Coping strategies adopted by infertile women

https://doi.org/10.33698/NRF0205  Sandeep Kaur

Abstract : Parenthood achievement is one of the major life goals for most men and women. In planning a life together, most of the couples have a vision about how their life should be, and most of them wish to have children of their own for the future life. When fertility fails, the couples become depressed psychologically and can experience a wide range of emotions. Couples may blame themselves even though it is not a personal failure or punishment.

The present descriptive study was conducted to ascertain the coping strategies adopted by infertile women attending Satjot Human Reproduction & research center, Amritsar (Punjab).A total of 112 infertile women were selected by using convenient sampling technique. The tool consisted of two sections i.e. demographic profile & rating scale.Rating scale consists of 27 items & domains used were; denial / wishful thinking, talking to others, taking control, passing as normal, and fate/acceptance/blame. Respondents were asked to indicate on a 4-point Likert scale how often they used each particular coping strategy. Thus 0=does not apply/or not used; 1=used somewhat; 2=used quite a bit; and 3=used a great deal. The findings revealed that 72% of the women keep information about their infertility to themselves, 82% women depended on their religious faith, 70% found comfort in their husbands’ support, others became absorbed in their occupation or profession, 45% of women reported regaining control of their infertility through reading and learning a lot about infertility that empowered them to make informed decisions and choices. In conclusion, infertility is quite distressing for patients, external support from family and friends, new treatment opportunities could all mitigate emotional distress, and so infertile women could be assisted to build on effective coping strategies. The findings of this study could be useful in designing and implementing psychological programmes for infertile women.

Keywords

Coping strategies; Infertile women.

Correspondence at

 Sandeep Kaur

M.Sc Nursing (Obstertrics and Gynaecological Nursing) Assistant Professor in Khalsa College of Nursing , Amritsar

Introduction

Infertility remains an important problem worldwide which affects men and women equally. It does affect a large percentage of the population and are on the rise in many countries. There are millions of couples right now struggling with infertility. It can be a hard struggle as couples see other people with their babies and wonder why it is not so easy for  them.1,2   The  World  Health  Organization (WHO,2004) estimates that 60 to 80 million couples worldwide currently suffer from infertility3. Infertility varies across regions of the world and is estimated to affect 8 to 12 per cent of couples worldwide4,5. According to WHO, primary infertility is the Inability to conceive within two years of exposure to pregnancy (i.e. – sexually active, non- contracepting, and non-lactating) among women 15 to 49 yr old6. Secondary infertility refers to the inability to conceive following a previous pregnancy. Globally, most infertile couples   suffer   from   primary   infertility7. Childless women will undergo varied psychological distress and in order to overcome psychological distress and maintain their quality of life they need to use more social support were less distressed. It was pointed out that drawing on their findings for the provision of support and professional intervention must be done with caution, the reason being that findings might lead to the conclusion that professionals should discourage avoidance and encourage support mobilization.13 Avoidance strategy of coping in infertility was found to be associated   with   increased   distress.14 Accepting responsibility and escape- avoidance were significantly and positively correlated with emotional disturbance.15  The most frequently used sources of support were talking with the spouse, family and friends, and using documentation on emotional aspects of infertility obtained through the clinic, newspapers or television appropriate  coping strategies.8 In a programmes. It was pointed out that while qualitative study conducted in the United States, it was found that women used coping strategies such as avoidance of reminders of infertility, being the best, regaining control, sharing the burden and giving into feelings in dealing with the problems of infertility.9 Seeking social support was an important coping mechanism used by couple during the process of taking treatment for infertility can be quite distressing for patients, external support from family and friends, new treatment opportunities could all mitigate emotional distress. Social support has been identified as playing a positive role in the experience of infertility.16 This study aims to identify the coping strategies adopted by infertile women .The findings have the potential of enabling the infertility.10 In Pakistan some women healthcare personnel in designing and resorted  to  adoption  in  coping  with  implementing supportive psychological infertility.11 However, from a cultural and programs for women faced with fertility social point of view, adoption remains an  problems.undesirable   option   in   India.12      A   study

Research Objective

conducted in the United States, found that women who coped through escape- avoidance and through accepting responsibility for their infertility showed more distress, whereas women who sought To identify coping strategies adopted by infertile women.

