PERCEPTIONS AND RESPONSES TO INFERTILITY AMONG INVOLUNTARY CHILDLESS COUPLES IN SOUTH EAST NIGERIA

CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Birth and death are the most basic of human events and reproduction transcends the boundaries of individual lives to signal the survival and continuation of the family and the species (McDaniel, Hepworth & Doherty, 1992). Fertility is revered in almost all cultures and the ability to reproduce is perceived as a milesone in adult development (Notman, 1990). Individuals who desire parenthood, often experience external or internal pressure to become parents (Monarch, 1993). Since the ability to reproduce is usually taken for granted, the realization of infertility problems, comes as a shock that has been labeled the “crisis of infertility” (Cook, 1987;).
According to Merlo (2002), procreation is the function of the family; every man takes a wife apparently to have children for the continuity of his name and linage and for general productivity and development in the society. In traditional Igbo society, many wives try to ensure the procreation of children to its fullest limit. Where this main purpose of marriage is not forth coming into fulfillment it results to tension.
Infertility or childlessness is a global reproductive issue for both sexes yet often neglected and not discussed in public. It is generally believed that more than 70 million couples suffer from infertility worldwide (Greil, 1991). In Sub-Saharan Africa, the prevalence differs widely from 9% in the Gambia (MCDaniel, Hepworth & Doherty, 1991), 21.2% in northwestern Ethiopia (Taymor, 1978), between 20 and 30% in Nigeria (NBS, 2017), and 11.8% among women and 15.8% among men in Ghana (Tori 2006).
Infertility has been defined as failure to conceive after one year of regular unprotected sexual intercourse in the absence of known reproductive pathology (Benice, 2003). 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 6 months, and 80% within one year. By the end of a second year, 85% to 90% will have conceived (Westwood 2015). Because some couples, who are not infertile, may not be able to conceive within the first year of unprotected sex, the World Health Organisation therefore recommends the epidemiological definition of infertility, which is the inability to conceive within two years of exposure to pregnancy (WHO 2009). Infertility may be primary or secondary. Primary infertility refers to infertility of women who have never conceived and secondary infertility refers to infertility of women who has conceived at least once before. The use of the ability of the female to conceive as a measure to differentiate between primary and secondary infertility is however problematic as it places couple infertility on the doorsteps of the female partners.
The lack of consensus on the prevalence of infertility is a consequence of differing definitions of infertility, the varying periods of time over which it is studied, and a failure to differentiate analytically between voluntarily childless and involuntarily childless (Yinka, 2002). However, the Nigerian Health Survey reports that voluntary childlessness is not common in Nigeria, and currently married women with no live births are likely to be those in relationships with fertility problems (NHS, 2017).
In the African culture, the true meaning of marriage is only fulfilled if the couple conceives and bears children (Polycap, 2007). Africans consider their child to be a source of power and pride, and children act as insurance for their parents in old age. The most important aspect of bearing children is an 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 (Brian 2012). A study among women seeking infertility treatment in Southern Nigerian revealed that infertile women used their internal coping strategies by keeping their fertility problem to themselves as a result of the stigma associated with it whilst others coped by drawing on their Christian faith (Brian 2012).
Currently many stigmas and myths about infertility still exist. Although there is much more scientific information about the biological or medical asepcts of infertility, understanding the psychological and social implications of infertility have lagged behind. One of the most prevalent myths about infertility is that since women ultimately conceive and become pregnant, infertility or the inability to conceive and become pregnant is perceived almost exclusively as a “woman’s” problem. Contrary to popular belief, however, statistics confirm that in fact, infertility impacts men and women almost equally: approximately 40% of infertility problems are male related, 40% are female related, 10% are a combination of male and female problems,. and 10% are of unknown etiology (McDaniel, Hepworth & Doherty, 1992). Although one or the other partner or both partners may exhibit specific conditions which lead to infertility, typically it is ultimately the couple that is infertile
Throughout the world and particularly in African societies, the word “childlessness” sends a cold signal and the sense of pity is immediately aroused. Having children is necessary for involuntary childless couples and is considered as a major necessity in marriage. From cultural and traditional perspective the reason for marriage is for procreation, continuity of linage and impact or transferring cultural values and norm form one generation to another within the society (Gibson 2002).
1.2 Statement of the Problem
Infertility and involuntary childlessness are traumatic human conditions. Many couples desire to have biological children of their own and when there is an inability to reproduce, it creates a sense of personal loss and tragedy (kunam, 2012). The World Health Organization (WHO) views the medical condition of infertility as a global health problem and accepts that it is more of a critical health problem in the developing world.
A 2012 WHO study based on previous data gathered from the Demographic and Health Surveys estimate that one in four couples in developing countries is infertile (WHO 2012). Several of these infertile or involuntary childless people are located in what some scholars have described as pro-natal states (Middleton 2007). Some of these states fall within the Sub-Saharan African region which consists of countries that lie geographically south of the Sahara desert (Mascarenhas, 2012). 
Unlike other areas of the world where infertility is viewed as a personal traumatic experience, the condition of being involuntary childless in Sub-Saharan Africa is treated as a public condition that threatens the continuing existence of the family structure and the community at large (Wole 2001). The perceived existentialist threat that involuntary childlessness is meant to cause to the society has led to the social stigmatisation of the condition.
There is substantive evidence particularly in the social sciences and medical disciplines that shows that couples especially bear the brunt of this social stigmatisation because of the inability to procreate (khinde 2003, John 2011 and Belithe 2005). The stigmatising social construction of infertility and involuntary childlessness has been found to affect the social status, economic wellbeing and inherent worth of couples. Yet only up until recently, public health specialists have treated infertility and involuntary childlessness ‘a life choice that has gone awry and which did not deserve too much attention.
1.3 Research Questions
The following research questions have been put forward to guide this study.
1.     What is the level of knowledge about infertility as a social problem among couples in south east Nigeria?
2.     What are the cultural beliefs and practices about infertility which involuntary childless couples subscribe to in south east Nigeria?
3.     What are the perceived causes of infertility shared by involuntary childless couples
4.     What is the perceived effect of infertility by involuntary childless couples in the area
5.     What are the coping strategies adopted by childless couples for infertility problems?

1.4 Objectives of the Study
The general objective of this study is to examine the impacts of childlessness on involuntary childless couples in south east Nigeria. Specifically, the following objectives will be treated:
1 To find out the level of of knowledge about infertility as a social problem among couples in south east Nigeria
2 To identify socio cultural beliefs and practices about infertility which involuntary childless couples subscribe to in south east Nigeria
3: To examine the perceived causes of infertility shared by involuntary childless couples
4:  To examine the perceived effect of infertility by involuntary childless couples in the area
5: To examine the coping strategies adopted by childless couples for infertility problems.......

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