Couples in Search of Children: A Study of Strategies and Management of Infertility in Contemporary Ghana

ABSTRACT

Marriages in Ghana are considered incomplete when there are no children. Changing social values have, however, placed more emphasis on biological parenthood while de-bunking the traditional ways of dealing with infertility. The pronatalist culture continues to persist in the light of these changes thereby making the burden of infertility even more pronounced and individualized. This creates an endless search for conception from various treatment options. This study describes the experiences of infertile married men and women and their responses to their infertile situation through the use of modern treatment options. It has the following objectives: to identify the categories of people utilizing low tech, medical herbalists and high tech fertility treatments, to understand the motivations behind their treatment seeking, to understand what determines their treatment choice as well as the contestations that exist between couples and other actors over treatment choices and how they are resolved. In addition, the study explored the processes that respondents follow in seeking treatment and reported on the social, religious and cultural context surrounding the use of ARTs as evidenced in respondents ‘ways of navigating around components of ART treatment. The respondents for the study were purposively selected from three sites namely a private herbal clinic, a government hospital and a private orthodox fertility clinic which utilizes Assisted Reproductive Technologies (i.e. IVF, ICSI etc). These clinics are located in the capital, Accra.

Based on qualitative in-depth interview data obtained through convenience sampling of 45 respondents and nine key informants, the study noted the following: infertile men and women continue to desire to become biological parents based on both societal considerations and personal desires. Specifically, factors such as marital security, vi children as social security and for purposes of inheritance and social status were at play. In addition, although the health seeking behavior of respondents was influenced by both kin and non-kin actors, some respondents showed a degree of autonomy in the final decision taken regarding treatment. Explanations provided for the cause of infertility by both respondents and their friends and relatives led them to seek treatment from either the biomedical or spiritual healer. However, where such treatment options were unfavourable and/or did not achieve the desired results, some respondents moved from herbal treatment to orthodox treatment and vice versa. In addition, they intensified their efforts at obtaining healing by complementing biomedical healing with spiritual healing. Finally, respondents accessing ART treatment were found to select aspects of the treatment procedure that created the least forms of dissonance for them based on socio-cultural, religious and personal considerations. The use of these technologies were not seen as conflicting with religious beliefs as in most cases, respondents drew on religion to explain treatment successes and failures. The study therefore recommends, amongst other things, that medical herbalism should be developed due to the continued reliance on herbal treatment. Some infertility treatments should also be considered for incorporation into the National Health Insurance scheme to improve access and reduce the burden of infertility. People also need to be well informed about treatment options while reducing the negative effects of media advertising. Future studies should also cover other major cities of the country and include an exploration of other modern treatment options such as surrogacy and the incidence of reproductive tourism as well as target those who may not be accessing any form of formal treatment.