P-465 Rehabilitation services and the infertility journey: a study on women’s experiences in Ethiopia
Authors: Araya B , Velez M , Dyer S , Alemu K , Aldersey H 
Published: July 2024

Abstract

Study question
How does infertility affect women in Ethiopia, and can rehabilitation service providers mitigate its impact?

Summary answer
Introducing rehabilitation services for women with infertility in Ethiopia could mitigate the frequent adverse psychosocial consequences and maintain women’s integration into family and community structures.

What is known already
Infertility is a disease that generates a disability as an impairment of function. Globally, millions of people are affected, and women bear the brunt of its consequences. In Ethiopia, infertility can cause significant distress and burden for women who are unable to meet societal expectations of motherhood. Despite this impact, no previous research has been conducted in Ethiopia to explore the role of rehabilitation services in providing support for these women.

Study design, size, duration
We followed a sequential mixed methods design that consisted of three parts: The national prevalence of infertility in Ethiopia was first determined using data from the 2016 Ethiopian Demographic and Health Survey (DHS); using Interpretive Phenomenology, the lived experiences of Ethiopian women living with infertility was explored; and finally, an Interpretive Description approach was applied to evaluate the role of rehabilitation services in assisting women with infertility. Data were collected between 2022 and 2023.

Participants/materials, setting, methods
For the first part, we performed secondary data analysis from 15,683 women in Ethiopia through the 2016 Ethiopian DHS. The data were analyzed using two approaches to infertility – the demographic and current duration. In the second part, 13 women undergoing treatment at a fertility center were interviewed. In the third part, 14 rehabilitation, medical, and policy service providers were purposefully selected from diverse institutions across three different geographical locations in Ethiopia.

Main results and the role of chance
Using the demographic definition, the overall prevalence of infertility was 7.6% (95% CI 6.6-8.8), with a prevalence of primary and secondary infertility of 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5-10.1), respectively. The current duration approach resulted in a prevalence of overall infertility of 24.1% (95% CI 18.8-34.0) at 12-months, 13.4% (95% CI 10.1-18.6) at 24-months, and 8.8% (95% CI 6.5- 12.3) at 36-months. Thus, the demographic definition resulted in a lower estimate compared to the current duration approach which could be more appropriate for the early detection and management of infertility in Ethiopia. According to participants, infertility had far-reaching consequences that substantially affected women’s psychological, socio-cultural, and spiritual lives. Despite this, women developed various coping mechanisms and resilience. Women had minimal access to psychosocial and financial support and no access to rehabilitation services. Finally, interviewees recognized the potential of rehabilitation services to maximize the day-to-day functioning and overall well-being of women with infertility.

Limitations, reasons for caution
Using demographic proxies to determine exposure to pregnancy can make estimation unreliable. The fertility center only treated married couples; hence, single, separated, or divorced women were not included. Results are context-specific and cannot be extrapolated to all infertility cases in Ethiopia or elsewhere.

Wider implications of the findings
This is the first study to explore infertility in Ethiopia from a rehabilitation perspective. Based on the prevalence and impact, infertility in Ethiopia represents a major public health issue. Strengthening policies, integrating rehabilitation services into fertility care, and recognizing infertility as a disabling condition are crucial steps toward addressing infertility.

Trial registration number
not applicable