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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