A Study To Assess Knowledge, Attitude and Practice of Infertility Among Adults in Indian Population
A Study To Assess Knowledge, Attitude and Practice of Infertility Among Adults in Indian Population
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Dr. Samiya Ashraf1, Dr. Tuba Tanveer2, Dr. Neha Taneja*3, Dr. Aanchal Anant
Awasthi4 and Dr. Rajiv Janardhanan5
1,2
MPH Student, Laboratory of Disease Dynamics & Molecular Epidemiology, Amity
Institute of Public Health, Amity University, Noida, Uttar Pradesh, India.
3,4
Assistant Professor, Laboratory of Disease Dynamics & Molecular Epidemiology,
Laboratory of Health Data Analytics & Visualization Environment, Amity Institute of Public
Health, Amity University, Noida, India.
5
Laboratory of Disease Dynamics & Molecular Epidemiology, Laboratory of Health Data
Analytics & Visualization Environment, Amity Institute of Public Health, Amity University,
Noida, India.
ABSTRACT
Article Received on
02 August 2020, Background: Infertility is growing public health problem in India.
Revised on 23 August 2020,
Accepted on 13 Sept. 2020,
Due to infertility couples face lots of discrepancies in socio-religious
DOI: 10.20959/wjpr202011-18739 activities and may also develop mental health issues in couples.
Objective: To assess the knowledge, attitude and practice on infertility
*Corresponding Author among adults of India. Introduction: Infertility is defined as not being
Dr. Neha Taneja able to get pregnant despite having frequent unprotected sexual
Assistant Professor, Amity intercourse for at least one year without using birth control methods.
Institute of Public Health,
Infertility may be a result from an issue with either female partner or
Amity University, Noida-
male partner or a combination of factors which prevent pregnancy.
UP, 201304.
Methods: A cross-sectional study was conducted through internet chat
application to assess the knowledge, attitude and practice among adults in Indian population.
Sample size was of 119 participants within inclusion criteria. Data analysis was done using
Statistical Package of Social Sciences (SPSS) software Version 25 and p-value<0.05 was
considered significant. Results: The study revealed that 61.3% of participants had good
knowledge, 66.4% had good attitude, 58.8% had adequate practice on infertility. Age was
found to be statistically significant (p-value=0.009) with attitude. Also, age and education
were significantly associated with practice as well with p-value=0.015 and 0.002
respectively. Conclusion: This study concludes that there is a need to improve the knowledge
attitude and practice of adult population regarding infertility, health professionals and
electronic media can play a vital role in improving the same.
INTRODUCTION
Infertility has become one of the global public health problems, where couple is unable to
bear a child, they are not able to conceive and remain childless For women under the age of
35 years infertility is defined as inability to conceive a child after 1year of unprotected sexual
intercourse. For women aged 35 to 40 years it is defined as inability to conceive after 6
months of unprotected sexual intercourse. For women above 40 years of age it is defined as
inability to conceive after 3months of sexual intercourse. Infertility is also an inability to
carry a pregnancy to term, such as in cases of recurrent pregnancy loss.[1] There are two types
of infertility primary infertility and secondary infertility, primary infertility refers to couples
who have not become pregnant after at least 1year having sexual intercourse without using
any birth control method. While secondary infertility refers to couples who have been able to
get pregnant at least once, but unable to conceive second time.[2][3] According to WHO the
prevalence of primary and secondary infertility is 3% and 8% respectively.[4] A study
conducted in Asian institute of infertility management and Shefali Jain test tube baby Centre
among 1000 cases it was experienced that maximum infertility is due to female factors which
is 30.2%, cause of infertility in females was observed due to ovulation problem and most of
the cases were from the females falling in age group of 35yrs to 40yrs. While male factors in
infertility contributes 19.5% which is less than females, causes of infertility was observed in
males due to absence of sperms in semen, low count of sperm, motility problem most of the
cases were from males falling in the age group of 35yrs to 40yrs. But majority of 37% cases
was observed with unexplained causes.[5]
Infertility takes place in the couple when there is problem in their reproductive system. Not
only reproductive system, diagnosis of infertility can also be attributed to many factors I: e
hormonal and metabolic problem, age, infection, lifestyle (smoking, alcohol), tubal disease,
cancer treatment, genetic and environmental chemicals.[1] It has been found out that
decreasing fertility is directly related to female literacy rate, resulting educated women easily
could postpone their marriage hence it effect the child birth they are also in position to plan
their family and most of women opt for smaller family size to increase the income of
individual other reason may be given regarding the decreasing infertility are lack of physical
activities and sedentary lifestyles, which give rise to obesity, thus causing them PCOS. It has
been also noticed that infertility among couples are due to rise in unprotected sexual
intercourse, which results into STD’s and regular use of emergency contraception and
surgical abortions results in increasing of infertility.