Materials & Methods

The sample consisted of 112 in fertile women attending Satjot Human Reproduction & research center, Amritsar (Punjab). Convenient sampling technique was used to collect the data. The tool consisted of two sections i.e. demographic profile & rating scale. Demographic profile includes age, education level, occupation, duration of marriage, type of infertility, duration of treatment and reasons of infertility.The Likert scale has 27 items. Domains used in rating scale were; denial / wishful thinking, talking to others, taking control, passing as normal, and fate/acceptance/blame.Respondents were asked to indicate on a 4-point Likert scale how often they used each particular coping strategy. Thus 0=does not apply/or not used; 1=used somewhat; 2=used quite a bit; and 3=used a great deal. The data was coded and analysed by using SPSS.

Results

Table 1 presents the socio- demographic details of 112 women encountering fertility problems. According to age, nearly half of the subjects (42.8%) were found in 31-35 years of age group followed by  25-30  years  (37.5%),  36-40  years (13.3%) & ≥ 41 years (6.25%) years of age group. As per education level, nearly one third of subjects (33%) were graduate & above. With respect to occupation, almost half (48.2%) were housewife. According to family income, one third of subject (30.3%) had family income in the range of Rs. 15, 001– 20,000. Majority of subjects, (69.6%) hailed from urban areas. Pertaining to type of family, almost half of subjects (48.2%) were from joint family.

Table 1: Socio-demographic characteristic of infertile women     

N=112

Socio demographic variables N(%)
Age (in years) 42(37.5)
25-30 48(42.8)
31-35 15(13.3)
36-40 7(6.25)
Educational status  
Illiterate 12(10.7)
Primary 8(7.14)
Matric 25(22.3)
Secondary 30(26.7)
Occupation  
Private employee 31(27.6)
Government employee 22 (19.6)
Self-employee 5 (4.4)
Homemaker 54(48.2)
Family income (in Rupees)  
5,000-10,000 21(18.7)
10,001-15,000 30 (26.7)
15,001-20,000 34 (30.3)
>20,000 27 (24.1)
Place of Living  
Rural 34 (30.3)
Urban 78 (69.6)
Type of Family  
Joint 54 (48.2)
Nuclear 35 (31.2)
Extended 23 (20.5)

Table-2 depicts that half of subject (51.7%) had duration of marriage 6-10 years. Maximum (82%) subjects suffered from primary infertility. More than half (58%) of subjects were on treatment from last 1-5 years & very few (4.4%) from >10 years. When women were asked what their doctor says was the cause of their infertility, 33% said it was attributed to their husbands, 18.7% indicated that they did not know what they said it was, 17.8% said it was due to tube defect/ tubal blockage.

Table-2: Variables related to infertility

N=112

Variables related to infertility n(%)
Duration of marriage (in years)  
?5 27(24.1)
6-10 58(51.7)
11-15 19(16.9)
?16 8(7.1)
Type of infertility  
Primary infertility 92(82.1)
Secondary infertility 20(17.8)
Duration of treatment (in years)  
1-5 65(58.0)
6-10 42(37.5)
>1 5(4.4)
First visit 13(11.6)
Any other cause 11(9.8)
Don’t know 21(18.7)

Table 3 depict that out of 112 infertile women, 29% did not used any coping strategies, 27% used sometime & 43% used the below mentioned coping strategies always.

Table 3: Percentage distributionof infertile women using coping strategies

Variables n %
Not used 33 29
Sometime used 31 27
Always used 48 43

In reporting, the percentage response of women on items of how they coped with their fertility problems were grouped together using our own grouping themes in terms of denial / wishful thinking, talking to others, taking control, passing as normal, and fate/acceptance/blame (Table 4).

