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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 30  |  Issue : 1  |  Page : 40-46

Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria


1 Department of Nursing, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria Enugu Campus, Nsukka, Nigeria
2 Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
3 Department of Nursing Sciences, Abia State University, Uturu, Nigeria

Date of Submission02-Jul-2020
Date of Decision30-Jul-2020
Date of Acceptance29-Dec-2020
Date of Web Publication15-Feb-2021

Correspondence Address:
Dr. Uchenna Anthony Umeh
Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu 400001
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_124_20

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  Abstract 


Background: Infertility is the failure of a couple to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. It causes psychological and social consequences for couples. This study aimed to ascertain the “Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria.” Subjects and Methods: A cross-sectional descriptive survey was used. One hundred and twenty participants were drawn from a population of one hundred and fifty clients, using the power analysis formula of sample size calculation. Participants were selected using a purposive sampling technique. One hundred and seventeen participants were analyzed using the Statistical Package for the Social Sciences version 25. Descriptive and inferential statistics were used at a 0.05 level of significance. P < 0.05 was considered statistically significant. Results: Majority of the participants use self-controlling, positive reappraisal coping strategy, and social seeking support strategy. There is no significant difference in the mean responses of male and female participants with infertility on their use of coping strategies. The respondents used more self-controlling (86.3%) strategies than they used positive reappraisal (62.4%), escape-avoidance (59.8%), and other coping strategies (47.0%) and these showed statistical significance (P < 0.05). Even though they used social support seeking as much as they used self-controlling strategies, this finding was not significant (P > 0.05). Furthermore, gender was found to have a significant influence on the coping strategies among the study participants (P < 0.05). Conclusion: The couple's capacity to adapt to infertility-related stress depends on the coping strategies, which have different impacts on individuals' mental health. Hence, this study suggested the need for health-care providers to integrate psychological counseling into the care of clients with infertility challenges.

Keywords: Coping strategies, infertility, psychological, South-East Nigeria


How to cite this article:
Maduakolam IO, Umeh UA, Ndubuisi IF, Onyekachi-Chigbu AC. Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria. Niger J Med 2021;30:40-6

How to cite this URL:
Maduakolam IO, Umeh UA, Ndubuisi IF, Onyekachi-Chigbu AC. Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria. Niger J Med [serial online] 2021 [cited 2021 Mar 7];30:40-6. Available from: http://www.njmonline.org/text.asp?2021/30/1/40/309497




  Introduction Top


Infertility is the failure of a couple to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.[1] According to Donkor and Sandall,[2] in Ghana, 15% of women of child bearing age have infertility which have been regarded as a health problem. Causes include the woman, man, or both and can also be unexplained.[3] It is associated with psychological and social consequences and tends to affect females more than the males.[4] The effect of infertility is felt by individuals and couples as a stressful experience. Research has shown that women with infertility experience a lack of control in their life, social isolation, loneliness, sexual dysfunction, low self-esteem, and fertility distress. They endure a myriad of felt losses and high level of suffering and sorrow as a result of their inability to have children.[4]