In rural section, the percentage of women infertility is due to genital infections like
tuberculosis, these may result into blockage of tubes. In villages there is use of pesticides and
fertilizers which contributes in declining fertility.[6][7][8]
On the other part if we analyze the male problem regarding the low fertility it has been
studied in the systematic review article on dietary patterns, food and nutrients in male fertility
parameters and fecundability by Albert Salas-Huetos that male fertility is affected by
consumption of smoking and alcohol, increased use of gadgets like mobiles, laptops,
environmental chemicals and it is also found that some dietary patterns also affects the male
fertility like diets rich in processed meat, soy foods, potatoes, full fat dairy products, cheese,
sugar sweetened beverages and sweets has harmful effects associated with quality of
semen.[9]
METHODOLOGY
Study design and study population:
A web based cross sectional survey was conducted among 119 adults from 14th March 2020
to 6th April 2020. As it was not feasible to do a community-based national sampling survey
during the lockdown period, we decided to collect data online.
An online questionnaire was administered via social networks and all the possible networks
to contact potential participants. The link to the Google form was sent to the study
participants which contained a brief introduction, objective, voluntary nature of participation,
declarations of anonymity and confidentiality. The study protocol and procedures of informed
consent before the formal survey was done. The participants had to confirm their willingness
to participate voluntarily.
Study Tool
A self-structured, pre-tested questionnaire was used to collect information. It consisted of
four sections, these four sections contained questions assessing the socio-demographic data of
participants, their knowledge, attitude and practice regarding the infertility, respectively.
The basis for correct answer was selected from literature and clinical expert’s knowledge. For
assessing knowledge, attitude and practice each correct answer was awarded a score of one
and each incorrect answer was awarded a score of 0. Quartiles were generated for each
component. Based on quartiles, knowledge, attitude and practice were divided into adequate
and inadequate.
Statistical analysis
Data analysis was done using Statistical Package of Social Sciences (SPSS) software Version
25. The categorical data is presented as percentages and the continuous data is presented as
mean ± standard deviation analyzed through descriptive statistics. The chi-squared test was
also applied to find out the association between different variables considering the
significance level of p<0.05.
RESULTS
The socio-demographic data revealed that participants between age group of 15-35yrs were
107(89.9%), and 36-45yrs were 12(10.1%). Out of which females were 66(55.5%) and males
53(44.5). It is shown that married participants were 43(36%) and unmarried participants were
76(63.9%). Educational status revealed that 59(49.6%) were graduates and post-graduate
participants were 60(50.4%). It is observed that 69(58.0%) participants in the study were
Hindus, and 50(42.0%) participants were Muslims. Table 1 depicts the same.
Table 2 indicates the different knowledge variables asked from the study participants. In the
study to know about the level of knowledge of participants regarding infertility it was noticed
that out of 119 participants, majority of participants 76(63.9%) considered problem with eggs
and tubal factors both as the cause of infertility, only 7(5.9%) participants didn’t know the
cause of infertility. When participants were asked about infertility, 21(17.6%) participants felt
that infertility is inability to conceive after one year of sexual intercourse without
contraception. When the participant’s knowledge was checked on fertilization, majority
49(41.2%) of participants knew correctly that fertilization of egg takes place in tube while
only 6(5%) participants didn’t know where fertilization of egg takes place. 75(63%) of
participants had correct knowledge that only one egg is released in ovulation. When the
participants were asked that which phase of menstrual cycle, women are most likely to
become pregnant the majority of participants 64(53.8%) knows correctly that women is most
likely to get pregnant in halfway between two periods phase of menstrual cycle.55(46.2%)
strongly agreed, 51(42.9%) participants agreed that smoking and alcohol consumption can
decrease the sperm count.52(43.7) agreed with it and 40(33.6%) participants strongly agreed
that polycystic ovary syndrome and obesity are the main reasons for global rise in infertility
in India. Majority of participants 95(79.8%) knows correctly about surrogacy that it is about
putting embryos in other women’s uterus.60(50.4%) agreed, 32(26.9%) participants strongly
agreed that donation of sperms and eggs can be helpful in infertility.
