INVOLUNTARY CHILDLESSNESS AND ASSISTED CONCEPTION: PERCEPTIONAMONGST NURSES AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

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O.O. Saanu^1,2, G.O. Obajimi1^,2

1. Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan.
2. Department of Obstetrics and Gynaecology, University College Hospital, Ibadan.

Abstract

Introduction: Involuntary childlessness, a pas de deux is perceived as a stigma in many developing countries and often leads to marital disharmony due to the high premium placed on childbearing emanating from deep rooted socio-cultural beliefs. Nurses play a pivotal role in patient management due to their close contact and association with patients and their relatives. A nexus therefore exists in the uptake of clinical services by patients because of the disposition of nurses towards certain services. Efforts at improving perception about assisted conception services through education and information for both patients and health workers cannot be over-emphasized.

Methodology: A cross-sectional study of consecutive clinical nurses from the general-outpatient, surgical, medical, paediatric, and gynaecology clinics of the University College Hospital, Ibadan. One hundred and ninety-six nurses were recruited into the study using a self-administered questionnaire. Data collected was analyzed using the Statistical Package for Social Sciences version 23. Descriptive analysis generated was presented with the aid of a pie chart and frequency tables. Chi-square statistic was used in testing for associations between categorical variables and P value was set at 0.05.

Result: The mean age of the respondents was 41.47 ± 9.24 years with a mean duration of clinical nursing service of 15.18 ± 8.70 years. Majority (86.7%) of the nurses were married and were predominantly of the Christian faith. One hundred and sixty nurses (81.6%) were of Yoruba extraction. Majority (94.8%) demonstrated good knowledge about assisted conception services and therefore had a positive attitude towards advanced fertility management (P<0.05). Age, marital status, religion, and years of service were not significantly associated with a positive attitude.

Conclusion: The recent establishment of an in vitro fertilization centre at the University College Hospital, Ibadan, has resulted in a paradigm shift in the management of infertility. Continuous education and enlightenment of clinical nurses will not only enlist their support but promote better patient engagement through constructive and informative interactions, thus eliminating barriers to the uptake of assisted conception services in a country strongly influenced by socio-cultural beliefs and taboos.

Keywords: Infertility, Assisted conception, Perception, Nurses

Introduction

Involuntary childlessness, also known as infertility, is defined as the inability of a couple to achieve conception after twelve months of regular and unprotected sexual intercourse¹. It is a stigmatized health issue with significant public health implication especially in poor resource nations like Nigeria, where a high premium is placed on childbearing². Prejudice, stigma, and discrimination against those affected in low-income nations can result from pervasive ignorance, myths, and misconceptions regarding the aetiology and perception of the health challenge.² Infertile couples require the services of health workers who possess not only the right knowledge but exhibit supportive and compassionate care towards the actualization of the objectives of infertility management^3,4.

Marriage in the African context is heavily influenced by the desire to achieve conception. Infertility on the other hand is associated with a variety of detrimental psychosocial manifestations including stigma, neglect, aggression, marital disharmony, poverty, and mental health challenges^4,5. In resource poor countries, the aetiology of involuntary childlessness has been primarily linked to infectious morbidities following sexually transmitted diseases, unsafe abortion and puerperal sepsis^4,5. The delay in the commencement of parenting responsibilities past the optimal fertile age, between 20-24 years, has been noted as concerning in developed countries where studies have revealed that women give birth at an average age greater than thirty years⁵. This may not be unconnected with the pursuit of greater educational achievements and career advancement at the expense of early marriage and childbearing.

An increasing number of people around the globe who were unable to have biological children have been able to do so because of the deployment of assisted reproductive technologies (ART). In the past three decades, ART has resulted in almost three million births around the world, allowing infertile individuals create genetically linked families, including single persons, lesbian, gay, and transgender couples⁶. The societal perspectives about reproductive health have been greatly altered due to ground-breaking innovations and possibilities through assisted conception particularly in developed nations⁷. Intrauterine insemination and invitro-fertilization are two examples of ART that have been widely deployed across the globe. Several studies have demonstrated that infertility and its management has been associated with profound psychological stressors^8,9,10

In Nigeria, assisted conception services commenced over two decades ago with the private sector taking the lead. However, in the last couple of years, the Nigerian public sector has embraced this very important reproductive health service and the IVF centre of the University College Hospital, Ibadan, commenced operation on the 14th of February 2019. Public fertility centres were set up to bridge the gap in access to advanced fertility management through the provision of affordable and subsidized care.

Nurses play a pivotal role in the education and demystification of sociocultural concerns related to IVF. They are usually the first health contact with infertile couples and often provide the much-needed counseling and encouragement to this highly vulnerable group. Fertility nurses play a crucial role in the coordination of various stages of treatment, and they ensure compliance and adherence to management protocols during advanced fertility management.11 Therefore, the perception of nurses about assisted conception can significantly affect the standard of patient care during ART cycles^11,12,13. Ignorance and poor understanding of the processes involved in assisted conception by health care providers can lead to prejudice which may adversely affect the outcome of care¹⁴. This study, therefore, sought to evaluate the perception of nurses at the University College Hospital, Ibadan, a public health facility, which recently introduced ART as part of its infertility management.