Denial / wishful thinking – Some of the women admitted that they had a fertility problem, whereas others denied it. For example, half of the women (50%) refused to believe that they were in such situations, where the majority of the women (88%) wished the situation would go away. When asked whether they avoided people or activities that reminded them of their inability to have children only 25% of the women responded in the affirmative. In addition, about 37% of the women indicated that they avoided situations that would make them feel uncomfortable.

Talking to others – Talking to others about fertility problems was not a common strategy that the women used. In response to a question to ascertain whether women let their feelings out somehow in dealing with their fertility problem, 50% indicated that the question did not apply to them. Considering the percentage of responses of talking to someone to find out about their inability to have children did not apply to 55% of women; and 53% of the women did not talk to someone who could help them find a solution to fertility problems. Further, 40% of them did not ask a relative or friend for advice, 66% did not talk to people about how they felt, and 48% did not accept sympathy and understanding from others. These findings suggest that a high percentage of the women preferred to keep issues of their infertility problems to themselves.

Taking control – When women were asked if they kept themselves busy with other activities as a way of coping with infertility, almost half 48% said that they did not use this strategy. To a question on whether women had set a time limit for their infertility treatment, more than half 55% indicated that they had not. Women were asked whether they had read and learned much about infertility as a way of coping with their infertility experiences, 45% indicated that they used this strategy and 61% women seek

Table 4: Coping strategies among infertile women

 

Sr.

No.

 Items Response
Not used % Used some what % Used quite a bit % Used a great deal %
Denial/ wishing thinking
1. I refuse to think about being unable to have children. 51 14 9 25
2. I refuse to believe that I am in this situation. 28 8 14 50
3. I wish that the situation would go away. 0 9 3 88
4. I avoid people or activities that remind me of my inability to have children. 45 17 13 25
5. I avoid situation which would make me feel uncomfortable. 38 16 11 37
Talking to others
1. I let my feelings out somehow. 50 12 16 22
2. I talk to someone to find out about my inability to have children. 55 18 14 13
3. I talk to someone who could help me find a solution to my fertility problem. 53 20 12 15
4. I ask a relative or friend for advice. 40 30 12 18
5. I talk to people about how I feel. 66 7 10 17
6. I accept sympathy and understanding from others. 48 13 10 29
Taking control
1. I keep myself busy with other activities. 48 10 32 13
2. I have set a time limit for my infertility treatment. 55 11 29 5
3. I have read and learnt a lot about infertility. 30 14 10 45
4. I get professional help. 10 17 12 61
5. I have made a plan of action and followed it. 11 16 18 55
6. I have come up with a couple of different solutions to my problem. 22 19 17 41
7. I have been inspired to do something creative. 30 26 25 18
Passing as normal
1. I try to keep my feelings to myself. 8 7 13 72
2. I keep others from knowing how bad things are. 5 5 6 84
3. I try to keep my feelings from interfering with other things too much. 3 18 33 46
4. I refrain from discussing my problems with anyone other than my husband/ partner. 3 16 11 70
Fate/acceptance/blame
1. I pray. 2 11 5 82
2. I believe that it was God’s will, and if He chose, I would eventually conceive. 4 13 6 77
3. I hope a miracle will happen. 2 1 2 95
4. I have rediscovered what is important in life. 27 21 20 32
5. I blame myself for my inability to have children. 71 4 9 15

professional help. Women were asked whether they had made a plan of action and followed it in relation to their infertility problem; 55% mentioned they had made such plans. About 41% of the women indicated that they had come up with a couple of different solutions to their infertility problem ; and when women were asked whether they had been inspired to do something creative , 30% of them replied in the negative. Despite their reluctance to talk to people about their infertility problem, they all sought professional help. This may suggest that women felt more comfortable to share their infertility issues or seek help from health professionals; doing so could serve as a way of taking control of their situation.

