue that does not only affect the health care services but also social environment. Infertility has serious consequences especially in Nigeria where a high premium is placed on child bearing. The childless couples suffer from problems ranging from personal, interpersonal, social and religious expectations thus bringing a sense of failure to them. They are not even allowed to lead an important family functions and events and therefore faced with problems ranging from overt ostracism or divorce to more subtle forms of social stigma leading to isolation, depression, grief, and mental distress. Moreover, in most developing countries where there is no social security, older people are completely dependent on their children, therefore, many infertile couples will take considerable trouble to conceive and thus avoid the social and psychological problems associated with childlessness (Adeniyi, Etti, Akinwumi, Akinlusi, 2018).

Although there are many management options for infertile couples, the outcome of the treatment depends on etiological factors, available diagnostic tools, skills of the attending physician and above all financial status of the couple. There are limited assisted reproduction control because they are mostly private driven. Even when they exist, the cost of accessing them is high and there is a low success rate despite the huge financial resources which constitute a major hindrance for most desiring couple (Oladokun et al, 2020).

According to Ali and Sami (2020), child adoption in Nigeria and other developing countries is not a well-accepted option for infertile women, the study did not narrow down to the infertile couples directly facing the challenge. Again, studies have shown that the couples that adopt a child or children grieve less about their childless challenges and also gain emotional support compared to their peers. The concerns of many adoptive parents that usually constitute a barrier to this infertility management option include fear of disloyalty and religious reasons (Sandall, 2019).

Adoption is an alternative strategy in the management of infertility aimed at bringing succor to the affected couples. This management option had gained wider acceptance in developed countries even before the era of reproductive technologies but not much acceptance is found in developing countries like Nigeria (Oladokun et al, 2020).

Though, reported research works above did ascertain the acceptance level of adoption, however, the present research is poised to assess the acceptance level of the people (the infertile) directly facing the challenge with respect to the factors influencing such decisions. This is the reason why gynecology clinic in ESUTH is chosen as a study area.

Statement of problem

In general, infertility are not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. About 6% of married women aged 15 to 44 years in Nigeria are unable to get pregnant after one year of trying (infertility). Also, about 12% of women aged 15 to 44 years in Nigeria have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity). infertility is not always a woman’s problem. Both men and women can contribute to infertility. Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause. Almost 4% of men aged 25 to 44 years in the Nigeria reported that they or their partner saw a doctor for advice, testing, or treatment for infertility during their lifetime (WHO 2019).

Availability, access, and quality of interventions to address infertility remain a challenge in most countries. Diagnosis and treatment of infertility is often not prioritized in national population and development policies and reproductive health strategies and are rarely covered through public health financing.

Government policies could mitigate the many inequities in access to safe and effective fertility care. To effectively address infertility, health policies need to recognize that infertility is a disease that can often be prevented, thereby mitigating the need for costly and poorly accessible treatments. Incorporating fertility awareness in national comprehensive sexuality education programmes, promoting healthy lifestyles to reduce behavioural risks, including prevention, diagnosis and early treatment of STIs, preventing complications of unsafe abortion, postpartum sepsis and abdominal/pelvic surgery, and addressing environmental toxins associated with infertility, are policy and programmatic interventions that all governments can implement (WHO 2020).

This report aroused the interest of the researcher on this topic and therefore the need to narrow the research down to the people directly affected using a particular unit of the hospital as a study location.

Objectives of the study

Objective of this study is to determine the level of acceptance of adoption as pattern of treatment of infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital (Park Lane) Enugu specifically the study is designed:

1.         Determine the number of women needing adoption as pattern of infertility treatment in Enugu State University Teaching Hospital Enugu.

2.         Ascertain the perception of women on adoption as pattern of treatment of infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu.

3.         Determine the level of acceptance of adoption as pattern of treatment for infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu.

4.         Determine the factors influencing acceptance of adoption as pattern of treatment of infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu.

Significance of the study

This study will be of immense benefit to infertile couples, families, health workers, government researchers and the society. When the study is concluded finds will reveal the number of women needy adoption and their perception on adoption. They will be counseled on adoption matters. The health workers also will benefit as the findings will reveal areas of counseling which they must embark on. They families will also benefit as they will be helped out by the health workers to clear their misconceptions about adoption. The government will also benefit if these couples understands what to do and how they can go about adoption. This will reduces the chances of child trafficking and stealing. The society will also benefit in that when adoption is accepted and done orderly many ills of childlessness will be reduced and the cases of developing of unwanted babies will become a thing of the past since these babies can be adopted. Future researchers can also benefit from this study because it is going to add to the already existing pull of literatures in this areas as to help those who will like to carry out studies of this nature.

Research Questions

  • What are the number of women needing adoption as pattern of infertility treatment in Enugu State University Teaching Hospital Enugu?
  • What are the perception of women on adoption as pattern of treatment of infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu?
  • What are the level of acceptance of adoption as pattern of treatment for infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu?
  • What are the factors influencing acceptance of adoption as pattern of treatment of infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu?

Scope of the Study

The study is delimited to adoption as a pattern of Infertility treatment among women attending gynaecology clinic in Enugu state University Teaching Hospital Enugu. It covers the determination of number of women needing adoption, the perception of women on adoption level of acceptance of adoption among infertile women attending gynaecology clinic in Enugu State University teaching Hospital and factors influencing acceptance of adoptance as pattern of treatment of infertility among women attending gynaecology clinic in Enugu State University Teaching Hospital Enugu. It involves only women attending gynaecology clinic of Enugu State University Teaching Hospital Enugu. It is also delimited to the use of questionnaire as an instrument for data, it involves the use frequencies and percentages as method of data analysis

Operational Definition of Terms

Acceptance of adoption: This is the willingness of infertile couple to adopt a child that is not biologically their own and transfer the legal right of an offspring to such a child.

Infertile couple: This refers to couple that is not able to give birth to a child of their own.

Age: This refers to the age of the infertile women attending gynecology clinic in ESUTH.

Economic status: It is the financial status/class of an individual or group. It is referred as an income of infertile women attending gynecology clinic in ESUTH.

Influence of age: This means the effect the age of an infertile woman would have on the practice of child adoption amongst women attending gynecology clinic in ESUTH.

Influence of economic status:

This means the effect the economic position of an infertile woman would have on the practice of child adoption amongst women attending gynecology clinic in ESUTH.


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