Coping Strategies Towards Fertility Challenges Among Clients Attending Gynecological Clinic In Ekurede Urhobo Health Center

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Coping Strategies Towards Fertility Challenges Among Clients Attending Gynecological Clinic In Ekurede Urhobo Health Center


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.



Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses
  • 4.5 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


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 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) 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 utilised 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 Gynaecological clinic in Ekurede Urhobo health center 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 Objectives of the Study

The purpose of this study was to determine the coping strategies adopted by clients with fertility challenges attending Gynaecological clinic in Ekurede Urhobo health center.

  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.

1.4 Research Questions

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

1.5 Hypothesis of the Study

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


1.6 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 Gynaecological clinic in Ekurede Urhobo health center which will assist them not only to give assistance in reproductive treatment but also gives psychological counselling to people with fertility challenges.


1.7 Scope of Study

This study is confined to assessing the coping strategies of clients with fertility challenges attending Gynaecological clinic in Ekurede Urhobo health center. 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 Gynaecological clinic in Ekurede Urhobo health center.


1.8 Limitation Of The Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.


1.9 Operational Definitions of Terms

Coping strategies of clients with fertility challenges;

Refer to the way men and women adjust to the stress of not having children. These coping strategies specifically refer to the use of Lazarus and Folkman’s (2005) four out of eight coping strategies which have been adapted in this study. The four coping strategies have been adapted because the researcher thinks they suit the environment in which data will be collected.

Escape-Avoidance

Refer to clients directing their attention away from the problem as a reality e.g. not participating in discussion involving pregnancy or children.

Self Controlling

Refer to ability of the clients to restrain/regulate their feelings or action e.g. keeping one’s feelings to one’s self.

Seeking Social Support

Refers to the readiness or attempt by the clients to seek informational, tangible and emotional support from the society e.g., by asking friends for advice or information on fertility challenges.

Positive Reappraisal

Refer to effort of the clients to create positive meaning by focusing on personal growth, spiritual life and seeking fertility assistance e.g., by channeling one’s effort toward his/her career or seeking assisted reproduction

Clients With Fertility Challenges

Refer to individuals who have been married for more than two years and have not been able to conceive or sustained pregnancy to term.

Primary Infertility

Refers to involuntary childlessness after one year of continuous frequent unprotected sexual intercourse by the couples.

Secondary Infertility

In this study refers to the ability to conceive but not able to sustain the pregnancy to term and so has not had a child.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusion and Recommendation

5.1 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 Gynaecological clinic in Ekurede Urhobo health center. 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 Gynaecological clinic in Ekurede Urhobo health center 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.


5.2 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.


5.3 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


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