Infertility is a global problem and leads to distress and depression as well as discrimination and ostracism.[5] Studies confirm that women experience greater amounts of infertility-related stress.[6],[7] Women are also more likely than men to report depression and anxiety symptoms, and also take a more active role in medical treatment, and respond poorly following treatment failure.[4] Men experience stress more in infertility but look less emotionally affected, and they are willing to consider treatment termination.[6] With regard to counseling services, women have more positive attitudes toward seeking psychological help than men and are more likely to seek couple counseling for general distress.[6] For this reason, couples with fertility challenges adopted several coping strategies in managing the stress of infertility. A qualitative study conducted in the United States by Davis and Dearman[7] showed that women used a variety of coping strategies to solve infertility problems. In Pakistan, some women resorted to adoption in coping with infertility.[1] However, from a cultural and social aspect, adoption remains an undesirable option in India.[3] Coping, according to Folkman et al.[8] is a constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Coping strategies, according to Davis[9] are conscious efforts to solve a personal or interpersonal problem that will help in overcoming, minimizing, or tolerating stress or conflict. Ntoumanis et al.[10] emphasized that some coping strategies are not better than others; in essence, effective coping requires a fit between situational appraisals and choice of coping responses (this notion is also known as the goodness of fit model). Specifically, perceptions of controllability of the situation should lead to the utilization of problem-focused strategies to a greater degree than emotion-focused strategies, which are more suitable for situations that are less controllable. According to Folkman and Lazarus.[11] coping strategies are classified into two: problem-focused coping strategy and emotion-focused strategy. The problem-focused strategy is directed toward reducing or eliminating a stressor, adaptive behavioral condition.[12] Users of problem-focused strategies do this by getting information on the problem and learning new ways to manage the problem. Emotion-focused coping is when we feel we have little control of the situation, thus we cannot manage the source of the problem.[12] It involves gaining strategies for regulating emotional distress. They include escape-avoidance, seeking social support; exercising, relaxing, and confronting.[13] For this study, four of these coping strategies will be used extensively. Meanwhile, other remaining types will be discussed collectively. Self-controlling strategy means clients trying to control themselves and their emotions through the diversion of their attention, e.g., watching television and reading interesting novels. Heshmat[14] explained that “while the physical independence of today and tomorrow is real enough, the fact remains that today's actions affect tomorrow's.” Escape-avoidance means clients directing their attention away from the problem as a reality. The strategy comprises wishful thinking and behavioral efforts to escape or avoid the problem at hand through regulation of stressful emotions related to the problem;[15] positive reappraisal means clients trying to see the positive aspect of the situation instead of thinking about the negative impact.[15] Mikulincer et al.[16] categorized clients with infertility as secure, anxious-ambivalent, or avoidant and found that secure men and women reported more well-being, less distress, and more dyadic consensus than those who were avoidant or anxious-ambivalent. Secure and avoidant individuals also reported more dyadic satisfaction. Social-seeking support refers to when clients seek social support by interacting with people who they think can be of help concerning their infertility challenges. According to Peterson et al.,[6] women seek more social support through medical professionals and those also going through infertility stress. Because infertility is so commonly linked with negative symptoms such as depression, anxiety, and stress in quantitative studies, the finding that some couples can experience a relational benefit from infertility is encouraging and worthy of future study.[17] It is against this background that this study is based.


  Subjects and Methods Top


A descriptive cross-sectional survey design was used among infertility clients attending gynecological clinic in South-Eastern Nigeria. The design was successfully used by Nelson et al.,[3] in studying the coping strategies of clients with challenges of fertility in Borno State. The sample size of 120 participants was obtained using the power analysis formula by Gill et al.[18] A homogenous purposive sampling technique was used. It was used as clients were selected based on their similar characteristics of fertility challenges and not all clients in the clinic register attend the clinic during the period of data collection. A letter of introduction was obtained from the Department of Nursing Sciences, University of Nigeria, Enugu Campus, and the ethical approval was obtained from the Health Research and Ethics Committee of the University of Nigeria Teaching Hospital. Two research assistants were trained on the purpose of the study and data collection. One hundred and twenty questionnaires were administered to clients with fertility challenges who met the inclusion criteria as they attend the clinic. Those who could read and write in English were given the questionnaire to fill and return. Those who could not read and write the researcher and research assistants used the questionnaire as an interview guide to obtain information from them and assisted them in filling the questionnaire. Data collection lasted for 2 months and only 117 questionnaires were available for analysis as three questionnaires were wrongly filled. Data collected were analyzed using both descriptive and inferential statistics. The descriptive statistics – frequency, percentage mean and standard deviation – were used to summarize the items of the questionnaire. Specifically, the mean and standard deviation were used to assess for the four-point scaled items on the coping strategies, where strongly agree (SA) = 4, agree (A) = 3, disagree (D) = 2, and strongly disagree = 1. A cutoff of 2.5 was used for decision; hence, an items with a mean above 2.5 was judged to be the respondents' status.[8] The inferential statistics – Chi-square Homogeneity of Proportions and Student's t-test – were used for the comparisons: testing for the difference between the groups at 5% level of significance. Chi-squared test and t-test were used for categorical and continuous variables, respectively. Statistical difference hence existed if P < 0.05; otherwise, no significance. These statistics were done with the aid of the Statistical Package for the Social Sciences (SPSS) version 25.


