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The results are organized according to the demographic profile of informants (Table 1) and themes. Three main themes, with their subthemes, were obtained. Some illustrative quotations are also included in the text.
Socio-Demographic profile of informants
Nineteen female participants were interviewed in this study. All participants were married and their ages ranged from 21 to 50 years. Four participants had received education up to primary level, eight to the junior high level while seven had tertiary education. Nine participants were traders, three teachers, one nurse, two seamstresses, three store supervisors, a shop attendant, and a police officer. Duration of diagnosis ranged from 2 to 15 years.
Three main themes were identified from the data gathered namely emotional experiences, social experiences and coping strategies (Table 2).
Emotional experiences
Most participants described how they worry about their diagnosis of infertility most of the time. The feeling of not having a child after several years of marriage and the expectations from society and families on both sides caused them to worry a lot. They worried about when it would be their time to get pregnant and eventually deliver.
I think about my infertility a lot because other people will be thinking about why I haven’t given birth after a long time in marriage. [2]
Some participants compared themselves with their friends and neighbours who married after them but had given birth. This made them feel that they had delayed so much, putting them on an emotional roller-costa.
I got married before a neighbour but she gave birth almost immediately. Everyone is talking about me because I have kept long [in giving birth]. [3]
Most participants perceived infertility as a problem, with their happiness dependent on having a child.
If I’ll be happy in this world, I need a child. As a married woman, if you do not have a baby, you will not have any happiness in your life [15].
Participants, generally, worried persistently because of their diagnosis and this, they believed, had led to the development of conditions such as hypertension, loss of appetite, and even sexual problems. Sex, according to some participants, had lost its role in the marriage as it had not achieved its ultimate purpose of childbirth. This appeared to make the act unpleasant and painful for such women.
I think a lot. When I got to the hospital, I was told my blood pressure was high. I’m desperate. It is more like many others who married after me have given birth. I’m not happy. Sometimes I’m moody [18]
Some participants described events that gave them the impression that they had conceived at certain times, only to be disappointed later. Some of these events were a delayed menstrual cycle that lasted for months, weight gain and increased belly sizes which gave the impression that they were pregnant.
What sometimes hurt is that my period does not come on the scheduled date, so I think I’m pregnant but then it [the period] comes later then I realize I am not pregnant [9]
Participants described circumstances that triggered painful and/or sorrowful emotions about their diagnosis.
When I am chatting with friends and they begin to talk about their children, how they talk about their children, sometimes, reminds me of my situation [16]
Some participants also explained that they feel miserable when they see other women walking hand-in-hand with their children. These are sights that they perceived as lovely but were unable to have because of their diagnosis. Seeing such ‘lovely sights’ caused emotional despair for them as they were reminded of their challenges in having a child. Some participants ended up avoiding social gatherings where they would behold sights of other parents with their children while, in some cases, others questioned why they were having such challenges.
It’s nice to take your children out to have fun. Sometimes when I see things like these on TV, I ask myself “when shall I get my own?”. After we worship during Eid, I lock myself in the room alone, feeling I don’t have any happiness in my marriage and my life [1]
Some participants described feeling awkward when questions about pregnancy were asked, making them view life as unfair.
Life is not fair; I sometimes feel God shouldn’t have created me [2]
Some participants were convinced that they would have children in a matter of time and perceived their challenge as less severe, compared with the problems faced by other individuals/families in life.
It’s a matter of time. Others have problems bigger than mine. For me I just thank God.[7]
Social experiences
Participants expressed mixed reactions about how infertility had affected their relationships with their husbands in their matrimonial homes. Some participants explained that nothing had changed in their matrimonial home.
I live with my husband alone. Nothing has changed since the diagnosis; there has always been happiness in the home. My husband and I are still having a happy married life [8].
The second category of participants perceived differences in attitudes of their husbands, which they attributed to their infertility.
He expected me to go to the hospital but I had resigned myself to the situation. So, he got angry because he thinks that it doesn’t bother me [4].
Participants were mostly concerned that though their husbands were responsible and supportive, there was the possibility of them having children outside the marriage and this could lead to divorce. With the pressure that comes from parents and friends, they could be tempted by the idea of getting another spouse or ending the marriage.
My husband says he loves me but the childlessness can cause a breakup [16].
Some participants explained that they were being pressurized by their own families, mostly their mothers, as a result of their infertility.
My mother thought my husband was the cause but since he got another woman pregnant, she now thinks I am the cause. She advises that I find another man because our blood may not be compatible [12].
Participants explained that, sometimes, family members prevented their children from getting closer to them for reasons possibly related to their infertility. Other participants complained of the insolence of children of family members who lived with them and, whenever they were disciplined, they told their parents, causing further issues in the family.
