Ms. M. Divyashree1*,
Mrs. Theresa Mathias1
1M.Sc. (Mental Health Nursing) Nursing, Laxmi Memorial College of Nursing, A.J. Towers, Balmatta, Mangalore-575002, Karnataka, India
2Professor, Mental Health Nursing, Laxmi memorial College of Nursing, A.J Towers, Balmatta, Mangalore- 575002, Karnataka. India.
*Corresponding Author
Email: divyakulal29@gmail.com,
tresavinay@yahoo.com
ABSTRACT:
Parenthood is one of the major transitions in
adult life for both men and women. The stress of non-fulfillment of a wish for
a child has been associated with emotional related problems such as anger,
depression, anxiety, marital problems, sexual dysfunction, and social
isolation. Couples experience stigma, sense of loss, and diminished self-esteem
in the setting of their infertility1. Among infertile couples, in general,
women show higher levels of distress than their male partners. Both men and
women experience a sense of loss of identity and have pronounced feelings of
incompleteness and incompetence2. The aim of this study was to assess the bio-psychosocial
problems of infertile women attending selected infertility clinics at
Mangalore”. The descriptive survey approach was adopted to determine the bio
psychosocial problems of infertile women. The conceptual framework was based on
Callista Roy’s adaptation model (1976). A sample of 100 infertile women were selected by the
purposive sampling technique. The data was collected by using demographic Proforma, checklist on biological problems and rating
scales on psychosocial problems questionnaire. The collected data was analyzed
to achieve the objectives of the study and to test the research hypotheses
using descriptive and inferential statistics. The analysis of study reveals
that Maximum (81%) of infertile women had moderate biological problem and Majority
89% of the infertile women had moderate psychosocial problems.
KEYWORDS: Bio-psychosocial problems, Infertility clinic,
Infertility women.
INTRODUCTION:
Reproduction is the fundamental right of
every living organism aimed at the propagation of its species. Human
reproduction involves many complex changes and mechanisms which ultimately lead
to conception. The couple is a biologic unit of reproduction and both male and
female contribute to normal fertility3.
The normally developed reproductive tracts in both male
and female partners are essential. The normal functioning of an intact
hypothalamic-pituitary gonadal axis supports gametogenesis, the formation of sperm and ova2.
The World Health Organisation
(WHO) defines positive reproduction health of women as a state of complete
physical, mental and social well being and not merely the absence of disease
related to reproductive system and functions4.
Infertility is defined as the
inability to achieve pregnancy after one year of unprotected intercourse. An estimated
15% of couples meet this criterion and are considered infertile. Conditions of the male alone are now estimated to
account for nearly 30% of infertile
couples, and conditions of both the female and the male account for another 20%5.
Being unable to conceive and give birth to a child has long been
recognized as a very disturbing
situation for the estimated 1: 6 couples involved .Our society is generally
seen as one that places as high value on
couples bearing children and consequently may be less than supportive to those who cannot fulfill this expectations6.
There is no longer any disagreement that infertility is a distressing
experience, between
1970 and 2000, the world population experienced a major and unprecedented
reduction of fertility levels, driven
mostly by the decline in fertility in developing countries. Average fertility levels in the developing world dropped
from over 5.9 children per woman in the 1970s to about 3.9 children per
woman in the 1990s. The median fertility reduction in developing countries
between the 1970 and 1990 s was of the order of 1.8 children per woman and a
quarter of all developing countries appear to have achieved reduction of 2.6
children per woman or more7.
The woman or couple facing infertility exhibits behaviours of the grieving process and have impaired
self-concept. Intrauterine inseminations technique has been providing hope to
infertile couples and when it fails, they may move towards in vitro
fertilization. When in-vitro fertilization is either not possible or has
repeatedly failed, surrogacy may be viewed as an alternative8.
MATERIAL AND
METHODS:
Callista Roy’s adaptation mode (1976) was used to provide the conceptual
framework for this study. Roy’s model focuses on the concept of “Adaptation of
man.” According to Callista Roy, a person is a
“bio-psychosocial” being in constant interaction with a changing environment.
Environment is the input into the person as an adaptive system involving both
internal and external factors. The main concepts are human beings, stimuli,
coping mechanisms, adaptation modes and nursing9.
Ethical clearance was obtained prior to the study. The
study was conducted in Santhathi fertility centre at
Mangalore. A written permission was obtained from the concerned authorities.
For validity the criteria
checklist, the tool along with blueprint, answer keys was submitted to 9 experts along with the objectives. Reliability of the tool was calculated split
half method using Spearman’s brown Prophency formula
and Kuder Richardson method. The reliability of the
assessment tool was r= 0.88, hence the tool was found to be reliable. Research approach used for the study was Descriptive survey approach.
The study was conducted in the Santhathi fertility
centre at Mangalore on 100 infertile women were selected by the Purposive
sampling technique. Informed consent was obtained from each women
for participating in the study. The data was collected by using Demographic Proforma, checklist on biological problems and rating scale
on psychosocial problems of infertile women. The data collected was analyzed to
achieve the objectives of the study and to test the research hypotheses using
descriptive and inferential statistics.
