COPING STRATEGIES OF CLIENTS WITH FERTILITY CHALLENGES ATTENDING OBSTETRIC AND GYNAECOLOGICAL CLINIC

1.0 Introduction

1.1 Background to the Study

Infertility is perceived as a problem across virtually all cultures and societies and affects an estimated 10-15% of couples of reproductive age (Bovine, Bunting, Collins & Negron, 2007). It has been viewed differently in different cultures. The population in the developed and developing countries hold different attitudes regarding infertility. In developing countries, infertility may be linked to an act of God, punishment for sins of the past, prolonged use of contraceptives, and the result of witchcraft which is causing childlessness, whereas people in developed countries view infertility as caused by biological and other related factors like excessive alcoholism, lack of cooperation between the man and the woman during sexual intercourse (Bovine, Bunting, Collins & Negron, 2007). No matter the culture, infertility is viewed as an enormous problem by couples everywhere.

According to Dhont, Van der Wijgert, Coene, Gasarabwe & Temmerman, (2010) children are seen as blessings of marriage and in some societies of the world; it is even believed that they are symbols of God's approval and blessings on marriages. Under normal circumstances, it is the choice of each individual and couple, within their own sense of conscience, to determine if they intend pregnancy and if so, the size of their family unit and the timing of when to have a child or children. However, in many African cultures, married couples who are unable to bear children shortly a few years after marriage are faced with all forms of unfriendly pressure from the family and social groups which could lead to unnecessary frustration, resentment and depression.

Apart from the rare cases when couples deliberately decide not to have children, inability to bear children has been the cause of many failed marriages and even destroyed many homes. It affects the self-esteem of a man, dampens his sense of control and also throws a woman into total confusion, frustration and anxiety. It is therefore an issue that should not be taken lightly by both the man and the woman. Many women believe that without children, life is without hope (Marida & Ulla, 2008).

World Health Organisation, 1987 as cited in Tabong & Adongo, (2013) defined infertility as failure to conceive after one year of regular unprotected sexual intercourse in the absence of known reproductive pathology. However epidemiological studies have revealed that in a normal population of heterosexually active women who are not using birth control methods, 25% will become pregnant in the first month, 63% within six months and 80% within one year. By the end of the second year, 85% to 90% will have conceived (National collaboration centre for women and children heath, 2012).

Because some couples who are not infertile may not be able to conceive within the first year of unprotected sex, World Health Organization (WHO) therefore recommends the epidemiological definition of infertility, which is the inability to conceive within two years of exposure to pregnancy (WHO, 1987 in Tabong & Adongo, 2013).Individuals who are thought to be infertile are generally relegated to an inferior status, and stigmatized with many labels. As a result, childlessness has varied consequences through its effects in the society and on life style of individuals. Though in some cases, the childless life style enhances life satisfaction for some individuals, yet it is diminishing for others for whom parenthood is a personal goal (Aysel & Gul, 2015).

Graham (2015) noted that, parenthood is one of the major transitions in adult life for both men and women. The stress of the non fulfilment of a wish for a child has been associated with emotional related problems, sexual dysfunction and social isolation. Couples passing through the stress of infertility challenges experience stigma, sense of loss, and diminished self esteem in the society. Among couples with infertility challenges in general, women show higher levels of distress than their men partners. They experience sense of loss of identity and have pronounced feelings of incompleteness and incompetence.

However, infertility is a significant medical problem that affects many couples and has multiple aspects including physical, emotional, financial, social and psychological effects (Omu & Omu, 2010). Experience of fertility challenges is a stressful condition itself, becoming particularly traumatic with previous pregnancies ending up in abortions, stillbirths and neonatal/infant deaths (Rouchou & Brittany, 2013). Receiving a diagnosis of infertility is a significant life crisis (Alesi, 2007). Feeling of grief and loss are very common as couples come to terms with the fact that they are not able to conceive. Infertility may result in a decrease in quality of life and an increase in marital discord and sexual dysfunction (Sameer, Trupti & Surendranths, 2010).

For many couples, infertility is undeniably a major life crisis and psychologically stressful (Holstein, Christensen & Boivin, 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” (Mogobe, 2010). Studies have found infertile women to be more neurotic, dependent and anxious than fertile women, experiencing conflict over their femininity and fear associated with reproduction. Others studies have similarly come to negative conclusions regarding the relationship between psychological factors and infertility (Noble, 2009).

Worldwide, more than 70 million couples suffer from infertility. In sub-Saharan Africa, the prevalence differs widely from 9% in the Gambia, 21.2% in north-western Ethiopia, 11.8% among women and 15.8% among men in Ghana and between 20 and 30% in Nigeria (National collaboration centre for women and children health, 2012). In African culture, the meaning of marriage is only fulfilled if the woman conceives and bears children as they are seen as sources of power and pride as well as assurance of family continuity. Anthropological and sociological studies bear testimony to the considerable suffering associated with involuntary childlessness due to negative psychosocial consequences such as marital instability, abuse and stigmatization (Dyer, Abraham, Hoffman & Van der Spy, 2012).