Passing as normal – A higher percentage of women (72%) tried to keep their feelings to themselves, 84% of women kept others from knowing how bad things were, and 46% tried to keep their feelings from interfering with other things too much . In addition, most women (70%) refrained from discussing complete their male or female character and identification, and their final goal of life. Although infertility as a source of stress could threaten the mental health of infertile people but the magnitude of its effects depends on personal coping behavior. Coping is the cognitive and behavioral efforts to control and manage stressful events of life and could moderate the negative effects of the stressful situations most of the times.

The main aim of this study was to investigate the coping strategies of women in the experience of infertility. The majority of women in the sample used their religious faith as a means of coping with their fertility problems. In the study of Davis & Dearman9 some of the women believed that their infertility was God’s will and if He chose they would eventually conceive. In this, they were looking for hidden reasons for their infertility. Unisa17  also found that in India many women relied on their strong religious beliefs and varied religious practices in addressing their fertility problems. Similarly, in a study in their problems with anyone other than their South  Africa18 all the groups of women husbands / partners.

Fate / acceptance / blame – In coping with their infertility problems, the majority of women (82%) prayed. Findings show that 77% of women believed it was God’s will and if He chose they would eventually conceive; and 95% hoped a miracle would happen. About 32% of the women also mentioned that they had rediscovered what is important expressed religious belief as an important source of support.

The findings of the present study suggest that the majority of the women in the sample preferred to keep information about their infertility to themselves and not to disclose to other people. In a study carried out in South Africa, several of the women did not want to speak to others about their in life. The majority of the women (71%) did involuntary  childlessness.18 Remennick 19 not blame themselves for their infertility problems.

Discussion

The desire to have children is one of the basic human instincts; because in most of the couples fertility is an important matter to also found that women in Israel were concerned about their reputation after disclosure of their infertility. Miall’s20-21  study of women in the United States also found that most women in that setting reported that they were concerned that an awareness of problems with fertility would cause others to see them in a new and damaging light; it al16 found that talking with one’s spouse lessened the woman in the eyes of others. In managing information about themselves, women hesitated in telling others about their fertility problem, and some did not reveal the exact details of their condition.21 This appears to be a common strategy among those with stigmatising conditions.

In the present study, majority of women reported regaining control of their infertility through reading and learning about infertility. Finding were similar to a study of Davis & Dearman,9   in which the majority of women reported regaining control of their infertility through reading and learning as much as possible on the subject to gain knowledge about the various causes and treatment of infertility. The finding of Parry22   of a study carried out in the United States is of a similar nature, in which women reported that they read and learned about their infertility; and that enabled them to play an active role in the decision-making process and influenced the medical processes affecting their lives. Thus the knowledge they had concerning their situation empowered them to make informed decisions and choices.

Some of the women in this study reported coping through the support they received from their husbands. This finding is consistent with a further finding from South Africa18  where some of the women described their husbands as supportive, understanding, and trustworthy, and they saw them as friends. However, some women were concerned that the good relationship they were enjoying with their husbands might change if the fertility problem persisted.In other studies,Todorova23 infertile women have expressed similar sentiments in feeling supported by their partners. Boivin et served as a source of support. In the study of Lee et al24  in Taiwan, infertile women coped with fertility problems through sharing feelings related to infertility with their husbands. It is important that infertile women receive support from their spouses as lack of support has been found to be a key source of anxiety and depression.25 In a study in which perceptions of provided and received emotional support and disregard were examined among infertile couples, both significantly contributed to the quality of marital life.26

Conclusion

When the women were asked about the strategies that they used to cope with the experience of infertility, they gave a range of answers. Avoidance of stigma was attempted by keeping information about their infertility to themselves, and some women depended on their religious faith, some found comfort in their husbands’ support, others became absorbed in their occupation or profession, majority of women reported regaining control of their infertility through reading and learning a lot about infertility that empowered them to make informed decisions and choices. Infertile women could be assisted to build on effective coping strategies. The findings of this study could be useful in designing and implementing psychological programmes for infertile women.

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