|Year : 2018 | Volume
| Issue : 1 | Page : 10-15
Awareness and willingness to adopt among infertile women seen at a tertiary hospital in Northern Nigeria
Amina Mohammed-Durosinlorun, Joel Adze, Stephen Bature, Amina Abubakar, Caleb Mohammed, Matthew Taingson, Lydia Airede
Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Nigeria
|Date of Web Publication||28-Aug-2019|
Dr. Amina Mohammed-Durosinlorun
Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
Introduction: Infertility is associated with adverse psychosocial effects and adoption provides a simple and affordable option for managing infertile couples, but are Nigerian women aware or willing to adopt? Methodology: This was a cross-sectional study. Interviewer-administered pretested questionnaires were given to a total of 236 consenting clients seen at their first visit to the gynecology clinic with complaints of inability to conceive, between the period of July 2016 to March 2018. Data on sociodemographics, gynecological, and infertility history was analyzed using the Statistical Package for the Social Sciences computer software version 22. Descriptive analysis was done using frequencies and percentages. Chi-square (and fishers test where relevant) was used as a test of association. Significance level was established at P < 0.05. Results: Majority of clients were aged between 20 and 29 years (44.5%), educated up to secondary level or above (80.9%), Muslims (65%), homemakers, and 59.3% had previous pregnancies. Most were aware about adoption (85.2%), but only 38.1% would consider adoption in the future. Respondents and husbands age, education, religion, respondents and husband's occupation, and knowing someone who had adopted in the past was significantly associated awareness of adoption. However, only order of marriage was significantly associated with willingness to adopt children in the future. Conclusion: Despite high levels of awareness, adoption is underutilized as most women have hope of having their own children or husbands may object. Couple counseling and community education are important for any change.
Keywords: Adoption, awareness, infertile women, Northern Nigeria
|How to cite this article:|
Mohammed-Durosinlorun A, Adze J, Bature S, Abubakar A, Mohammed C, Taingson M, Airede L. Awareness and willingness to adopt among infertile women seen at a tertiary hospital in Northern Nigeria. Afr J Infertil Assist Concept 2018;3:10-5
|How to cite this URL:|
Mohammed-Durosinlorun A, Adze J, Bature S, Abubakar A, Mohammed C, Taingson M, Airede L. Awareness and willingness to adopt among infertile women seen at a tertiary hospital in Northern Nigeria. Afr J Infertil Assist Concept [serial online] 2018 [cited 2019 Nov 14];3:10-5. Available from: http://www.afrijiac.org/text.asp?2018/3/1/10/265672
| Introduction|| |
An estimated 48.5 million couples worldwide experience infertility, higher in developing countries with genital infections contributing a major cause in Africa., Nigeria has high fertility and maternal mortality rates, so infertility may be neglected, yet can lead to negative psychosocial consequences.,,,,,,
Assisted reproductive technology has revolutionized infertility treatment but is too expensive for some.,, Adoption is a more affordable option, hindered by cultural barriers., This study assesses factors affecting awareness and willingness to adopt.
| Methodology|| |
Approval for the study was obtained from the Barau Dikko Teaching Hospital (BDTH) Health and Research Ethics Committee. The study was conducted at the BDTH, Kaduna, Northwestern Nigeria. The hospital serves as a major referral facility for the metropolis and its environs. The gynecology clinic is run twice a week with an average number of 50 new clients seen weekly, half of which are infertility clients.
This was a cross-sectional study. Interviewer-administered pretested questionnaires were given to a total of 236 consenting clients seen at their first visit to the gynecology clinic with complaints of inability to conceive, between the period of July 2016 to March 2018. The minimum sample size was determined using the formula by Lemeshow et al. and the prevalence rate for infertility of 15.7%. Questionnaires had sections to collect data on sociodemographics, gynecological, and infertility history of the respondents including previous treatments, awareness, and acceptability of child adoption.
After data entry and cleaning, data was analyzed using Statistical Package for the Social Sciences computer software version 22 ([SPSS] for Windows Inc., Version 22, Chicago, Illinois). Descriptive analysis was done using frequencies and percentages. Chi-square (and fishers test where relevant) was used as a test of association. Significance level was established at P < 0.05.
| Results|| |
Two hundred and thirty-six clients participated in the study and their baseline characteristics are shown in [Table 1]. Majority were aged between 20 and 29 years (44.5%), with a mean age of 31.5 ± 7.4 years, minimum age of 17 years and maximum age of 51 years. Majority of their husbands (41.5%) were aged between 30 and 39 years, with a mean age of 41 years ± 8.0, a minimum age of 25 years and maximum age of 65 years. Majority of clients were educated up to secondary level or above (80.9%), there were slightly more Muslims (65%) than Christians, and all clients were married except one. Most clients had been married for 5 or more years and 18.2% had been married more than once, with 28% in polygamous marriages. Clients were mostly homemakers (46.6%), their husbands were mainly self-employed, and average income was <50,000 Naira for majority of clients. About 59.3% of clients had been pregnant in the past.
