ANNALS OF IBADAN POSTGRADUATE MEDICINE
S.O. Akande, I.O. Dipeolu and A.J. Ajuwon
Introduction: In most developing countries, the joy of every married man and woman is to procreate and raise children of their own. However, this desire does not always find fulfilment among some couples because of primary or secondary infertility. The majority who experience this condition live in developing countries where fertility services including Assisted Reproductive Technologies (ARTs) are not always available. This study, therefore, investigated the attitude and willingness of infertile persons to uptake ARTs.
Methods: The study was a descriptive cross-sectional survey; a three-stage multi-stage sampling technique was adopted to select 202 married persons receiving fertility services at a gynaecological clinic in Ibadan, Nigeria. A validated interviewer-administered semi-structured questionnaire was used for data collection. Data were analysed using SPSS with descriptive and inferential statistics with the level of the significant set at <0.05.
Results: Respondents’ age was 34.3 years (SD ± 6.5); 88.6% were female; 55.5% had tertiary education; 54.5% reported a history of primary infertility. The negative attitude towards ARTs was observed among many of the respondents; however, some were willing to use ART services. In vitro fertilization (IVF) was the most preferred method; only 15.0% were optimistic of non-complications. The cost was the most mentioned barrier to use of ART. Positive association existed between attitude and willingness to use ART. Females are three times more likely than males to have a positive attitude toward the uptake of ART.
Conclusion: Public enlightenment and advocacy are recommended to influence negative attitude towards ARTs.
Keywords: Infertility, Couples, Assisted reproductive technologies, Attitude, Willingness
Samson O. Akande
Dept. of Health Promotion and Edu.,
Faculty of Public Health,
College of Medicine,
University of Ibadan,
One of the reproductive health concerns of women and a common reason for gynaecological clinic consultations is infertility. In sub-Saharan Africa, the prevalence of infertility is about 30% and of this proportion, male contribution in most countries, including Nigeria, had been estimated to range from 30% to 50%1. In most communities in Nigeria, having children is a social obligation, parenthood is culturally mandatory, childlessness is socially unacceptable and stigmatized due to a high value placed on children2,3,4,5,6,7. For example, in South West Nigeria, premium is placed on children for both economic and social reasons8. Consequently, couples experiencing infertility may be rejected by the in-laws, causing many infertile couples to seek treatment through different pathways8.
As affected couples seek treatment options, they are faced with other serious challenges such as limited treatment facilities and the exorbitant cost of treatment in Nigeria2,5. Many couples are wary of choosing adoption as a way of resolving infertility because of cultural factors and non-specific provisions for adoption in the Nigeria legal system2. Thus, the determination of infertile couples to find a solution to their gynaecological problem has resulted in the patronage of various treatment centres with different interventions. Assisted Reproductive Technologies (ARTs), including In Vitro Fertilisation IVF with fresh or frozen embryos as well as Intra-Cytoplasmic Sperm Injection(ICSI), have come into increasing use in Western nations since the late 1970s9, solving more than 50 per cent of infertility cases10. ART refers to all forms of treatments or procedures that include the in vitro handling of human oocytes and sperm or embryos for the purpose of establishing a pregnancy9. Previous studies in Nigeria have focused on prevalence, awareness, perception and attitude towards ARTs2,11, however, only a few studies exist on the willingness to use ARTs services. The study whose findings are reported in this article was, therefore, conducted to determine the attitudinal disposition and willingness of infertile persons towards the uptake of ARTs in Ibadan, Oyo State, Nigeria.
The study was a descriptive cross-sectional survey conducted in Ibadan North, one of the Local Government Areas (LGA) in Ibadan metropolis in South West region, Nigeria. Residents of this LGA are mostly of Yoruba ethnic group, which is the predominant ethnic group in the region. Most residents are in the low and middle socioeconomic status. The study site was Adeoyo Maternity Teaching Hospital, a facility owned by the Oyo State Government and highly utilised by Ibadan residents, especially those in the LGA. The facility also serves as a referral centre for many primary health centres and private clinics within Ibadan and neighbouring towns and communities.
Sampling and Procedures for Data Collection
The study population were married individuals who were receiving care for fertility-related conditions at the gynaecological clinic of the facility. A three-stage sampling technique was used to select 202 consenting individuals among those who visited the clinic for fertility-related challenges during the period of the data collection. After briefing patients about the study, a consecutive number was assigned to every individual who submitted their cards on appointment or check-up on each day of data collection. An average of 10 patients with fertility-related health issues visited the gynaecological clinic on clinic days. The clinic runs from Monday to Thursday, making use of Mondays and Thursdays for registrations and booking of an appointment for new patients, while Tuesdays and Wednesdays were used for consultations with gynaecologists. Therefore, participants who were utilising the clinic for fertility-related problems were recruited from Monday to Thursday. The register in which these patients’ data were recorded during their visit to the clinic served as the sampling frame.
A systematic random sampling of eligible patients was performed sequentially using every 2nd interval from the list of those who were present on each day of the clinic until the desired sample size was achieved. Thereafter, individuals selected were informed of the objectives of the study. Eligible participants who refused to participate were replaced with other patients who consented and signed the consent form before administration of instruments for data collection. Detailed information was also provided to those who sought further explanation on the various forms of ARTs under investigation through the use of animations and pictorials. An average of 10 respondents was interviewed every clinic day for 6 weeks. A total of 255 patients were approached and invited to participate in the study. Of this number, 220 consented to participate, giving 88% response rate. Four trained interviewers conducted face-to-face interviews with study participants. Training of interviewers consisted of inter-personal communication, interview techniques, and ethical considerations. Interviewers’ skills were verified through the display of a well-coordinated demonstration and return-demonstration skills. They also completed and signed confidentiality forms before the commencement of the study.
Measures and Data Management
A validated interviewer-administered semi-structured questionnaire (both English and Yoruba versions) was used for data collection. The questionnaire consisted of four sections on demographic characteristics, history of infertility, attitude towards and willingness to utilise ARTs. The questionnaire was pre-tested to establish its reliability; the Cronbach’s Alpha correlation coefficient of the instrument was 0.744. Each questionnaire was checked in the field for completeness. They were later sorted, cleaned, coded and entered into a computer; analysis was performed using the IBM/Statistical Package for Social Sciences (IBM/SPSS) version 22 software. The analysis consisted of descriptive and inferential statistics (Chi-square test) with a level of the significant set at p<0.05. Likert scale was adopted in developing a 9-point attitude scale with four options ‘agree’, ‘disagree’, ‘undecided’ and ‘no response’ used to assess attitude. All positive attitude statements were allotted 1 point while all negative attitude statements were allotted 0. Scores <4 and >4 were categorised as negative and positive attitudes respectively.
Ethics approval was obtained from the Oyo State Ministry of Health Research Ethical Review Committee, Ibadan, Nigeria (AD 13/479). Written informed consent was obtained from each participant after explaining the objectives of the study, the procedures involved, assurance of confidentiality and that participation is voluntary.
Socio-demographic characteristics of respondents
The demographic profile of the study participants is shown in Table 1. The ages ranged from 22 to 55 years with a mean age of 34.38 years, with a standard deviation of ± 6.5. More than half (57.4%) belonged to the 30-39 years of age group. Most (92.1%) participants were Yoruba, 88.6% were female and almost all (98.5%) were married. Half (50.0%) of the respondents were Muslims. Slightly more than half (55.5%) had tertiary school education while only 59.4% were traders/artisans.