P-716 What do Africans know about their fertility? A systematic literature review exploring fertility knowledge, attitudes, and behaviour among African population groups
Authors: Usman N , Tlagae C , Grace B 
Published: July 2024

Abstract

Study question
What is the knowledge, attitude, and behaviour regarding fertility, among African population groups?

Summary answer
Fertility knowledge and uptake of treatment options for infertility were found to be sub-optimal while the attitude towards fertility were mixed.

What is known already
Infertility affects 1 in 6 couples worldwide according to the WHO, with some evidence of higher incidence among the African population. Health policies have highlighted the importance of optimising fertility through better knowledge and, recently, there has been a concerted effort from several stakeholders to improve fertility-education. An important component of doing this effectively is to understand the current status and identify gaps. Most studies on this topic, however, have focused on high-income countries. This study aimed to assess current patterns of fertility knowledge, attitudes, and behaviour; and identify improvement opportunities but with a focus on the African population group.

Study design, size, duration
Global Health, MEDLINE, Web of Science PubMed, Scopus, and Google scholar databases were systematically searched for articles published between 2000 and 2023. Articles covering fertility knowledge, attitude and practices were included if they had been conducted in Africa and were published in an English language peer-reviewed journal.

Participants/materials, setting, methods
Articles were extracted and reviewed independently by two researchers. Content was analysed and categorised thematically. Quality assessment of studies were conducted.

Main results and the role of chance
The systematic search yielded 1939 articles and 25 articles were included, studies were from Nigeria, South Africa, Gambia, Egypt, Kenya. Overall, the reviewed studies showed that Africans place a high value on their fertility and have high aspirations towards parenthood, with childbearing being perceived as fulfilment or destiny. Knowledge and understanding of ART and treatment options was found to be low in studies assessed. There was also low knowledge of age-related fertility decline and low understanding of the menstrual cycle and ovulation. Although the attitude towards infertility and assisted reproductive technology was mixed, there is more openness within the higher-socioeconomic demographics, although generally sub-optimal. Overall studies also highlighted several myths and misinformation about ART. There were important factors influencing behaviour: such as the importance of being married, having a steady income, and safe-housing. Some studies also highlighted that cultural beliefs and religion also play an important role. Research findings showed that there is stigma associated with childlessness in many African communities. Although some studies reported attributing infertility to fate or destiny, most remain open to treatment through various methods, ranging from ART to herbalist and spiritual intervention, with some considering prayer a method of treatment.

Limitations, reasons for caution
This study focused on fertility knowledge, attitude and practices of Africans which has implications for generalisability among wider population groups. From our quality assessment, some of the studies in the systematic review had methodological limitations.

Wider implications of the findings
While strategies and policies to improve fertility awareness are being deployed, it is important to consider the needs of lower- and middle-income countries. Findings can inform government policies aiming to improve education, minimise ART costs, improve health-equity and access; ultimately allowing people to achieve their desired family-building intentions.

Trial registration number
not applicable