INTRODUCTION

Infertility is a global issue causing a lot of psychological and social problems among couples. In-vitro fertilisation (IVF) is one of the options available for couples who want children but cannot have them. Fertility and having children have always been considered as blessings from God in the traditional societies and have cultural importance.¹ Globally, statistics have shown that ten in every seventy couples are faced with at least one of different types of infertility in both developed and developing countries.^{2, 3} Infertility is inability to get pregnant after one year of unprotected sex.⁴

Infertility can be primary or secondary. Primary infertility is defined as the inability to achieve conception by couples who engage in regular unprotected sexual intercourse for a period of at least 12 months, whereas secondary infertility is the inability to achieve pregnancy after a previous conception irrespective of the outcome, whether a live birth or an abortion.⁵ Couples with conception difficulties may experience negative  social consequences to some extent and also suffer health challenges.⁶ According to United State of America Centre of Disease Control (CDC)⁷ and  Loto,⁶ the negative  social consequences experienced by infertile couples are now reduced as a result of technological advancement known as Assisted Reproductive Technologies (ART). In-Vitro fertilization is one of the options available for couples who want children but cannot have them through the conventional process.

A study by Adeyemo⁶ on knowledge and acceptance of IVF in Surulere Local Government Area, Lagos, South-West Nigeria, among fertile and infertile couples, revealed that knowledge of IVF among couples was low, but a majority of the infertile couples were willing to accept the IVF technology if it can be highly subsidised. There was a significant relationship between knowledge and acceptance. Another study conducted on final-year medical students in South-West Nigeria by Ajayi et al,⁸ revealed that most of the respondents knew the basic IVF procedure. Study by Osian et al,⁹ on knowledge and perception of IVF among women attending University of Benin Teaching Hospital revealed high awareness level and low knowledge of ART. A similar study conducted among Indian women revealed that knowledge of fertility and acceptability of ART were low.¹⁰

Another study on knowledge and factors influencing the use of ART among women in Lagos revealed that the women do not know ART.¹¹ Study by Mulder et al¹² revealed that religion, culture, personal belief and cost were some of the factors that affect the acceptance of IVF. Fortin and Abele,¹³ on impact of increased length of awareness of ART among women revealed that several factors influence attitudes that women hold with regards to IVF. Simple linear regression using length of awareness as predictor and general attitudes as the dependent variable revealed a significant regression weight for the length of awareness. Other factors according to Okafor et al,¹⁴ that influence attitude to IVF were being too costly and unnatural.

According to the study conducted by Aluko-Arowolo et al,¹⁵ on the effect of native culture and religious beliefs on human infertility and ART, a majority of people living with infertility did not use ART facility due to religious and cultural beliefs. They also did not access ART services because of social cost in term of lack of support from the religious community which reinforced its poor adoption by others. A similar study revealed that cultural and demographic factors influence the acceptability of IVF.¹ Studies have also shown that the acceptability of babies conceived through IVF is very low. For instance, Olorunfemi et al¹⁶ in their study in Benin City revealed that acceptability of babies conceived through ART among participants is very low. A similar study on perception and  misconceptions among women of reproductive age group in Sokoto, Nigeria, also revealed that a majority of respondents did not accept IVF  and gave reasons such as religion and high cost of the procedure.¹⁷ Despite the breakthrough recorded from ART, several factors still militate against its acceptability.¹⁸ This study is aimed to assess the knowledge, religious, socio-cultural  issues and the acceptability of IVF among the reproductive age women in Oredo Local Government Area of Edo State.

Specific objectives are to; determine the level of knowledge of IVF, ascertain the religious and socio-cultural issues surrounding IVF, determine the acceptability of IVF, and determine the association between knowledge and acceptability of IVF among reproductive age women in Oredo LGA, Edo State, Nigeria. This study tested the null hypothesis that there is no significant association between women’s knowledge level of IVF and its acceptability.

METHODOLOGY

Study design and setting

A descriptive cross-sectional survey carried out in Oredo Local Government Area, Edo State, Nigeria. It has an area of 249 km² and a population of 374, 671 with 188,895 males and 185,620 females at the 2006 census. Age groups of 0 – 14 years has 122, 916 populations; 15 – 16 years, 237, 188; and 17-51 years, 14, 411 persons. Oredo is made up of different towns and villages, which are, Abiala, Egbaton, Ekehuan, Gelegle, Ibaro, Igbobi, Ikpako, Mikotowa, Oduna, Orogo, Ugbike and Ughoton. The major occupation found among them is trading, teaching and tailoring.

