Title: LIVED EXPERIENCES AND COPING STRATEGIES OF PERSONS SEEKING
INFERTILITY TREATMENT IN THE KUMASI METROPOLIS: A DESCRIPTIVE
PHENOMENOLOGICAL STUDY
Version: 9 Date: 06 Jan 2022
Reviewer's report:
I still believe that this paper is methodologically sound and the results important in the
larger discussions around the impact of infertility, particularly in shining a light on the under-
researched regions of sub-Saharan Africa. I think qualitative work on the experiences, impacts,
and coping strategies of Kumasi women is important to publish. Much of the results, particularly
the rich quotes from participates, demonstrates a valuable paper. For example, I think a valuable
contribution is the experience these participants seem to have with social and community
surveillance of their bodies and potential pregnancies. However, I cannot yet recommend this
paper for publication, as it still requires significant revisions.
Many of my original recommendations and concerns still hold, and the authors have not made
the necessary corrections to the manuscript to move this toward publication. I will detail these
below. The most significant improvement has been the addition of the section on the study
setting. This should further include information on the religious and economic character of the
region (and the costs of ARTs) to better understand the spiritual coping strategies described later
and the financial barriers to accessing biomedical fertility care.
The introduction section needs the most work. This section needs to explain the significance of
the research and where in the academic literature it is contributing, both of which is currently
missing. There are structural issues. The text moves from rates of infertility in the region
to psychosocial challenges for infertile couples to biomedical treatment and then back to
psychosocial stress and the need for counseling. (As a side note, the mention of counseling is
supported by a reference to a UN document on child adoption, which I could not find, nor do
I understand how it supports the claim of the need for fertility counseling). There is not a clear
line of argumentation, and it leaves the reader scattered.
This is compounded by language issues in spelling, grammar and sentence construction as
mentioned by the other reviewer. Some examples: What is “conjugal precariousness”? Or
“conjugal victory”? This clause “particularly empowering the spouse to require up a moment
spouse when the women is suspected to be the cause” does not make sense. What are “conjugal
alterations”? “Couples may lock in in practices” is unclear. I am assuming “helped regenerative
innovation (Craftmanship)” is assisted reproductive technologies (ART), and the latter term
should be used. These are just a handful of the many issues with spelling, grammar and sentence
construction that need correction throughout the manuscript. I suggest a thorough copy-edit and
proof-reading.
In the intro, and later in the discussion, studies from other regions need the location of the work
to be consistently identified and not presented as universal fact (an example is the top paragraph
on Page 18; this is not the only instance, however). This is particularly relevant has this paper
addresses the cultural importance of procreation in Ghana.
Both myself and the other reviewer asked for clarification on the ethics in relation to navigating
participants’ potential distress, and this was not addressed in the revisions nor explanation given
for why it should not be included.
I previously asked for a citation for the claim that a growing number of individuals are seeking
fertility treatment. One has been provided but that citation does not support this claim.
My previous request to have more detailed number of participants identified with the sub-themes
(for example, delineating the number of participants next to a claim that “Many described x, y,
z”) was taken in the first half of the results and not later. There is also inconsistent formatting
in the quotes. In the first half, participants are named as “Mrs Talata says….”. Later quotes are
given with the first name in parenthesis. These need to be consistent throughout.
The discussion is very unclear and scattered. The manuscript moves from comparisons and
issues without a clear organizational strategy or narrative throughline. Adoption is mentioned as
a coping strategy, and yet it seems that this is not actually a coping strategy for any participant.
Is it then relevant? If this is not a viable option for the women in the study then it should not be
considered a coping strategy, as similarly, accepting childlessness does not seem like a potential
coping mechanism.
Again, infertility is not only the inability of “married people” to procreate. Though I can
understand the argument that the social stigma is only made visible when one is married and not
visibly pregnant. But those are important differences.
The discussion now ends with calls to “awareness” and fertility counseling. This is relatively
vague and not elaborated to explain how this study’s results lead to the conclusion of the need
for greater social awareness for infertility treatment. What would this ‘awareness’ consist of that
would lessen the social stigma and isolation women experience? In the discussion (Pg 21-22),
the authors point out that studies in the Global North that point to greater social support through
friends and family members as ways to alleviate social isolation and psychological distress don’t
necessarily work in a setting such as Ghana. This is because, as shown in this study, community
members often aggravate social isolation. I think these are, again, important findings; but the
authors needs to enrich their discussion, thoroughly edit the work, and specify their analysis and
call for ‘awareness’ to make sure that these points are clear.