In 29.7% of cases, clients had foster children mainly relatives or stepchildren. A lot of clients were aware and they could legally adopt a child (85.2%), but only 23.7% knew anyone who had ever adopted a child. Most respondents had never considered adoption in the past, and only 90 respondents (38.1%) would consider adoption in the future. Among those who would consider adoption in future, most (69.9%) had no sex preference, 43.3% prefer to adopt children aged <1 year, 52.2% would disclose that they adopted a child to others, and 61.1% would recommend adoption to a friend as shown in [Table 2]. Reasons for adopting or not adopting a child are shown in [Figure 1] and [Figure 2].
|Table 2: Awareness and acceptability of adoption and preferred characteristics of adopted children among respondents|
Click here to view
Respondents and husbands age, education, religion, respondents, and husband's occupation and knowing someone who had adopted in the past were significantly associated awareness of adoption. However, only order of marriage was significantly associated with willingness to adopt children in the future [Table 3].
|Table 3: Cross-tabulation showing factors affecting awareness and willingness to adopt among respondents|
Click here to view
| Discussion|| |
The mean age of respondents is within the reproductive age group and consistent with when couples would likely present with infertility. Women in this environment usually marry husbands older than them. There are slightly more Hausas and Muslims, probably because the study was conducted in Northern Nigeria. More clients were educated, probably because it was a hospital-based study. Nigeria is still fairly conservative, and it is still unusual for single women to seek infertility consultations.
The level of awareness of adoption was high among respondents (85.2%). This is comparable but slightly lower than what was found by Avidime et al. in Zaria (89.4%). It is also similar to high levels of awareness found in Lagos, Southwestern Nigeria (85.7%) and Eastern Nigeria (86.4%) and Kano (82.5%). Adewunmi et al. found much higher levels of awareness (97.2%). Adoption seems to be common knowledge, though this study did not assess the correctness or depth of awareness of adoption.
Increasing age and husband's age were positively associated with level of awareness, probably because older people have more experiences and opportunity to interact with others and learn. It might also be linked with being more educated. It is not surprising that more educated people were more likely to be aware of adoption, and this is similar to other studies.,
Muslims were more aware of adoption, probably because they constituted majority of the respondents. Perhaps also because Islam has specific rules relating to adoption, which may sometimes be a barrier.
It is not quite clear why being unemployed or self-employed was associated with increased awareness, probably because there is more time to interact with others and media where this information may be gotten.
Despite the high level of awareness, only 38.1% of respondents would consider adoption in the future. This is similar to low levels of willingness to adopt found in Lagos (33.7%), Ibadan (33.7%), 30.7% and 34.1%. It is however in sharp contrast to the high rates of willingness to adopt (75%) found in Zaria.
Among those willing to adopt, most had no sex preference and is similar to findings from Adewunmi et al. This may be because respondents just want to have a child, so the sex of the child is not too important for now. Omosun and Kofoworola, however, found a slight preference to adopt girls, rather than boys. Some of the respondents in our study indicated that girls can also help with housework. Furthermore, most would prefer to adopt younger children aged <1 year because they believe they would be able to mould the child's character better at that age. Other studies had similar findings.,
Disclosure is a sensitive issue and can be a barrier to adoption, but 52.2% of respondents in this study indicated that they would disclose that they adopted a child, probably because they know the child may find out later.
In this study, the most common reasons why respondents would not consider adoption was because they wanted their own child and still had hope they could have one, as well as barriers related to their husband. Adewunmi et al. noted Nigerians to be very religious and that adoption may be misconstrued as a lack of faith. Obviously, the couple must agree in order to adopt, but Nigeria is still a patriarchal society and pressure is more on the infertile woman than man. Furthermore, polygamy is common among Muslims in the North so a man can have children from other wives. The age-related fertility decline is also less with men, who can easily get remarried. Husband-related barriers to adoption are similar to what was found in other studies., Some respondents may also prefer more informal versions of adoption where they raise a relative or nonrelative child. This is easy in our environment with an extended family culture but is not legally binding.