In Nigeria, the prevalence of infertility has been studied in demographic surveys, epidemiological surveys and through clinical observation (Okonofua, 2010). The Nigeria demographic and health survey for the period 2006-2010 reported a prevalence rate of primary infertility of 22.7% in 15-49years old women and 7.1% in 25-49years old (Okonofua, 2010). The inability to have children affects both men and women across the globe and lead to distress and depression as well as discrimination and ostracism (Cui, 2010). In order to deal with the stress of infertility, couples adopt various coping strategies.

According to Jordan & Revenson (2013) Coping strategies are ways in which one learns to deal with stressful situations. Every one copes with stress differently. Over time, people construct coping strategies that are good for mental wellness. Coping with infertility is often challenging because “infertility can be conceptualized as a chronic, unpredictable, and (personally or medically) uncontrollable stressor that may exceed the couple's coping resources”. Carrol, Robinson, Marshall, Callister, Olsen, and Dyches, (2011) noted the following coping strategies including distancing themselves from reminders of infertility (such as avoidance of families with children), instituting measures for regaining control, acting to increase feeling of self-worth in other areas of their lives such as achieving professional success, trying to find meaning in infertility, or sharing the burden with others.

Many people have reported encountering a number of stressors associated with the medical diagnosis of infertility. These stressors include but not limited to stress related to endurance, sexual functioning, quality of their relationship and changes in their social and family as well as family networks (Newton, Sherrad & Glavac, 2014). The severity and frequency of these stressors can contribute to negative outcomes such as psychological distress or marital dissatisfaction. To curb the potential negative consequences of excessive infertility stress, couples often use a number of coping strategies. This study investigated the various coping strategies utilized by clients with fertility challenges attending Obstetrics and Gynaecological (O and G) clinic of University of Maiduguri Teaching Hospital (UMTH).

1.2 Statement of Problem

Fertility challenges are the most frequent reason for gynaecological consultation in Nigeria (Okonofua, 2010). However, experiences from actual clinical practice indicate that, infertility is a major burden on clinical service delivery in Nigeria (Ajayi, 2013). More than 50% of gynaecological caseload consultation and over 80% of laparoscopic investigations are as a result of infertility (Obiechina, Okoye & Emelife, 2009).

Individuals who are thought to be infertile are generally relegated to an inferior status, and stigmatised experiencing sense of loss, and diminished self esteem in their community. Among people with fertility challenges in general, women show higher levels of distress than their men partners (Aysel & Gul, 2015). Married individuals experience sense of loss of identity and have pronounced feelings of incompleteness and incompetence. In 2014, while supervising students during the clinical posting in Obstetric and Gynaecological clinic of UMTH for six weeks, the researcher observed that 30% of the clients that came for consultation had fertility challenges and these raised questions in the mind of the researcher on how clients with fertility challenges cope with infertility. Which coping strategies do they adopt? Are there differences in the use of coping strategies based on gender? This study attempted to address these questions.

1.3 Aim / Purpose of the Study

The purpose of this study was to determine the coping strategies adopted by clients with fertility challenges attending Obstetrics and Gynaecological clinic of UMTH.

1.4 Objectives of the Study

1. Ascertain the use of escape/avoidance coping strategy by clients with fertility challenges.
2. Determine the use of self-controlling coping strategy by clients with fertility challenges.
3. Determine if clients with fertility challenges use seeking social support as a coping strategy.
4. Assess if clients with fertility challenges use positive reappraisal as a coping strategy.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What type of escape/avoidance coping strategies do clients with fertility challenges use in coping?
• To what extent do clients with fertility challenges use self controlling strategies in coping?
• Which of the seeking social support coping strategies do clients with fertility challenges seek to use in coping?
• To what extent do clients with fertility challenges use positive reappraisal to cope?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant difference based on gender and the use of coping strategies of clients with fertility challenges.
• H1: There is significant difference based on gender and the use of coping strategies of clients with fertility challenges.

1.7 Significance of the Study

The result of this study will reveal how clients cope with infertility challenges using various coping strategies and as well help to improve the coping strategies of people with fertility challenges by identifying positive coping strategies which will be accessible when the work is published.

The society and significant orders will also accept individuals with fertility challenges and give the necessary social and psychological support needed by them. The findings from this study will be communicated to the health team of Obstetric and Gynaecological clinic of UMTH which will assist them not only to give assistance in reproductive treatment but also gives psychological counselling to people with fertility challenges.

1.8 Scope of Study

This study is confined to assessing the coping strategies of clients with fertility challenges attending Obstetric and Gynaecological clinic of UMTH. It focuses both on primary and secondary infertility. Four coping strategies adapted from Lazarus and Folkman eight coping strategies of infertile couples will be utilized. The study will be confined to clients with fertility challenges attending the Obstetric and Gynaecological clinic of UMTH.

1.9 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint:

   The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.

2. Financial Constraint:

   Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

3. Initial Cooperation Delay from Respondents:

   A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.