I brought my younger sister’s child to live with me but whenever I discipline him, he goes to tell his mother and the mother is not happy about it [9].
Some participants also noted that they have had issues with their friends. They explained that their friends complained about their infertility and, in some cases, mocked them. Some were made to feel that they had no use for their wealth as they had no children that they had to cater to while others also felt blamed for not doing much to address their infertility issue.
They [my friends] pass comments like ‘what are you doing with money since you don’t have a child’. They make it seem like you don’t use the money for anything because you don’t take care of a child [6].
Society became advisers, with a lot of people asking questions or seeking to provide possible solutions for participants. Some of these solutions proffered include the use of herbs, visits to hospitals, and visits to native doctors.
Some people advise me to get help from native doctors and other sources. For instance, when I was living with my husband our landlord advised my husband to take me to see a certain native doctor but 1 refused. [7].
Generally, participants noted that society expected married women to bear children within a year of marriage. People began to ask them questions when there was no sign of pregnancy or childbirth after the first year of marriage, and they were usually on the lookout for possible signs of pregnancy. Thus, any minor change in the physique or health of the woman was attributed to pregnancy, and participants felt pressured by these acts.
Since everyone is just waiting for you to give birth or get pregnant, the moment you say you are ill or they see certain changes in you they think you are pregnant [11].
Coping Strategies
The study found three main coping strategies that were employed by participants in dealing with infertility and its associated challenges – faith-based strategies, herbal-based strategies, and care from the biomedical setting (fertility clinic). Another coping strategy that was explored among the participants was child adoption but it did not receive favourable responses. All identified coping strategies were mainly driven by their hope that having a child of their own was a possibility despite all the prevailing circumstances.
It was their firm belief that God/Allah would work for them to have a child. This was usually utilized concurrently with seeking care at the fertility clinic and was mainly through fasting and prayers.
I believe Allah will give me children when it’s my time. It’s just that, sometimes, some people make you think and worry about these situations. [4]
Participants also mainly reported using herbal medicine before coming to the fertility centre when they realized that the approach was not helping in achieving their desired outcome.
There was a woman who used to give me herbal medicine but it did not work so she recommended that I see the doctor [19].
I was using herbal medicine. When it was not working, my sister recommended the hospital to me [7].
Participants mentioned some factors that caused them to seek care at the fertility centre. The first dominant factor was related to the perceived ineffectiveness or negative side effects of alternative medicines.
The pain from menstruation made me come to the hospital. Had it not been for the pain, I would have continued with the herbal medicine [8]
I used herbal medicine for a long time. Before then I had been to the hospital and I was told my tubes were blocked. The doctor told me the only way I could conceive was either through a miracle or IVF [4]
Another major factor was the attitude of the husbands of the women.
The man I live with impregnated another woman and when I got to know, I realized my childlessness was a serious issue. He wasn’t paying attention to me. He told me he will be with the one who is pregnant for him. And he warned me not to take any action that will bring untold issues. That is why I’m here [15]
When child adoption was explored as a way of managing infertility, all the participants said they have heard of it, except one woman. However, most of them were not aware of the processes involved in child adoption and this was because participants were generally not prepared to consider child adoption as an alternative to having children. Some were firm in their responses to the extent that they mentioned that they would opt out if anyone talked or attempted to force them into it.
“I have heard of it but I am not sure I will do it. I do not think I will ever become happy when I adopt a baby. I’ll know it’s not my child I’m living with [1].
There were several reasons why participants opposed the idea of child adoption. The first issue was related to possible problems that may arise, especially when the child finds out that he is not living with his/her biological parents. They were concerned that their behaviour towards the adopting parents may change as a result.
I know of it [child adoption] but I don’t like it. This is because someone will tell you he or she is not your child. My mum had one and when he grew up, he was told my mother was not his mother. And since then, he started misbehaving. It even got to a point he started stealing from the house [12].
I have taken care of a lot of children that are not biologically mine, but when they grow, they leave to go find their biological parents [9].
According to some participants, adopted children were seen as outsiders by extended family members.
I have heard of it, and I think it’s good. However, people will say I’ve bought a child since they never saw me pregnant [15].
Again, participants were not sure of their husbands’ behaviour towards the idea of adoption.
It is not a bad idea but as I’ve told you I don’t want to do anything that will offend my husband. Child adoption is something he doesn’t like [14].
There was only one participant who was of the view that although she believed that childbirth is a gift from God, it would not be a bad idea to go for adoption as long as someone would call her mother.
For me, I think adoption will be okay because if the person does not know his or her parents but will call me mother or will come and meet me when I am returning from work, I will be fine with it [19].
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