  Results Top


Out of the 120 copies of questionnaires administered, three were observed to be filled wrongly, representing a return rate of 97.25%. As shown in [Table 1], the age distribution of the respondents was slightly varied with respondents aged between 30 and 39 years comparatively higher (54.7%). Females (78.7%) constituted a majority of the participants. However, 47.0% and 45.3% were educated up to secondary and tertiary levels respectively, and 36.8% were self-employed. In addition, a large proportion were Christians (97.4%) and were married (83.8%). A total of 100 (85.5%) respondents admittedly used self-controlling strategy. Further figures in [Table 2] showed that they used this strategy majorly by trying to control their emotions 96.5%, keeping their feelings to themselves 89.7%, and not letting others know how bad things are in their family 87.2%. The opinions of the respondents showed that on average, 59.8% adopted one or more forms of the escape-avoidance coping strategy. The most common form adopted by 80.3% was the refusal to believe that they cannot be pregnant or impregnate a woman [Table 3].
Table 1: Sociodemographic characteristics of the participants (n=117)

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Table 2: The use of self-controlling coping strategy

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Table 3: The use of escape-avoidance coping strategy

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From [Table 4], majority of the respondents employed the positive reappraisal strategy while coping with infertility by trying to channel their effort to do something creative (85.5%) and to their career (76.1%). As shown in [Table 5], the respondents' responses on the use of social seeking support coping strategy indicate that 94.0% talk to someone about how they are feeling, and 90.6% try to stay with other children in their house believing that they will have theirs someday. Furthermore, 89.7% ask people that had previous infertility problem for advice, 88.9% read/listen or watch programs on television on infertility management, and 88.0% talk to someone about how they feel. [Table 5] also illustrates other ways of coping which clients with fertility challenges adopt. These ways include praying to God/other beings (85.5%), engaging in exercises to bring about distractions (73.5%), and accepting to move on with life without bothering anyone ever again (62.4%).
Table 4: The use of positive reappraisal strategy

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Table 5: The use of social seeking support strategy and other ways of coping

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As shown in [Table 6], the self-controlling coping strategy was the most dominant coping strategy used by the respondents with a mean response of 3.12 ± 0.74. This was statistically significant when compared with escape-avoidance, positive reappraisal, and other ways of coping (P < 0.05). However, there was no significant difference in their use of the self-controlling and social seeking support strategies (P = 0.603). [Table 6] also shows the existence of a statistically significant association between the gender of the respondents and the coping strategies they use. There were significant differences in gender and among the use of self-controlling, escape-avoidance, positive reappraisal, and social support seeking coping strategies (P = 0.020, P = 0.020, P = 0.040, and P = 0.025, respectively). There was, however, no significant association between the participants' gender and their use of other ways of coping (0.573).
Table 6: Comparison of differences in the use of coping strategies and relationship between gender and the use of coping strategies

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  Discussion Top


The present study reports on the coping strategies adopted by clients with fertility challenges in dealing with the psycho-social consequences associated with infertility. 85.5% of the respondents adopted the use of self-controlling coping strategies in dealing with their infertility challenges by trying to control their emotions, not letting others know how bad things are in their family and trying not to let their feelings interfere with other things they do. Self-controlling strategy enables the client to invest their own conscious effort, to solve personal and interpersonal problems, in order to try to master, minimize, or tolerate stress and conflict. This was similar to the findings by studies in Ghana[2] and India[7] where self-controlling strategy was adopted as 91% tried to keep their feelings to themselves. The gender difference in the use of self-controlling strategy was also statistically significant (P = 0.020). Even though all male respondents were found to use self-controlling coping strategy, a proportionate number of female respondents also adopted the use of this strategy. Comparable findings were also noted by a study in Canada[6] whose result showed that men used proportionately greater amounts of self-controlling and problem-solving than women.

