ABSTRACT
This study was on coping strategies of clients with fertility challenges attending Obstetric and
Gynaecological clinic of University of Maiduguri Teaching Hospital. The objectives of the
study were to ascertain the use of escape/avoidance coping strategy by couples with fertility
challenges, determine the use of self controlling coping strategy by couples with fertility
challenges, determine if couples with fertility challenges use social seeking support as a
coping strategy and assess if couples with fertility challenges use positive reappraisal as a
coping strategy. A descriptive survey design was used for the study. A sample size of 232
respondents was used for the study which was calculated from the target population of 456
using power analysis. The instrument for data collection was adapted from Folkman and
Lazarus ways of coping. The face and content validity were determined by the supervisor,
psychologist and a consultant in Obstetric and Gynaecological clinic in UMTH. The results
were presented in tables as percentages, means and standard deviation. Pearson Chi-square
and Fisher’s Exact test were used to determine the association between coping strategies
based on gender at 0.05level of significance. Major findings of the study revealed that males
used most coping strategies than the females. The analysis shows 57% of males and 31.1% of
females drinks smokes and indulges in drugs as escape/avoidance coping strategy. There was
significant difference in the used of this coping strategy (P=0.000). Similarly, there was
significant difference in the use of self controlling coping strategy as P=0.000, where 79.2%
of males and 50.3% of females avoid people who trouble them about pregnancy and children.
However, there was no significant difference in the used of social seeking support as 75% of
males and 92.2% of females ask people with similar problem for advice with P=0.080. In the
same vein, 64.9% of males and 89.2% of females used praying to God to change the situation
as a positive reappraisal coping strategy with P=0.087. In conclusion, escape/avoidance and
self control coping strategies were used more by men and there was no difference in use of
social seeking support and positive reappraisal coping strategies. It was recommended that
where couples cannot achieve pregnancy on their own, they should go for assisted
reproduction.
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CHAPTER ONE
INTRODUCTION
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
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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).
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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).
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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