Project Materials

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

ABSTRACT

This study focused on the coping mechanisms of clients with fertility issues who visited the Obstetric and Gynaecological Clinic at the University of Maiduguri Teaching Hospital. The study’s objectives were to determine the use of escape/avoidance coping strategies by couples with fertility challenges, the use of self-control coping strategies by couples with fertility challenges, whether couples with fertility challenges use social seeking support as a coping strategy, and whether couples with fertility challenges use positive reappraisal. The investigation was conducted using a descriptive survey design. The study employed a sample size of 232 respondents, determined from the target population of 456 using power analysis. The data gathering instrument was derived from Folkman and Lazarus’ coping strategies. The supervisor, psychologist, and consultant from the Obstetric and Gynaecological Clinic at UMTH determined the face and content validity. The findings were given in tables as percentages, averages, and standard deviations. Pearson Chi-square and Fisher’s Exact tests were employed at the 0.05 level of significance to examine the association between coping techniques based on gender. The study’s major findings revealed that men utilised more coping mechanisms than women. According to the findings, 57% of men and 31.1% of women drink, smoke, or use drugs as an escape/avoidance coping method. There was a significant difference in the application of this coping method (P=0.000). Similarly, there was a substantial difference in the employment of self-controlling coping strategies (P=0.000), with 79.2% of men and 50.3% of women avoiding persons who bother them about pregnancy and children. However, there was no significant difference in the usage of social support, with 75% of males and 92.2% of females receiving counsel from persons who had experienced comparable problems (P=0.080). Similarly, 64.9% of men and 89.2% of women reported praying to God to improve the situation as a positive reappraisal coping method (P=0.087). Finally, men used more escape/avoidance and self-control coping methods, while social seeking support and positive reappraisal coping strategies were employed equally. It was recommended that couples who are unable to conceive on their own should seek assisted reproduction.

Chapter one

INTRODUCTION

Background of the Study

Infertility is regarded as an issue in almost every culture and society, affecting an estimated 10-15% of couples of reproductive age (Bovine, Bunting, Collins, & Negron, 2007).

It has been perceived differently in many cultures. The populace in industrialised and developing countries has differing perspectives towards infertility.

In developing countries, infertility may be attributed to a divine act, punishment for past sins, prolonged use of contraception, or the result of witchcraft causing childlessness, whereas in developed countries, infertility is attributed to biological and other related factors such as excessive alcoholism and a lack of cooperation between the man and the woman during sexual intercourse (Bovine, Bunting, Collins & Negron, 2007). Infertility is considered as a major issue by couples across the globe, regardless of culture.

According to Dhont, Van der Wijgert, Coene, Gasarabwe, and Temmerman (2010), children are viewed as blessings of marriage, and in various cultures around the world, they are even regarded as emblems of God’s approbation and blessings on couples.

Under normal conditions, each individual and couple has the freedom to decide whether or not to become pregnant, the size of their family unit, and the timing of having a kid or children.

However, in many African cultures, married couples who are unable to bear children within a few years of marriage suffer a variety of unfavourable pressures from their families and social groups, which can lead to unnecessary frustration, bitterness, and melancholy.

Aside from the few circumstances in which couples actively choose not to have children, failure to bear children has resulted in many unsuccessful marriages and even destroyed many homes.

It lowers a man’s self-esteem, diminishes his sense of control, and causes a woman to become completely confused, frustrated, and anxious.

As a result, both men and women should take this matter seriously. Many women fear that life without children is hopeless (Marida & Ulla, 2008).

Infertility was defined by the World Health Organisation in 1987, as reported by Tabong and Adongo (2013), as failure to conceive following one year of frequent unprotected sexual intercourse in the absence of known reproductive illness.

However, epidemiological studies have shown that in a typical group of heterosexually active women who do not use birth control techniques, 25% become pregnant in the first month, 63% within six months, and 80% within a year.

By the conclusion of the second year, 85% to 90% will have conceived (National Collaboration Centre for Women and Children’s Health, 2012).

Because some couples who are not infertile may be unable to conceive within the first year of unprotected sex, the World Health Organisation (WHO) 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 stigmatised with many labels. As a result, childlessness has a variety of implications, including effects on society and individual lifestyles.

Though the childless lifestyle increases life satisfaction for some people, it decreases it for others who want to have parents (Aysel & Gul, 2015).

According to Graham (2015), parenthood is a significant change in adulthood for both men and women. The stress of being unable to achieve a child’s dream has been linked to emotional disorders, sexual dysfunction, and social isolation. Couples dealing with the stress of infertility issues face shame, a sense of loss, and low self-esteem in society.

Women experience more distress than their male spouses in general while dealing with infertility issues. They feel a loss of identity and have strong sentiments of incompleteness and ineptitude.

However, infertility is a serious medical issue that affects many couples and has a variety of consequences, including physical, emotional, financial, social, and psychological implications (Omu & Omu, 2010).

The experience of fertility problems is unpleasant in and of itself, but it becomes especially traumatic when previous pregnancies result in abortions, stillbirths, and neonatal/infant deaths.

A diagnosis of infertility is an important life event (Alesi, 2007). As couples come to terms with their inability to conceive, they frequently experience feelings of sadness and loss.

Infertility can lower quality of life and increase marital conflict and sexual dysfunction (Sameer, Trupti, & Surendranths, 2010).

Infertility is definitely a huge life issue for many couples, as well as a source of psychological stress. It has been linked to depression, pain, and the promise of frequently unfulfilled dreams in women.

Individuals and couples may feel lonely since “infertility is often a silent and solitary crucible, since it is not visible, life-threatening, or disfiguring” (Mogobe, 2010).

According to studies, infertile women are more neurotic, reliant, and worried than fertile women, and they struggle with their femininity and the fear of reproduction.