The use of escape-avoidance coping strategy when compared to the use of self-controlling coping strategies showed a significant difference (P = 0.020) and was used less commonly by 59.8% of the respondents. In employing this strategy, the respondents refused to believe that they cannot be pregnant or impregnate a woman, became a workaholic, tried to leave when people are talking about pregnancy or children, and avoided being with pregnant women or children. Hence, they deny their condition or act as there is no stressor, and therefore, there is no need to seek medical treatment. This result is similar to studies conducted in Ghana[2] and Nigeria[3] which revealed that majority refused to believe that they were in such a situation and wished it would go away. There was also an observable significant association between the use of this strategy and the gender of the study participants (P < 0.05). The proportion of males who used the escape-avoidance coping strategy was greater than females. This corresponds with the findings of a study done in Nigeria[3] which showed that most respondents, especially males (54.7%), used escape/avoidance coping strategy by drinking, smoking, and taking drugs to forget they are childless than the females.

From the findings, the proportion of the respondents who used a positive reappraisal coping strategies was 62.4%. This figure was lower when compared to the proportion of the respondents who use the self-controlling coping strategies with a statistically significant difference (P < 0.05). In employing this strategy, the respondents tend to channel their effort to do something creative, to their career, making a plan to adopt a child, and planning to go for assisted reproduction. The findings are consistent with the studies conducted in Ghana[2] and India.[7] Furthermore, the difference in the respondents' gender and their use of the positive reappraisal coping strategy was statistically significant (P = 0.040). This has differed from the findings in an Iranian study[13] which revealed that positive reappraisal was lower in wives than husbands, but these differences are not significant (P > 0.05).

Similar to the self-controlling strategy, the social seeking support was also another common strategy adopted by majority (86.3%) of the respondents but was statistically insignificant (P > 0.05). The respondents' achieve this through talking to someone about how they feel, asking people with similar problems for advice, talking to someone to find out more about their problem, reading/listening, or watching programs on television on infertility management. Through social seeking strategy, they believe that others understand their needs and will try to help them. Similar findings were noted in a Jordanian study[19] in which the study participants reported receiving emotional support from extended family as well as instrumental support to overcome the financial burden of infertility treatment costs (social support coping strategy). In contrast to the finding is the work of Donkor and Sandall[12] in which the clients talking to others about fertility problems was not a common strategy that the respondents used. The responses on the use of this strategy showed a significant association with the gender of the participants (P = 0.025). This means that both male and female participants have an increased tendency to use this strategy in coping with fertility challenges.

On average, other ways of coping with infertility were the least common strategy adopted by only 47.0% of the respondents. Praying to God/other beings for a miracle was identified to be the most prevalent way by which 85.5% of the respondents coped with their fertility problems. This finding is in line with the work conducted by Obeit et al.[20] in which the authors considered trust in God a powerful coping strategy. Similarly, a Ghanaian[5] study also reported that 99% of the respondents pray to God and 98% hoped a miracle would happen. The current study did not find any significant association between the gender of the participants and their use of other ways of coping (P = 0.573).


  Conclusion Top


Infertility can have a devastating effect on the mental health of couples. The capacity to adapt to infertility-related stress is strongly dependent on which forms of coping strategies are used more commonly by infertile couples. Based on the results, the study concludes that first, the respondents used more self-controlling strategies than they used positive reappraisal escape-avoidance and other coping strategies and these showed a statistical significance (P < 0.05). Even though they used social support seeking as much as they used self-controlling strategies, this finding was not significant (P > 0.05). Furthermore, gender was found to have a significant influence on the use of coping strategies among the study participants (P < 0.05). Hence, this study highlights the major coping strategies adopted by infertile couples and underscores need for health-care providers to integrate psychological counseling into the care of clients with infertility challenges so as to help them increase their use of positive strategies such as positive reappraisal strategy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Sexual and Reproductive Health: Infertility Definitions and Terminology. Special Program Research 2018. WHO HRP News Monthly Electronic Newsletter of New Publications, Research Articles and Events from the Department of Reproductive Health and Research; 2018.  Back to cited text no. 1
    