Table 3 shows the attitude towards infertility of the study participants. To observe the attitude
of participants towards infertility, participants were asked whether infertility could be treated,
59(49.6%) participants strongly agreed, 51(42.9%) participants agreed. When participants
were asked whether infertility is a serious medical condition, 51(42.9%) participants strongly
agreed, 46(38.7%) participants agreed to it. When participants were asked whether infertility
is a treatable condition 44(37%) strongly agreed, 58(48.7%) agreed to it, 12(10.1%) remained
neutral. When participants were asked whether they are concerned about infertility 30(25.2%)
were strongly agreed, 64(53.8%) participants agreed to it, and 20(16.8%) participants were
neutral. When participants were asked whether they like to have knowledge on infertility
majority of participants 50(42%) strongly agreed, 49(41.2%) participant agreed to it,
16(13.4%) participants were neutral. When participants were asked if couples conceive once,
they might have problem in conceiving again, 20(16.8%) participants strongly agreed,
31(26.1%) participants agreed to it and 17(14.3%) participants were neutral while majority of
51(42.9%) participants disagreed on this. When participants were asked infertility is a
problem in both men and women majority of participants 66(55.5%) strongly agreed to it,
47(39.5%) participants agreed to it. 28(23.5%) participants strongly agreed that sedentary
Disagree 51 42.9
INFERTILITY IS A PROBLEM IN BOTH MEN AND
WOMEN
Strongly agree 66 55.5
Agree 47 39.5
Neutral 04 3.4
Disagree 02 1.7
SEDENTARY LIFESTYLES CONTRIBUTES IN
INFERTILITY
Strongly agree 28 23.5
Agree 60 50.4
Neutral 28 23.5
Disagree 03 2.5
Table 4 depicts the practice towards infertility among study participants. In the study to
observe the practice of participants on infertility few questions were asked like, which is the
best place for the treatment of infertility, majority of participants 82(68.9%) felt that it is
good to be taken at higher centers, 30(25.2%) participants felt that government hospitals are
good for infertility treatment while only 7(5.9%) participants felt that local doctors should be
consulted. Majority of the participants 49(41.2%) felt, in women fertility starts declining at
the age of 39yrs, 43(36%) participants felt that it declines at the age of 35yrs, and 14(11.8%)
participants felt it declines at the age of 32yrs while 13(10.9%) participants felt that it
declines at the age of 27yrs. When participants were asked which of the treatment is good for
infertility majority of participants 86(72.3%) responded that intra uterine insemination, IVF,
surrogacy all of them are good treatment, while only 5(4.2%) participants felt only surrogacy
is a good treatment. Participants were asked that is it acceptable to have a test tube baby
32(26.9%) participants strongly agreed with it. Participants were asked that whether fertility
drugs are acceptable 27(22.7%) participants strongly agreed, 59(49.6%) participants were
agreed. Participants were asked husband wife both should be investigated for infertility
majority of participants 71(59.7%) strongly agreed. Participants were asked whether reducing
alcohol and caffeine consumption helps in enhancing fertility majority of participants
59(49.6%) were agreed, 34(28.6%) participants were strongly agreed, 19(16%) participants
were found neutral on this. When participants were asked women who are trying to conceive
should boost their intake of folic acid 58(48.7%) agreed with it, 39(32.8%) participants were
strongly agreed and 19(16%) were found neutral.