RESULTS:
Section A:
Demographic variables of the sample
Highest of the infertile women (44%) are in the age group
25-29 years and least seven percentages are in the age group 20-24 years.
Highest percentage (59%) of the infertile women was Hindus, 23% Muslims and
least (18%) were Christians. Highest percentages (28%) of the infertile women
were high school and only 5% were postgraduates. Majority (60%) of the
infertile women were housewife whereas the 14% were government employee.
Highest (66%) of infertile women belong to the monthly income > Rs. 5,000
and least (2%) were in the income group of < Rs. 15,000. Majority (48%) of
the infertile women were married at the age of 18-25 years and least (12%) of
the infertile women were married at the age of 31-35 years. Highest percentage
(88%) of the infertile women marriage was no consanguineous marriage and least
(12%) of the infertile women marriage was consanguineous marriage. Majority
(50%) of the infertile women are belonged to 2-5 years duration of married life
and least (5%) of the infertile women are belonged to 10-13 years duration of
married life. Highest percentages (37%) of the infertile women were belonged to
nuclear family and least (31%) of the infertile women were belonged to joint
family. Highest (80%) of the infertile women were not having family history of
infertility and least (20%) of the infertile women were having family history
of infertility. Majority (34%) of the infertile women were motivated by their
husband and least (8%) of the infertile women were motivated by their family
members. Highest (80%) of the infertile women were having history of irregular
menstrual cycle and least (20%) of the infertile women were having history of
thyroid problem. Majority (80%) of the infertile women are staying with their
husband and least (20%) of the infertile women are not staying with their
husband. Highest (100%) of the infertile women were not adopted family planning
methods immediately after marriage.
Section B:
Description of biological problems scores among infertile women
The biological assessment scores are assessed and
presented in the form of tables and figures as percentage.
Table 1: Percentage distribution of samples
according to their biological problems scores n=100
|
Biological problem scores |
Percentage |
|
< 2% (Mild) |
12 |
|
3-5% (Moderate) |
81 |
|
6-8% (Severe) |
7 |
Table 2: Obtained range of score, maximum
score, median, standard deviation, mean percentage and level of biological
problems of infertile women.
n=100
|
Obtained range |
Max. score |
Mean |
Median |
Standard deviation |
Mean percentage |
Level of biological problems |
|
2-7 |
7 |
3.39 |
4 |
1 |
48.42 |
Moderate |
The data presented in Table 1 shows that 12% of infertile
women had mild biological problem. Eighty-one percent of infertile women had
moderate biological problem and 7% of infertile women had severe biological
problems.
The data presented in Table 2 shows that the obtained
range score, maximum score, mean, median, standard deviation and mean
percentage of biological assessment questionnaire were 2-7, 7, 3.39, 4, 1 and
48.42, respectively. This indicates that that the infertile women had moderate
biological problems.
Section C:
Description of psychosocial problems scores among infertile women
The psychosocial problems are assessed and presented in
the form of tables and figure as percentage.
Table 3: Percentage distribution of samples
according to their psychosocial problems scores n =100
|
Psychosocial problèm scores |
Percentage |
|
<8% (Mild) |
1 |
|
9-24% (Moderate) |
89 |
|
25-40% (Severe) |
10 |
The data presented in Table 3 shows that 1%
of infertile women had mild, 89% of infertile women had moderate whereas 10% of
infertile women had severe psychosocial problems.
The data presented in Table 4 shows that the
obtained range score, maximum score, mean ,median, standard deviation and mean
percentage of psychosocial scores were 6-29, 29, 18.19, 20, 4, 62.72
respectively. This indicates that infertile women had moderate level of
psychosocial problems.
Section D: Association of bio-psychosocial problems with selected
demographic variables
In order to find the association of
bio-psychosocial scores with selected demographic variables null hypothesis was
formulated.
H1: There is significant association of bio-psychosocial problems with
selected demographic variables.
Chi square test was computed to test the
significant association of the bio- psychosocial problems with selected
demographic variables.
The data presented in table 5 shows that there is
significant association of bio-psychosocial problems with religion (c2=7.591), education (c2=18.17), occupation (c2=11.48), type of marriage (c2=5.95), duration of married life (c2=9.466), type of family (c2=5.60), stay with husband (c2=37.88). Thus the null hypothesis was
rejected and research hypothesis is accepted at the same time. There is no
significant association with age (c2=0.93), monthly income (c2=0.37), age at marriage (c2=1.36), family history of infertility (c2=2.27), inspiration to attend the fertility
clinic (c2=0.66),
history of systemic disorder (c2=3.64), and
adoption of family planning methods (c2=0). Thus the null hypothesis was accepted
and null hypothesis is rejected at the same time.