Study population

Reproductive age women in Oredo Local Government Area, Edo State, Nigeria.

Inclusion criteria

Reproductive age women above twenty-five (25) years old in Oredo Local Government Area, Edo State, Nigeria, who consent to participate in the study.

Sample size determination

A sample size of four hundred and forty (440) was used for this study. This was obtained using TaroYamane,¹⁹ formula as shown below.

formula as shown below.

n=N/1+N (d)²

N = population size.

D = level of precision

Therefore,

N = 160, 590,²⁰ population of women of reproductive age in Oredo Local Government Area, Edo State.

D = 0.05

Thus  n=160,590/1+160590(0.05)²

n=160,590/1+160590(0.05)² =160,590/1+401

n = 399.5 ≃400

Attrition rate of 10%

40 + 400= 440, therefore, sample size is 440

Sampling technique.

A multistage sampling technique was used. Simple random sampling technique by balloting was utilized in selecting 50% (six wards) of the twelve (12) wards in Oredo Local Government Area, Edo State. The wards randomly selected were GRA/Etete, New Benin I, New Benin II, Ogbelaka, Ibiwe and Urubi.

Proportionate sampling technique was used to proportionately allocate samples to each ward based on the population of reproductive age women in each ward.

Convenience sampling (based on their accessibility and availability as at the time of data collection) was used to select the participants household by household in each of the selected wards until the allocated sample size was achieved.

 Data collection instrument

This was a self-developed questionnaire relevant to the study.  Closed-ended set of questions were used. The questionnaire was divided into four sections. Section A consisted of demographic data of respondents, section B comprised knowledge about IVF, section C consisted of questions on religious and sociocultural issues surrounding IVF and Section D comprised questions to determine the acceptability of IVF among women.

Face and content validity of the research instrument was ascertained by a statistician and a fertility expert.  A pilot study was conducted using 41 participants who were women of reproductive age in Uselu community, Egor Local Government Area, to pretest the reliability of the instrument. The questionnaire was administered after which data obtained was analyzed using Cronbach’s Alpha statistic to obtain coefficient of 0.92 from the pilot study.

Data collection

Ethical clearance with reference no LGC.155/248 was obtained from the Ethical and Research Committee of the Local Government Area. Before commencing data collection, advocacy visit was paid to the local government chairman with four research assistants trained on the aim, objectives and administration of the questionnaire for the study. Approval was obtained from the household heads. The purpose and benefit of the study were explained to the women to obtain their informed verbal consent. Questionnaires were thereafter administered and respondents were given time to fill the questionnaire. Questionnaires were retrieved after completion. This was done in each of the six (6) wards starting from an identified central location. At the central point, a bottle was spun and the direction of the bottle head when it stopped determined the starting point of the sampling of the households. Data was collected for a period of three (3) weeks.

Data analysis

Data was analysed using the descriptive statistics frequency distribution table and percentage. Hypothesis was tested using the inferential statistic, Pearson correlation analysis, at 0.05 level of significance.

RESULTS

Out of the 440 questionnaires distributed, 410 were retrieved indicating 93% retrieval rate. Table 1 shows demographic characteristics of respondents. A majority (58.3%) were within the age range of 31-35 years, 23.2% were 36-40 years, and the rest were above 40 years.  Majority (42.9%) had secondary education, another 33.4% had tertiary education, while the rest 23.7% had primary education.  Most were either married (37.1%) or cohabiting (32.4%).

Table 1: Demographic characteristics of respondents

Table 2 shows knowledge of IVF. It shows that the average rate of wrong answers to questions asked on knowledge of IVF was 90.2%, while the rate of correct answers was 9.8%. Figure 1 shows the level of Knowledge of IVF. It shows that 68.0% had poor level of knowledge, 18.8% had fair knowledge while 13.2% had good level of knowledge of IVF.

Table 2: Knowledge of in-vitro fertilisation

 Figure 1: Level of knowledge of in-vitro fertilisation

 Table 3 shows that all the items listed were part of religious and socio-cultural issues surrounding IVF among the participants, as the average means were > 2.5.

Table 4 shows that the acceptability of IVF among the participants was low. The average mean for all the items of the acceptability questions was <2.5. Furthermore, the overall average mean of 1.89 also indicates there was a generally low acceptability of IVF.

