Access to Infertility Care in the Developing World: The Family Promotion Gap

Asemota, O.A.; Klatsky, Peter C.

doi:10.1055/s-0034-1395274

Cited by 53 publications

(52 citation statements)

References 36 publications

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“…Fears related to infertility may impact contraceptive use (Gebremariam and Addissie, 2014; Hyttel et al ., 2012), and infertility has been associated with high-risk sexual behaviors (Dhont et al ., 2011a,b). Limited access to infertility care in the developing world exacerbates these concerns (Asemota and Klatsky, 2015). …”

Section: Introductionmentioning

confidence: 99%

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

et al. 2017

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STUDY QUESTIONCan infertility prevalence be estimated using a current duration (CD) approach when applied to nationally representative Demographic and Health Survey (DHS) data collected routinely in low- or middle-income countries?SUMMARY ANSWEROur analysis suggests that a CD approach applied to DHS data from Nigeria provides infertility prevalence estimates comparable to other smaller studies in the same region.WHAT IS KNOWN ALREADYDespite associations with serious negative health, social and economic outcomes, infertility in developing countries is a marginalized issue in sexual and reproductive health. Obtaining reliable, nationally representative prevalence estimates is critical to address the issue, but methodological and resource challenges have impeded this goal.STUDY DESIGN, SIZE, DURATIONThis cross-sectional study was based on standard information available in the DHS core questionnaire and data sets, which are collected routinely among participating low-to-middle-income countries. Our research question was examined among women participating in the 2013 Nigeria DHS (n = 38 948). Among women eligible for the study, 98% were interviewed.PARTICIPANTS/MATERIALS, SETTING, METHODSWe applied a CD approach (i.e. current length of time-at-risk of pregnancy) to estimate time-to-pregnancy (TTP) and 12-month infertility prevalence among women ‘at risk’ of pregnancy at the time of interview (n = 7063). Women who were 18–44 years old, married or cohabitating, sexually active within the past 4 weeks and not currently using contraception (and had not been sterilized) were included in the analysis. Estimates were based on parametric survival methods using bootstrap methods (500 bootstrap replicates) to obtain 95% CIs.MAIN RESULTS AND THE ROLE OF CHANCEThe estimated median TTP among couples at risk of pregnancy was 5.1 months (95% CI: 4.2–6.3). The estimated percentage of infertile couples was 31.1% (95% CI: 27.9–34.7%)—consistent with other smaller studies from Nigeria. Primary infertility (17.4%, 95% CI: 12.9–23.8%) was substantially lower than secondary infertility (34.1%, 95% CI: 30.3–39.3%) in this population. Overall estimates for TTP >24 or >36 months dropped to 17.7% (95% CI: 15.7–20%) and 11.5% (95% CI: 10.2–13%), respectively. Subgroup analyses showed that estimates varied by age, coital frequency and fertility intentions, while being in a polygynous relationship showed minimal impact.LIMITATIONS, REASONS FOR CAUTIONThe CD approach may be limited by assumptions on when exposure to risk of pregnancy began and methodologic assumptions required for estimation, which may be less accurate for particular subgroups or populations. Unrecognized pregnancies may have also biased our findings; however, we attempted to address this in our exclusion criteria. Limiting to married/cohabiting couples may have excluded women who are no longer in a relationship after being blamed for infertility. Although probably rare in this setting, we lack information on couples undergoing infertility treatment. Like other TTP measure...

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Section: Introductionmentioning

confidence: 99%

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

et al. 2017

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“…It is generally believed that more than 70 million couples suffer from infertility problem worldwide and this constitutes 15% of reproductive aged couples globally [1]. In Sub-Saharan Africa region, infertility problem prevalence varies from 9% in Gambia [2], 21.2% in northwestern Ethiopia [1] [3], between 20% and 30% in Nigeria [4] [5] and 11.8% among women and 15.8% among men in Ghana [6], however, men are mostly excluded in infertility discourse [7]. World Health Organization (WHO) demographic studies also show that in Sub-Saharan Africa, more than 30% of women aged 25 -49 years suffer from secondary infertility, the inability to achieve a subsequent pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Infertility in Sub-Saharan Africa: A Woman’s Issue for How Long? A Qualitative Review of Literature

Chimbatata¹,

Malimba²

2016

JSS

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Infertility or childlessness is a major reproductive health issue for females as well as males respectively. Many couples suffer from infertility worldwide and in Sub-Saharan Africa, which has a cultural preference for high fertility; women shoulder the highest infertility consequences. The objective of this review was therefore to explore socially acceptable and culturally effective reproductive health strategies for the social management of infertility in sub-Sahara Africa. Different databases were searched to source articles on infertility in Sub-Saharan Africa. The databases included Medline, Pubmed and Fudan University library. Google scholar was also utilized to get additional relevant articles. Titles and abstracts of the articles searched were critically evaluated for relevance based on the inclusion criteria. Final extraction of the articles was done by getting only those studies that met the inclusion criteria. Twenty articles were identified and five were included in this review. The findings reveal three main themes: perception, health seeking behavior and the social impact of infertility. In many Sub-Saharan Africa societies, there is negative perception of infertility problem as such those affected do not seek medical attention early. There is also a disproportionate social impact of infertility on women in the region. In Sub-Saharan Africa, high value is placed on children and those who are infertile are greatly stigmatized. In such a setting, the concept of reproductive health should include policies which could make it possible for couples and the whole society aware of the reality of infertility as a reproductive health problem and seek medical attention early.

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“…There is limited access to infertility care in the developing world (6). No study has analysed the contribution of sperm dysfunction, tubal blockage, uterine abnormalities, ovulatory dysfunction and unexplained infertility in Zimbabwe.…”

Section: Introductionmentioning

confidence: 99%

The Causes of Infertility in Women Presenting to Gynaecology Clinics in Harare, Zimbabwe; A Cross Sectional Study

Madziyire

Magwali

Chikwasha

et al. 2020

Preprint

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Background Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care.Methods A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15.Results A total of 216 women were recruited. The mean age of the women was 32.9±5.7 years. Two thirds (144) of the women had primary infertility. The overall period of infertility ranged from 1-21 years with an average of 5.6±4.7 years whilst 98 (45.4%) of the couples had experienced 2-4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was ‘unexplained’ in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had ART in the form of IVF/ICSI or IUI. Assisted Reproduction was significantly associated with conception.Conclusion Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal factors, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal factors, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.

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Access to Infertility Care in the Developing World: The Family Promotion Gap

Cited by 53 publications

References 36 publications

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

Estimating infertility prevalence in low-to-middle-income countries: an application of a current duration approach to Demographic and Health Survey data

Infertility in Sub-Saharan Africa: A Woman’s Issue for How Long? A Qualitative Review of Literature

The Causes of Infertility in Women Presenting to Gynaecology Clinics in Harare, Zimbabwe; A Cross Sectional Study

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