Table 4: Obtained
range of score, maximum score, mean, median, standard deviation, mean
percentage and level of psychosocial problems of infertile women n=100
|
Obtained range |
Max. score |
Mean |
Median |
Standard deviation |
Mean percentage |
Level of biological problems |
|
6-29 |
29 |
18.19 |
20 |
4 |
62.72 |
Moderate |
Table 5: Association
of the bio-psychosocial problems with selected demographic variables
n=100
|
Sr. No. |
Demographic variables |
c2
value |
Table value |
Level of significance |
df |
Inference |
|
1. |
Age in years |
0.9390 |
3.841 |
p>0.05 |
1 |
NS |
|
2. |
Religion |
7.5910 |
5.991 |
p<0.05 |
2 |
S* |
|
3. |
Education |
18.1700 |
5.991 |
p<0.05 |
2 |
S* |
|
4. |
Occupation |
11.4800 |
3.841 |
p<0.05 |
1 |
S* |
|
5. |
Monthly income |
0.3730 |
3.841 |
p>0.05 |
1 |
NS |
|
6. |
Age at marriage |
1.3640 |
5.991 |
p>0.05 |
2 |
NS |
|
7. |
Type of marriage |
5.9530 |
3.841 |
p<0.05 |
1 |
S* |
|
8. |
Duration of married
life |
9.4660 |
3.841 |
p<0.05 |
1 |
S* |
|
9. |
Type of family |
5.6020 |
3.841 |
p<0.05 |
1 |
S* |
|
10.
|
Family history of
infertility |
2.7270 |
3.841 |
p>0.05 |
1 |
NS |
|
11.
|
Inspired to attend
the fertility clinic |
0.6610 |
3.841 |
p>0.05 |
1 |
NS |
|
12.
|
Systemic disorder |
3.6457 |
3.841 |
p>0.05 |
1 |
NS |
|
13.
|
Stay with husband |
37.8800 |
3.841 |
p<0.05 |
1 |
S* |
|
14.
|
Adoption of family
planning methods |
0.0000 |
3.841 |
p>0.05 |
1 |
NS |
Table value of c2 at 0.05% level S*=
Significant NS= not significant
DISCUSSION:
Demographic characteristics of the sample
In present study accordance with 100 samples,
it is observed that,
·
Highest percentage of infertile women
(40%) is in the age group of 25-29 years.
·
Highest percentage (59%) of infertile
women was Hindus.
·
Highest percentage (28%) of infertile
women has High school education.
·
Majority (60%) of the women were
housewife.
·
Majority (66%) of the infertile women
were belong to the family income of less than Rs.
5,000.
·
Highest percentage (48%) of infertile
women was married at 23-27 years of age.
·
Majority (88%) of infertile women
marriage was non consanguineous
·
Highest percentage (50%) of infertile
women belonged to 2-5 years of married life.
·
Majority (37%) of infertile women were
belonged to nuclear family.
·
Majority (80%) of infertile women are
not having history of infertility in their family.
·
Highest percentage (34%) of infertile
women was inspired by their husband to attend the fertility clinics.
·
Highest percentage (80%) of infertile
women is having irregular menstrual cycle.
·
Majority (57%) of infertile women are
staying with their husband.
·
Highest percentage (100%) of the
infertile women was not adopted family planning methods immediately after
marriage.
Description of
biological problem assessment scores of the sample
Majority 81% percent of infertile women had
moderate biological problem, 12% of infertile women had mild biological problem
and 7% of infertile women had severe biological problem.
Description of psychosocial problem assessment scale
Majotiry 89% of infertile women had moderate, 1% of infertile women had mild,
whereas 10% of infertile women had severe psychosocial problems.
The findings of the
study were supported by a study conducted in Greece on “Psychosocial problems
of infertile people”. The study was exploratory in nature and quantitative by
design. Sixty individuals
(43 women and 17 men), with history of infertility (diagnosed 1–5 years ago)
of mean age of 34 years (34±5), married,
well educated, with no children at all, were participated in this study. According to results severe psychosocial
problems impact the everyday life
mostly the woman (74%) of an infertile couple that includes feeling of stress
(35%), angry (20%) and guilty (20%) for the
infertility.
The findings of the study were also supported
by a “the psychosocial consequences of childlessness among infertile women in
Andhra Pradesh, India in 2008”. The 150 samples were currently married women
aged 20 or more who has been married for at least 3 years with no live births
were included in the study. The rate of childlessness was 5 %. For a minority
of women there was a risk of divorce and husband marrying a second wife to have
child. Two – third of women experience violence from their husband (13%)
thought that this is mainly due to their childlessness10.
The findings of the study were also supported by a
“prevalence of psychiatric morbidity and factors suffering from infertility” study conducted
on infertile women. General Health Questionnaire, Beck Depression Inventory and
the Anxiety Subscale of the Hospital Anxiety and Depression Scale were
administered to 112 women with infertility at the time of their first
presentation to a fertility clinic in a tertiary referral centre. The
comparison group comprised of 96 women presenting at the family planning clinic
of the same institution. In addition to demographic data, a structured
questionnaire was used to collect obstetric information and clinical details
from the participants Results shows that the prevalence of psychiatric morbidity
was (46.4%) in the infertile women cases of anxiety (37.5%) and depression
(42.9%) respectively3.
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Received on 24.12.2014 Modified on 07.01.2015
Accepted on 13.02.2015 © A&V Publication all right reserved
Asian
J. Nur. Edu. and Research 5(2): April-June
2015; Page 270-273
DOI: 10.5958/2349-2996.2015.00053.1