2.
Donkor ES, Sandall J. Coping strategies of women seeking infertility treatment in southern Ghana. Afr J Reprod Health 2009;13:81-93.  Back to cited text no. 2
    
3.
Nelson L, Danlami S, Njidda U, Hamina D, Jidda K. Coping Strategies of Clients with Fertility Challenges Attending Obstetric and Gynaecological Clinic of University of Maiduguri Teaching Hospital, Borno State, North Eastern Nigeria. J Adv Med Med Res 2019;28:1-11.  Back to cited text no. 3
    
4.
Pedro A. Coping with infertility: An explorative study of South African women's experiences. Open J Obstet Gynecol 2015;5:49-59.  Back to cited text no. 4
    
5.
Cui W. Mother or Nothing: The Agony of Infertility. Vol. 88. WHO Bulletin Geneva, Bull World Health Organization; 2010. p. 881-2.  Back to cited text no. 5
    
6.
Peterson B, Boivin J, Norré J, Smith C, Thorn P, Wischmann T. An introduction to infertility counseling: A guide for mental health and medical professionals. J Assist Reprod Genet 2012;29:243-8.  Back to cited text no. 6
    
7.
Davis D, Dearman E. Coping strategies of nontraditional female students in Southwest Michigan and Northern Indian. Educ Psychol 2017;5:1-11.  Back to cited text no. 7
    
8.
Lazarus RS, Folkman S, Lazarus RS. Manual for the Ways of Coping Questionnaire. Research Edition, Palo Alto, C.A: Consulting Psychologists Press Inc.; 1988. p. 18-25.  Back to cited text no. 8
    
9.
The UC Davis Obstetrics and Gynecology Department in Collaboration with California IVF Fertility Center in Sacramento. Reproductive Endocrinology and infertility. UC Davis Health; 2018. p. 3-7.  Back to cited text no. 9
    
10.
Ntoumanis N, Edmunds J, Duda J. Understanding the coping process from a self- determination theory perspective in Birmingham UK. Health Psychol 2009;14:240-60.  Back to cited text no. 10
    
11.
Folkman S, Lazarus RS. Appraisal and Coping. 2nd ed. New York: Springer; 1988. p. 23-36.  Back to cited text no. 11
    
12.
Buhawe J. Coping strategies in Lucena. Healthcare 2015;20:255-60.  Back to cited text no. 12
    
13.
World Health Organization Regional Office for Europe. Physical activity strategy for the WHO European Region 2016-2025. Geneva, Swaziland: World Health Organization Regional Office for Europe; 2015. p. 1-15.  Back to cited text no. 13
    
14.
Heshmat S. 10 Strategies for developing self-control the elements of enduring and sustained change in spring fields; 2017.  Back to cited text no. 14
    
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Images for Ghaderi A. Coping: Escape-avoidance in Sweden division of psychology 2015;10:81-7.  Back to cited text no. 15
    
16.
Mikulincer M, Horesh N, Levy-Shiff R, Manovich R, Shalev J. The contribution of adult attachment style to the adjustment to infertility. Br J Med Psychol 1998;71(Pt 3):265-80.  Back to cited text no. 16
    
17.
Peterson B, Pirritano M, Block J, Schmdt L. Marital benefits coping strategies in men & women undergoing unsuccessful; fertility treatment over a 5-years period in Orange California. Fertil Steril 2011;95:1759-63.  Back to cited text no. 17
    
18.
Gill J, Johnson P, Clark M. Research Methods for Managers. SAGE Publications; 2010. p. 4-10.  Back to cited text no. 18
    
19.
Mohammadi M, Samani R, Navid B, Maroufizadeh S, Sabeti S. Coping strategy in infertile couples undergoing assisted reproduction treatment in Tehran, Iran. Middle East Fertil Soc J 2018;23:482-3.  Back to cited text no. 19
    
20.
Obeit H, Hamlan A, Callister L. Missing Motherhood: Jordanian women's experiences with infertility. Adv Psychiatry 2014;2014:1-7.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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