In the study, only order of marriage was significantly associated with willingness to adopt children in the future. Those in their first marriage were less likely to adopt, while those who had previously been married were more likely to adopt. Perhaps, such clients had more hope of having their children. Besides, infertility may have been the cause of failure of the first marriage. Other studies, however, found other associations such as duration of infertility, no living child, and a maternal age of >35 years., Ethnicity was not significant in our study, but in Ibadan, more Igbos were willing to adopt than Yorubas.,
Limitations to this study are that it is hospital based, with a quantitative design, so it may be difficult to generalize findings to the community.
| Conclusion|| |
Adoption is a simple and underutilized management strategy to treat infertility in our environment, especially since artificial reproductive techniques may not be accessible. Despite high levels of awareness, low levels of uptake of adoption have not changed among infertile Nigerian women due to hopes of still having a child and husband-related barriers. Counseling the couple early that adoption is an option is thus important. Further community-based studies and studies with qualitative designs are suggested to provide deeper insight. Community education is also important as adoption may be beneficial to both the couple and the child.
Dr. Solomon Avidime (Ahmadu Bello University Teaching Hospital, Zaria) who gave general support and advised as a visiting consultant during part of the study period was acknowledged.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLoS Med 2012;9:e1001356.
Gnoth C, Godehardt E, Frank-Herrmann P, Friol K, Tigges J, Freundl G, et al.
Definition and prevalence of subfertility and infertility. Hum Reprod 2005;20:1144-7.
Araoye MO. Epidemiology of infertility: Social problems of the infertile couples. West Afr J Med 2003;22:190-6.
Oladokun A, Arulogun O, Oladokun R, Adenike Bello F, Morhassan-Bello IO, Bambgoye EA, et al.
Attitude of infertile women to child adoption in Nigeria. Niger J Physiol Sci 2010;25:47-9.
Oladokun A, Arulogun O, Oladokun R, Imran O, Bello M. Adoption and infertility in Nigeria. Afr J Reprod Health 2009;13:79-91.
Avidime S, Ameh N, Adesiyun AG, Ozed-Williams C, Isaac N, Aliyu Y, et al.
Knowledge and attitude towards child adoption among women in Zaria, Northern Nigeria. Niger Med J 2013;54:261-4.
] [Full text]
Bell AV. Beyond (financial) accessibility: Inequalities within the medicalisation of infertility. Sociol Health Illn 2010;32:631-46.
Cui W. Mother or nothing: The agony of infertility. Bull World Health Organ 2010;88:881-2.
Greil AL, Shreffler KM, Schmidt L, McQuillan J. Variation in distress among women with infertility: Evidence from a population-based sample. Hum Reprod 2011;26:2101-12.
Aniebue PN, Aniebue UU. Adoption practices in Enugu, Nigeria. Niger J Clin Pract 2008;11:5-8.
] [Full text]
de Mouzon J, Goossens V, Bhattacharya S, Castilla JA, Ferraretti AP, Korsak V, et al.
Assisted reproductive technology in Europe, 2006: Results generated from European registers by ESHRE. Hum Reprod 2010;25:1851-62.
Okonofua F. Infertlity in sub-Saharan Africa. Contemporary Obstetrics and Gynaecology for Developing Countries. Vol. 8. Benin city, Nigeria: Women's Health and Action Research Centre; 2003. p. 128-56.
Lemeshow S, Hosmer DW, Klar J, Lwanga SK. Adequacy of Sample Size in Health Studies. Chichester: Wiley: World Health Organization; 1990. p. 1-4.
Pantii AA, Sununu YT. The profile of infertility in a teaching hospital in North West Nigeria. Sahel Med J 2014;17:7-11.
Omosun AO, Kofoworola O. Knowledge, attitude and practice towards child adoption amongst women attending infertility clinics in Lagos state, Nigeria. Afr J Prim Health Care Fam Med 2011;3:259.
Ezugwu FO, Obi SN, Onah HE. The knowledge, attitude and practice of child adoption among infertile Nigerian women. J Obstet Gynaecol 2002;22:211-6.
Abubakar S, Lawan UM, Yasir JN. Knowledge and attitudes toward child adoption and fostering among infertile women in Northern Nigeria. Sahel Med J 2013;16:19-23. [Full text]
Adewunmi AA, Etti EA, Tayo AO, Rabiu KA, Akindele RA, Ottun TA, et al.
Factors associated with acceptability of child adoption as a management option for infertility among women in a developing country. Int J Womens Health 2012;4:365-72.
Onah HE, Ogbuokiri CM. The knowledge and attitude of fertile and infertile Nigerians regarding adoption. Int J Gynaecol Obstet 2002;79:279-80.
Olubola T, Adejuwon G. Impact of self-esteem, locus of control and gender on attitude towards child adoption and adoptive parents among some adults in Ibadan metropolis. IFE Psychol 2005;13:22-37.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]