CHAPTER ONE
INTRODUCTION
Background to the Study
Infertility is perceived as a problem across virtually all cultures and societies and affects an estimated 10-15% of couples of reproductive age (Bovine, Bunting, Collins & Negron, 2007). It has been viewed differently in different cultures. The population in the developed and developing countries hold different attitudes regarding infertility. In developing countries, infertility may be linked to an act of God, punishment for sins of the past, prolonged use of contraceptives, and the result of witchcraft which is causing childlessness, whereas people in developed countries view infertility as caused by biological and other related factors like excessive alcoholism, lack of cooperation between the man and the woman during sexual intercourse (Bovine, Bunting, Collins & Negron, 2007). No matter the culture, infertility is viewed as an enormous problem by couples everywhere.
According to Dhont, Van der Wijgert, Coene, Gasarabwe & Temmerman, (2010) children are seen as blessings of marriage and in some societies of the world; it is even believed that they are symbols of God's approval and blessings on marriages. Under normal circumstances, it is the choice of each individual and couple, within their own sense of conscience, to determine if they intend pregnancy and if so, the size of their family unit and the timing of when to have a child or children. However, in many African cultures, married couples who are unable to bear children shortly a few years after marriage are faced with all forms of unfriendly pressure from the family and social groups which could lead to unnecessary frustration, resentment and depression.
Apart from the rare cases when couples deliberately decide not to have children, inability to bear children has been the cause of many failed marriages and even destroyed many homes. It affects the self-esteem of a man, dampens his sense of control and also throws a woman into total confusion, frustration and anxiety. It is therefore an issue that should not be taken lightly by both the man and the woman. Many women believe that without children, life is without hope (Marida & Ulla, 2008).
World Health Organisation, 1987 as cited in Tabong & Adongo, (2013) defined infertility as failure to conceive after one year of regular unprotected sexual intercourse in the absence of known reproductive pathology. However epidemiological studies have revealed that in a normal population of heterosexually active women who are not using birth control methods, 25% will become pregnant in the first month, 63% within six months and 80% within one year. By the end of the second year, 85% to 90% will have conceived (National collaboration centre for women and children heath, 2012). Because some couples who are not infertile may not be able to conceive within the first year of unprotected sex, World Health Organization (WHO) therefore recommends the epidemiological definition of infertility, which is the inability to conceive within two years of exposure to pregnancy (WHO, 1987 in Tabong & Adongo, 2013).Individuals who are thought to be infertile are generally relegated to an inferior status, and stigmatized with many labels. As a result, childlessness has varied consequences through its effects in the society and on life style of individuals. Though in some cases, the childless life style enhances life satisfaction for some individuals, yet it is diminishing for others for whom parenthood is a personal goal (Aysel & Gul, 2015).