Table 3: Religious and socio-cultural issues surrounding in-vitro fertilisation

NB: average mean cut off 2.5; items with average mean 2.5 and above are regarded as strong. Strongly disagree (SD), Disagree (D), Agree (A), Strongly agree (SA)

Table 4: Acceptability of in-vitro fertilisation

NB: average mean cut off 2.5; items with average mean < 2.5 is regarded as low acceptability. Strongly disagree (SD), Disagree (D), Agree (A), Strongly agree (SA)

Table 5 shows that there was a positive significant relationship between knowledge of IVF and its acceptability. That is, the higher their knowledge of IVF, the more they would want to accept the technology.

Table 5: Association between women knowledge level of in-vitro fertilisation and its acceptability

DISCUSSION

The study was to determine the level of knowledge of IVF, ascertain the religious and socio-cultural issues surrounding IVF, determine the acceptability of IVF, and determine the association between knowledge and acceptability of IVF among reproductive age women in Oredo Local Government Area of Edo State. The findings from this study revealed that a majority of the respondents have low level of knowledge of IVF. This is in line with the studies done by Adeyemo,⁶ Mahey et al,¹⁰ Osian et al,⁹ and Abazie et al.¹¹  However, findings from the present study is at variance with the study of Ajayi et al whose finding reveal a higher level of IVF knowledge among their respondents.⁸ This variance may be attributed to the different geographical locations between this studies as well as level of exposure as because majority of the respondents the present study  have secondary level of education when compared to the later study whose majority of participants have higher education. Although attainment of education is not a necessary criterion for having knowledge of the modern technology.

Findings showed that the issues that influence the acceptance of IVF the most was cultural belief, such as “IVF is not a natural process created by GOD”, “babies born from IVF are not legitimate, not accepted by the society”. This is supported by the works of Prag et al,¹ which revealed that cultural and demographic factors influence the acceptability of IVF. The plausible reason might be that culture in Africa has a strong grip on the average African, Nigeria inclusive.

Other factors revealed in the findings are religious beliefs and religious taboos. This is supported by the studies of Okafor et al,¹⁴ and Aluko-Arowolo and Ayodele.¹⁵ Africans are very religious, and they attach a lot of connotations to social situation and medical conditions. Therefore, seeking care for infertility is often associated with supernatural method of treatment. Recourse to supernatural interpretation of infertility vitiates genuine attempt on IVF acceptability. Finding also revealed that being “too expensive” and “unnatural” were also part of the social cultural issues surrounding IVF. Okafor et al,¹⁴ which revealed that misconception such as too costly and unnatural affect the acceptability of IVF treatment also supports this finding.

Findings from this study revealed low acceptability of IVF among the respondents. This is supported by the studies of Oloruntemi et al,¹⁶ Ochei et al,¹⁷ and Osian et. al.⁹ The observed low acceptability in this study may not be unconnected with social and cultural factors earlier revealed in the study. Additionally, the low level of knowledge of IVF observed in the present study was associated with low acceptability, as shown by a correlation analysis which shows a positive association between knowledge and acceptability (p<0.05). Similar finding was also reported by Adeyemo.⁶

These findings suggest the need for more enlightenment campaign on IVF so as to positively change its perception and acceptance, thereby reducing stigma and health problems arising from childlessness. There is a need for stake holders to work closely with religious and traditional leaders through media campaigns in a drive to clear the misconceptions of the public regarding IVF, and government should provide facilities that will make IVF readily available and affordable.

CONCLUSION

Findings showed that there is poor level of knowledge and low acceptability of IVF among reproductive age women in Oredo Local Government Area, Edo State, Nigeria. Increasing the knowledge of IVF will increase its acceptability.  Religious and socio-cultural issues exist surrounding IVF among the population studied that may influence its acceptability. There was a positive significant relationship between knowledge of IVF and its acceptability, therefore the null hypothesis which states that there is no significant association between the women’s knowledge level of IVF and its acceptability is rejected.

ACKNOWLEDGEMENT

Our acknowledge goes to the management of the Oredo Local Government Area, Edo State, and the people of the community especially our respondents who availed us their time.

 AUTHORS CONTRIBUTION

Author ECA conceived and designed the study, prepared the first draft of the manuscript and edited the manuscript. Author ETA managed literature search, collected, analysed data and attended all manuscript revisions. All authors read and approved the final draft.

CONFLICT OF INTEREST

The researchers declare no conflict of interest.

FUNDING

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

ETHICAL APPROVAL

Ethical approval was obtained from the management of Oredo Local Government Area, Edo State, Nigeria.