Other research have also reached negative conclusions about the relationship between psychological factors and infertility (Noble, 2009).

Worldwide, more than 70 million couples are infertile. In Sub-Saharan Africa, the prevalence ranges from 9% in the Gambia to 21.2% in north-western Ethiopia, 11.8% among women and 15.8% among males in Ghana, and 20-30% in Nigeria (National Collaboration Centre for Women and Children’s Health, 2012).

In African culture, marriage is only complete if the woman conceives and has children, which are regarded as sources of power and pride, as well as assurance of family continuity.

Anthropological and sociological studies demonstrate that involuntary childlessness causes significant suffering due to negative psychosocial repercussions such as marital instability, abuse, and stigmatisation (Dyer, Abraham, Hoffman, & Van der Spy, 2012).

In Nigeria, the prevalence of infertility has been investigated using demographic surveys, epidemiological surveys, and clinical observation (Okonofua, 2010).

According to the Nigeria demographic and health survey conducted between 2006 and 2010, the prevalence of primary infertility was 22.7% in women aged 15 to 49 and 7.1% in those aged 25 to 49 (Okonofua, 2010).

The inability to have children affects both men and women all around the world, causing pain, despair, prejudice, and ostracism (Cui, 2010). To deal with the stress of infertility, couples use a variety of coping mechanisms.

According to Jordan and Revenson (2013), coping techniques are means of learning to deal with stressful events. Everyone deals with stress differently. People gradually develop coping techniques that promote mental well-being.

Coping with infertility is typically tough because “infertility can be conceptuali zed 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) identified the following coping strategies: distancing themselves from reminders of infertility (such as avoiding families with children), instituting measures for regaining control, acting to increase feelings of self-worth in other areas of their lives such as professional success, attempting to find meaning in infertility, or sharing the burden with others.

Many people have reported confronting a variety of difficulties related to the medical diagnosis of infertility. These stressors include, but are not limited to, stress about endurance, sexual functioning, relationship quality, and changes in their social and family networks (Newton, Sherrad, & Glavac, 2014).

The magnitude and frequency of these stressors might lead to negative effects like psychological anguish and marital dissatisfaction. Couples frequently employ a variety of coping mechanisms to mitigate the negative effects of extreme infertility stress.

This study looked into the various coping methods used by clients with fertility issues who visited the Obstetrics and Gynaecology (O and G) clinic at the University of Maiduguri Teaching Hospital (UMTH).

Statement of the Problem

Fertility issues are the most common reason for gynaecological consultations in Nigeria. However, experiences in clinical practice show that infertility is a significant burden on clinical service delivery in Nigeria (Ajayi, 2013).

Infertility accounts for more than half of all gynaecological consultations and more than 80% of laparoscopic investigations.

Individuals who are perceived to be infertile are often demoted to a lower status and stigmatised, enduring feelings of loss and low self-esteem in their community.

Among people with fertility issues in general, women show higher degrees of anguish than their men partners (Aysel & Gul, 2015).

Married persons have sensation of loss of identity and have severe sentiments of incompleteness and ineptitude. In 2014, while supervising students during a six-week clinical posting in UMTH’s Obstetric and Gynaecological Clinic, the researcher noticed that 30% of the clients who came for consultation had fertility challenges, which raised questions about how clients with fertility challenges cope with infertility.

Which coping mechanisms do they use? Are there gender disparities in coping strategies? This study aimed to answer these questions.

The purpose of the study

The goal of this study was to determine the coping methods used by clients with reproductive issues who visited the Obstetrics and Gynaecology clinic at UMTH.

Objectives of the Study

1. Determine the usage of escape/avoidance coping strategies by clients with reproductive issues.

2. Determine the utilisation of self-controlling coping strategies by clients facing reproductive issues.

3. Determine if clients facing fertility challenges seek social help as a coping mechanism.

4. Determine whether clients with fertility challenges employ positive reappraisal as a coping mechanism.

Research Questions

1. What form of escape/avoidance coping mechanisms do clients with reproductive issues employ?

2. To what extent do clients facing fertility issues employ self-control skills to cope?

3. Which of the seeking social support coping techniques do clients with reproductive issues prefer to use?

4. To what extent do clients with fertility issues employ positive reappraisal to cope?

Hypothesis

Ho: There is no significant difference between gender and the usage of coping mechanisms among clients with reproductive issues.

Significance of the Study

The findings of this study will highlight how clients cope with infertility issues using various coping strategies, as well as how to improve the coping strategies of persons facing fertility challenges by identifying positive coping techniques that will be available when the work is published.

Individuals with fertility issues will be accepted by society and significant orders, and they will receive the social and psychological support they require.

The study’s findings will be communicated to the health team at UMTH’s Obstetric and Gynaecological Clinic, allowing them to not only provide reproductive treatment but also psychological counselling to people facing fertility challenges.

Scope of Study

The purpose of this study is to analyse the coping methods of clients with reproductive issues who visit the UMTH Obstetric and Gynaecological Clinic. It focusses on primary and secondary infertility.

Four coping techniques developed from Lazarus and Folkman’s eight coping strategies for infertile couples will be used. The study will only include customers with fertility issues who visit the Obstetric and Gynaecological clinic at UMTH.

Operational definitions of terms

Clients’ coping strategies for fertility challenges refer to how men and women deal with the stress of not having children. These coping methods explicitly refer to the usage of four of the eight coping strategies developed by Lazarus and Folkman (2005) and adopted for this study.

The four coping techniques have been adopted because the researcher believes they are appropriate for the situation in which data will be collected. The coping strategies include:

Escape-avoidance refers to clients moving their focus away from the problem as a reality, such as not participating in discussions about pregnancy or children.