Thus, 61.3% of participants have adequate knowledge regarding infertility while 38.7% have
inadequate knowledge regarding infertility. 66.4% of participants have good attitude towards
infertility while 33.6% have poor attitude towards infertility. 58.8% of participants have good
practice on infertility while 41.2% have poor practice on infertility.
Like in other developing countries, in India also have importance of children in married
couple’s life. Infertility has negative effect on psychological and social wellbeing of women
and men in society. In recent years fertility has been decreasing worldwide. Although the
infertility rate is rising, but till date no study has been conducted to assess the knowledge
attitude and practice on infertility among general population in India and to evaluate how
much knowledge attitude and practice of infertility is associated with the age, education,
gender, location of general population.
Table 6 indicates the type of attitude towards infertility among study participants. 62.6% of
study participants had positive attitude in the age group of 15-35 years. It was also found to
be statistically significant (p value=0.009). 66% males and 66.7% females showed positive
attitude. 63.8% Hindus and 70% Muslims had a positive attitude towards infertility.
Graduates (76.3%) showed higher positive attitude than post graduates (56.7%). Unmarried
participants (69.7%) were found to have more positive attitude than married (60.5%)
participants.
Table 7 indicates the kind of practice of infertility among study participants. 91.7% in the age
group of 36-45 years and 55.1% in the age group of 15-35 years were found to have efficient
practice towards the issue of infertility. It was found statistically significant as well (p-
value=0.015). 63.6% females and 52.8% males were noticed showed similar efficiency of
practice in infertility. 64% Muslims and 55.1% Hindus were noticed in the same clan.
Graduates (72.9%) showed better practicing habits than post-graduates (58.8%). It was also
found to be statistically significant (p-value=0.05).
DISCUSSION
A study conducted by Samta on similar grounds to assess the knowledge and attitude of
infertility in couples diagnosed with infertility with the sample size of 60 found that half of
the male participants (53.3%) and female participants (43.3%) had adequate knowledge of
infertility while 56.6% of female participants had inadequate knowledge of infertility and its
management. Also it was noticed that about 58.8% of female participants had adequate
attitude towards infertility.[3]
In other study on knowledge attitude and practice among Saudi couples conducted by
Mostafa A Abolfotouh, with the sample size of 277 fertile participants from out patient clinic
and 104 infertile patients from IVF clinic at King Abdul Aziz medical city. During the study
when the participants were asked about couples conceived once, might face problem in
conceiving second time the study shows that 68.3% of IVF patient participants and 87.9% of
fertile out patient agreed for the same, while in our study only 42.9% participants supported
that problem might comes in conceiving second time in the couples conceived once.[2]
Further in study conducted at King Abdul Aziz medical city participants being asked whether
infertility can be treated medically 93.5% IVF participants and 96.6% participants from
fertile out patient reported infertility can be treated medically. In this regard our study shows
85.7% participants reported that infertility is treatable condition. On asking the participants
about the acceptance of test tube baby, 92.4% 0f IVF patients and 73.3% of fertile out patient
agreed the acceptance of test tube baby while in our study 84.0% of participants accepted to
have test tube baby.(2)
The same study showed 87.5% of IVF patients and 68.4% of fertile out patient agreed for the
acceptance of infertility drugs where as in our study it shows that 72.3% participants agreed
for the fertile drugs are acceptable. Also, 82.7% of IVF patients and 85.4% of fertile out
patient agreed that both partner needs to be investigated for infertility while in our study 95%
of participants reported that both husband and wife needs to be investigated about the causes
of infertility.[2]
CONCLUSION
The study suggests that some programs should be developed to improve the knowledge of
adult population regarding the infertility management and progress themselves with higher
attitude and practice satisfactorily. Result may be oriented with the help of health
professional and further their need of individual counseling for the urban and rural adult
population. The program in this regard could be taken at government hospitals were best
counseling could be parted with. Electronic media can also play a vital role in the
development of knowledge-practice gap of infertility among adults. Media like audio-visual
television advertisement and newspaper helps in the spreading the knowledge of infertility.
This study also revealed there is need of research which could further help in making the
policies and programs by the government authorities in the field of infertility.
ACKNOWLEDGEMENTS
We are thankful to all the participants who willingly participated in the study.
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